Last week, a four year old severely malnourished boy from Doti was brought to a nutrition rehabilitation home in Dadeldhura, the neighbouring district for treatment. But since the upper flat of the rehabilitation home was converted into an isolation ward for Covid-19 patients some three months ago, the boy could not be admitted there.

"We were forced to shut down our services due to the risk of disease transmission," Puja Chand, programme manager of the rehabilitation home, told the Post over the phone.

The boy weighed just 10 kg, underweight for his age, when he was brought for rehabilitation. He had a problem moving his arms and legs due to weakness. 

Despite his poor health, he could not get the help he needed at the rehabilitation home. 

There are 22 nutrition rehabilitation homes operating across the country and several of them have been turned into Covid-19 units and doctors’ quarters in recent times. 

A few homes that are in operation lack patients, according to a nutrition officer at the Family Welfare Division under the Department of Health Services.

But the low number of patients in these rehabilitation homes can be attributed to the ongoing lockdown.

Over 2,000 children suffering from severe acute malnutrition used to come to health facilities for treatment every month. Since the lockdown began on March 24, only 227 malnourished children from 25 districts were brought to health facilities for treatment, according to the Department of Health Services.

In one of the rehabilitation homes in Kanchanpur, 10 malnourished children were forced to discontinue their treatment after the facility was converted into an isolation centre for Covid-19 patients.

"Of the 10 children, three were severely malnourished," Indra Kumari Bhatta, programme manager of the home, said over the phone. "We have been informed that the conditions of those children are deteriorating, but we are unable to bring them back for treatment."

Bhatta said even referral centres for malnourished children have been shut down.

On Sunday, officials from Lalitpur Metropolitan City directed a nutrition rehabilitation home in Sunakothi to vacate the facility so that it could be used as a quarantine centre.

Sunita Rimal, coordinator of malnutrition and treatment programme of Nepal Youth Foundation, said they don’t know how to agree to the city’s directive by depriving treatment to malnourished children.

"The city office has put us at a difficult spot. Hospitals are contacting us to send in their patients and the city office is telling us to vacate the buildings," Rimal told the Post.

Other nutrition rehabilitation homes in Dang, Birgunj, Janakpur, Nepalgunj, Butwal, Sindhupalchok and Baglung have also been forced to discontinue their services by the local governments to make rooms for Covid-19 patients and health workers.
Dr Atul Upahdyay, an expert in the field of nutrition, said by shutting down the nutrition rehabilitation homes, the government was putting the lives of tens of thousands of children at risk. 

"We will have more deaths from malnutrition than from Covid-19 if we continue to ignore the seriousness of the issue," he said.

Over one million children under five years of age in Nepal are stunted, over 800,000 are underweight and over 300,000 are affected by wasting, according to the National demographic Health Survey-2016.

"Child and infant mortality rate will increase, our efforts of years and investments to reduce child mortality rate will be wasted, if we keep ignoring the issue and focus only on Covid-19 cases,"Dr Shyam Raj Upreti, former director of Child Health Division, told the Post.   

Kedar Prasad Parajuli, chief of nutrition section at the Department of Health Services, they were trying to open some rehabilitation homes that have not been requisitioned by the authorities to treat Covid-19 patients.

"We have been trying to open some centres, patients have been unable to reach these centres due to the ongoing lockdown," Parajuli told the Post.

Malnutrition is brewing into a silent crisis for Nepal. According to the Nepal Demographic Health Survey of 2016, 36 percent of children under the age of five years were suffering from chronic malnutrition, while 10 percent suffered from acute malnutrition. Another 27 percent of the children were underweight and one percent overweight, the study found.