Heavy rainfall in mid and far western Nepal in October 2009 caused widespread flooding and landslides, resulting in 73 deaths, 7 people missing, and 32 injuries. Over 2097 families comprising 67,402 people were displaced. The government and humanitarian organizations immediately responded to search and rescue efforts and provide food, water, shelter and medical assistance to affected communities. A lessons learned review identified weaknesses in early warning systems, coordination, gender equality, use of local knowledge, and public expectations that need to be addressed to improve future disaster preparedness and response.