The Damage You Cannot See

Sonam(name changed) was 58 when the river took her son in Dhunche. He was the household's only earner and had just bought a vehicle on a loan. Now the loan was hers, and so were his 25-year-old widow and their two small children. 

She stopped eating, then sleeping. The headaches came, then the nausea, then an exhaustion that would not lift. Her home far from any health post, she never thought of seeing a doctor. Neighbours finally took her to hospital, where, trembling, she was sent to the UNFPA-managed One-stop Crisis Management Centre.

There, case manager Sajana Rai took her into a quiet room, handed her a glass of water and held her hands. Then it came out her resons: the flood, and the husband who had abused her and left. "I was already abused like this at home," Sonam said, her voice breaking, "and now my son is gone."

Hers is one of over 84,000 lives the flood upended on 26 August. The National Disaster Risk Reduction and Management Authority counts over 1,400 dead and 5,000 still missing, leaving families suspended between grief and hope. In Nuwakot, parents still wake at night and run uphill, sure another surge is coming. The river went back between its banks weeks ago. The fear did not.

"At Trishuli Hospital, Dr Shitanshu Dhakal noticed something invisible: "the mental trauma experienced by all those directly or indirectly affected by the floods.” 

In Betrawati, UN Resident Coordinator Lila Pieters Yahia heard Sonam's story in other voices. "Almost every family I met had lost the person who was the financial and emotional anchor of their home, leaving them to navigate profound personal loss while facing unsustainable debt. True recovery must look beyond economic relief to address the severe mental health toll of carrying both unresolved grief and future financial uncertainty," said the UN Resident Coordinator, Lila Pieters Yahia. 

Displacement, crowded shelters and lost income raise the risk of gender-based violence, trafficking, child labour and child marriage, while older people and persons with disabilities lose medicines, assistive devices and carers.

Children carry grief differently, often without words. In a UNICEF-supported tent at a Nuwakot hospital, they slowly find ways, with counsellors, to name what happened. An estimated 17,000 children need this support, and 541 have been separated from their families. 

The Health Cluster, led by the Ministry of Health and Food Safety with WHO, and UNICEF and UNFPA, is trying to close that gap. UNICEF and partners offer psychological first aid, counselling and confidential care for survivors of violence. WHO has trained 120 school health nurses to notice a struggling child, and IOM 24 field staff to prevent sexual exploitation and abuse. So far, nearly 2,900 people have received specialist mental health care and over 1,900 community-based psychosocial support. The Flash Appeal puts health care for all 84,270 people at US$7.6 million until 31 December. That is about seven cents of every appeal dollar.

Sonam went home with medicines, the 1145 helpline and her case manager's number, and follow-up calls have helped her sleep again. But she is back in a remote village with a loan she did not take, a household that depends on her, and a grief that will not keep to the timeline of an emergency appeal.

"Trauma is sudden," Rai says, "but recovery is progress." 

Above the Trishuli, Roads and bridges can be rebuilt on a schedule. Healing what the flood did inside people depends on someone still being there to pick up the phone.

**Name changed to protect her privacy.