Difficulties of peace-building in Nepal

I agree with Amod Poudyal and colleagues that health care professionals face challenges if they are to play an active role in peace-building efforts in Nepal, as I suggested in my article.¹ However, they must rise to this challenge, as they have already been drawn into the conflict. The government has issued directives to all health care professionals and institutions stating that if they provide treatment without appropriate notification, they will be regarded as supporters of terrorists and be prosecuted according to the Terrorist and Disruptive Activities Ordinance, 2001.² This puts medical professionals in an impossible situation. During the ongoing conflict, they are at risk of encountering armed groups demanding treatment for their wounded; however, provision of such treatment might lead to subsequent prosecution. The Maoists have similarly targeted health care workers.

Despite these challenges, there is still room for continuation of health-related projects, through an approach known as “conflict-sensitive development” — development that is sensitive to the conflict environments in which it occurs.³ There is a need for transitional programs in conflict areas that can adapt to the rapidly changing environment, as well as greater involvement of humanitarian agencies with experience in conflict settings, such as Médecins Sans Frontières. A participatory role in development for neutral local agencies and increasing community participation are essential.

Ultimately, how much of themselves health care workers must sacrifice will depend on individual choices and the local context. It is their response to these challenges that may determine the future of Nepal in this time of crisis.

Sonal Singh Department of Medicine Unity Health System Rochester, NY