Dikari Aire lies flat on her stomach and raises her head as two visitors arrived to see her last week in the middle of a winter storm.

"You have taken the trouble to come to see me, I am so grateful," Dikari smiled weakly, bobbing on her water bed. One year after getting married, at age 18 she fell from a tree and broke her back. She has been a paraplegic for the last 22 years, looked after by the TEAM hospital in Dadeldhura.

In December, the hospital was shut down after the Health Ministry was pressured by Maoists who accused doctors of being "agents of American imperialism".

Thousands of patients like Dikari Aire from neighbouring Doti, Bajhang, Achham and Baitadi now have nowhere to go. Those with money take relatives to India for treatment. At least eight patients have died because they couldn't get emergency care after the hospital closed down.

"This is the most direct proof I have seen that politics kills people," says Deb Raj Joshi, a Dadeldhura trader, himself a patient.

The TEAM hospital was set up in 1960 at a time when it took 10 days to walk here from Dhangadi. It was the only hospital in the mountains of far-western Nepal and specialised in leprosy, TB and deliveries.

The maternal and child mortality rates in the far-west have improved, but there are still gaps. For instance, four percent of women here suffer from prolapsed uterus.

At the time it closed down, TEAM was treating up to 500 patients a day, and doing nearly 800 deliveries a year. Plans were underway for a Rs 30 million expansion.

The hospital's out-patient courtyard which used to be filled with patients and relatives was silent and empty last week. The wards and surgery theatre were padlocked. The rainwater system was still working, feeding water to overflowing tanks. A VSAT dish recently installed for telemedicine was not in use.

TEAM Dadeldhura was part of a string of missionary hospitals in Nepal which in 2002 were given five years to hand over to local management. The Nepali organization, Human Development and Community Service (HDCS) which runs hospitals in Lamjung and Rukum was all set to take over Dadeldhura. But in December the agreement was terminated and the government said it would run the hospital itself.

Most people here are convinced the Maoists arm-twisted the Jana Morcha-run ministry not to allow HDCS to run the hospital. Health ministry officials and members of a parliamentary committee who came to investigate last month were locked up by angry locals. An agreement was nearly reached, but local Maoist commander, Comrade Pukar, sent a fax to Kathmandu saying the hospital would not be opened.

He accused the hospital of being run by \'imperialists\' and argued that health services were the central government's prerogative and shoudln\'t be managed by NGOs.

"Is it because we are from the far west that Dadeldhura was punished?" asked TEAM medical assistant Madan Bhatt, who has no work. "Politicians in Kathmandu are fighting at the expense of the people."

In Kathmandu, Govinda Jha of the Health Services Department told Nepali Times: "TEAM didn\'t agree to work by the government\'s rules, it was their decision to close down. Besides, there is a district hospital that can take care of patients."

The Health Ministry did transfer three doctors from Bajhang and Bharatpur to Dadeldhura's district hospital in January. But last week there was only one doctor left, and there is so little trust in the government that there were few patients.
Dadeldhura\'s District Health Office even refused permission for Rs 2 million worth of TEAM medicines to be given to the sick. TB patients who need DOTS antibiotics and heart patients who need regular checkups aren\'t getting treatment.

Rama Aire is another paraplegic patient who has been cared for by the hospital for the past 20 years. She was abandoned by her family after her injury, and there is no one to take care of her with the hospital closed. Rama and Dikari used to earn money making bandages and knitwear for the hospital, now even that income is gone.

Says Rama: "My family and the government both abandoned me. The hospital used to take care of us, now it
has closed down. We are now in god's hands."