IRIN news highlights the following gruesome picture of Nepal’s poor road conditions. Nepal has built about 7,000km of roads nationwide over the past decade, according to the World Bank, but this still leaves more than half the population without access to all-weather roads in a country where millions struggle to reach safe, nutritious food, which ranks as one of the world’s worst places for a child to fall ill (out of 161 countries evaluated by NGO Save the Children) due to women’s and children’s poor access to health care.

Nearly half of Nepal’s 27 million people live in rugged hill and mountain areas. People living in the mountains (roughly 7 percent of the population) report some of the weakest development indicators nationwide. The national average for children under the age of five who are chronically malnourished is 41 percent; this figure exceeds 60 percent in the mountains. According to the government’s most recent Nepal Living Standards Survey in 2011, Nepalis living in rural areas – especially in hills and mountains – report roads in their areas are unsatisfactory.

Traveling across difficult terrain has been cited by HIV service providers as one reason patients fail to adhere to treatment regimens. Due to the lack, or poor quality, of roads in rural Nepal, maternal healthcare facilities may be more than a day’s walk away which, practitioners say, can be deadly. “If women can’t get to a healthcare facility in time, they either die or have a fistula,” Shirley Heywood, a gynecologist who has been working in rural Nepal for a decade with the International Nepal Foundation, told IRIN.

Obstetric fistula is a condition caused by prolonged and obstructed labor resulting in a hole in the birth canal, leading to continuous urine leakage. According to the UN Population Fund, an estimated 4,602 women in Nepal are living with fistula; there are up to 400 new cases annually. “I have had patients who are carried for more than two days to us for fistula treatment. I hear all the time how we need to increase capacity for fistula surgery in Nepal, but I don’t think that’s the whole picture – access is a huge issue, and roads are a vital part of that,” Heywood said. Analysts have also pointed to the lack of reliable road access as a factor in weak education achievements, including the 35 percent of Nepalis who remain illiterate.