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Comment Volume 408, Issue 10561 p1148-1150 September 26, 2026
Beyond rescue: building a resilient health system after Nepal's 2026 flood
Abhilasha Karkeya Send email to akarkey@oucru.org ∙ Sudeep Adhikaria ∙ Buddha Basnyata
Nepal clearly needs robust disaster preparedness involving multiple sectors
such as hydrometeorology, health, finance, infrastructure, security, food, energy, telecommunications, and many more.
The health system should be capable of operating along two simultaneous tracks. The first must provide search and rescue, emergency and trauma care, medical evacuation, and timely referral.
The second must protect population health by
maintaining disease surveillance and laboratory diagnosis,
preventing and managing outbreaks,
ensuring safe water and sanitation,
preserving maternal and child health and mental-health services,
maintaining vaccination and disease-control programmes, and
ensuring continued access to treatment for chronic diseases.
Neglecting either track will cost lives.
Rural health systems cannot depend excessively on Kathmandu or other major cities for emergency care, essential diagnostics, medicines, vaccines, and specialist advice.
High-risk districts need pre-identified alternative referral routes and facilities, strategically located emergency stocks, reliable communication systems, and laboratory networks able to continue operating when roads, bridges, or electricity supplies fail.
Health facilities should have regularly tested business-continuity plans, and health workers should receive practical training and participate in multisectoral disaster simulations.
Early-warning messages must also be locally understandable and linked to clear instructions about where people should go and what they should do.