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Health effects of Maoist insurgency in Nepal

Laxmi VilasGhimireemail addressa and MatiramPuna

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 36 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 534%, anxiety in 807%, and depression in 803%bleak data indeed.4

For the past fiscal year (2005/06), of the Rs 768 billion allocated for health, only Rs 264 billion (345%) 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.


1.CollinsS.Assessing the health implications of Nepal's ceasefire.Lancet2006;368:907-908. Full Text | PDF (36 KB) | CrossRef

2.Integrated Regional Information Networks.Nepal: focus on the impact of the conflict on rural health
(accessed Sept 11, 2006).

3.SinghS, BohlerE, DahalK, MillsE.The state of child health and human rights in Nepal.PLoS Med2006;3:e203. CrossRef

4.ThapaSB, HauffE.Psychological distress among displaced persons during an armed conflict in Nepal.Soc Psychiatry Psychiatr Epidemiol2005;40:672-679. MEDLINE | CrossRef

5.KhanalP.Development spending bears brunt of insurgency.Kathmandu PostJune 21 2006; .

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a. Tribhuvan University teaching Hospital, PO Box 20425, Kathmandu, Nepal