Almost a year after a devastating earthquake, Nepal and its people are struggling to make ends meet. Food and fuel shortages are exacerbating an already critical situation, as Sophie Cousins reports from Kathmandu.
On a crisp, foggy early morning on the outskirts of Kathmandu in Sunakothi village, 14 malnourished children crowd around the visiting doctor for their weekly check-up.
Normally there are more children at the 24-bed Nutritional Rehabilitation Home run by the Nepal Youth Foundation (NYF) but the NGO can no longer accept severely malnourished children because of the ongoing fuel crisis that has crippled the country.
"We have to send the severely malnourished children to the hospital, we can only take moderate cases," says Sunita Rimal, health and nutrition program coordinator at NYF. "We don't know what will happen to them if they stay here because of the cold."
Still recovering from the earthquake last year that killed 9,000 people, Nepal was thrown into further chaos after it adopted a new constitution five months ago which resulted in an unofficial blockade at the Indian border.
Protestors from Nepal's Madhesi ethnic group claim the constitution excludes them from representation in government. The protests have closed major road-crossings along the border preventing trucks from India carrying fuel and other essential commodities such as medicine and cooking gas from entering the landlocked country.
Running on empty
As a result, the country has been running on empty for months, with some hospitals running out of life-saving medicine, schools closing, food prices rising drastically and very little transportation available.
Tulesi Laxmi, a shop-owner, burns wood in the street in order to stay warm. He says fuel has become too expensive for heating since the blockade.
To cope with the lack of fuel and freezing winter temperatures, Rimal says the rehabilitation home has to "put the children in one room so they can warm up."
"It's really cold here and we have no electricity and no gas," she told DW. "It's so hard for the children, most have coughs and colds."
The home focuses on rehabilitating the children, who come from all around the country, by providing locally-sourced nutritious meals eight times a day. But because of the lack of fuel, staff have to cook food on firewood.
"It takes time to cook over firewood which means the food loses nutrients. They also can't cook the meals as frequently as we used to," Rimal said.
Mansa Bhattarai, who also works at NYF, says the fuel crisis means that it has become not only difficult for the organisation to run its rehabilitation home in Kathmandu but also in 15 other centers across the country.
"We just can't keep all the children. In villages, deaths are happening. Most people are living below the poverty line and they are unemployed, how can they make their lives better?"
Bhattarai is referring to the sharp increase in food prices. According to the World Food Program (WFP), the blockade has caused cooking gas to increase in price by as much as 630 percent, while the cost of rice has doubled and essential commodities such as lentils and flour have risen sharply.
Last month, WFP said the fuel shortage had caused "severe delays" in its ability to get tonnes of food to more than 220,000 people.
"Food prices have increased significantly and because of a lack of fuel, food is not reaching markets," the organization's Seetashma Thapa told DW. "Consequently, mothers and children are consuming less food than they're supposed to."
In addition, UNICEF warned last month that more than three million children under the age of five are at risk of death or disease during the winter months due to the severe shortage of fuel, food, medicines and vaccines.
According to locals, some hospitals and pharmacies have run out of life-saving medicine, or are running critically low.
Amil Raghramdani, a pharmacist from Kathmandu, says he's been short on life-saving medicine for months.
"We have a scarcity of medicine. It's a struggle," Shreekrishna Shrestha, medical superintendent at Western Regional Hospital in the lake city of Pokhara, told DW.
"We haven't got life-saving medicines such as adrenaline. We also don't have instruments for surgeries. But we have a lower patient flow because people can't make it to the hospital - the rural population simply cannot get here."
Struggling to cope
Back at the picturesque rehabilitation home, doctors are looking at multiple chest x-rays of the children. They say that with the brutal weather and no heating, pneumonia is a major concern.
Wearing a bright pink and blue jumper, 8-year-old Sinju, from Sindhupalchowk, one of the worst-affected districts as a result of the April 25 earthquake, is waiting for her check-up.
Despite wearing layers of thick clothes, Sinju's malnutrition is obvious; she is extremely stunted for her age and her hands resemble the size of a baby's.
Her mother is waiting for the women's afternoon education session to learn about nutritious foods.
But, as Rimal stresses, many of the mothers who come to the home with their children simply can't afford to buy nutritious food because of the fuel crisis.
"We're trying to help them as best as possible but the rise in food prices is definitely affecting the population," she says.
"Black gram used to be 180rs (1.50 euros) per kilo, now it's 280rs. Rice, lentils and flour are all very expensive. Those who are poor simply cannot afford good food."