In her World Report (Sept 9, p 908),1 Sophia Collins states that health was the sector least affected during the insurgency. We disagree.
40 health posts were completely destroyed between January, 2002, and December, 2004, and tens of others were rendered unusable.2 Some of these health posts were attached to the offices of the village development committee, which are the Maoists' favourite targets. Maoists also destroyed the electrical supply to Okhaldhunga hospital, a small hospital in eastern Nepal, because an army camp nearby was using electricity from the same source.3
It was not easy for health workers to do their jobs during the insurgency. The government issued a directive to all health workers not to treat Maoists without notification of security personnel. In cases of defiance, doctors were to be regarded as supporters of terrorism and punished accordingly. It was impossible to work under such conditions when Maoists demanded treatment for their wounded.
Frequent, lengthy shutdowns of transportation by Maoists (eg, in March, 2005) prevented the supply of vaccines, vitamin A, and deworming drugs to nearly 3·6 million children.3
Some women, displaced in their tens of thousands from the rural areas to cities in search of food, shelter, and security, have ended up in prostitution, which will further concentrate the HIV epidemic. In a study done among the internally displaced population, post-traumatic stress disorder was found in 53·4%, anxiety in 80·7%, and depression in 80·3%—bleak data indeed.4
For the past fiscal year (2005/06), of the Rs 7·68 billion allocated for health, only Rs 2·64 billion (34·5%) has been spent. The remainder was taken away for security purposes.5
In summary, we experienced a far greater health effect of the Maoist insurgency in Nepal than your report suggested.
We declare that we have no conflict of interest.
2. Integrated Regional Information Networks. Nepal: focus on the impact of the conflict on rural health
5. Khanal P. Development spending bears brunt of insurgency. Kathmandu Post June 21 2006; .Back to top
a. Tribhuvan University teaching Hospital, PO Box 20425, Kathmandu, Nepal