The massive 7.8 earthquake that rocked Nepal and left hundreds dead still hasn’t been fully noted by the government but a report on the state of the healthcare system shows the country is in serious trouble.

A new report given to the Nepal planning commission shows that one third of the nation’s healthcare system has been destroyed or severely damaged to the point it is currently inoperable.  Almost 450 public health facilities in the nation were completely destroyed by the quake and its aftershocks.

Over 700 public health facilities have been reported with significant damage although they are still able to provide some services.

The total value of the damage is estimated to be around $58 million and the estimate cost to rebuild is close to $110 million over the next five years.

The situation is being complicated by the monsoon season with landslides threatening some of the remaining damaged healthcare structures.

The WHO said Nepal was one of the worst nations in the world for healthcare before the quake, with only 2.1 doctors per 10,000 residents of the population.    The WHO says native doctors head for more industrialized nations in search of better pay and working conditions.

“Health services must be rebuilt and made accessible to all, while risk-reduction programmes must be implemented at the sub-national level,” Poonam Khetrapal Singh, the WHO regional director for Southeast Asia, wrote last week. “Soil testing, the enforcement of health facility-related building codes, and investment in design of quake-proof facilities and homes must be encouraged across the country.”