Babita Lama used to run a string of health posts in Nepal's most remote and harsh regions, providing free medical care to women and children.

After her clinics in Torpa was destroyed six months ago by Maoists, villagers tried to talk them into leaving health posts alone. But they destroyed the clinic in Albang too. "They told us they don't want any NGOs here, they want to destroy everything built by the government and have a republic," Babita Lama told us. "Now we have to take our sick to Muchu or Simikot."

It was Humla's remoteness that had saved the district from the worst effects of the insurgency, but that doesn't seem to be a protection any longer. Maoists are even travelling across the border into Tibet to buy winter clothes and food, and Chinese border guards at Taklalot now examine the elbows of Nepalis. If they are rough and scratched, they are taken for Maoists and refused entry.

"We used to be neglected by Kathmandu even in normal times, now it is much worse," says Jivan Shahi, the elected ex-chairman of the Humla DDC. "Development has come to a halt." Even Humla's highly effective food-for-work program has slowed. Some 35 km of a vital road from the Chinese border to Simikot is only half-finished because dynamite isn't allowed.

The Chinese have offered to build two bridges in Hilsa and Muchu. "If only our own government was as supportive, Humla would be transformed," Shahi told us. "But the most important thing is to restore peace, without that everything is futile."

Simikot airfield (seen in picture, above) will remain a lifeline for food until the road is completed. Subsidised rice is flown into Simikot from Surkhet and Nepalganj after the Maoists destroyed bridges over the Karnali. The Maoists have set up a checkpoint on the main southbound trail from Humla, and take a tax of Rs 3 from every traveller. Tourists bound for Mansarovar have to pay $100. Villagers need a "visa" to go south. Locals need papers from both the Maoists and the district administration to go anywhere.

Ironically, the food situation is not so bad because the conflict has driven away so many people. Southern Humla is depopulating fast, there are few young men left. Many of them had offered to enlist in the security forces. "The Maoists were going to come after us, so we offered to join the police or army," one young Humli in Nepalganj told us. "They didn't take us, so we decided to get out."

A 200-strong police force is stationed near the airport. The army unit has set up a base on Rani Ban, a strategic ridge above the main bazar. But at 10,500 ft, it is bitterly cold and windy here for the soldiers. "Forget about protecting the headquarters," one of them grumbled. "We are just trying not to freeze to death."

The security forces rarely go on patrol, but when they do, the villagers cower. On the road from Limi, one man huddled inside a dark tea shop whispers: "In the daytime, the soldiers come and beat us up, and at night the Maoists do the same."

Two teachers from Simikot were kidnapped and killed a few days before Dasain. Simikot resident, 29-year-old Juna Buda, was killed for not paying extortion money. Ex-MP Chakra Bahadur Shahi and VDC chairman Padam Lama had their houses looted. Jivan Shahi's home has been attacked twice.

Most schools are closed. The government school in Simikot is open, but the teachers there dare not make the children sing the national anthem. "We take classes, but our heart is not in it, we just live from one day to the next," says one teacher. "There has never been anything here worth destroying."

An autonomous Karnali Authority to oversee development and administration could bring hope. But Kathmandu has only paid lip-service to the idea. With a resigned air, Jivan Shahi tells us: "If the donors push it, it could still happen."