To understand how badly the conflict is affecting the health of Nepalis, a visit to this rudimentary 15-bed hospital, the only government-run facility in the remote district of Rukum in mid-western Nepal, is enough.

Inadequately-funded, understaffed and caught between the guerrillas and the soldiers, hospital staff struggle to do the best they can to cope with help from an international charity group. Some patients are direct victims of conflict, wounded by explosives or bullets, but thousands of others are indirectly affected by under-nourishment, a lack of vaccines and unsafe drinking water. Then there are the thousands who are still beyond the reach of basic health care.

Even before the conflict flared up here eight years ago, this rugged and roadless district, with a peacetime population of 250,000, was among those with the worst health and education statistics in the kingdom. Massive numbers of young men and women have left, and life for the very young and very old who remained behind in the remote outlying hamlets is much worse than before.

The conflict here has forced hospital staff to adhere to medical ethics, and they never disclose the identity of a patient. So far, they have been left alone by both warring sides. Yet the facilities are woefully inadequate. Right now, there is a diarrhoea epidemic, frequent measles outbreaks kill children and skin diseases and other infections are rampant. There has been a marked rise in sexually transmitted diseases-of the 57 blood samples collected recently, 16 tested positive for STDs, two had hepatitis B and two were HIV positive.

Currently, the hospital is the node for polio, measles and other vaccination campaigns in the district. "We don't face any interference from the Maoists, they leave us alone," says Bhabani Sharma, an ayurvedic doctor who heads the Rukum Hospital. The Maoists only seem worried about the army's own occasional field health camps.
However, the rebels take away up to half the medical supplies, especially first aid material, sent to outlying health posts. Health workers don't use the word 'loot' because they say the Maoists also organise health camps just like the army does and some of the supplies are used to treat the population. And since only the Maoists can go into the interior of the district, they are actually taking health care to the villages.

There are still some health workers left in the surrounding VDCs, and they have what they call "a special adjustment" with the Maoists. "They don't come to our health post, but they are always watching us, we can't really do much without their approval," says a health worker from Taksera village. The Maoists seem to be better equipped than the health posts, and take care of their wounded and sick. For major war wounds, they carry patients to Chaurjhari, or even across the mountains to India.

Most health posts don't have personnel, and some health workers in others have gone over to the rebels. Impressed by what they saw as the dedication of the Maoists, two auxiliary health workers, Krishna Regmi of Rukumkot and Lokendra Dangi of Arma sub-health post joined the Maoist last year. Regmi was a permanent government civil servant.

"Maoist medics are better equipped and they have good doctors," says Shiba Narayan Rajak, a senior health worker in Rukum. The hospital at Rukum is getting vital help from the France-based charity, M?decins Sans Fronti?res (MSF), which looks after the tuberculosis and pathology units and provides extensive care for the people of Musikot. MSF also provides food and some medial supplies to patients. However, the organisation hasn't been allowed to operate freely in the surrounding villages.

The hospital was set up 16 years ago and has a lab and x-ray unit which treats some 75 patients every day. The 15 beds are always packed, and there is always a waiting list as each patient stays an average of one week.