"There's nothing left there," says Shushma Bhusal, the regional lead for the International Federation of Red Cross and Red Crescent Societies. "There's no village, no sign of anyone there. A lot of houses have just been washed off."
Bhusal is describing parts of Bidur municipality after the flood. Before disaster struck, it was a bustling place, home to about 60,000 people. Hundreds of homes and businesses hugged the Trishuli River, which cuts a winding path through the Nepali Himalayas. It was a central transit hub, about two and half hours from Kathmandu, Nepal's capital.
Now Bhusal sees only devastation.
Across the river, Trishuli hospital served the larger region. But the bridge to get there was destroyed by the enormous torrent of water, mud and debris unleashed by a collapsed glacier on Aug. 26.
"The time taken to cross the bridge in normal times was just 10 minutes," says Bhusal. "Now it takes about 10 hours for people to go and walk through the trail and get to the other side of the river. It leaves the people here in Bidur out of access to health services."
It's a situation playing out across communities along the river, imperiling the physical and mental health of tens of thousands.
"It's an unbelievable disaster," says Padam Simkhada, a global health researcher from the area who is now at the University of Chester. "The health system in Nepal is not prepared for this."
Damaged infrastructure, disrupted care
The floods killed at least 1,200 people in Nepal and neighboring Tibet, according to authorities. The disaster also completely destroyed or damaged at least seven hospitals and health centers, says Allison Gocotano, the World Health Organization representative to Nepal. While some hospitals remain functional, "access remains hindered because of the road blockages," he says. "Continuity of electricity is also an issue across the board."
The damage is making it harder to care for those injured by the floods. It's also disrupting routine medical care.
"We know in the community there are pregnant women who have delivery dates in the next few weeks," says Abhilasha Gurung, a health specialist with UNICEF in Nepal. The aid organization is in the process of setting up medical tents to provide that basic care. She says they've also distributed basic items, including hygiene kits and bed nets to protect against mosquitoes, to 19,000 people.
People with chronic conditions requiring medication, like diabetes, hypertension or cancer, are especially vulnerable in crises like these, says Simkhada.
"Even if they survive because they ran away, they lost their medication. There is no health facility to get that medicine. Even if there is another supply, they don't know [the] dosage," he says. "People who already have chronic conditions even become worse."
As health officials scramble to shore up this basic medical care, they're also on the lookout for new threats.
Clean water is hard to come by, as the floods contaminated water systems and damaged infrastructure. That's raising fear of waterborne diseases, says Simkhada. "There is a high risk of an epidemic that could be cholera, diarrheal disease."
Thousands of survivors are being relocated into cramped temporary shelters where airborne diseases like tuberculosis could spread. The Ministry of Health has deployed technical staff to help beef up surveillance in these centers, says Gocotano, the WHO official.
"The dead are gone, I am the one alive"
The devastating floods have also left a mental health crisis.
Roughly 2,500 to 3,000 people are currently in temporary holding centers, including everyone rescued from the floods, says UNICEF's Gurung. Many are grappling with profound loss.
Ayush Joshi, who works for the non-profit Save the Children in Nepal, visited one such center in Nuwakot earlier this week. His visit was often interrupted by the sound of helicopters overhead, searching for survivors.
"Whenever a helicopter passed by, you would see children in these holding centers looking up in the sky," he says. "Not just one child, it's like every child, they just look up."
Joshi saw flashes of hope on their faces.
"A hope that the security forces will find their family members trapped beneath the rubble or stranded somewhere," he says. "Every helicopter carries, even for a moment, the possibility that someone they love might be found."
Many survivors are holding onto that hope for the thousands still missing, he says, and struggling to come to terms with what's been lost.
"One girl that I spoke to told me that she could not sleep because she had seen four of her best friends being washed away by the flood. She was also separated from her parents while staying at the holding center," he says. "You can imagine the emotional burden that a child has to carry in this situation."
UNICEF's Gurung spoke to one woman who was rescued by a helicopter and who seemed in a state of shock. "I asked 'How are you?' and the response I got was, 'The dead are gone, I am the one alive,' " says Gurung. "I asked, 'Are you OK?' and she said, "I lost my children.'"
Save the Children and other responders are trying to provide support for that acute psychological distress, sending in counselors and providing mental health support at the shelters. But Joshi says mental health care is often treated as an afterthought in disaster situations, and resources can get pulled before people have fully made sense of the trauma.
"It's something that no one talks about, and it has a prolonged, long-term effect," he says. "The focus must go beyond immediate relief."
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