KATHMANDU, 15 December 2008 (IRIN) - Most of Kathmandu's 50 hospitals are poorly built and would collapse if there were a major earthquake, experts warn. They also note that health institutions lack emergency response plans and are generally ill-prepared.

Kathmandu valley lies in a high risk earthquake zone; poorly constructed buildings [see: http://www.IRINnews.org/Report.aspx?ReportId=81632] and lack of preparedness could significantly increase the casualty rate if there were another big earthquake.

The Nepal-Bihar Earthquake of 1934, measuring 8.4 on the Richter scale, left thousands dead and over 200,000 buildings severely damaged or destroyed.

According to the Nepal Red Cross Society's Earthquake Contingency Plan 2008 [see: http://www.nrcs.org/documents/contingency_plan_2008.pdf], an earthquake measuring 7-8 on the Richter scale could kill up to 50,000 people in the city, injure 100,000 and destroy 60 percent of buildings, leaving 900,000 homeless.

Most of the hospitals in Kathmandu would be so badly damaged that medical services would be virtually impossible for months, local NGO National Society for Earthquake Technology (NSET) [see: www.nset.org.np], told IRIN.

"Our health capacities are so weak. We still don't have emergency medical response mechanisms in place yet," said disaster expert Amod Dixit, NSET executive director.

Study

A 2001 joint assessment entitled Structural Vulnerability Assessment of Hospitals in Kathmandu Valley by Nepal's Ministry of Health and Population, the World Health Organization (WHO) and NSET, said over 80 percent of assessed hospitals were vulnerable, while the remaining 20 percent were at high risk of total collapse.

The findings were based on an assessment of 14 major government and private hospitals (deemed a cross section of most health institutions across the city). But seven years on, conditions have yet to improve.

According to NSET, the city's health sector is ill- prepared to cope with the 100,000 or more people likely to be injured in a big earthquake.

"Most hospitals already lack the capacity to deal with mass casualties," said social worker Bijay Male, president of the community-run Chattrapati Free Clinic, the only hospital in the country to have been retrofitted to withstand a major quake.

Emergency response plans

"All hospitals should immediately develop emergency response plans and make it an important component of their medical programmes," said earthquake preparedness expert Mahesh Nakarmi.

Government officials say measures are gradually being taken. The Ministry of Health is working on the development of hospital emergency preparedness plans with the support of WHO.

WHO representative Alexander Andjaparidze told IRIN the agency, in collaboration with the UN International Strategy for Disaster Risk Reduction (UNISDR) [see: http://www.unisdr.org/] had launched a 2008-09 safer hospitals campaign. "We are also discussing how to strengthen health facilities with the World Bank," he said.

The Emergency Health and Nutrition Working Group (EHNWG) - made up of UN agencies, donors and international and local NGOs - has been meeting regularly to do capacity assessments and coordinate response plans.

Pre-positioning of health kits

WHO officials told IRIN they were focusing on pre-positioning such things as inter-agency emergency health kits (IEHK), diarrhoeal kits, medicine and equipment in vulnerable areas.

Three sets of IEHK, each capable of serving 10,000 people for three months, have already been pre-positioned; another three sets are on their way to Kathmandu and could help at least 60,000 people for 90 days, according to WHO.

Five diarrhoeal kits (enough for 3,000 people) are in place, with 15 more on their way. WHO also has five large tents ready to be set up as an emergency field hospital.

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