Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study
Samita Giri, Kari Risnes, Oddvar Uleberg, Tormod Rogne, Sanu Krishna Shrestha, Øystein Petter Nygaard, Rajendra Koju, Erik Solligård
PLOS ONE · 2018 · DOI: 10.1371/journal.pone.0192076
Countries: Nepal
What Was Studied
This prospective observational study describes the burden and distribution of emergency cases presenting to Dhulikhel Hospital (DH), a 375-bed non-government university hospital in Kavrepalanchok district, Nepal, over 21 days following the 25 April 2015 (M7.8) Gorkha earthquake — a period that also captured the 12 May 2015 (M7.3) aftershock. All 2,003 emergency patients registered between 25 April and 16 May 2015 were classified as earthquake-related injuries (EQIs), non-earthquake (NEQ) health problems, or pregnancy complications, using the hospital's systematic emergency registry and triage system (introduced through the pre-existing DHPCARE project with Norwegian partners). Of 1,791 analysable EQI/NEQ patients, 653 had recorded phone numbers, and a random sample of 346 of these was followed up by structured telephone interview 90 days after admission to assess socio-demographic status, disaster impact, and clinical outcome.
What They Found
Of 2,003 emergency patients registered over 21 days, 1,395 (70%) presented with earthquake-related injuries (EQIs) and 396 (20%) with non-earthquake health problems; total patient load in the first five days averaged 150 patients/day, almost five times the pre-incident daily baseline of 35. The hospital performed 345 surgical procedures (338, or 98%, orthopaedic) and treated 111 patients with severe injuries (compartment syndrome, n=18; crush injury, n=36; internal injury, n=57); among 815 EQIs with documented diagnoses (1,083 injuries in total), 624 (58%) of the injuries were fractures, and 348 (56%) of those fractures were in the lower extremities. In-hospital mortality was low — 1% among EQIs and 2% among NEQ patients — but the 90-day mortality recorded in follow-up telephone interviews was two and five times higher than the in-hospital rate for EQIs and NEQ patients respectively, and 91% of the 346 interviewed patients reported severe disruption to their lives (house destroyed, displacement to a temporary shelter, or loss of a family member).
What This Means for Nepal
Nepal's 2015 earthquakes killed roughly 8,800 people, injured about 22,000, and destroyed or damaged more than 1,200 health facilities (446 destroyed, 765 damaged) — with only about 58% rebuilt five years later — so the five-fold surge in daily caseload that this one non-government hospital absorbed illustrates exactly the shock Nepal's health system must be ready to withstand, given the country's continuing high seismic risk. DH's own systematic triage and registry system, built through its pre-existing DHPCARE partnership rather than improvised mid-crisis, was credited with enabling orderly patient flow: the Ministry of Health (MoHP/DoHS) and the Nepal Health Sector Strategic Plan (NHSSP) 2023-2030 should require all provincial and district referral hospitals to maintain a standing mass-casualty triage protocol and surge staffing plan rather than build one only after disaster strikes. Because the worst-hit district in this study (Sindhupalchok) was still at least a two-hour drive from the hospital and many severely injured people likely never reached care, local governments — which constitutionally own "basic health and sanitation" under Schedule 8 — should also be resourced for community-level emergency transport and first response in remote hill and mountain districts.
Contextualisation
The 2015 Gorkha earthquake sequence killed roughly 8,800 people, injured about 22,000, and destroyed or damaged more than 1,200 health facilities (446 destroyed, 765 damaged) — exposing how a single earthquake can simultaneously generate a casualty surge and cripple the facilities meant to treat it. Only about 58% of damaged health facilities had been rebuilt five years on, and Nepal remains one of the world's most seismically exposed countries, so the surge-capacity gaps this study documents are a live, unresolved concern rather than a historical one. As a single non-government hospital study, its specific caseload figures may not generalise to public referral hospitals with different capacity or catchment, but the core lesson — that a pre-existing triage system, not an improvised one, determined how well the surge was managed — is broadly transferable across Nepal's disaster-prone districts.