Kamala BK of Nalgad Municipality of Jajarkot realised that her eight-month-old son, who was frequently sick, was suffering from moderate malnutrition only after reaching a health centre on November 3. Health workers advised her to feed the child vegetables, eggs and fruits.

Kamala, who has to struggle hard to make ends meet, was anxious about managing nutritious food for her son. On the same day, she faced a double whammy after an earthquake destroyed her house, forcing the entire family to live in a tarp on the field where food grains were grown.

As many as 13 people from the same village lost their lives in the magnitude 6.4 earthquake. Her house crumbled and all the food grains were buried under the rubble.

Observers say the quake will push households with similar economic status to Kamala’s into a vicious cycle of poverty further and it will directly impact the nutrition of children.

Kamala said the weight of her son dropped by 2.2 kg within a month after the earthquake. “We used to feed him corn flour earlier. But the quake buried all the grains. The child is already malnourished, and things are getting worse now.”

According to the Disaster Preparedness and Response Section of the Ministry of Home Affairs, the jolt destroyed 34,500 houses in Jajarkot. The biggest impact of the earthquake fell on the poor like Kamala.

Her husband, a migrant worker in India, returned home empty-handed soon after hearing of the quake. “He arrived home in a state of shock, believing false reports that I died in the quake. His boss didn’t give him any money as he left the job abruptly. We have nothing to eat now,” said Kamala.

According to the health section of the municipality, 308 children in the municipality are malnourished. Eight children are undergoing treatment for the condition. Health workers said over 300 children had moderate malnutrition before the earthquake, adding that cases of severe malnutrition have started to surface now.

“Most of the malnourished children belong to poor families. Families who are unable to get nutritious foods have suffered further after the calamity,” said Prachanda Karki, head of the health branch. “Our efforts are to reduce the severely malnourished to moderate and cure the moderately malnourished. But the condition of the moderately malnourished has started to worsen after the quake.”

He said the parents of malnourished children living in rural areas are unable to afford treatment. “Families with sound financial status are aware of how to get their children treated. The situation of people with low income has worsened after the earthquake,” he said.

An example of Tajakot Rural Municipality in Humla is enough to show how disasters are increasing the risk of malnutrition in Karnali and Sudurpashim provinces. A landslide on October 9, 2002, swept away 80 houses in the rural municipality. A total of 249 people were displaced after 169 houses developed cracks in the disaster. Most of the children of displaced families who lived in tarps for months suffered from malnutrition. Most of them are children from the Dalit community.

As per the data maintained by the rural municipality, 150 children were malnourished in the rural municipality as of January 5, 2023. Among them, 35 children were severely malnourished. According to Dhanaraj Dhakal, head of the health section, all the malnourished children are from families displaced by landslides and most of them are Dalits.

“The number of unreported cases can be much higher. The situation of malnutrition worsened after the disaster,” he said.

He said that the number of malnourished children is increasing unexpectedly as the landslides washed away farms of Dalit families with low income and they are unable to meet even the minimum nutritional requirements.

“They are forced to eat rice with a pinch of salt. It is obvious for the malnutrition graph to shift up in such situations,” he said.

For Lopa Damai of ward 3 of Tajakot, eating rice with pulses and vegetables is a rare occurrence. The locals are unaware of nutrition and malnutrition as they are living hand to mouth. “It will be enough even if we get to eat just rice every day,” she said.

Disasters such as earthquakes, floods, landslides and droughts seem to be increasing malnutrition in Karnali and Sudurpaschim provinces. And the poor are the most hit.

Muktikot of Swamikartik Khapar Rural Municipality of Bajura serves as another example of how malnutrition has spread in disaster-stricken areas. The Human Rights Year Book 2024 published by the Informal Sector Service Center (Insec), states that eight children died due to malnutrition in Muktikot in 2023 alone. Most of them belonged to Dalit families. It is worth remembering that 12 children in the village died due to malnutrition in 2021-22 (2078 BS).

The village has been reeling under landslides and droughts for a decade now. Frequent landslides have put Manjhwada and Bhaisikhaal settlements at a high risk. A total of 49 families are living in the high-risk zone for a mudslide while 39 families have been displaced.

The study conducted by the Health Office, Bajura in 2022 revealed that 196 women above 10 years of age are malnourished and 43 severely.

‘Ambitious target’

According to the data maintained by the District Disaster Management Committee, 549 families in Bajura were rendered homeless by landslides and floods in the past three years, while 45 people have died due to landslides and floods in the past 14 years.

The report by the committee pointed out that 16 villages of nine local units in Bajura are at high risk of landslides and more than 44 are at moderate risk.

The survey on nutrition conducted by the Sudurpaschim province health directorate mentioned that almost half (48.8 percent) of children aged 6 to 59 months in the Bajura district are stunted, 8.6 percent are wasted and 30.6 percent of children are underweight.

The survey pointed out that malnutrition is rapidly becoming a major health problem in western Nepal, and other factors such as climate-induced disasters including floods, landslides, and droughts have exacerbated challenges for subsistence agriculture.

The Fourth Nepal Living Standards Survey 2022-23 report released by the National Statistics Office has revealed that as many as 20.27 percent of the population is still living below the poverty line in Nepal. As per the survey, Sudurpaschim has the highest poverty at 34.16 percent and Karnali at 26.69 percent. The survey also concluded that the poverty rate did not decrease as expected due to the 2015 earthquake and the Covid pandemic.

A study by the National Planning Commission on the nutritional status of the 14 districts most affected by the 2015 earthquake showed that around 250,000 children between six months and 59 months of age and 135,000 pregnant and post-partum women were at risk of malnutrition due to the decrease in food availability in the districts.

Karnali and Sudurpaschim, which are also neighbouring provinces, fall under the disaster and malnourished areas. According to the 'Nepal Demographic Health Survey 2022' report, 36 percent and 28 percent of children under the age of five in Karnali Province and Sudurpaschim Province respectively have severe malnutrition (stunting). The national average is 25 percent.

The country needs to reduce stunting to 15 percent from the existing 25 percent by 2030 to meet the UN-backed Sustainable Development Goals (SDGs) targets, wasting to four percent from the current eight percent, and underweight to 10 percent from the existing 19 percent.

Sunita Rimal, who has been working in the field of nutrition for 27 years, says, “The target of reducing wasting to four percent is ambitious given the extreme poverty and disaster risks in the country.”

Misuse and underutilisation of funds

To achieve this goal, the National Planning Commission has recorded that the government has spent at least Rs67 billion in the last decade by implementing the ‘Multi-sectoral Nutrition Plan’ nationwide.

Several donor organisations, such as the World Bank, World Food Programme, UNICEF, and the EU, among others, have initiated various programmes to facilitate the goal.

According to Dr Jagadish Joshi, director of the Sudurpaschim Province Health Directorate, Rs106,365,000 had been allocated to conduct the programmes in nine districts of Sudurpaschim and Karnali provinces.

Of the total amount, only Rs100,718,000 has been spent.

Likewise, as per the annual report of the Karnali Province Health Directorate, Rs165.3 million had been allocated for nutrition programmes for children, teenagers, women, and pregnant women in fiscal 2021-22. Only Rs125 million was spent.

According to Navaraj Kadel, information officer at the Karnali Health Directorate, preparation of the annual expenditure report of last fiscal year’s budget is currently underway.

Although Rs112.8 million is spent for the improvement of the nutrition sector each year in these provinces, no significant progress has been made.

Bishal Bhandari, who has worked as an expert development advisor for the Ministry of Women, Children and Senior Citizens and also as a national policy advisor for governmental and non-governmental organisations in Nepal, says that if one is to compare the amount spent by the authorities and the progress made in nutrition in the past decade, the programmes have merely been used a means to amass illicit wealth.

The programmes are announced, and the allocated amount is spent under the various pretexts of salary for staff, field visit expenses, meetings, operational costs and others, Bhandari says. “Barely 20 percent of the announced amount reaches the communities. How will that be sufficient?”

Joshi states that just investing the allocated budget alone is not enough to help eradicate the problems and that it takes time to see results.

“The inadequate food production and food insecurity are also the reasons why expected improvements have not been seen,” Joshi added.

No allocation for disaster awareness

Studies show that the number of malnourished children has drastically increased in disaster-affected areas.

“Taking into consideration the situation in Sudurpaschim and Karnali provinces, children have been found to be prone to malnutrition due to the recurring natural disasters in the area,” said Gyanendra Dawadi, an officer at the Sudurpaschim Police and Planning Commission.

“The conditions of the poverty-stricken families only get worse after a disaster and the children are pushed to malnutrition due to a lack of nutritious food.”

Jajarkot, Rukum West, Salyan, Bajhang, Doti, Bajura and other districts in the Karnali and Sudurpaschim were badly affected by an earthquake in November last year. Likewise, Kanchanpur, Kailali and Surkhet districts experience annual floods.

The residents of the other 16 districts in the province are also affected by floods and drought every year, among which Baitadi, Achham, Dailekh and Rukum West also experience landslides.

Due to a lack of proper rehabilitation of the disaster-affected and the loss of agricultural land, food shortage has become a chronic problem for the people of the province.

The lack of proper food and safe accommodation has also led to a deterioration of the health of pregnant women, women and children.

A landslide in October last year had displaced 24 families in Lum settlement of Chhayanath Rara Municipality. The disaster has left a lasting impact on the nutrition of the locals to this day, said health volunteer Aamkala Khadka.

“The disaster swept away the fertile land, rendering them barren. Pregnant women are not fed properly, and their families cannot afford to buy nutritious food. This leads to the newborns being malnourished,” Khadka added.

According to Municipal Health Inspector Kushal Khadka, nutritious food was distributed in Lum, Jhyari, Reba and other settlements, with the help of the ‘Multi-sectoral Nutrition Plan’ programme, after a rise in the cases of malnutrition. However, no survey was conducted to study the intensity of the problem in those areas.

National Planning Commission spokesman Yam Lal Bhusal claims that there has been an improvement in nutrition nationwide. Bhusal, however, admits that natural disasters have added challenges to the eradication of the issue.

“Disasters worsen the economic state of those affected, and the lack of proper food leads to malnutrition,” Bhusal said. “The ‘Multi-sectoral Nutrition Plan’ programme was focused on those affected by the 2015 earthquake. Now we’re taking the programmes to those areas in Karnali and Sudurpaschim.”

Karnali Province Planning Commission Vice Chair Yogendra Bahadur Shahi says that due to calamities like earthquakes, floods and landslides, the people of Karnali are falling into a “vicious cycle” of poverty.

“The survivors of such disasters require immediate relief, but we should keep in mind to not make them dependent on such donations,” Shahi said. “Instead, we must help them become self-sufficient.”