On the evening of July 9, 2022. It had been drizzling continuously. There were no signs in the sky of heavier rainfall. The nearby Doda River was not swelling rapidly. Feeling somewhat reassured after observing the sky and the river, the residents of Kanj village were preparing to sleep, though they had not yet fallen asleep.
It was the rainy season. Suddenly, after a cloudburst in the upper part of the village, the Doda River surged in the downstream area. All of a sudden, the floodwaters began entering the village. Darkness prevailed everywhere. Recalling the moment, Ward Chairperson of Laljhadi–2, Asharam Rana, said, “There was chaos at midnight. Before our eyes, the river flood started entering the village. Villagers began losing hope. There was nowhere to take the children for safety.”
In recent days, Kanj village has almost turned into a mound-like landscape. During winter, it appears as if there is no river at all. Only a vast riverbed can be seen. Pointing towards the riverbed, he said, “Just look at it, it hardly seems like a river anymore. There is only sand and gravel, no water. It is hard to believe such an unimaginable situation could occur. When the villagers realized that floodwaters could arrive at any moment, they used bamboo stored in their homes to stop erosion. During the night, villagers somehow worked together and used biological and traditional techniques to prevent the river current from entering the settlement. The flood submerged paddy and sugarcane crops. Had we not managed to stop it, Kanj village would no longer exist today.”
During emergencies, whole bamboo poles and bamboo leaves are used to prevent river water from entering the village and to control erosion. Such materials are reportedly kept ready in advance. According to Ward Chairperson of Laljhadi–1, Pyarelal Rana, the level of the Doda River has been rising every year. Soil and sand carried by floodwaters during the monsoon continue to raise the riverbed. However, no authority has yet conducted an exact measurement of how much the river level has increased. The river continuously changes its course. He said, “The river changes its flow every year. There has never been a year without erosion and inundation. There is no record of how much land the river has eroded, how much crop has been submerged, or how much harvest has been destroyed by wild animals. How much pain should we continue to narrate? Our work has become only to listen to suffering and speak about it. If we leave, where do we go? If we stay, living has become impossible.”
Non-Communicable Diseases Rising, Red Cross Raising Awareness
Residents of Laljhadi, one of the most remote areas of Kanchanpur that suffers yearly from floods, erosion, and attacks by wild animals, have increasingly been affected by non-communicable diseases in recent years. In this rural municipality, which always remains at high disaster risk, the graph of non-communicable diseases continues to rise steadily. According to the DHIS-2 data regarding non-communicable diseases such as hypertension, diabetes, cancer, cardiovascular, and respiratory diseases, “In fiscal year 2021/22, 257 people had hypertension, 124 had diabetes, and 122 suffered from cardiovascular and respiratory diseases. By fiscal year 2024/25, these numbers had nearly doubled, reaching 600, 250, and 252, respectively.” The figures are expected to rise even further in the current fiscal year.
According to the latest census, this rural municipality consisting of six wards has a population of 5,411 people above 30 years of age, including 1,088 in Ward No. 1, 811 in Ward No. 2, 883 in Ward No. 3, 1,179 in Ward No. 4, 721 in Ward No. 5, and 737 in Ward No. 6. Although the World Health Organization has been supporting the Ministry of Health and Food Security in implementing the PEN-D package for managing non-communicable diseases at the primary healthcare level, it has not proven effective during disasters. In such situations, treatment is interrupted, regular medication stops, and people are even displaced, said Anil Maharjan, Health Program Co-Coordinator of the Resilience NCD Project.
Non-communicable diseases are becoming the leading cause of premature deaths and disabilities in Nepal. According to the World Health Organization, non-communicable diseases accounted for 71 percent of deaths in 2019, and this figure is projected to reach 79 percent by 2040.
Chairperson of Laljhadi Rural Municipality, Nirmal Rana, stated that the implementation of the “Resilience Non-Communicable Disease Treatment Service” project in the municipality has greatly increased awareness regarding non-communicable diseases. He informed that the PEN-D package would be included in next year’s policies and programs to ensure continuity of treatment services for people with non-communicable diseases during disasters. According to him, all wards of the rural municipality are at high risk of floods and inundation. In particular, Kanj, Duga, Kaswakanch, Binwari Bichwa, Siklapati, Baijnath Tol, Annapurna Tol, Binaywari Bichwa, Bichhuwa Tol, Deuwatol, Chandev, Siklapati Mukta, Kanj, Kashwa, Bichhuwa Tol, the rural municipality office building, and health institutions remain vulnerable to flooding.
The “Resilience Non-Communicable Disease Treatment Service” project has been operating in Laljhadi Rural Municipality from April 2024 to May 2026 with financial support from the Novo Nordisk Foundation and collaboration from the Danish Red Cross, Canadian Red Cross, and Aarhus University.
As hypertension, diabetes, cancer, cardiovascular, and respiratory diseases have emerged as major public health risks in recent times, the PEN-D package was introduced to ensure continuity of treatment services for people suffering from non-communicable diseases during disasters.
Coordinator of the “Resilience Non-Communicable Disease Treatment Service” project, Pramod Adhikari, said, “The main objective of the Resilience NCD project is to bridge the gap between the health sector and disaster response systems by ensuring that people with non-communicable diseases are not neglected during disasters. Prioritizing patients with non-communicable diseases during disasters can reduce emergency complications and the risk of death. It can reduce patients’ mental stress and prevent diseases such as diabetes, hypertension, and heart disease from worsening. If addressed through policy measures, it can also help ensure regular access to medication and continuity of treatment.”
Seventy-three-year-old Rambhajan Rana, whom we met at Shankharpur Health Post in Laljhadi–2, had come accompanied by a female community health volunteer to receive blood pressure medication. Female community health volunteer Rammati Rana from Bagwadhi Tol, Laljhadi–2, said, “The number of people in the village taking medication for hypertension, diabetes, cancer, cardiovascular, and respiratory diseases is increasing.” Rambhajan, 73, complained that obtaining medicine during the rainy season also becomes difficult. He said, “Sometimes we even have to buy medicine ourselves.” The government has been distributing medicines for hypertension and diabetes free of charge.
Chief Public Health Officer of Laljhadi Rural Municipality Health Section, Khagendra Chaudhary, informed that the municipality remains vulnerable from a health perspective. He said, “The problem of non-communicable diseases is increasing more than communicable diseases.” The municipality has also started screening for non-communicable diseases.
Chief of the Disaster Management Section of Laljhadi Rural Municipality, Hemraj Upadhyaya, informed that most wards of the municipality lie in high-risk flood and inundation zones and suggested that greater attention be paid to controlling the Doda River. He said, “The community’s disaster response capacity has improved, but it is still not sufficient.” According to him, sirens have been installed at four locations within the municipality to provide early warning alerts.
Senior AHW at Shankharpur Health Post, Yagya Bahadur Dhami, stated that efforts are ongoing to ensure continuity of treatment services for people with non-communicable diseases during disasters, though at times health facilities themselves become inundated. He said, “The PEN-D package is good, but implementation is difficult.”
Binayak Paudel of the “Resilience Non-Communicable Disease Treatment Service” project informed that the Nepal Red Cross has been facilitating various activities in the municipality to ensure continuity of treatment services for people with non-communicable diseases during disasters.