Lessons from Nepal
For the past four years, several dozen Nepali research staffers have worked for Tufts as part of a project looking at the connections between agriculture and health in their homeland. As employees of the Nutrition Innovation Lab at the Friedman School, they have been conducting annual surveys of farm families at 21 sites across the country, including in some of the most remote villages.
That research came to an abrupt halt on April 25 with the earthquake that killed more than 7,000 people and left hundreds of thousands homeless. The Tufts field researchers in Kathmandu, some injured and all shocked but alive, quickly began helping organize local relief efforts and offering any medical assistance they could. Like many others, they slept in their cars or in the open.
But not having been trained as humanitarians, there was only so much they could do. Patrick Webb, the McFarlane Professor at the Friedman School, director of the lab’s program in Asia and former chief of nutrition for the UN World Food Programme, quickly approved a plan that would put the local staff’s skills to work.
Tufts Now: How did their mission change?
Patrick Webb: They wanted to do whatever they could. I was getting calls and emails asking, “What can I do?” We thought the best way they could contribute was to use their statistical and sampling and survey experience.
So we managed to get the donor, the U.S. Agency for International Development, to agree to allow us to reallocate the team. They will train other Nepalese workers to form needs assessment teams who go out to remote areas to assess damage and needs for food, health and shelter. Then they will work with UNICEF and the ministry of health to manage data and quickly analyze it so it can support prioritization of the relief efforts. They are being reallocated to help in a substantive way that speaks to their strengths.
How does this affect your research?
I’ve always firmly believed that research should only be done if it can be useful. We are likely to go ahead with the household surveys we had planned—with some additional questions—starting with the districts that were least affected, and then by July and August we hope to reach the districts that were affected the most. It will allow us to immediately compare what was there before and what is there now.
A challenge will be finding the people we have interacted with in past years. We had GPS locations for everyone’s home, but if the house is gone, we don’t know where the people have gone. But to the extent possible, we’ll do this next survey and feed those data back to the government as quickly as possible. It will be like a real-time assessment of how people’s lives are affected and the impact of relief resources.
What have you heard from the researchers?
Things are gradually improving, at least in parts of Kathmandu. The difficulty is getting out to remote regions, because so many roads are impassable and there are not enough helicopters. Five of the 21 sites where we have been doing these panel surveys are among the most affected; the initial assessments estimate 80 percent to 90 percent total destruction of housing stock and buildings, including hospitals—total devastation. But nobody really knows how many more people died who are still buried under the rubble, who has lost their stocks of food, where access to clean water is an immediate concern and so on.
This is all important because health services have collapsed. We’re hearing stories about many mothers facing pre-term births, stillbirths and even mothers dying in childbirth because they couldn’t get obstetric care. But at this point, these are anecdotes filtering out of the distant rural areas that have barely been reached by the relief effort.
In some areas, food is becoming scarce very quickly. It is not just because grain stores have been demolished—it’s also because kitchen and cooking utensils have disappeared. You can have as much grain and potatoes as you want, but if you can’t cook them, it’s like having no food. So relief resources have to include not just food, but means of preparing it.
We’re hearing concerns about breakdown of law and order. Just as you see looting in urban areas during many crises around the world, in rural areas you start seeing theft and assault increasing as resources become scarce.
Are there unique factors at play in Nepal compared with other disasters that aid workers have to contend with?
What is unique is the topography. It’s the Himalayas, some of the highest and most remote parts of the world, with very poor infrastructure. It’s unusually difficult to get to these places. The people there are pretty much out there on their own, if they survived.
Nepal is emerging from a destructive civil war. There has been a lot of uncertainty about political leadership and the ability of government to function. For example, at the end of the civil war, there was a decision to rewrite a constitution that everyone would agree on. Almost 10 years later, it still hasn’t been finalized.
You have said that the fallout from this earthquake is more than a “natural” disaster. In what way?
If you don’t protect the gains of development you’ve been making over the decades—improved roads, clean water, pipes, education and health care—then it takes literally 30 seconds for it all to be destroyed. The fact that regional hospitals collapsed is outrageous. They should have been built to standards that would withstand earthquakes or at least retrofitted to be more resilient to shocks. But too few donor partners have funded such activity, and Nepal is still a desperately poor country.
What’s the old phrase? “Hope for the best, but plan for the worst.” That means regarding shocks not as “abnormal” events, but as entirely normal, and therefore factoring them into long-term strategies for development. Natural forces cause these disasters, but it is human inactivity—lack of investment in building resilient livelihoods and food systems, and ignoring the need to strengthen public services—that turns a disaster into a catastrophe. We need to be less reactive to shocks by preparing better and making the foundations of development less fragile.
Follow Patrick Webb on Twitter.
Julie Flaherty can be reached at email@example.com.