Nepal is in critical condition. But as to the prescribed treatment, there are many opinions. I am a specialist in emergency and critical care medicine. We care for unstable, severely ill or injured persons with all kinds of problems. We often have to act quickly to stabilise the patient before we have time to fully assess all details or attend to less urgent problems, so we use priority-based protocols, doing the most important things first. We are also realists; we must be accurate, pragmatic and flexible. This perspective informs my thinking about Nepal’s crisis; first the situation needs to be stabilised, then problems addressed.

The most critical problems are the ongoing violence and the failure of governance. These two are inseparably linked. One cannot have democracy, which requires free and fair all-party elections, without a bilateral ceasefire and non-interference on all sides. Nor can one have peace without an agreement between the armed factions — the monarch, army and Maoists.

The US plan, which calls for renunciation of the 12-point agreement, fails to accept an admirable attempt at resolution which recognises the importance of making peace with the Maoists and bringing them into the mainstream. Instead it returns to a royally appointed party government with continued war. Its justification focuses on Maoist atrocities and dishonesty, while ignoring the same offences in the government; it is special pleading. The 12-point agreement, because it insists on republicanism and a constituent assembly, is doomed to rejection by the King. And a Maoist-King pact without party involvement would be undemocratic. Only a trilateral agreement, which none of these schemes can bring about, can succeed.

The nexus between peace and democracy is clear but no strategy is possible unless it is acceptable to all three factions. Continued intransigence brings continued war. All factions have to start with the principles: enduring peace, justice, equality, development, human rights and democratic governance with fair elections. Then they have to consider goals: ending the war, reinstating true democracy, and healing the nation’s wounds. Next they have to agree on the strategies where the impasse arises.

Nepal’s 1990 Constitution is badly flawed. The King and his retainers are happy with it, but the parties and Maoists are calling for a constituent assembly. It’s clear that the palace will never accept it. The parties and Maoists will not accept a monarchy in control of the military because of the risk to democracy. This seems an insoluble problem, but it is not. Until 2001 Nepal was effectively demilitarised; the army was small and poorly armed, existing only to guard the palace and provide pomp on state occasions. The RNA would be useless in the unlikely event of an external attack. Its military spending takes away badly needed funds from social programmes, and discharging 100,000 RNA personnel and tens of thousands of Maoist troops will aggravate unemployment and crime. Better to use them for development by building infrastructure, improving health care and education, and otherwise striking at the roots of the insurgency: poverty, discrimination, lack of opportunity, illiteracy and poor health.

The King wishes to be an active monarch but the 12-point agreement envisions no monarchy. This seems irresolvable, but it isn’t. If the present form of monarch is changed from an actual or potential autocracy into something positive, it should be acceptable to the parties and the Maoists. The solution is obvious: disarm RNA and Maoists, place security responsibilities under a better trained and more accountable police force, and put the troops to solving the problems under the King.

Peace and democracy can be restored in nine steps: bilateral ceasefire, agreement on the plan’s terms, including constitutional amendments, reinstatement of the dissolved House and appointment of all-party government, placement of RNA under UN commanders as a peacekeeping force, voluntary disarmament of Maoists, all party parliamentary elections, disarmament of RNA, incorporation of former Maoists, and transformation into a national development corps under royal supervision, formation of elected parliament and democratic governance under the constitution, and passage of the previously agreed constitutional amendments or, better yet, a constituent assembly to draft a new constitution whose terms would be negotiated by the House and the palace.

This plan will stabilise the situation, end war, promote sustainability and reconstruction, and restore democracy. By putting principles first, the factions will also act in their own interests. It was corruption, callousness and incompetence of the parties, the brutality and arrogance of the government, and the cruelty of the Maoists that have brought Nepal to its moribund condition, and only by reversing those pathologies can a cure be effected.

Dr Cobb taught Medicine in Nepal and is now based in Dhaka