Compared to other South Asian countries, the spread of the novel coronavirus disease, COVID-19, in the Himalayan nation Nepal has been relatively modest to date. The first instance of the virus was reported in the country on January 24, and the second case in the third week of March. Soon after the second case was reported, the Nepal government enacted a week-long lockdown across the country. Kathmandu is operating under the reality that if the virus spreads, Nepal may not be equipped to handle it. The first lockdown expired on March 30 and has been extended.
As the number of coronavirus cases gradually increases, it’s clear the government has made some mistakes. When the virus was spreading rapidly in other countries, Nepal did not impose travel restrictions. Meanwhile, visitors to Nepal did not all strictly follow government requests that they self-quarantine for 14 days and the government did little to follow up with travelers to ensure compliance. A ban on international flights was only imposed in the third week of March and subsequently the border with India was closed.
If case numbers swell, observers say it would be very difficult for Nepal to fight the coronavirus alone due to its limited resources and fragile healthcare system. The Nepali healthcare system is not fully prepared to deal with a large-scale pandemic that is straining healthcare systems even in developed countries.
Local governments in Nepal, which have a key role in contact tracing and treatment, are facing a serious resource crunch and have been slow to act.
Nepal only recently adopted a federal system. The previous centralized structures have crumbled, but new effective mechanisms are not all in place. There is a lack of coordination among the three tiers of government: federal, provincial, and local. According to Dr. Sushil Nath Pyakurel, former director general of the Department of Health Services under the Ministry of Health and Population, there was a robust chain of command from center to the grassroots, which was broken after the country adopted the federal structure two years ago.
“First, the federal government has failed to properly manage human resources. The adjustment of civil servants has not been completed even in over three years; there is either over- or under-staffing. Second, management of logistics and infrastructure has been faulty. Third, there is lack of effective coordination and information sharing-system among three-tier of government,” he said.
There are not sufficient resources and manpower for the massive testing and treatment of people that may be needed. Testing facilities are concentrated in Kathmandu valley, with a capacity to test just 30-40 people in a single day. To date, only about a thousand people have been tested. That said, the government has started to set up testing labs in other regions of the country. Still, there is a lack of sufficient manpower and logistics for testing. There is not a specific agency to deal with the pandemic, such as the Centers for Disease Control that exist in some countries, nor has Nepal done any long-term planning to deal with a pandemic.
When last time Nepal faced a serious crisis — the earthquake of 2015 — the international community rushed to offer support. But with this crisis, the powerful and well-resourced countries that had previously assisted Nepal in its hour of need are themselves facing the same crisis. They are not in the same position to offer assistance. Nevertheless, some countries — such as the United States and Germany — have announced monetary assistance to Nepal to fight the coronavirus. However, Nepal desperately needs further support for basic needs such as testing kits, personal protective equipments (PPE), and other medicines.
Donations from China’s Sichuan province and the Chinese Embassy in Kathmandu include different kinds of masks, thermometers, chloroquine phosphate tablets, protective clothing, and portable ventilators weighing 1.1 tons, according to Chinese media. Similarly, donations from the Alibaba Foundation and Jack Ma Foundation include 100,200 N95 masks and 20,064 test kits weighing 1.4 tons, according to media. The Nepal government has also purchased relevant goods from China.
India, so far, has not announced any medical assistance but media reports say that Delhi is ready to send a rapid response team to Nepal. According to The Hindu, “Army medical teams and two Indian Navy ships were on standby to provide required assistance to friendly countries in the neighborhood.” In 2015, after the earthquake, India was the first country to send rescue teams followed by China, the United States, and others. In this crisis, India is not in a position to send largescale medical logistics and equipment because of its own domestic needs.
In the past, big countries used to compete in providing assistance to Nepal; this crisis is different in that all countries are facing their own domestic troubles too. For example, in 2015 India and China competed with each other to announce ever bigger assistance packages. To date, the United States has announced it would provide $1.8 million to fight the coronavirus in Nepal. Earlier, the United States provided some personal protective equipment. Germany has announced that it is enhancing its existing health program in Nepal with an extra 1 million euro grant to respond to emergency situations related to COVID-19.
Due to an open border, there is a need for strong collaboration between Nepal and India to fight the coronavirus. Approximately 1 million Nepali migrant workers are in India. Due to the the 21-day lockdown enacted by the Indian government, Nepali migrant workers are returning to Nepal and hundreds are stranded along the border area. The Nepal government has decided to allow them to return with the condition that they live in quarantine for 14 days. However, some of those who returned in the past are violating the isolation directive. Due to the open border, it is very difficult to restrict the movement of people.
Similarly, Nepal is heavily dependent on India for essential supplies, including medicines. If lockdown in India results in the interruption of supply chains, Nepal will obviously face difficulties.
Regional organizations such as the South Asian Association for Regional Coordination (SAARC) and the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) are arguably in a position to coordinate and provide support to member countries. But both organizations are now almost obsolete.
On March 15, Indian Prime Minister Narendra Modi held a video conference with SAARC members proposing a common strategy to fight the coronavirus. In the same meeting, Modi proposed the establishment of a fund to help support countries in their fight with the virus, but the move has not progressed far enough. Other countries have announced that they would contribute to the SAARC fund, but Pakistan held back. Lately, Pakistan has proposed to keep the COVID-19 emergency find under the SAARC Secretary General, but other member countries have not reacted to the proposal. Sar far, BIMSTEC has not taken any measures to collectively fight the coronavirus.
Small developing countries like Nepal, hamstrung by resource constrains and fragile healthcare systems, cannot fight the coronavirus alone. Bigger, wealthier, and more developed countries, despite their own constraints, and regional organizations are in a position to lend support to smaller countries.
Kamal Dev Bhattarai is Kathmandu-based writer and journalist.