Monsoon — The Next Biggest Challenge for Nepal that Nobody is Talking About!

Every year, water-borne diseases cause hundreds (or thousands) of deaths in Nepal. Monsoon will be here soon, possibly in the next 3 weeks. Why is that such a big deal this year?

Post-Earthquake Monsoon Concerns

  1. Housing: Many people across Nepal are living under plastic tarps or tents since their homes were damaged or have collapsed in the earthquake. It will be a struggle to keep any of their remaining belongings dry and clean.
  2. Relief Effort: Several remote villages of Sindupalchowk District have yet to receive any aid whatsoever. The situation is dire, and heavy rainfall will make accessibility even more difficult.
  3. Water contamination: Any existing water sources in villages will likely get contaminated. “Contaminated food or water can transmit bacteria and parasites to your body” which can cause diarrhea, according to the Mayo Clinic*.
  4. Accessibility: Many villages and town that are currently accessible will no longer be accessible by road after the rivers swell up by the end of May. For example: This is especially true for Sindupalchowk District, where villagers in Manikharka told me that they will lose the road link within 2–3 weeks (end of May) for upto 5–6 months, unless there is a new bridge built over Hadi Khola or Madev Khola rivers in the foothills of the mountains.
  5. Resources: Since the earthquake, the volunteer networks and government funds are already being pulled in many different directions.
  6. Landslides: I have personally seen dozens of landslides across the Sindupalchowk District mountains caused by the earthquake. The land is unstable, and a large amount of rainfall will only exacerbate the problem. Right now, quite a few villages are not even accessible by foot from nearby villages due to landslides.

Worst case scenario

Due to the challenges listed above, and the sheer incompetence of government’s relief efforts thus far, the monsoon season could lead to a cholera epidemic. “The risk of cholera epidemic is highest when poverty, war or natural disasters force people to live in crowded conditions without adequate sanitation,” according to the Mayo Clinic. Cholera causes severe diarrhea, and can lead to death by dehydration. It’s also very contagious. The death toll from the epidemic could reach in several thousands in this monsoon season alone.

The cholera outbreak after the 2010 Haiti earthquake has claimed 9,403 lives thus far. Within 10 days of the cholera epidemic, it had spread to all 10 departments/provinces in Haiti. More than 420,000 were hospitalized in Haiti alone. The cholera outbreak spread to the Dominican Republic, Cuba and Mexico and claiming lives there too.

Since the cholera outbreak in Haiti, 6% of the population have had the disease. Assuming the same percentage in Nepal, over 1.65 million** people in Nepal will get cholera.


Even though cholera and diarrhea are preventable and “easily treated”, it will be a logistical nightmare in Nepal, especially after this M7.8 earthquake. The treatment, which needs to be started within hours of cholera, includes immediate rehydration, antibiotics, intravenous fluids, zinc supplements, and more.

What can we do to prevent it?

  • Accelerate relief to remote regions — food and shelter is a priority.
  • Invest the time and effort to educate villagers in proper sanitation.
  • Soaps! Soaps! Soaps! — Distribute them to the remote regions.
  • Water tanks for proper storage of water.
  • Buckets — storing water in house for washing dishes, washing hands, etc.
  • Water disinfectant pills — for drinking water.

Big Idea

Ask China to build a few bridges in Nepal, especially across the Hadi Khola or Madev Khola, in Sindupalchowk District because otherwise, up to 100 towns and villages will be out of reach via road for 5–6 months. If we have access to the remote regions even during monsoon, we can help treat it quicker, contain it’s spread and better education villagers on sanitation.


It will come back again this year with a vengeance, if we don’t solve the clean water crisis in villages, towns and “tent cities” across the country within the next 2–3 weeks.


  1. Prevention and Control of Cholera: Read from
  2. Simple rehydration recipes: PDF
  3. Cholera symptoms: Read from Mayo Clinic


Thank you Dev Narayan Mahato for bringing this upcoming monsoon challenge to my attention. Dr. Fahim Rahim, Adam Reinstein and Camille Pane contributed to this article with their experience and research too.

*Mayo Clinic in Rochester, Minnesota.
** 6% of 27.8 million people = 1,668,000 people.

If you enjoyed reading this, you should probably follow me on Twitter at @amrit_sharma.

P.S. If you have any suggestions that I should edit or add to this article, please let me know. Thank you!

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