On April 25, 2015, Nepal was struck by a devastating 7.8-magnitude earthquake — the worst disaster to hit the country in more than eighty years. Almost nine thousand lives were lost. Over twenty thousand people were injured. Entire villages and temples were turned to rubble, and homes and hospitals were wiped out. More than eight million people were affected — about a third of the country.
I was in Indonesia, leading my office’s emergency, disease surveillance, and epidemiology programs, when the earthquake hit. When I heard the news, I requested my management to deploy me to support the response. For me, it was not just a duty. It was a wish from my soul.
I arrived in Nepal on May 1, 2015, as part of my office’s emergency response team. I was deployed to Sindhupalchok, the heart of the devastation. For almost a month, I travelled across Chautara, Kulchok, Nawalpur, Sikharpur, Melamchi, and Bhimtar, working closely with the local health workers. Many of them had lost everything—their homes and families—yet they still showed up to serve their communities. Their courage and dedication were beyond inspiring.
Knowing how much support we would need, I contacted a local agency, READ Nepal. They immediately agreed to help and provided a volunteer, Mr. Durgesh Yogi, who supported me in the response. Without that help, many things we achieved would not have been possible.
Sindhupalchok became a symbol of both devastation and resilience for me. Babies were still being born, wounds still needed stitching, and epidemics still loomed. Life had to continue, even while the ground beneath us kept trembling.
The destruction was everywhere. In Sindhupalchok alone, over 3,400 people had lost their lives. More than 65,000 homes were gone. Out of 116 health facilities, only a handful were still partially functional. Health services collapsed almost overnight, but the needs only grew.
We adapted however we could. Tents replaced hospitals. A damaged training centre and a cold chain room became my makeshift office. I used a battered printer box as my desk. We slept sometimes in crowded rooms or under tarpaulins, braving aftershocks and the early monsoon rains. I still remember witnessing the second major earthquake on May 12, which destroyed even the already damaged District Health Office where we worked.
“Amid broken walls and broken hearts, we found unbreakable hope — and the courage to innovate from nothing.”
Building Health Services From Scratch
As the Health and Nutrition Cluster Coordinator for Sindhupalchok, I coordinated with national and international partners to restore essential health services. It was not easy, but it had to be done.
We organized nine critical cluster meetings, rebuilt communications, and worked across different sectors—health, water and sanitation, shelter, protection, logistics, and early recovery.
We fought hard to make sure services continued, because when health services collapse, everything collapses.
Mobile Phones: A Lifeline in Chaos
One of the most significant breakthroughs came from our simplest tool — mobile phones.
With traditional communication and reporting systems down, we created an SMS-based Early Warning Alert and Response System (EWARS) across nine Village Development Committees (VDCs). Health workers could send simple coded messages reporting cases of diarrheal diseases, respiratory infections, and other potential outbreaks. We did it all in 24 hours.
I was an expert who helped establish the Early Warning and Response System (EWARS) for the Government of Indonesia. This very cost-effective system has proven effective in saving lives during crises.
This simple idea—sending health alerts through SMS—saved lives. It helped us catch problems early and send rapid response teams before outbreaks. It showed how even small innovations can make a big difference in a crisis. No outbreaks were reported.
Fighting Disease, Fatigue, and Despair
Every day brought new challenges. Warehouses were full of supplies, but no one had a distribution plan. We often sat on warehouse floors, organizing diarrheal kits to airlift to villages. Power outages threatened cold chain systems vital for vaccines. Generators became our lifelines. Health workers lived in tarpaulins, working around the clock without proper food, shelter, or rest. Fatigue and burnout were everywhere.
Seeing how overwhelmed everyone was, I called my friend Dr. Pramod Khanal to join the team. Without hesitation, he came, helping not just me but the entire health workforce in the district.
Despite everything, the health workers’ spirit never broke. They showed up tired, hungry, and grieving but determined.
Some memories still stay with me—nurses, whose homes had been flattened, delivering babies under plastic sheets, working with teams to demolish the unsafe District Health Office so we could install a Mobile Clinic Kit and watching health surveillance reports come in through battered mobile phones, bringing hope that we could still act, even in chaos.
Thinking Beyond Survival: Recovery and Dignity
Our goal was not just survival, but restoring dignity.
We revived birthing centres so no mother would face childbirth alone. We mobilised Female Community Health Volunteers (FCHVs) to offer psychosocial support. Realising their contribution, I published an article on their contribution in the Lancet. We helped restart immunisation programs and nutrition services. We prepositioned outbreak kits before the monsoon season, knowing another wave of disaster could come anytime.
We also worked closely with the District Health Office to identify destroyed health facilities and coordinate rebuilding efforts. Semi-permanent structures were quickly planned, so health services would continue even before full reconstruction could start.
Managing the Flood of Help
Another big challenge was managing the flood of national and international agencies.
Many agencies wanted to help, but they preferred working in easier-to-reach areas. Together with the district chiefs, we mapped out the needs across Sindhupalchok. When any agency arrived, we matched them to one of the hardest-hit, remotest areas. Some tried to resist, but we insisted: support must go where needed, not where it is convenient.
Ultimately, the principle held, and it made a real difference.
Lessons
The 2015 earthquake showed Nepal’s fragility in emergency preparedness and response. But it also revealed our strength—our people’s resilience, creativity to innovate under pressure, and the power of coordination.
Some of our learnings have been implemented. The digital and mobile-based early warning system is being strengthened, earthquake-resistant health infrastructures have been constructed, investment in the protection and empowerment of health workers has increased, supply chain management has improved, and coordination among health, water, sanitation, housing, and mental health sectors is strengthening. However, these areas still need further strengthening, and much more work must be done.
Nepal has made good progress, but we cannot afford complacency. Building a stronger, more resilient system requires political commitment, financial investment, and putting people first.
Nearly a decade has passed since those devastating days. But the faces, the struggles, and the spirit of Sindhupalchok stay with me.
Even during my short tenure, I received excellent support from the then-Chief of the District Health Office, Dr. Sagar Raj Bhandari, Public Health Chief Mangala Manandhar, and their team.
I express my gratitude to the Government of Nepal for providing the opportunity to offer technical support and coordination during that time of crisis. National and international organisations also deserve thanks. Special thanks go to Durgesh Yogi and Dr. Pramod Khanal.
Amid ruins, we proved that while the ground could shake our structures, it could not shake our humanity.
The ground may have shaken.
Our hearts did not.
Dr. Kandel is a medical epidemiologist and anthropologist based in Geneva, Switzerland.
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