Garfield and Santana have reported evidence of significant adverse outcomes such as increases in tuberculosis incidence, low birth weight, and rates of maternal anemia after the Cuban trade embargo.1 A similar situation occurred after the collapse of the Soviet Union.2 Our fear is that Nepal is undergoing an analogous situation today in its relation to India and that the public health gains made in Nepal in recent decades might be accordingly reversed.
Nepal is facing a looming humanitarian disaster in the aftermath of two recent earthquakes (April 25 and May 12, 2015; 9000 deaths, 23 000 injured), with aftershocks still occurring and no specific steps taken so far toward sustainable recovery.3 Approximately two million displaced people living in makeshift or temporary shelters need permanent shelter and food before winter. Adding to the agony, a series of violent protests regarding an “economic blockade” broke out in September in the southern plains after the promulgation of Nepal’s new constitution.4 Vehicles have been stranded at the Indian side of the border as of January for more than three months, blocking the supply of fuel, essential medicines, and other goods.5
There is also the possibility of gain reversal against eradication of polio, and elimination of measles and maternal/neonatal tetanus. Nepal works closely with its Indian counterparts in prevention of malaria, visceral leishmaniasis, Japanese encephalitis, and polio with support of the World Health Organization’s South-East Asia Regional Office.6 It would not be surprising if there is an outbreak of infectious diseases as a result of interrupted public health interventions. If any outbreak occurs in Nepal, the disease is likely to cross the Indo-Nepal border easily because both countries share inextricably linked social, economic, and cultural ties and an open border.
As warned by the United Nation’s Children’s Fund (UNICEF) last November, winter is putting more than three million infants at risk for death or disease in Nepal because of shortages of fuel, food, medicines, and vaccines.7 Previously, India was the first nation to react to Nepal’s recent earthquake with tons of relief materials being sent into earthquake affected districts within 24 hours of the disaster. Enabling the flow of vehicles and supporting health programs could increase political capital and improve the relationship between the countries. Bilateral health agencies and international health organizations have an added responsibility to make the best collective efforts to engage all sides of the conflict to bring this health crisis under control.
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