At 3 pm on Thursday, last week, Chhani Gurung, a local from Dharche Rural Municipality-2, was hit by a rolling stone when it fell off a cliff.

She sustained a serious head injury. Gurung, 21, was hired as a labourer to break rocks into pebbles. The pebbles are supplied to a project under which Tsum Nubri Rural Municipality-5 is building a walking trail.

“It took more than two hours to bring her to the nearby health post,” Chhiring Khando Lama, an auxiliary nurse midwife serving at Bihi health post, told the Post. “The health post referred her to a hospital after assessing her condition, which was critical.”

The far-flung Tsum Nubri village in Gorkha, near the Nepal-China border, is still not connected by motorable roads.

The district is famous for the popular Manaslu trek, the nearest trek from Kathmandu, and has been a major draw for trekkers and mountaineers.

But daily life in the far north is a challenge.

People have to make an arduous journey, sometimes for up to three days, to reach a motorable road, from where they can hire a jeep.

For Gurung, it was not possible, financially. She had to be rescued by a chopper.

Locals in many remote areas have no alternative but to charter a helicopter to take patients to hospital as many villages are not connected by roads and the medical treatment is not available locally.

Upper Mustang, Upper Dolpo, Manaslu, Lower Dolpo, Upper Gorkha, Rasuwa, Manang, Humla, Mugu, Makalu, Kanchenjunga and Gunsha in Taplejung and a few areas in Dolakha are among the restricted areas in Nepal that even helicopters cannot enter without a special permit.

The process of obtaining a permit is so long that patients requiring immediate care risk dying.

According to a representative of a helicopter company the Post spoke to, in order to get a permit, they have to make the rounds of the Home Ministry, Tourism Ministry and the Civil Aviation Authority of Nepal. There are many cases of sick or injured people dying by the time the permit is granted, the representative said.

According to helicopter operators, normally, six procedures are involved to get a medical evacuation flight permit.

First, the family which is chartering the flight has to submit a request to the chief district officer of the concerned district, in writing. The family has to provide a copy of the application to the helicopter company.

Second, the helicopter company has to write separately to the chief district officer.

Third, after the application is verified, the chief district officer writes to the Home Ministry, recommending that a permit be issued.

Fourth, the Home Ministry issues a permit based on the identity of the sick or injured person.

Fifth, the Home Ministry writes to the Tourism Ministry stating that security issues have been cleared and the helicopter may be granted a permit.

Finally, the Tourism Ministry writes to the Civil Aviation Authority of Nepal to grant a permit.

Gurung is one of the few lucky survivors.

“We managed to get the permission to fly a helicopter, but it was already dark,” said Rajendra Bajgain, the newly-elected lawmaker from Gorkha constituency-1. “We could not rescue the patient on the same day as we don’t have night vision choppers.”

Gurung, the mother of a four-year-old child, could be airlifted only at 2 pm the next day.

“She was still vomiting due to the head injury. But she survived,” said Bajgain, who funded the rescue effort.

“Doctors at HAMS hospital have said that her condition is now stable,” said Asha Gurung, a nurse, who accompanied the patient from Tsum Nubri Rural Municipality to Kathmandu.

Gurung is among the few who got rescued and was airlifted to Kathmandu within 24 hours of the accident. “[Often], the victims bleed to death en route to the Capital while papers are being prepared for a medevac permit,” said Bajgain.

Many people, and pregnant women in particular, die due to the lengthy procedures to fly out from restricted areas.

“Most people from our area cannot afford to pay for a chopper to go to hospital,” said Neema Lama, chairman of the rural municipality. “Seriously ailing patients, women in labour and elderly die without seeing healthcare facilities due to the absence of road access.”

The President’s Women Uplift Programme of the federal government offers helicopter rescue services free of cost and has saved many lives of pregnant women, but it has not been effective in most remote areas, where the access has been restricted for decades.

People in remote areas have long raised concerns over bureaucratic processes that need to be completed to charter a flight. There are frequent emergencies in remote areas.

“In the remote, hilly and mountainous regions, delay in issuing a permit also means waiting for bad weather,” said one helicopter company. “If the permit is issued in a timely manner, the helicopter can plan effectively—look for the good weather window—and mount the rescue flight. But a delayed permit puts the helicopter too at risk.”

Most villages in Taplejung, Sankhuwasabha, Solukhumbu, Dolakha, Rasuwa, Gorkha, Mustang, Manang, Dolpa, Mugu and Humla districts that adjoin the Chinese border were declared out of bounds for foreign visitors in the 1970s.

Back then, the government imposed restrictions on the movement of foreigners in a number of northern villages bordering Tibet as Khampa rebels were found to be using the Nepali territory to mount raids into China. In 1974, the Nepal Army succeeded in completely disarming the Khampa rebels, but the travel restrictions remained.

Since then, helicopters need to take special permits to enter the restricted areas.

Tsum Nubri village is far-flung and isolated from the rest of the country every six months during monsoon landslides.

“There were no major landslide problems until the 2015 earthquake,” said Laxmi Gurung, deputy chairman of the Tsum Nubri Rural Municipality. “Now there are frequent landslides. During the monsoon, the locals are trapped—they can neither enter the village nor go on outings. We don’t know the exact cause of frequent landslides here.”

Due to the obstructions in the walking trails during monsoon, foodstuffs cannot be transported.

The goods transported by mules or flown by choppers are expensive. Most of the time, locals suffer from food shortages. The locals said that they have to pay Rs40 for a kilo of salt.

Newly-elected Prime Minister Pushpa Kamal Dahal, who represents the Gorkha-2 constituency, had visited the area during his campaign and committed to addressing the woes of the residents.

Locals in Tsum Nubri said that a lot of lives could be saved only if the authorities lifted flight restrictions.

“China itself has built roads and railways in Tibet, the other side of the border, and welcomes hundreds of tourists every year. But we are yet to lift the restrictions, which makes people’s lives difficult,” said Lama, the chairman of Tsum Nubri Rural Municipality. “You have not seen the living conditions here. The people are deprived of even the basics. That's how the state discriminates against us.”