Flood: Health Care Preparedness and Planning

Flood Risk in Nepal

As per the disaster risk reduction portal of Nepal Nepal is home to over 6,000 rivers and rivulets that flow from the north to the south. Among them, there are perennial rivers like the Koshi, Narayani, Karnali, and Mahakali, which are fed by snow and originate from the Himalayas and snow-capped mountains. These rivers traverse through the hills and eventually reach the Terai plains. However, during the monsoon season, which spans from June to September, these rivers experience a significant increase in their water levels, resulting in severe damage to villages, croplands, and the inhabitants and livestock residing within the river basins. Even 6 inches of water can cause a person to fall, and just 2 feet of water can easily sweep away a car.

Health Concerns During Flood

The priority of flood survivors is shelter, food, and warm clothes, approximately 0.2% to 2% of flood survivors require urgent medical care. Drowning is the primary cause of death during floods, due to the challenges of reaching victims during the acute phase of a flood, cases of near-drowning leading to emergency department presentations are relatively uncommon. However, successful resuscitation and complete neurologic recovery have been reported for patients submerged in cold water for 40 minutes, thanks to the neuroprotective effects of hypothermia.

Fast-flowing floodwaters carry various large debris, including cars, trees, and other objects, resulting in trauma, such as orthopedic injuries and lacerations. Contaminated wounds resulting from traumatic injuries caused by floodwaters should be managed conservatively through irrigation and allowed to heal through secondary intention. There have also been reports of floodwaters displacing snakes and other animals, leading to an increased risk of animal bites. Moreover, the presence of excessive water during and after a flood contributes to a higher incidence of insect bites and the transmission of vector-borne illnesses. The force of floodwaters may also lead to the disruption of power lines, flood electrical circuits, and submerge electrical equipment, heightening the risk of fires and electrical hazards.

The temporary shelters to accommodate those displaced by flooding can create crowded and unsanitary living conditions, thereby increasing the likelihood of gastrointestinal and other infectious diseases. Victims of floods, as well as other natural disasters, are prone to elevated risk of developing mental illnesses and substance abuse disorders. The population affected may be devoid of basic health needs like basic health services, emergency health services, and sexual and reproductive health. Besides this Gender-based violence (GBV), and managing the health needs of disabled persons and patients living with chronic illness increases the vulnerability.

Health Care Facility Planning and Preparedness for Flood

  • Evacuation routes should be planned and practiced.
  • The availability of an emergency communications system such as two-way radios, cell phones, and internet connectivity is important.
  • Social media resources in community and hospital communications plan for information sharing and reporting of health and rescue needs are important parts of planning.
  • Floods can be long-term events lasting days to weeks, so hospitals should have at least 72 hours’ worth of disaster supplies, including food, water, and essential items.
  • Emergency kits should include a portable battery-operated radio, flashlights, batteries, first aid kits, personal sanitation items, local maps, and a cell phone with a charger or spare batteries.
  • Hospitals should establish a plan for requesting additional staffing, services, or evacuation assistance through their emergency communications system.
  • During floods, transport times may increase, and hospitals may rely on alternative means of transport, such as aeromedical support needs to be planned.
  • Planning for addressing GBV, SRH, and shelter for mothers and newborns are important aspects of preparedness.
  • Disaster plan needs to be disability-inclusive and address the needs of the patient with chronic illness.


In order to uphold the constitutional right to free Basic Health Services and ensure that every citizen has access to emergency care, it is imperative to establish comprehensive preparedness measures. This entails developing robust systems and protocols to effectively respond to health emergencies, providing necessary resources and training for healthcare professionals, and implementing efficient emergency medical services. By prioritizing preparedness, Nepal can ensure that its citizens are not deprived of essential healthcare services during critical times.

Ashis Shrestha