District Assessment Nepal Earthquake SINDHUPALCHOK Assessment Unit 09.06.2015

Between 11 May and 24 May, a key informant multi-cluster assessment was conducted in Sindhupalchok covering 64 out of 79 VDCs, or 240,000 people. 93% of people covered under the assessment were reported to be in need of assistance, while 38% were in immediate need. Key informants indicated that shelter and food are the top priority needs, with 80% and 66% of VDCs ranking shelter and food within their top 3 priority needs respectively. Health was ranked as the third priority need. The main sources of information currently used by the population are radio and telephone. However, key informants indicated that there is an urgent need for additional hardware and electricity to charge communication equipment.

DISPLACEMENT 88% of the total population was displaced. 39% of the population was living in makeshift shelters in scattered sites, and 46% were in displacement sites. Key informants expect that 70% of the IDPs will remain displaced for more than 6 months, which includes the monsoon period, primarily due to the fear of aftershocks and damages to buildings. (p. 3)

SHELTER 88% of houses were reported to be severely damaged or destroyed. A lack of suitable land to rebuild is hampering reconstruction. Key informants estimated that only 1,600 HH (or 3% of the HH covered) started reconstruction. One of the reasons mentioned for this was people’s fear of natural hazards. (p. 8)

FOOD SECURITY 80% of households had lost more than half of their food stocks and 56% of households had lost all food stocks. VDCs had on average 4 weeks of food autonomy. Lack of storage space available for food was highlighted as a major concern, especially during the upcoming monsoon season. (p. 9)

HEALTH 19% of existing health facilities were reported as closed due to damage or lack of staff and 10 VDCs reported that no health facilities were open. Diarrhea is reported as the most common health problem among children and the second most common among adults. (p. 10) EDUCATION 92% of schools were reported to have been destroyed and key informants indicated that parents were hesitant to send their children to school due to their fear of aftershocks. (p. 12)

WATER, SANITATION AND HYGIENE A shortage of water sources is the main priority identified in the sector. This is partly due to the damage to pipelines and taps. This has resulted in a shift towards unsafe water sources, primarily unprotected wells. Key informants indicated that 70% of the population currently does not have access to clean water. Furthermore, key informants estimate that 50% of people are practicing open defecation, primarily due to the lack of toilets. (p. 13)

CASH AND NFIS In 41 VDCs of the 64 VDCs, key informants indicated that less than half the shops or markets were open. The main source of cash before and after the earthquakes changed from banks, including cooperatives, to borrowing. Remittances have decreased in importance according to key informants. This is most likely illustrative of the widespread damage to the financial infrastructure. In 50% of the VDCs covered, less than half of the needs can be covered through cash according to informants. (p. 16)

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METHODOLOGY Between 11 and 24 May 2015, 64 out of 79 VDCs in Sindhupalchock were assessed with the objective to capture the needs of the population within the district. These VDCs represent 83% of the district population or approximately 240,000 people, according to the 2011 Census results.

The assessment was designed to collect data from primary sources at the VDC level, through group key informant interviews. Key informants included Government officials, social workers and teachers. In each VDC, at least 3 categories of KIs have been interviewed; a government representative was present in each interview. On average, 10 key informants were interviewed and 40% of the key informants were female.

The multi-cluster assessment form was developed through consultations with the district government and humanitarian clusters at district level. Afterwards, data collection enumerators synthesised information from the different key informants into 1 form per VDC, registering information directly on to a tablet using the KoBo Toolbox system.

Trained enumerators interviewed key informants and used their training and judgement to control for potential biased answers. In addition, debrief sessions were held with all enumerators where their findings were discussed. Data was inputted and cleaned using Excel. Enumerators were requested to record their confidence for each group of responses and on average, 90% of sector specific responses were ranked as above acceptable confidence. Where data was deemed unreliable, questions were removed from the analysis.

During the data collection period on 12 May, a 7.3 magnitude earthquake struck the region and this was followed by several aftershocks. The impact of the earthquake on the primary data collection exercise was significant:  The relevance of the data already collected on 18 VDC decreased as it is assumed that the situation has significantly changed particularly because of the proximity of the epicentre to the district.  The assessment activities were halted for 6 days following the earthquake and a reduced number of enumerators were available to continue data collection.

The resulting dataset includes around 240 indicators from all priority clusters as well as cross-cutting themes such as vulnerable groups.

Assessment schedule:

Date Event 8 May Assessment preparation 9 May Training enumerators 11-12 May Pre-earthquake data collection 12 May Earthquake 18 – 24 May Resumption of data collection 28 May Dissemination of preliminary findings 9 June Publication of final report

While interpreting the findings within this report it is important to be aware that:  The results are based on the perceptions of key informants on the situation within a specific VDC. As a result, this assessment is subject to all the general limitations of a key informant assessment, including recall bias and the fact these informants might not represent all segments of the population.  All schools were closed during the primary data collection period and several have reopened since. As a result, not all the education specific information will remain relevant.  As a result of the reduction in staff following the 12 May earthquake, and existing access constraints, 15 out of the 79 VDCs in the district were not covered.  The estimates on population in need and the extent of the problems are a function of the proportion of the population affected and the 2011 Census population figures.  21 questions within the questionnaire were prioritization questions, during which key informants are requested to rank their top 3 problems or needs. An example of such a question is ‘in this area, what are the top 3 priority needs’. The responses were aggregated using the Borda count method and are visualized through heatmaps. These maps are coloured in descending importance order to allow for easy comparison between categories. The darker the colour, the higher the importance of the variable.

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KEY PRIORITIES Priority sectors as reported by key informants Shelter was perceived as the top priority need despite having the lowest number of people in need reported. This potential contradiction was likely attributed to the shelter response already provided. In addition, the upcoming monsoon also influenced the priority and the need for more permanent and robust shelter. Shelter is of greater priority in rural areas than in population centres. Food was also reported as a high priority, with population centres recording it as a higher priority compared to rural areas. This could be attributed to a more self-sufficient rural lifestyle; however, assistance is still necessary in both areas as large quantities of food and food storage spaces have been destroyed. Health was perceived as the third highest priority followed by education. Communication, protection and NFIs were perceived as of lower importance.

HUMANITARIAN PROFILE

The humanitarian profile categorises the affected population into mutually exclusive categories, each of which has unique needs. The level of damage to shelters has been used as the defining variable as it is the most representative of displacement and need. The results on the number of people affected illustrate the widespread impact of the earthquakes. Of the 240,000 people surveyed, over 237,000 people (or 99%) have been affected due to damage to their home. At the time of assessment, 88% of the population was displaced due to uninhabitable shelters. This finding is confirmed by a recent shelter cluster assessment in the district, which found 91% of households residing in a shelter different from before the earthquakes. The displaced population were primarily residing in displacement sites (52% of the total number of IDPs). 44% of recorded IDPs were residing in scattered site, defined as families under tarpaulins or in other makeshift shelters, usually in closer proximity to their previous residence.

In as many as 52 VDCs more than 75% of the population were displaced. There were only 3 areas where less than 50% of the population were displaced. These are Banshkarka, Fulpingdandagau and Fulpingkatti. As the proportions of those affected and displaced were universally high, there was no significant difference between population centres and rural areas or hard to reach areas compared to other areas. The results indicate that the majority of the population was already affected before the earthquake on 12 May. Of the 18 VDCs assessed before the May 12 earthquake, almost all recorded an affected population of above 90% of the total population.

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IMPACT Number of people injured and killed per VDC Key informants reported 3,000 deaths (or 1.2% of the population covered) and over 1,000 people have been injured. In many instances, the number of injured people was not known. These findings are corroborated by government figures, which total 3,429 deaths as of 25 May. The existing discrepancy can be explained by the fact that 83% of the district population was surveyed and that some VDCs were assessed prior to the May 12 earthquake. The VDCs with the highest proportion of people killed and injured are Fulpingkatti (15% of the total population), ThampalChhap (7%) and SyauleBazar (7%).

Rural areas have a significantly larger causality caseload than population centres with 1.5% and 0.85% of reported deaths respectively. This may be associated with traditional construction methods used in rural areas. There are more female casualties than male casualties, which may be explained by the larger volume of male migration.

Number of buildings damaged per VDC The magnitude of destruction is evident with almost all of VDCs reporting near complete destruction to households regardless of geographical location (population centres or rural). There is only 1 outlier, , where 52% of houses were reported destroyed; this VDC was visited prior to the May 12 earthquake and is expected to have sustained more damage since the assessment was conducted. In instances where complete destruction was not reported, almost all remaining houses are reported as damaged in every VDC. The government figures, as of 25 May, indicate 96% of houses destroyed within the district with the remaining 4% partially damaged. These findings are corroborated by a representative shelter recovery assessment, undertaken between 21 and 25 May, which found that 99% of HH reported housing damage as a result of the earthquakes. 20% of hospitals were closed at the time of the assessment. According to key informants, at least 17 government buildings were damaged while 142 have been destroyed.

In 45 VDCs the official VDC building had been destroyed thus impeding the capacity of local officials to respond. Only 1 official building (in ) was reported to be undamaged.

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DISPLACEMENT PATTERNS Main obstacles to return In the large majority of the areas (70% of VDCs assessed), key informants estimated that the majority of the displaced population would not return within 6 months. The main obstacles to return were the on- going aftershocks, followed by the damage sustained. It can therefore be assumed that once the aftershocks subside and reconstruction starts, people will start to return to their homes.

HUMANITARIAN ACCESS Access of humanitarian organisations to beneficiaries Access of beneficiaries to aid

Physical Accessibility VDCs The assessments results show that access of humanitarian organisations to beneficiaries was of greater concern than access of beneficiaries to aid. However, it should be noted that there is a higher level of uncertainty among key informants on the beneficiary specific access constraints, and many key informants indicated that they did not know whether a certain factor is an impediment. Physical access was the main constraint with 43 VDCs mentioning this as a medium or high constraint. 5 VDCs have been reported as very difficult to reach as they were only accessible by foot or helicopter. Furthermore, 4 VDCs were only accessible by car or motorbike. These 9 VDCs hosted over 30,000 people in 2011. The more densely populated areas in the south had relatively better accessibility, predominately with truck access. However, within a VDC, geography and infrastructure, and thus accessibility will vary. Accessibility is expected to decrease during the upcoming monsoon season. Fear of accessing aid (mainly due to the risk of landslides when travelling) was also reported as a significant concern; this highlights that in some instances, the magnitude of fear had overcome need and is perhaps indicative that continued psychosocial support is required. There is a strong correlation between reported fear to access aid and the level of physical access to a VDC, which is illustrative of how the earthquakes have impacted not only infrastructure but also people’s behaviour. Denial of aid has been reported to be of less concern. However, as can be expected, the denial of aid because of a lack of documentation is correlated with the denial of aid due to ethnicity or caste.

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VULNERABLE GROUPS

Priority vulnerable groups

According to key informants, the most vulnerable groups are child headed households, followed by female headed households and elderly headed households. There are limited differences between the situation in rural areas as compared to population centres. Key informants almost never selected the option of marginalised caste as a vulnerable group. Whilst it may not be perceived to be an issue at the VDC level, this does not indicate that this is not an issue at the district or national level.

VDCs with a high proportion of vulnerable groups

11 out of 64 VDCs can be prioritised in terms of vulnerability, as these recorded a large proportion of vulnerable groups: Talramarang, Golche, Bhimatar, , Sipapokhare, Bhotasipa, , , Nawalpur, Batase and Kubhinde.

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INCIDENTS Reported increase of observed incidents since 25 April earthquake

An increase in tensions between different groups within the communities during the direct aftermath of the earthquake was reported in nearly half of the VDCs. However, according to the enumerators this is currently no longer a major concern. Other security incidents mentioned include discrimination by caste or ethnicity. Discrimination by caste or ethnicity was reported slightly more often in rural areas compared with population centres. Although other data indicates that there is a large number of marginalized groups within the VDCs, discrimination by caste or ethnicity was not often mentioned by key informants. Key informants in 11 VDCs reported no observations of increased security incidents since the earthquake.

COMMUNICATION AND INFORMATION Most important sources of information since the 25 April earthquake Key informants indicated that the predominant information sources for the population were radio and telephone, with limited differences between rural areas and population centres. The importance of radio as a main information source before the earthquakes and currently has been confirmed in multiple other assessments (e.g. USAID 2013, Internews 10/05/2015, Internews 17/05/2015). Other sources of information were ranked significantly lower in order of importance. The assessment results do not provide an indication of the different preferences by age group. However, it is likely that results differ when looking at the specific sources used by youth as compared to adults.

Top 3 priorities related to information The prioritisation of communication needs indicates that communities had difficulties accessing the main information sources they use. Hardware had been destroyed during the earthquake or were stuck in collapsed buildings. Illustratively, phones and radios were highlighted as the main priorities. In rural areas, communities continued to face difficulties in accessing electricity required to charge equipment. In areas with a large proportion of single headed households (where women are the main earners of the household), a greater need for information from aid workers and NGOs was recorded.

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SHELTER People in need People in need (%of total pop) People in immediate need (% of total pop)

199,500 people were in need of shelter support, of which 71,500 people needed immediate shelter assistance. The areas with the highest proportion of people in need were clustered around Chataura. The VDC of Fulpingkatti had a high number of people in immediate need. The VDC, which was only accessible by foot, had a high proportion of people in immediate need across almost all sectors and above average high levels of damages. Priority problems 3 most pressing problems according to key informants

As can be expected, the damage to buildings was the most concerning problem. The lack of suitable land to rebuild was highlighted as a major problem as well, with debris and damaged housing limiting building space. It is likely that a significant part of the community will not start reconstructing houses until after the height of the monsoon season in June and July, when the fear of aftershocks and landslides will have reduced. Damage and repair % of HH whose permanent shelter are*

Undamaged Minor Damage Severely Damaged Destroyed 4% 5% 63% 25%

*for 3% of the HH the status was unknown For 88% of HH, their permanent shelter was either severely damaged or destroyed. Key informants estimated that only 1,600 HH had restarted repairs or reconstruction, which constitutes only 3% of total HH. However, many have built temporary shelters. Anecdotal information indicates that people are waiting to see the impact of the upcoming monsoon season, and accompanying landslides, before starting to rebuild. The results did not indicate a strong relationship between the availability of construction materials and the % of HH who had started to rebuild. In 2 VDCs, ThuloSirubari and , 20% of the HH had started reconstruction and repairs. However, in both VDCs none of the required NFIs were available on the market and the activities were presumably fully dependent on support of organizations or the Government.

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FOOD SECURITY AND LIVELIHOODS People in need (%of total pop) People in immediate need (% of total pop)

220,000 people were in need of support, including 91,500 in immediate need with regards to food security and livelihoods. As in other sectors, the proportion of need was highest in the southern areas in and around Chataura and in the central eastern VDCs. , an area only accessible by foot, was the main area in the western part of the district with a high proportion of people in need. Priority problems 3 most pressing problems according to key informants The availability of food in general both in rural and population centres was of concern. This may be related to destruction of food stocks following the earthquake as well as poor food storage conditions, both of which were the two most recorded problems by key informants.

Key informants estimated that 55% of HH assessed lost all foodstocks, while 26% lost more than half of their stocks. The destruction of shelter has resulted in food storage issues and this is of particular concern with the upcoming monsoon. Storage issues further decrease the stock available. Only in 40% of the VDCs assessed, communities have sufficient food to last for more than a month. In 9 VDCs, or 14% of the VDCs assessed, key informants indicated that there was not sufficient stock within the community to be self-sufficient.

Food stock autonomy (in weeks)

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Crisis impact Main livelihood activities before the crisis Impact on livelihood activity

Agricultural activities formed a key part of the Sindhupalchok population’s livelihood strategy. The top 3 livelihood activities prior to the earthquakes were related to the agricultural sector including casual agricultural labour, livestock sales and agricultural sales. The main livelihood activities were also those most impacted by the earthquakes - in 42 VDCs it was for example reported that the earthquakes have had a high impact on agriculture related casual labour.

Coping mechanisms Borrowing money or food and relying on help from friends or relatives were the most common coping mechanisms reported. There are 2 main differences in coping mechanisms identified in rural areas compared to population centres. The sale of animals was been reported more often in population centres, while reducing the number of meals per day was reported more in rural areas.

HEALTH AND NUTRITION People in Need People in need (%of total pop) People in immediate need (% of total pop)

220,500 people were in need of support of which 99,000 people were in immediate need. The highest proportion of people in immediate need were clustered in 3 regions: in the central south, in the east (Fulpingkatti and Listikot) and in the West (Barshkarka and ) The health facility destruction combined with the higher population density of the southern-central VDCs, may explain why the immediate health needs were greater there. Immediate health needs were also reported in the eastern VDCs of Tatopani, Fulpinkatti and Listikot.

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Priority problems 3 most pressing problems according to key informants

There was a general consensus that the lack of proper nutrition or cooking supplies was the main health problem at the time of the assessment. Sickness and the unhealthy environment were categorized as the second and third priority problem, both of which can contribute significantly to poor nutrition status.

Key informants were asked to explain the underlying causes of the stated problems. The most mentioned cause can be categorised as a lack of availability, including the destruction of health facilities, the lack of NFIs and means to maintain hygienic practices.

Impact on health infrastructure Status of health facilities According to key informants, 37 health facilities have been damaged as a result of the earthquakes. However, the Health Cluster reports that all facilities are open, although several health facilities have moved to different location for security reasons such as landslides. The assessment results show that the total number of facilities in the district has increased (from 201 to 258), which could be explained by the high number of DNKs before the earthquake and a number of temporary health facilities established in response to the earthquakes.

Most commonly reported health conditions Among Adults Among Children

Diarrhea was reported as the most common health problem among children and the second most common problem among adults. This is of concern due to the increased risk of diarrheal disease associated with the onset of the monsoon season, and the ease with which diarrhea spreads in crowded and unsanitary living conditions. This is of concern particularly for children, for whom diarrhea could contribute to undernutrition. Injuries were the most common health related condition reported among adults and the second most common reported problem among children. Fever was reported as the third most common health condition among adults and children. It is important to note that as with diarrhea the risks associated with the monsoon season are likely to increase the incidence of fever.

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EDUCATION People in need

People in need (% of school aged children) People in immediate need (% of school aged children)

91% of the school aged children in the areas covered were in need in the education sector, while 47% are in immediate need. With the reopening of the schools on 31 May (after the end of data collection) it can be assumed that this number has decreased children have since been able to access education. According to the Department of Education information, 25-30 % of students in the district were attending school on 1 June. The pattern of needs reported for education is similar to other sectors, with immediate needs being reported in the southern VDCs, as well as Fulpingkatti and the northern VDC of Golche.

Impact on education infrastructure Key informants indicated that before the earthquakes, 396 schools were open in the assessed VDCs, including 9 without staff. As many as 266 of the schools recorded were damaged or destroyed.

Priority problems 3 most pressing problems according to key informants

By far the most mentioned concern was the damage to school buildings, both in population centres and in rural areas. It is likely that with the reopening of the schools, some problems that were ranked as a low priority have become more of concern. The lack of teachers and fear of aftershocks will for instance be more pressing now that children have returned.

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WATER People in Need People in need (%of total pop) People in immediate need (% of total pop)

210,000 people, or 88% of the assessed population, are in need of support, including 94,500 people in immediate need. The overall need is distributed quite uniformly throughout the entire district, with key informants in only 5 VDCs indicating that less than half of the population is in need of support. The VDCs in immediate need are restricted to the eastern VDCs of Tatopani, Listikot, and Fulpingkatti, as well as a cluster of VDCs in the south including and surrounding VDCs. This may be explained by large scale impact on water pipe systems, which are traditionally concentrated in population centres. In the more northern VDCs the assessment results show that people were using alternative sources of water before the earthquake, including wells, which are likely to have been less affected by the earthquake.

Priority problems

The damage to pipelines and taps has necessitated a shift to alternative water sources. However, these sources are not sufficient to meet all the needs, and across the board a shortage of clean water sources was highlighted as the main problem. The main problems identified are similar in rural areas and population centres, despite the fact that the main sources of water differ. According to the key informants, the foremost cause of the problems can be categorized as an availability as opposed to an access concern.

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Impact on water sources Before the earthquakes After the earthquakes

Access to clean water before and after the earthquakes (%)

Prior to the earthquakes, taps (both community and private) were the main sources of water supply. Following the earthquakes the use of taps decreased, and a shift towards ground and surface water sources has been reported. There has been an increased use in unprotected water sources, predominately through the use of newly created wells. The majority of the population is relying on communal water sources, of which the water quality is reported to be lower. The importance of bottled and tankered water has remained low.

SANITATION People in Need People in need (% of total pop) People in immediate need (% of total pop)

The number of people in need of sanitation support is the highest across all sectors covered, with 220,000 people reported to be in need. 99,000 people are in immediate need, which amounts to 41% of the total population assessed. The need for sanitation is widespread in assessed VDCs, although the immediate needs are concentrated in the southern VDCs surrounding Chautara. Immediate need for sanitation was also identified in northern and more mountainous VDC of , where key informants indicated that open defecation is currently the main defecation practice, when compared to the situation prior to the earthquakes where household and community pits were used.

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Priority problems 3 most pressing problems according to key informants

Key informants attribute the needs in sanitation to the lack of toilets, particularly in the population centres. Awareness of safe sanitation practices is also a concern and this is likely to be contributing to the practice of open defecation. The causes of the main problems are almost equally divided between access and availability of sanitation. While the widespread damage to infrastructure has impacted the number of sanitation facilities available, the fear of aftershocks is hampering the usage of existing infrastructure. These findings are corroborated by a recent WASH cluster assessment, which found that 72% of toilets in 33 VDCs in Sindhupalchok were completely damaged. Impact on defecation sites

Before the earthquakes After the earthquakes

The earthquakes have had a clear impact on sanitation practices. Prior to the earthquake, most of the population was using improved sanitation facilities and many households had access to either a flush (population centres) or pit toilet (rural areas). Before the earthquake, 67 VDCs in Sindhupalchok were designated as Open Defecation Free (ODF) (DWSS 20/01/2014). However, after the earthquake, open defecation has become the main defecation practice, particularly in rural areas. The majority of the population is aware of the risk of open defecation and thus most defecate away from their home and drinking water supply.

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NFIS, MARKET & CASH People in need People in need (%of total pop) People in immediate need (% of total pop)

220,000 people are in need of support, including 90,500 in need of immediate support (38% of the assessed population). Key informants in 37 VDCs indicated that none or less than half of the shops were open during the assessment. According to 2011 population data, these areas host around 131,000 people. Immediate needs are concentrated in southern areas including Sanachok, Chautara and surrounding areas, as well as in the eastern VDCs of Fulpinkatti. Fulpingkatti has been heavily affected by recurring landslides, which block access to markets and other services. In the south, where there is better access to roads and markets in normal circumstances, markets and cash have been disrupted according to key informants. Priority problems 3 most pressing problems according to key informants

The main problem in population centres and rural areas according to key informants is the damage to or lack of access to financial structures such as banks. The main difference between population centres and rural areas is the lack of access to markets or shops, which was more of a concern in rural areas. Market access is traditionally lower in rural areas and the impact of the earthquakes has compounded existing issues.

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Market functionality % of markets open according to key informants

During the assessment, key informants in 4 VDCs indicated that markets were closed, while in 33 areas less than half of the shops were open. The findings indicate that shops in rural areas have been more affected, or slower to reopen, compared to markets in population centres. In only 4 out of the 41 rural areas more than half of the markets were open, compared to 3 out of 23 in rural areas. In 16 VDCs, the key informants could not reach agreement on the status of the shops within the specific area ( and recorded do not know answers). Market functionality is dynamic and thus these results are only indicative of the situation at the time of the assessment.

Extent to which needs can be covered through cash In 31 VDCs, or 50% of VDCs covered, key informants estimate that less than half of the needs can be covered through cash. As expected, there is a strong relationship between the proportion of shops open and the extent to which needs can be covered.

NFIs available and required Top NFIs required The NFIs most required overall are construction materials (such as bricks and cement), shelter equipment (including CGI sheet, tarpaulin), and food preparation or water storage equipment. These needs are aligned with the top priorities of shelter and food security.

Availability NFIs by VDC The results indicate that rebuilding is impeded by the lack of NFIs available locally. Rural areas have a lower reported availability of construction materials, with key informants in only 9 out of the 41 rural areas reporting that construction materials are available. In 28% of the VDCs, necessary NFIs are not available locally and this is of particular concern in rural areas. However, it should be kept in mind that households in remote areas are traditionally used to travelling to larger markets to purchase durable items such as construction materials.

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Main sources of cash Before the earthquakes After the earthquakes

According to key informants, the main sources of cash before the earthquakes were banks, which people in general define formal banks as well as cooperatives, and remittances. After the earthquakes, borrowing was the most important source of cash. Banks have reduced in importance, particularly in rural areas. This can be attributed to the widespread damage to the financial infrastructure. The breakdown of traditional financial institutions could also explain the reduction in importance of remittances.

OCHA

The Assessment Unit welcomes all information that could complement this report. For more information, comments or questions please email [email protected]

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