Kathmandu, August 25

Health Minister Pradip Paudel expressed concern that while the recent cholera outbreak in Birgunj Metropolitan City appears to be under control, the source of the outbreak has yet to be identified.

"There is some doubt that it could be due to sewage contamination," Minister Paudel told THT on the phone following his visit to Birgunj. As per reports, the World Health Organisation has also collected water samples for testing.

Cholera, according to the WHO, is an acute diarrhoeal infection caused by consuming food or water contaminated with the bacterium Vibrio cholerae. It poses a global public health risk and reflects inequity and a lack of social and economic development. To avoid cholera and other water- borne diseases, people must have access to safe drinking water, basic sanitation and hygiene.

Health Minister Paudel expressed his suspicions after monitoring the cholera-affected areas of Birgunj with local officials and health agencies today. The ministry has dispatched a team to test water samples from the affected areas. So far, there has been no evidence of contaminated water. However, it has been determined that the pipeline structure is defective.

International standards prohibit the installation of drinking water pipes next to sewage pipes. However, this error has occurred in Birgunj. "This could have contributed to the spread of the disease," Minister Paudel said.

Birgunj's wards 11, 12 and 13 have so far been identified as affected. Hospitals have reported receiving a large number of patients from these wards. "Although 103 patients were reported to be affected, the discharge rate is high, and we are prepared to handle emergency issues," he said.

"Three patients' deaths were revealed to be due to other causes." He also stated that the exact source of the cholera outbreak is unknown, but locals and technical agencies believe the water supply system is the most likely source.

There is a suspicion that sewage seeped into the bore water - drinking water obtained through deep boring - that was supplied to the households, particularly following the acute water shortage in Birgunj a month ago.

The government of Nepal on July 23 declared Madhes Province a drought-hit area following severe drought in the Tarai. Birgunj is the business hub and one of the densely populated cities in Madhes. It is also referred to as the 'Gateway to Nepal' due to its trade route to India and commercial significance.

Minister Paudel stated, "Because the pipeline is long and buried deep underground in many places, it is difficult to track the exact location of the leak. However, there is a strong suspicion that the water supply system is the root cause of the problem."

Minister Paudel stated that the Ministry of Health is mobilising additional human resources in collaboration with the federal, provincial and local governments. He said doctors and nurses from agencies such as the Madhes Institute of Health Sciences and Madan Bhandari Institute of Health Sciences, among others, had been deployed in the communities alongside local health workers.

Talking to THT, Parsa Public Health Officer Jaymod Thakur said, "Of the 155 suspected cases in 13 hospitals, 96 active cholera cases have been confirmed so far."

He further said, "Door-to door health workers have been deployed for awareness programmes. Moreover, pani-puri and chatpatte stalls have been completely banned to avoid any risks of spread of the disease."

When asked about water contamination, he responded, "In some places, the sewage pipe and drinking water pipe have been laid alongside. However, no reports have confirmed infection due to drinking water contamination."

WHO and UNICEF are working together to identify the source too, Thakur said.

On the other hand, provincial governments have sent 20 medical professionals, including 10 doctors and 10 nurses. "They have already joined the duty. The prime problem is that the cases spiked unexpectedly, which led to difficulties in managing staff," Thakur told THT.

Meanwhile, medical professionals have reported that, in addition to cholera patients, hospitals are also seeing an influx of fever and snakebite patients. Dr Uday Narayan Singh, spokesperson for Narayani Hospital, lamented that the increasing patient load had resulted in a shortage of beds and medical staff.

"The hospital is overwhelmed not only with cholera cases but also with snakebite and fever patients. Institutional support has yet to arrive," he said.

Meanwhile, the Central Security Committee, chaired by Home Minister Ramesh Lekhak, has directed the mobilisation of medical teams in cholera-affected areas, with the Nepali Army, Nepal Police and Armed Police Force tasked with supporting the response. Authorities have announced that cholera patients will receive free care in both public and private hospitals. The first case of cholera was reported in Birgunj on August 22.