NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Monday, May 11, 2015

After years of intense effort, officials here in rural Sindhupalchok district had persuaded almost all of the nearly 61,000 households to each build a toilet. Then the earthquake struck, destroying most houses — and the very toilets that could have helped stave off the diseases that can run rampant after natural disasters.

Now, instead of celebrating a public health triumph, residents are holding services for their dead and digging through the rubble to find more bodies. And relief workers are pouring into the district, hoping to salvage the remarkable progress in improving hygiene made here in recent years.

“There will be outbreaks of cholera and other diseases,” said Antti Rautavaara, chief of water, sanitation and hygiene for Unicef in Nepal. “It is a battle we cannot win. We can only try to minimize the pain and death.”

Two weeks have passed since a magnitude 7.8 earthquake devastated large swaths of this mountainous country, killing more than 7,900 people and injuring more than 17,000. Nepal’s government and charitable organizations are racing to beat monsoon season, which begins in about six weeks, to get tents and food to as many as 800,000 Nepalis whose homes are uninhabitable. But they say an equally urgent task is to provide clean water and toilets before the rains make the poor sanitary environment in these devastated areas far worse by carrying contamination into water supplies and making direct contact with fecal bacteria almost inevitable.

Small outbreaks of diarrhea have been reported across Nepal since the earthquake, and although such outbreaks are routine here, they have raised worries that the quake’s aftermath is at least partly to blame. But getting residents to consider building more toilets amid the devastation has not been easy.

About every fourth house in Chautara, among the district’s largest villages, is rubble. Most of those still standing are leaning precariously or have slid down the hill. The road through town is a narrow pathway choked with the red dust of pulverized bricks.