On 25 April, Nepal was struck by a devastating earthquake. The 7.8 magnitude quake, which was followed two weeks later by another of 7.3 amid hundreds of smaller aftershocks, has now claimed more than 8,000 lives and injured more than 17,000 people. Nearly half a million homes have been destroyed or rendered uninhabitable. WaterAid has been working on developing clean water and sanitation systems in Nepal since 1987. Although we are not a traditional aid agency, through our Nepal office and our many local NGO partners, we have stepped up to deliver water purification drops and tablets, sanitary towels, nappies, bars of soap, buckets, jugs of latrine disinfectant and other items essential to daily health and comfort. In the first three weeks of our appeal, WaterAid delivered more than 60,000 water purification tablets and 1,000 bottles of water purification drops, supplied three community water filters to communities in need, handed out more than 1,000 hygiene kits of soap and personal supplies to maintain health and dignity, and delivered thousands of packages of oral rehydration salts and bars of soap. We’ve also supported partners on deliveries of emergency food supplies and some acquisition of tarpaulins and plastic sheeting to help relieve some of the tremendous need. As supplies come in, we will be distributing hundreds of thousands more water purification tablets and several thousand more hygiene kits. Another quake worsens the risks Just two weeks ago I was with a WaterAid team delivering aid supplies – water purification drops, sanitary towels, nappies and bars of soap – at a community health centre in the town of Siddhipur, a small town in Lalitpur district about a 45 minute drive from Kathmandu – when the earth began to shake. The quake was, at 7.3 magnitude, smaller but no less frightening to Nepal’s traumatised population than the first ‘Great Quake’. That day was meant to be my last in Nepal, after ten days of helping our team there document damage to projects which, in some cases, have been running for more than 20 years. With hundreds of thousands of people now based in tents or temporary housing – most often wooden frames with corrugated metal for walls and a roof – and monsoon rains due to begin next month, the risk of an outbreak of cholera or another waterborne disease is high, and worrying. In ten days of travelling through some of the hardest hit districts – Gorkha, Kavre, Lalitpur, Bhaktapur – we met family after family who had very little before the quake and even less now. Their resilience is incredible; nearly everyone we met was already trying to cobble together some sort of shelter and get back into their terraced fields of corn, wheat and potatoes. But the challenges ahead are massive. Years of progress Before these earthquakes, Nepal’s water and sanitation situation was difficult, but improving. One in eight people did not have access to clean water, and two out of three did not have access to a basic, sanitary toilet. Still, Nepal’s campaign to end the practice of open defecation was progressing. Just one month before the earthquake, WaterAid Nepal had celebrated the Open Defecation Free status of the community of Lele, in Lalitpur district. A tiny village carved into a mountainside, the moment was marked like a wedding, with music and local dignitaries. Today, most of Lele has been flattened. It was incredible to see that many of the latrines – built more recently of cement and brick, rather than the mud-and-stone of the houses – resisted the quake and remained standing, a small contribution towards health and comfort in an otherwise devastated community. However, the water supply is intermittent and there are fears of contamination. A few cases of diarrhoea were immediately put under monitoring for fear of a wider outbreak; even with a month to go before monsoon season, night-time rains had begun and outbreaks of disease were a very real fear. Without proper sanitation, heavy rains wash bits of faeces into the water supply, allowing waterborne diseases including cholera and typhoid to spread quickly.