Health effects of Maoist insurgency in Nepal.

摘要

In her World Report (Sept 9, p 908),1 Sophia Collins states that health was the sector least affected during the insurgency. We disagree.40 health posts were completely destroyed between January, 2002, and December, 2004, and tens of others were rendered unusable.2 Some of these health posts were attached to the offices of the village development committee, which arethe Maoists'favourite targets. Maoists also destroyed the electrical supply to Okhaldhunga hospital, a small hospital in eastern Nepal, because an army camp nearby was using electricity from the same source.3It was not easy for health workers to do their jobs during the insurgency. The government issued a directive to all health workers not to treat Maoists without notification of security personnel. In cases of defiance, doctors were to be regarded as supporters of terrorism and punished accordingly. It was impossible to work under such conditions when Maoists demanded treatment for their wounded.Frequent, lengthy shutdowns of transportation by Maoists (eg, in March, 2005) prevented the supply of vaccines, vitamin A, and deworming drugs to nearly 3-6 million children.3Some women, displaced in their tens of thousands from the rural areas to cities in search of food, shelter, and security, have ended up in prostitution, which will further concentrate the HIV epidemic. In a study done among the internally displaced population, posttraumatic stress disorder was found in53-4%, anxiety in 80-7%, and depression in 80-3%-bleak data indeed.