Why Working Abroad Has Sparked a Kidney-Failure Crisis in Nepal

KATHMANDU, NEPAL — For four years, Jit Bahadur Gurung spent 12-hour shifts grilling meat over charcoal in a restaurant. Water breaks and bathroom visits were luxuries. Rest came rarely — one day off every fortnight.

When Gurung embarked on a journey from Nepal’s Himalayan Gorkha district to the sweltering sands of Saudi Arabia as a 22-year-old, he thought he was so strong and healthy that he could handle anything. The agency that helped him through the process told him that the job of a waiter would be easy.

He was no stranger to hard work.

Gurung had spent a good part of his teenage years tending his family’s small farm, coaxing sustenance from stubborn soil. Despite long hours in the fields, the harvest rarely stretched to feed his family through the year. The opportunity to work abroad seemed like a lifeline — a chance to give his daughter the education he never had and to bring comfort to his aging parents.

Four years into the waiter job, a few days before a planned vacation to see his family, he realized his legs were swollen and each breath became a battle. When he went to the hospital, he found out that both his kidneys had failed.

It was time to get back home.

Now 32, Gurung sits at the National Kidney Center in Kathmandu to get dialysis three times a week. His once-strong frame is frail and any physical work, including lifting heavy objects, could be fatal.

Every day, about 1,500 young Nepalis leave their country for work. Their earnings power a significant portion of Nepal’s economy, with remittances comprising more than 25% of the country’s gross domestic product in 2024. But this prosperity comes at a cost: young, healthy adults return home with failed kidneys.

“The country has benefited from remittances, but families have had to pay a higher price,” says Dipesh Ghimire, an assistant professor of sociology at Tribhuvan University, Kathmandu. The burden is particularly significant because the affected individuals are in their prime productive years, he says. The average age of a Nepali migrant worker is 29.

As temperatures rise in Gulf countries, there’s growing global alarm about rising kidney diseases among workers doing intense physical labor in extreme summer heat with limited water breaks and restricted bathroom access.

Dr. Rishi Kumar Kafle, a nephrologist who pioneered dialysis in Nepal, says that migrants to Gulf countries and Malaysia often develop kidney disease within three to four years of relocation. Since kidneys regulate fluid balance, the organs are especially vulnerable to temperature extremes. While the disease is not caused by one specific factor, Kafle says screenings of returnees over years suggest a strong link between geographic migration and a decline in kidney function.

Behind the National Kidney Center stands a house where 12 dialysis patients and their families have found temporary shelter. Nearby, Gurung rents a room for 6,000 Nepali rupees (43 United States dollars) per month, sharing the tight space with his wife and daughters — a kitchen in one corner, a bed in another, and his luggage from Saudi Arabia stacked against the wall.

Three times each week, Gurung makes his way to dialysis. Unable to work, he finds community among the other patients, their days marked by card games and shared stories. His wife has become the family’s breadwinner, cobbling together 8,000 rupees (57 dollars) monthly through whatever work she can find. But financial struggles are plenty. There have been times when Gurung has had to beg on the streets.

Over the course of a decade, a kidney patient’s care costs the government 3 million rupees (21,669 dollars) in dialysis alone, while a patient pays an additional 2 million (14,447 dollars) from their own pocket, Kafle says.

Since 2016, Nepal has offered free kidney dialysis and transplants, plus a 5,000-rupee (36-dollar) allowance for patients with kidney failure.

While Nepal battles multiple serious diseases, Dr. Bikash Devkota, additional health secretary at the Ministry of Health and Population, says dialysis consumes the largest share of health care spending — 2.1% of the government’s health budget.

Still, Gurung spends around 10,000 rupees (72 dollars) monthly on medical tests and medicines.

When Global Press Journal visited the National Kidney Center in January, one-third of the patients undergoing transplant and dialysis were migrant worker returnees. Doctors at the center say this has been the case for many years now.

Like Gurung, of the workers going to Gulf countries and Malaysia, 59% are unskilled. Kafle says being unskilled makes it more likely for them to get jobs that require enduring harsh working conditions, exploitation and endless hours of physical labor — often in extreme heat.

The Gulf Cooperation Council, comprising Bahrain, Qatar, Saudi Arabia, Kuwait, Oman and United Arab Emirates, recorded several of the hottest days on record since 1940 in the third week of July 2024. In Riyadh, Saudi Arabia’s capital, that month’s temperatures reached 116 degrees Fahrenheit (46 degrees Celsius).

Despite the rising temperatures, many Gulf states do not have strict midday work bans. The ones in place “only prohibit outdoor work during pre-defined hours in the summer months instead of using the wet bulb globe temperature index, a widely used index that measures occupational heat stress based on air temperature and relative humidity,” according to Human Rights Watch.

Yet, the Gulf continues to be the most popular destination for Nepali migrants.

Following the 1970s construction boom in the Gulf, Nepali workers saw significant labor opportunities in these countries and started moving there in mid-1980s. In 1990, remittances from these workers contributed approximately 2% to Nepal’s GDP. Today, close to 3.5 million Nepalis work abroad, most in Gulf countries and Malaysia.

Sagar Tamang moved to Malaysia from Nepal’s remote Sankhuwasabha district with a dream of earning enough to build a concrete house in his village, one with sturdy walls and a roof that doesn’t leak.

In Malaysia, he spent two years in agriculture, working 12-hour days planting vegetables and picking fruits. But that didn’t pay him enough to realize his dreams. So, he chose a “better job,” working as a security guard. He worked there for six years, enduring 36-hour shifts, he says. Each month, he’d carefully count out 40,000 rupees (289 dollars) to send home. With this money, his mother built a house — just as Tamang had dreamed.

The toll of years of labor became evident when a workplace concussion triggered severe health complications. During a five-day stay in a Malaysian hospital, he learned that his kidneys were failing.

Emerging research shows that even for otherwise healthy workers, working in hot conditions with no breaks leads to slow, subtle assaults to the organ that often go unnoticed until it’s too late. In a 2021 study by Bournemouth University, 92.1% of Nepali nephrologists reported that most of the returnees with kidney-related diseases had no prior comorbidities.

Most migrant workers are deprived of basic health education and critical information, leaving them unprepared and unprotected, says Rajendra Bhandari, president of the Nepal Association of Foreign Employment Agencies. This is compounded by a migration system plagued by inadequate policies, poor health care access, and illegal travel and work issues, all of which hinder proper worker health screenings and protections, Bhandari says.

The government says it provides free dialysis to affected citizens. But Dandu Raj Ghimire, spokesperson for the Ministry of Labor, Employment and Social Security, says that “if workers are not careful about what they eat or don’t eat and fall ill, it is the individual’s responsibility, not the government’s.”

Despite searching for a kidney donor, Gurung maintains an unwavering spirit. Looking back at his younger self — energetic, full of life, stepping into the unknown — he finds no room for regret. “This suffering was part of my fate,” he says.

Correction: This article has been updated to accurately reflect the equivalent of 10,000 Nepali rupees in US dollars. Global Press Journal regrets the error.