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KATHMANDU, Nepal — At the Tribhuvan University Teaching Hospital, patients sit in the lobby waiting to be treated. Many made difficult journeys to get there, some only to be told that the hospital had run out of medication. Seeking care is a challenge these days. Transportation is becoming increasingly costly and unreliable throughout the country, and medicine is hard to come by. Last month UNICEF released a report stating that over 3 million children in Nepal under the age of 5 will be at risk of death or disease in the upcoming months because of “a severe shortage of fuel, food, medicines and vaccines.”
For almost four months, protests and an economic blockade at border crossings with India by Nepal’s Madhesi ethnic group have all but crippled the nation, which is still trying to get back on its feet since devastating earthquakes struck earlier this year. The most intense unrest began in September, after Nepal adopted a new constitution that Madhesis say excludes them from representation in government. Though Madhesis make up roughly 33 percent of Nepal’s population, fewer than 12 percent of people in the government, army and police force are Madhesi. Most Nepalese who live in the northern part of the country are Pahari.
Since protests began in the country’s southern Terai plains, political parties have forced store owners to shut down their shops, and cargo trucks driving through the region have risked attacks for violating the strikes. A large percentage of Nepal’s food and building materials are imported from India, as are half of Nepal’s medical supplies and almost all its gas.
Because of previous blockades and affinities between the Madhesis and Indian ethnic groups, Nepal’s government has accused India of supporting the blockade; India has denied any involvement.
Nowhere have the effects of the standoff been more apparent than in Nepal’s hospitals. “The real problem now is the basic things,” said Dr. Prem Khadga, the deputy director of Tribhuvan University Teaching Hospital in Kathmandu, one of the biggest hospitals in the country. “Bandages, gauze, syringes — basic things required in the operation theater are not available.” According to Dr. Yuba Raj Sharma, the medical director of Patan Hospital, outside Kathmandu, critical medicines such as epinephrine, which is used to treat cardiac arrest and severe allergic reactions, are also limited. In the western city of Pokhara, Western Zonal Hospital has faced scarcities of anesthetic and is on the verge of closing its operating theater. Less information is available about rural areas, but many suspect that the effects on the countryside have been even more pronounced. According to local media reports, thousands of children across the country have been deprived of immunizations since the start of the blockade.
Electricity is another concern. With power cuts in Kathmandu now averaging 58 hours per week, hospitals are increasingly reliant on diesel-powered backup generators to run ventilators, dialysis machines and equipment needed in operating theaters. Without a stable supply of gasoline from the government, some hospitals have turned to the black market for fuel to keep equipment running. Finding cooking gas has also been a problem, and Tribhuvan has begun using firewood to prepare food for patients. Throughout the day, clouds of smoke waft from the kitchen into hospital corridors.
“The staff and the doctors find it difficult to come to the hospital at the right time nowadays,” said Khadga of the difficulties posed by gas shortages. “If they are late or are leaving early, it is because of the blockade.” Sharma said he has been forced to ride his bicycle to work at times.
Patients have also had trouble accessing hospitals. Although many people were injured during the earthquakes, hospital visits have declined. In 2015 there have been 50 percent fewer patients at Tribhuvan compared with the year before.
“Madhesis feel that the negative effects of their protests are regrettable but that these are the only ways to make their voices heard and bring change to their situation,” said Prashant Jha, a Madhesi journalist who described the protests as “an act of desperation.” Hospitals have not been the only institutions affected by the unrest. Schools in Nepal’s southern plains were closed from August to November. They were reopened last month, but attendance has been irregular, and schools in the southern city of Janakpur were shut down again on Dec. 20 after protests intensified.
The Madhesis say they have been subject to exploitation and discrimination in Nepal for decades. In 2007 the killing of a 16-year-old Madhesi boy by Maoists in the southeastern Siraha district sparked protests that ultimately forced the government to reform its interim constitution. The aim of the current strikes, which many believe are related to issues left unresolved in 2007, is to pressure the government into revising the new constitution. In addition to continuing policies that deny many Madhesis full citizenship rights, the constitution redrew federal provinces in a way that places the group at a voting disadvantage in six out of the country’s seven provinces.
The new constitution solidified “an unequal citizen regime,” said Vijay Kant Karna, a political science professor at Tribhuvan University and a former ambassador. Among protesters’ demands are political representation based on population rather than geography, proportionate inclusion in government and rezoning the provinces drawn up in the new constitution. “When we are talking about equal representation, we are talking about the representation of all communities, not just Madhesis,” he said.
Protesters say that in blaming India for the blockade, the Nepalese government is ignoring domestic issues that need to be addressed, such as police brutality against Madhesis. Since the current unrest began, confrontations between protesters and police have lead to the deaths of over 50 people, including children. Most were Madhesi. These killings were so brutal that Human Rights Watch filed a report urging Nepal’s government to take action. Last month the U.N. released a statement condemning police for assaulting patients and hospital staffers at Sagarmatha Zonal Hospital in the southeastern part of the country. In response to police killings, newly elected Prime Minister K.P. Oli referred to protesters who were killed in September as “a few bruised mangoes,” implying that the integrity of the mango tree — Nepal — would remain intact without them.
Since then, Nepal’s government has initiated talks with Madhesi political party Samyukta Loktantrik Madhesi Morcha in an effort to end the protests, but little progress has been made. “How can we feel our country is genuinely trying to incorporate us within the national fabric when even our own prime minister is against us?” asked a Madhesi journalist who requested his identity be kept anonymous to avoid possible reprisals. “Anti-Madhesi sentiments have become the norm in Kathmandu politics. Even if you believe in Madhesi rights, speaking out for them will have you ostracized.”
Many Madhesis do not want to give up on their fight, but they would like to see a shift to more peaceful strategies. In early December an event was held in Janakpur in an attempt to foster better relations between the government and local communities by having young people clean the city alongside members of the army, police and Armed Police Force. In November a social media movement was launched in Janakpur under the hashtag #MadhesSpeaks with the goal of giving Madhesis a platform to convey their feelings to Nepalis in the north. This was followed by other peaceful events in Terai and an event in Kathmandu. In September thousands of protesters formed a human chain to symbolize unity and strength in the region. Oli referred to them as a “chain of flies.”
Although negotiations have taken place between the Nepali government and Madhesi political parties, Madhesi leaders have indicated that government officials are not willing to accept their terms. As a result, unrest has intensified. One child was shot by police on Sunday in the southern Rautahat district. Despite the effects on hospitals and local institutions, Madhesi leaders say the protests will continue until their concerns are addressed.