With its ancient culture and the stunning landscape provided by the Himalayas, Nepal has a romantic image. The country became a republic in May 2008 and despite ongoing political tensions following a ten-year insurrection, tourists are beginning to return to this beautiful landlocked nation.
But despite its attractions, Nepal still faces huge problems, particularly the poor conditions in which many of its people live. Most of the population work in agriculture and the United Nations estimates that approximately 40% of Nepalese live in poverty.
The population is also prone to epidemics, which account for high morbidity and mortality rates in Nepal. And with a weakened health system following years of violence and instability, many poor Nepalese struggle to access medical services when they fall ill.
Now efforts are being made to reduce the high incidence of illness caused by water-borne diseases through campaigns which emphasise the importance of sanitation. According to statistics published by the World Health Organisation (for 2008), only half the urban population in Nepal use proper sanitation facilities and in rural areas this drops to 27%.
The use by many Nepalese of the outdoors, instead of latrines, is a major cause of water contamination and gastrointestinal diseases. A specialist in water, sanitation and hygiene for UNICEF reported that of the 37,000 deaths of children under five during 2008, 14% were caused by acute diarrhoea. During the rainy season, the numbers of those affected are even higher, as contaminated water flows into the rivers. During the rains last year, 59,000 people fell ill from an outbreak of diarrhoea which killed over 300 people.
Various organisations are now advising communities how to tackle the problem. In the village of Siddhipur on the outskirts of Kathmandu, there are 1,300 households, but only 15-20 per cent of them have their own toilet. Public toilets are available in the village, but traditionally many people preferred to use the outdoors. With support from the Environment and Public Health Organization, a local NGO, UN Habitat and Water Aid Nepal, the villagers began a campaign to shame people who continued to ignore warnings and defecate outdoors. Children were encouraged to watch for anyone using the fields and write the offender’s name on a bright yellow flag where they went to the toilet. In a similar scheme in the western Kapilbastu District, children were asked to blow whistles when they saw offenders defecate outdoors.
Meanwhile, the government is also adding pressure on its citizens to install toilets in their homes by asking people about their sanitation facilities when they visit regional offices for birth certificates, passports and citizenship papers. With many people still saying they ‘feel more comfortable’ going to the toilet outside, it would seem that the government and health organisations still have their work cut out to persuade Nepalese people this is no longer acceptable because the health of the nation is at stake.