Human Rights Watch has warned the Nepal government that if it does not act urgently, the rapidly escalating CVOID-19 cases will have a devastating impact on public health.

Issuing a press release today, HRW notified the government that the health system was reaching breaking point with the number of recorded infections doubling every three days among a largely unvaccinated population.

It has asked the government to increase availability of emergency medical supplies, including bottled oxygen, ventilators, and therapeutic drugs with assistance from foreign donors.

"Nepal's under-resourced public health system is strained beyond capacity," said Meenakshi Ganguly, South Asia Director at Human Rights Watch. "Large volumes of oxygen equipment and other medical supplies are urgently needed to avert a COVID-19 catastrophe in the country."

It further said the government's response to the second wave of the COVID-19 pandemic had been slow and poorly managed. Citing government doctors, HRW said the government had imposed lockdown in the capital on April 29 when it was too late. It should have been introduced 10 to 14 days earlier. It further said the government had failed to set up infrastructure for oxygen supply, which was quite astonishing for health workers. Nepal's oxygen production capacity is also becoming overstretched.

Dr Roshan Pokharel, chief specialist at the health ministry, said: "We are in a very dire situation right now. We are running out of oxygen supply. Our oxygen plants are not working properly. The number of cases is increasing rapidly, and COVID patients are quite young."

The government's Health Sector Emergency Response Plan for the COVID-19 Pandemic outlines that hospitalisation with oxygen support should be available for 15 per cent of confirmed cases. With 6,700 new confirmed cases on May 5 alone, it is evident that the existing infrastructure will not be sufficient.

The HRW also notified that the government urgently needed to bolster supplies of therapeutic drugs such as Remdesivir, consumables such as oxygen tubes and masks, and ventilators and other critical care facilities.

Nepal has about 560 ventilators, less than half of what may be needed according to donor agency estimates seen by Human Rights Watch. Not everything is in working order and in some parts of the country there is lack of trained human resources to operate them.

Officials emphasised that oxygen equipment and other supplies – including vaccines – are needed, not funding. "Money is no use," one said, referring to the impossibility of obtaining supplies from neighbouring India due to the COVID-19 emergency there. Supplies from China, such as a recent order of 20,000 oxygen cylinders, may take two to three weeks to arrive by road, officials told Human Rights Watch.

The international human rights watchdog has also notified that private hospitals are also operating near or beyond capacity. Private treatment, which may cost between US$80 to $420 per day, is beyond the capacity of most people in a country where the average annual per capita income is around $1,000. The government is investigating allegations that private hospitals increased their prices during the emergency.

On April 26, the World Health Organisation reported a case-positivity rate of 37 per cent across the country, and officials told Human Rights Watch that an alarming 45 to 50 per cent of COVID-19 tests were positive. However, official figures are widely believed to under-represent the scale of the crisis. For example, the Birgunj region has only one testing centre, and health workers are reporting clusters of people suffering from high fever and deaths in several villages. "No one is tracking these cases," a social worker said.

It is said the global COVID-19 vaccine scarcity is undermining vaccination efforts in Nepal, particularly after the Indian government halted vaccine exports. "If we want to stop this transmission, we need vaccines," said Dr Lhamo Sherpa, an epidemiologist. Less than 10 per cent of the population in Nepal has received one dose of vaccine, and supplies are not available to provide a second dose to many of those who are awaiting one. Dr Pokharel said, "We are not getting vaccines from anywhere, although we do have the money."

The HRW has criticised the government's reluctance to focus on the crisis. "Prime Minister KP Sharma Oli has repeatedly recommended herbal remedies such as guava leaves, as a cure for COVID-19," the press release states. It further said that INGOs have been unable to transfer funds to the government because the bureaucracy is unable to complete paperwork due to COV- ID-19 cases among ministers and officials.

"Nepal's healthcare system was in no condition to confront an emergency of this scale, and the government needs to act to protect all Nepalis' right to health," Ganguly said. "To avert a terrible disaster it is critical for the Nepali government and donor countries to urgently make life-saving oxygen equipment and vaccines equitably available."

A version of this article appears in the print on May 11, 2021, of The Himalayan Times.