Lessons Learnt Conference: Health Sector Response to Nepal Earthquake 2015, Kathmandu, 21-22 April 2016

21 April 2016, Kathmandu, Nepal

Your Excellency, Mr Ramjanam Chaudhary, the Hon’ble Minister of Health and Population, senior officials of the Government of Nepal, distinguished guests, ladies and gentleman,

25 April 2015 was a fateful day for the people of Nepal. On that day a devastating earthquake took more than 8000 lives, and left thousands more injured.

Homes were reduced to rubble. Livelihoods were lost.

Seismologists had long warned of Nepal’s next great earthquake. But there was no way to predict when it would happen. The Government of Nepal had for several years initiated plans to strengthen the country’s preparedness for such an event. So too had the Health Sector.

Though the challenges were immense, the response was swift when disaster actually stuck.

Within hours of the earthquake, Nepal’s Ministry of Health and Population successfully established command and control at the Health Emergency Operations Centre – ground zero for the health sector response.

Even before the ground stopped shaking waves of patients began to present at health facilities, many of which lay in ruins. Nevertheless, frontline health workers steadied themselves. Mass casualty management programs were rolled out; emergency rosters took effect; and referral systems were activated.

The earthquake struck at 1156 am. By 2pm WHO’s Emergency Humanitarian Action Team was mobilized and packed onto the first flights to Kathmandu. By 5pm the first tranche of emergency funding from SEARHEF was released. And by early the next day four emergency health kits – each kit able to take care of 40 000 people for 3 months – were deployed.

Over the following days and weeks the Ministry and WHO-led Health Cluster acted with poise to ensure the response was orderly, efficient, and – most importantly – met the needs of affected groups. Foreign Medical Teams were dispatched to match capacity with need; disease surveillance was ramped-up across the most affected districts; and health services were reinforced.

Within the cluster system specific needs were identified and sub-clusters established. Sub-clusters were created for injury management and rehabilitation, tuberculosis and reproductive health among others. These clusters proved critical to the rapid exchange of information and effective delineation of tasks and activities. With the Ministry in lead, partners from across the world worked with one another to deliver the best possible health-related outcomes.

Through it all we all had to be agile in our approach. As many of you here know, Nepal’s earthquake was always projected to be an urban disaster, with Kathmandu suffering – in a worst case scenario – in excess of 100 000 fatalities. But the when the earthquake did strike, it was, for the most part, a rural disaster. The heaviest casualties and greatest health system damage occurred outside of the capital.

After initial needs were met, we needed to adapt. To ensure continuity of services WHO positioned Medical Camp Kits in strategic locations across the most affected districts. We likewise pre-positioned supplies in remote locations in case of a disease epidemic. And in order to ensure issues such as mental health and severe acute malnutrition were addressed, we trained staff at the local level to screen for symptoms and to refer patients to specialist services.

But while we succeeded in many areas, and were able to adapt – for the most part – to the challenges faced, we also had our failings and must be candid on reflection. While acknowledging what was done right, we must also identify areas where we could have done better. Disasters are, by definition, messy affairs. There is often a cleaving of policy and practice; of intention and actuality.

Indeed, did all health workers everywhere know how to triage? Were the skills and resources of foreign medical teams utilized as effectively as possible? How could health facilities have better managed water and sanitation requirements? Were referral pathways clear and did they function as intended? And did health authorities adequately communicate the risks communities faced and how best they could be avoided?

The discussions over the coming days will prove vital to answering these and many other questions. This is our opportunity as a sector to come together and to share experiences, to learn and make ourselves better at what we do.

In anticipation of this meeting important work has been done.

Nepal’s benchmarks for emergency preparedness and response readiness have been reassessed. The benchmarks are a tool to assess country capacity in these critical areas, and were developed after the 2004 Indian Ocean Tsunami. Using the benchmarks framework, a multi-sectoral group identified the capacities that were enhanced from 2011 onwards and the gaps that remained just prior to the earthquake.

The health Sub-Clusters, too, have conducted reviews on how they performed and where they could improve and coordinate better. This way we have more details on what was done well and where performance could have been better in the areas of stewardship, medical services and public health interventions. This will serve us well in prioritizing ongoing preparedness activities as well as guiding health sector response actions for a future event.

In addition, the Ministry has also examined various components of its own operations with an eye to enhancing future response capacities. Several departments and divisions of the Ministry of Health at central and district levels have also reviewed their response and identified critical lessons to feed into their current and future work.

The information and experiences all of us here share will provide the material for further analysis and reflection. Lessons will be learned so that if and when a similar disaster occurs – either in Nepal or anywhere else – we will not repeat the same mistakes or oversights. These lessons will also prove important as we move ahead with the health system recovery.

On that note – and as we talk about the virtue of candid reflection and self-examination – we must acknowledge the fact that almost one year after the disaster we remain in extended response mode. The Medical Camp Kits I mentioned earlier are still in place. We are once again preparing for the monsoon’s onset and assessing how it will affect vulnerable communities.

Though the road ahead is rough and will no doubt have our share of obstacles, we must continue on our journey. And we must do so with a commitment to continue to improve ourselves. The communities we work for deserve as much.

Excellencies, distinguished participants, ladies and gentleman,

As we meet here almost a year after Nepal’s devastating 25 April earthquake, it is worth remembering that we will always live with hazards. There will always be fault-lines to break the ground on which we stand, just as there will always be oceans and rivers to flood the areas in which we live.

But we must work to reduce the risks these hazards represent. At WHO SEARO, and as a broader health sector, we learned much from the 2004 tsunami. We must now also learn from the Nepal earthquake. I urge you to make the most of this opportunity.

I want to emphasize, before I close, that preparedness is the key to reducing the impact on the lives of affected people when disaster strikes.

Thank you.