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Koshi Province Health Minister Bhupendra Rai inaugurated the District Hospital in Diktel, the headquarters of Khotang, on July 6 with much fanfare, announcing its upgrade to a 50-bed facility. At the inauguration, he declared, “Khotang residents will no longer have to travel to the capital by helicopter for treatment. Services with specialist doctors will be available here.”

However, his assurance has proven to be little more than an empty promise. The hospital lacks specialist doctors, and residents still depend on Kathmandu for critical care, often forced to travel by helicopter.

Khotang, an eastern hill district about 270 kilometers from Kathmandu, faces not just geographic isolation but also deep disparities in healthcare. The District Hospital in Diktel has a building, beds, and some basic equipment, but without specialist doctors it functions more as a referral center than a treatment facility. Patients in critical condition must either charter helicopters to reach Kathmandu or endure costly ambulance journeys to Dharan or Biratnagar.

According to hospital chief Dr. Rupesh Sangraula, more than 50,000 patients seek treatment at the hospital annually. Yet, in the absence of surgeons, gynecologists, pediatricians, neurologists, and cardiologists, serious cases must be referred elsewhere.

Ram Kumar Rai (Pasang), a House of Representatives member from Khotang, says, “The situation where citizens must risk their lives in helicopters due to the lack of health facilities is inhuman. I have repeatedly raised my voice in parliament, but the government has yet to implement the policy of permanently posting specialists.” He has demanded immediate deployment of specialist doctors to Khotang.

The human toll is stark. Bed Prasad Acharya of Diktel-1 was admitted with a fever but, unable to be treated locally, was referred to Kathmandu. He died in an ambulance en route. His brother, Jeevan Acharya, lamented, “My brother died unnecessarily without treatment. When our father also needed care, we had to charter a helicopter to Kathmandu to save him.”

Similarly, 27-year-old Maiti Kala Rai of Buipa died at Diktel Hospital during pregnancy complications. According to local ward chairperson Dinesh Rai, her weak financial condition prevented her from reaching Kathmandu.

Such tragedies have become a collective pain for the district. With helicopter charters costing Rs 300,000–500,000, farming families often fall into lifelong debt. The premature loss of labor further reduces village productivity, while locals say their trust in the state is eroding.

Daman Rai, former president of the Federation of Nepali Journalists, Khotang, explains, “Residents here must keep Rs 500,000 standby in case they need to fly to Kathmandu. Otherwise, they risk dying.” Nagendra Dhakal of Diktel Rupakot Majhuwagadhi-15 adds, “For poor people like us, hospitals are just buildings. The rich survive by helicopter, the poor die on the way.”

Local leaders echo the frustration. Maoist Center Khotang Chair Deepak Pandey remarks, “While five-star hospitals are built in the capital, citizens here die without basic care. Specialists need incentives and a safe environment to come here.”

Municipality Mayor Tirtha Bhattarai says, “We have arranged a rescue fund, ambulances, and health workers. But this is not enough. The problem will persist until the provincial and federal governments expand Diktel Hospital into a provincial hospital.”

Despite longstanding government policy to post specialists in every district, Khotang has yet to receive permanent appointments. Even doctors who arrive on temporary contracts rarely stay. Although the Koshi provincial government has announced plans to upgrade Diktel Hospital to provincial-level, little progress has been made.

Locals are demanding an emergency fund for free air rescues for the poor and an immediate upgrade of Diktel Hospital. Chandra Budhathoki of Dorpa, who lost his wife without treatment, says, “Those with money survive in Kathmandu, while poor people like us are ignored. I feel the state has abandoned us.”

Currently, despite its 50-bed designation, the hospital has only 30 posts—including one MD physician and six MBBS doctors—leaving it far short of meeting the people’s needs.

It has been 15 years since the Koshi Barrage, built on the Saptakoshi River, outlived its designated lifespan. Yet, despite the expiry of the 56-gate barrage, neither the Nepal nor Indian governments have shown serious interest in its reconstruction. The Saptakoshi Barrage remains the only physical link between Koshi Province and Madhes Province. It was constructed under the 1954 bilateral Koshi Agreement, signed with the aim of providing irrigation, hydroelectricity, and flood control to farmers in Sunsari, Morang, and Saptari districts of Nepal and the Indian state of Bihar. However, no alternative has been sought even after its expiry.

Although the barrage has undergone periodic repairs, it has become dilapidated. The 66-year-old structure shakes alarmingly when vehicles cross, raising widespread concerns about safety, maintenance, and long-term reliability.

Construction of the barrage began on 30 April 1959, after King Mahendra of Nepal and Indian Prime Minister Jawaharlal Nehru laid its foundation stone. It was inaugurated on 24 April 1965, by then King Mahendra and then Indian Prime Minister Lal Bahadur Shastri. After its completion, canals were built in Sunsari, Morang, Saptari, and Bihar, boosting agricultural productivity and facilitating transportation, including the East-West Mahendra Highway. However, because the barrage gates are under Indian control and opened at India’s discretion, more than 10,000 residents of Sunsari, Morang, and Saptari have been displaced over the years by sudden floods.

The barrage is often hailed as a historic milestone in Nepal-India relations, but its agreed lifespan of 

about 50 years has long expired. “The expired Koshi Barrage could cause accidents at any time. Both governments must act urgently,” said Rajan Rai, former Minister of Social Development of Koshi Province.

By controlling the Koshi’s waters, the barrage has irrigated thousands of hectares of farmland in the eastern Tarai, increasing agricultural production and improving housing, roads, and overall living standards. But with its deteriorating condition and outdated technology, concerns about its safety and effectiveness are mounting. “The structure has aged, and its technology is obsolete. Both governments should begin planning for reconstruction,” said Rajan Mehta, head of the Sunsari District Coordination Committee.

The greatest threat is a potential collapse during heavy floods. “The main structures, including the sluice gates, embankments, and dam, were built with old materials and have not been upgraded with modern technology. Lack of regular maintenance has left them highly vulnerable,” said Gopal Koirala, former Land Acquisition Officer of the Sunsari-Morang Irrigation Project. He warned that failure of the barrage could unleash uncontrolled water, inundating farmland and damaging homes, roads, and bridges.

Provincial authorities also recognize the urgency. “Repair, modernization, and eventual reconstruction are indispensable. On behalf of Koshi Province, we will request the federal government to coordinate with India for its reconstruction,” said Bhupendra Rai, Minister for Physical Infrastructure Development of Koshi Province.

Local communities, who suffer recurring floods, remain deeply worried. “If the barrage collapses, floods will destroy homes, fields, schools, and roads. Victims already face hardship, and the Indian government has not provided relief or compensation as promised under the Koshi Agreement,” said Baburam Karki, secretary of the Koshi Victims’ Struggle Committee.

Similarly, Nawal Kishore Sah, Member of Parliament from Saptari Constituency-1, said the Indian Embassy has repeatedly urged New Delhi to rebuild the barrage, but the requests have gone unheard. “The issue must be raised at the highest political level, including during Prime Minister KP Sharma Oli’s visit to India,” he said.