Nilam Sah, 22, clutches her baby daughter, Akhil, as she serves customers at her wooden snack stand. It sits just outside her temporary home of timber and corrugated iron, which seems to tumble down the hillside.
“With twelve people crammed inside, it’s easy for illnesses to spread,” says Nilam.
She’s not too worried about the little girl right now, because at least Akhil has been immunised against the most common preventable diseases such as Measles, Polio, Diptheria and Hepatitis B - although she still has a few follow up shots to come.
The vaccinations are part of a government drive, supported by the Nepal Red Cross Society, to protect all infants under two, especially in the 14 districts worst-affected by last year’s earthquake.
The 7.8 magnitude quake and its aftershocks killed nearly 9,000 people and destroyed or damaged hundreds of thousands of homes - including Nilam’s, although she’s shortly to move to a better rented home.
Marching behind the Red Cross flag
Today in Ramechhap, dozens of Female Community Health volunteers, marching behind a Red Cross flag, move through the dusty streets on their way to a celebration, marking the achievement of total immunisation of the town’s under two population.
“In the post-earthquake landscape, immunisation has taken on an increased importance because of the new migration patterns after the disaster and because of the damage to our health infrastructure,” says Dr Mausam Bohara, head of the Nepal Red Cross Society’s health department.
The earthquake disrupted immunisation services for three to four months and there were some cases of measles reported.
According to Dr Bohara the contact which the Red Cross volunteers have with hundreds of thousands of families in towns and the countryside throughout Nepal is particularly important, serving as an entry point for Red Cross community based health programming.
“We will increasingly move from providing mainly psychosocial support to more of a community health model with local health officers and health posts,” says Dr Bohara.
Signal of recovery progress
The fact that several other districts have also claimed total immunisation coverage sends a signal that we are clearly moving from the post-disaster relief phase, towards the recovery phase, where the focus is on rebuilding homes and social and economic infrastructure,” says Michael Higginson, programme coordinator in Nepal for the International Federation of Red Cross and Red Crescent Societies (IFRC).
Following a green light from the newly-installed government, the IFRC is to disburse a first tranche of 50,000 Nepali Rupees (449 CHF, 412 EUR, 465 USD) in cash grants to some 7,500 of the most vulnerable families in Nepal’s worst-affected districts, enabling them to complete the foundations of their new homes.
This will go hand in hand with programmes to improve water and sanitation systems and help to enable people to find new ways of earning a living and maintaining and improving communities’ health.
Nowhere are these more crucial than in areas like the village of Hattachaur, which sits below Ramechhap town on the floor of the river valley and is home to some of the poorest families, who traditionally make their living from seasonal fishing and farming rice paddy and maize.
The sandy soil here has meant that many more houses were reduced to ruins by the earthquake, leaving many local people squatting for months in the shelter of a covered market, before they could construct temporary homes out of wood, metal or bamboo.
Eagerly awaiting rebuilding
Sisters Pabitra Majhi and Inju Majhi, who both have small babies, now fully immunised, are eagerly waiting for progress on rebuilding their homes. But local villagers have their worries.
Farmer Lal Bahadur Manjhi, 60, is concerned about the cost of demolishing his damaged house before he can rebuild and tractor driver Damber Khadka says he worries it will be difficult to find masons to work on his house in a village about 90 minutes drive from Ramechhap.
Water is another major concern, with local villagers forming a cooperative to pump it from the nearest well in order to irrigate their crops. “There is hardly enough to drink, so how can there be enough for irrigation,” says Khadka.
Local people’s estimate it will take two to five years for life I the town to return to normal but despite the hardships and frustrations there is also a mood of optimism.
“Even when we Nepalis are suffering, we laugh,” as one middle-aged woman in the village sums it up. Humour may be an unquantifiable input, compared with cement or drinking water, but most psychologists would agree it can only have a positive impact on people’s post disaster recovery.