The Karnali’s hunger emergency

Raju Rawal gave birth to twin boys 18 months ago, but one of the babies died soon after being born. The reason was that the 23-year-old mother was doing household chores throughout her pregnancy and did not have adequate nutrition.

The other son survived, but was seriously underweight and the hospital kept him under observation. Mother and baby were finally discharged with a few months’ supply of ready-to-use therapeutic food for the baby and fortified flour for herself.

The baby now weighs 9kg, but the last packet of the fortified flour is finished and Rawal herself is undernourished.

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“We had just enough rice to last until this morning, and we will have to depend on our neighbours,” Raju’s husband Karna Bahadur says in a resigned voice. The Rawals are subsistence farmers who grow just enough food to last four months, and do not have regular income.

This is the tragic reality behind the stereotype of the remote Karnali being a chronically food-deficit region of Nepal. Despite a reduction in Nepal’s national poverty rate and improvements in the national nutrition level, in these remote mountains hunger still stalks the land.

Sangita Damai is a 20-year-old mother who waited in line at the local health post in Tila Rural Municipality with 50 other women to receive their monthly packet of state supplied fortified flour 

“The harvest is all gone, so our children depend on this flour,” says Damai, whose six-month-old daughter was born malnourished. Her husband is in India for half the year to support their family of eight.

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Dilmaya Sarki is also in the queue, having made the half-day trek to the health post along with other mothers holding stunted and wasted babies. “There is no food at home,” says the 25-year-old listlessly.

The fortified flour is being provided by World Food Programme (WFP) since 1996, and the government distributes 3kg of fortified wheat flour per household each month for mothers and children between the ages of 6-23 months in Mugu, Jumla, Kalikot, Humla, and Dolpo districts of Karnali province.

The WFP says the program benefits 29,000 pregnant women, breastfeeding mothers and infants in the region every year. And the government procured 575 metric tons of fortified flour for this year.

“Fortified flour has helped a lot of households who lack adequate food, but it is just enough to feed the children,” explains Balika Rokaya at the health post in Jumla’s Hima Rural Municipality.

Female Community Health Volunteer Pulti Khatri agrees that without the nutritive flour has helped a lot of impoverished families. “Mothers come with their children to the health post to get flour, and get health check-ups at the same time,” she says.

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Karnali is the most food deficit part of Nepal because of historical neglect of this remote region by successive governments in Kathmandu. Lately, it has been made worse because of droughts induced by the climate crisis.

The province required 338,935 metric tons of food grains against availability of 319,818 metric tons. The shortfall had to be sent to the region by the state. 

The Nepal Demographic and Health Survey 2016 showed stunting in children under five in Karnali Province was 36%, higher than the national average of 25%. 

“These are just statistics, but you have to look at how hungry the children are to get the real picture,” says Man Bahadur Kunwar, provincial coordinator of the multi-sector nutrition plan till this year. “Our priority has been to provide enough food, we have not yet paid attention to what kind of food.” 

More than other parts of Nepal, Karnali families suffer from multidimensional poverty, which is measured in terms of access to healthcare, education, drinking water, cooking fuel, nutrition, and sanitation. 

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But just distributing fortified flour year after year may not be enough to fight hunger in the Karnali. The province needs a plan to increase local food production. 

“There has been food scarcity here for decades, but no sustainable solutions,” says Mangal Rawal of the Karnali Academy of Health Sciences.  “More than distributing food or money, people must have access to improved education, healthcare and sanitation, and be informed, self-reliant and independent earners.”

Yet, the Karnali Province has no choice but to provide emergency food aid to families. It sets aside Rs10 million annually for the fortified flour distribution program. 

“The situation in Karnali cannot be turned around by distributing fortified flour forever,” says public health worker Madhusudan Kafle. “The problem is chronic malnutrition caused by poverty.” 

Yogandra Bahadur Shahi, vice-chair of the Karnali Province Planning Commission, insists that women and children need fortified flour and financial support for the time being. 

He adds, “But in the longer term, we have to improve connectivity, tourism, industry, hydropower, as well as apple and herb and farming and marketing to raise incomes.”  

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