Patients are lying all over the emergency ward of Narayani Hospital. Some are writhing in pain, while others appear unconscious.
The emergency ward has only 26 beds. However, more than 50 patients suffering from cholera and diarrhea are arriving daily. There is also a similar crowd of patients with other illnesses.
As the beds cannot accommodate everyone, mattresses have been laid on the floor. Doctors and nurses are rushing around.
“We have had to keep patients on the floor in the emergency ward. A dedicated ward has been created for their treatment,” says, Dr. Chumanlal Das, Hospital Chief to Onlinekhabar.
Since the cholera outbreak spread in Birgunj Metropolitan City, more than 612 patients have been admitted since Friday, including 84 new patients in the past 24 hours alone.
Currently, 31 patients are being treated in ICUs, 6 in HDUs, and 141 in general wards of various hospitals in Birgunj. After Birgunj, cholera infections have also been confirmed in Parsa and Bara. “There are no signs of the numbers decreasing. Patients are still increasing,” said Dr. Das.
Suggestion to declare a health emergency
Public health expert Dr. Baburam Marasini said that since the growing number of patients indicates the situation could soon get out of control, the government must immediately declare a health emergency. He suggested imposing curfews and closing border points.
“Hospitals are full of cholera patients. The death toll is also rising,” Marasini says to Onlinekhabar. “Cholera that broke out in Birgunj has already spread to other districts. Now, a health emergency must be declared to mobilize all state mechanisms together.”
“Cholera is a waterborne disease, and the main source is contaminated drinking water. If it cannot be controlled within a few days, it will turn into an epidemic,” says Marasini. “Immediate action with coordination among all three levels of government is necessary.”
Once cholera is declared a public health emergency, both public and private hospitals must be involved in treatment. The government must also provide free treatment and tests for cholera patients.
According to the 2020 Infectious Disease Control Act, the government can issue orders to the general public to eradicate or prevent the spread of an infectious disease if it has spread or is likely to spread anywhere in Nepal.
Marasini further explains that under the Local Administration Act 2028, the Chief District Officer has the authority to impose curfews in cases of public health risks.
“The movement must be halted for 72 hours to cut off the sources of infection. Birgunj is a border area where thousands of vehicles enter daily via India. If the border is not sealed, it could spread from Kanchanpur to Jhapa, even reaching Kathmandu,” he says.
Experts suspect that cholera in Birgunj spread because sewage water contaminated the drinking water pipelines. Since many pipelines pass through drains and leaks are common, this could be the cause. However, even after seven days, the source of infection has not been identified.
In 2009, a cholera outbreak in Jajarkot killed 350 people and required treatment for over 60,000. At that time, cholera appeared in seven districts, including Surkhet, Dailekh, Rukum, and Rolpa.
“The Jajarkot outbreak created an epidemic across border districts. Cholera spread across more than 100 VDCs in eight districts simultaneously,” says Marasini. Referring to that outbreak, he warned, “Jajarkot was remote, yet a large workforce had to be mobilized. Within days, hundreds died, and thousands were infected.”
Senior infectious disease expert Dr. Sher Bahadur Pun also emphasized that the government must make cholera control its top priority.
“If the state focuses only on fighting cholera, many lives can be saved,” Pun says. “If neglected, it could cause huge losses.”
According to him, there are likely 10 times more asymptomatic carriers in the community than the official numbers released by the government, so urgent control is needed.
“If the situation remains the same for the next few days, it could become severe in Birgunj,” he warns. “The risk is not just for Birgunj but also for other districts with movement in and out of the city.”
Dr. Pun adds that the outbreak is becoming more serious as diarrhea and cholera cases rise in Parsa, Bara, and surrounding districts. Although cholera has been confirmed, the source has not been identified, making control more difficult.
“The delay in identifying whether the infection is spreading through water or food means more people could be affected,” Pun says.
The biggest challenge, according to him, is asymptomatic carriers. Some people only have mild diarrhea or fatigue as symptoms. Since they move around normally, they can easily spread the disease.
Through public toilets, sewage, or unsafe drinking water, these individuals could spread cholera quickly across the community.
Pun explains that cholera can raise mortality rates above 50%, but timely treatment can keep it low. Citing the large number of deaths in Jajarkot due to a lack of treatment, he urged the government to act immediately to prevent Birgunj from facing a similar situation.
So far, three deaths from cholera have been confirmed in Birgunj. However, the source of bacteria contamination in water has not yet been identified.
Tests conducted at the National Public Health Laboratory found cholera bacteria in 8 of 10 patient samples, confirming that the infection is spreading at the community level.
Struggling to identify source
Health Minister Pradeep Paudel said that identifying the source of cholera has been difficult. Although various efforts are underway to control the outbreak, the exact source has not been located.
Highlighting the increasing pressure at Narayani Hospital, Minister Paudel said that additional doctors and health workers have been mobilized from the provincial government, Madan Bhandari Academy of Health Sciences, and the federal government.
“All medicines and treatment protocols as per WHO standards are available free of cost at Narayani Hospital,” he says.
Although chlorine is being used in cleaning campaigns, Minister Paudel says it is still unclear whether sewage contamination or other factors are the cause.
“Teams from the Epidemiology and Disease Control Division and the Nepal Health Research Council are investigating, but the source has not yet been identified,” he says.
When asked about options like border closure or declaring a health emergency, Minister Paudel says, “There is no current preparation for closing borders or declaring a health emergency.”
However, as the number of cases is rising, he says a special discussion will be held in tomorrow’s cabinet meeting, and a decision may be made.
