By Utshab Nepal
A decade ago, the Government of Nepal declared 14 crisis-hit districts as the most severely affected areas following the devastating 2015 earthquake. Among them, Nuwakot and Dhading suffered heavy damage to homes and infrastructure, while Rasuwa faced severe landslides that nearly destroyed remote areas such as the Langtang Valley.
Displaced families from Gogane were resettled in Khalte Bagar, rebuilding their lives on ground they hoped was safer. However, on August 26 this year, the Bhotekoshi flood reached Khalte. Local representatives report that the flood wiped away everything these families had rebuilt after already surviving the hardships of the COVID-19 pandemic.
This is the true toll of back-to-back disasters. Beyond destroying homes and bridges, they drain people’s hope that life will ever improve. Compounded by ongoing political instability, the constant cycle of catastrophe leaves survivors deeply traumatized and struggling to manage daily life. With World Mental Health Day approaching on October 10, we must take the mental health of disaster survivors seriously and urgently provide personal counselling services to support their recovery.
Unfinished Struggle with Trauma
The 2015 earthquakes claimed nearly 8,900 lives, affected 8.5 million people, and destroyed nearly 450,000 houses. But the unseen trauma ran just as deep. A survey four months after the quakes showed that more than a third of adults in Kathmandu, Gorkha, and Sindhupalchok suffered from depression (34.3%) and anxiety (33.8%). One in five turned to dangerous drinking, and one in ten had suicidal thoughts.
Years later, the psychological wounds remained open. A study three years later found that nearly 19% of adult survivors were still living with post-traumatic stress disorder (PTSD). Research by TPO Nepal also highlighted that children, women, and the elderly were at the highest risk in districts such as Rasuwa and Nuwakot, the very same areas now devastated by recent, unthinkable flooding.
COVID-19
The nationwide lockdown that began on March 24, 2020, brought fear of infection, lost income, and isolation. A study of 24,350 suicide deaths recorded by Nepal Police between 2017 and 2021 found a sharp rise in monthly suicide rates during the pandemic. The largest increases were recorded in Sudurpaschim and Karnali, two of the country’s poorest provinces. At one teaching hospital in Kathmandu, suicide and self-harm cases in the emergency department rose by 44% and 72%, respectively, compared with earlier periods, even as total emergency visits fell.
The Bhotekoshi Flood
On August 26, 2026 (Bhadra 10, 2083), a massive surge of water, ice, and debris swept down the Bhotekoshi and Trishuli rivers. Scientists at ICIMOD and the Department of Hydrology and Meteorology point to a glacier-related trigger, likely an ice-rock avalanche, although the precise chain of events is still being studied.
Some experts describe it as the worst localized disaster in Nepal since the 2015 earthquake. By early September, official tallies had passed 1,369 confirmed deaths, with more than 5,132 people listed as missing before search operations were scaled down. Thousands of survivors were forced into temporary holding centres. Local education offices estimate that almost 622 students in Rasuwa and Nuwakot alone remain unaccounted for.
What Trauma Does to a Society
In the family, grief arrives with no clear ending. Some people have lost parents, others children, and many have lost entire extended families. Hundreds of bodies were recovered only partially, leaving families waiting for DNA identification, while thousands of others have received no news at all. Psychologists call this ambiguous loss, a state that makes mourning exceptionally difficult. Many of the missing were primary wage earners, including 933 hydropower project workers, as well as drivers and daily-wage workers, meaning acute grief and financial ruin arrive together.
In the village, the loss is a sense of belonging. A psychologist working in Nuwakot noted that when an entire village is altered, residents remain anchored to old memories, uncertain whether their community, culture, and norms will ever return. Rasuwa alone has experienced five significant flash floods between 2022 and 2026, including the major July 2025 flood at Rasuwagadhi. For residents, trauma is no longer a single past event; it is a state of constant anticipation, renewed with every monsoon.
In society, these shocks land on an already overburdened system. The 2020 National Mental Health Survey found that about 10% of adults had experienced a mental health disorder in their lifetime, while recent statistics report more than 7,055 suicide deaths annually, according to Nepal Police records. Deep-seated stigma keeps many from seeking help, and the vast majority of those who need care never receive it.
What It Is Not Yet
There is a real effort to acknowledge the crisis. Following the flood, the Ministry of Health and Population deployed mental health personnel to holding centres in Nuwakot. A specialised 22-member team featuring psychiatrists and counsellors reached around 740 survivors in early September. Armed Police Force medical units provided mobile health services, the Nepal Red Cross delivered Psychological First Aid, and the national suicide prevention helpline remains operational and toll-free.
The policy landscape has also shifted. The National Mental Health Strategy and Action Plan promised free basic mental health care at the primary level. The Ministry launched a National Mental Health Campaign in December 2025 alongside UNICEF and WHO to combat stigma.
However, the gap between policy and practice remains severe. Mental health receives less than 1% of the national health budget, which itself accounted for only 4.77% of the total 2025–26 budget. Nepal has roughly 0.13 psychiatrists and 0.02 psychologists per 100,000 people, mostly concentrated in urban centres. Only about one in four health facilities offer basic mental health services, and in districts such as Rasuwa and Nuwakot, many local health posts were swept away by recent floods.
Early counselling at holding centres provides vital temporary relief, but data from 2015 proves that psychological distress lasts for years. Civil society and the government must plan for years, not weeks.
Listening, Then Paying
After major catastrophes, the most common wound is invisible: grief. Survivors in Rasuwa and Nuwakot need safe housing, sustainable income, transparent information, and qualified professionals to listen to them over months and years.
Listening to real voices must translate into structural change: dedicated budget lines, a trained counsellor in every municipality, and local health posts equipped to treat the mind as well as the body. World Mental Health Day on October 10 is an opportunity to ask when that systemic change will arrive—and an even better day to begin delivering it.
Godawari, Lalitpur.
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