A burning problem that needs solutions

Last month, Finance Minister Bishnu Paudel and Pokhara Mayor Dhanraj Acharya were burned when hydrogen-filled balloons exploded at the launch of Pokhara Visit Year 2025. Both were flown to Kathmandu for treatment.

In 2023, Nepali Congress Member of Parliament (MP) Chandra Bhandari was severely burned in a kitchen fire. He was taken to India for treatment. His Rs5.6 million medevac and treatment bill was paid by the government.

It took the burn injuries of high-profile figures in Nepal to finally spark action on an issue that affects mainly the country’s poorest.

“We call this the burns paradox,” says Kiran Nakarmi at the Nepal Cleft and Burn Centre at Kirtipur Hospital, where the Pokhara patients received care. “Treatment is costly and most victims are poor." 

About 60,000 people suffer burn injuries in Nepal each year and 2,200 of them die. The demand for care in Kirtipur is growing. 

In 2014, it treated 90 burn patients and this more than doubled to 194 in 2015, reached 373 in 2016, and peaked at 790 in 2023. Last year the Centre treated 753 patients, and in January alone this year it was 111.

Ninety-two percent of cases come from outside Kathmandu from 75 districts,” says Nakarmi. “When we started it was 42%.” 

Ideally, burns treatment should be decentralised so that local levels have primary burn care centres no more than two hours away, where patients can get initial treatment like cooling and dressing of wounds, and fluid replacement.

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If necessary, they could be transferred to regional centres to handle surgery for minor burns. The government has already designated six such facilities across the country, and Nakarmi says the Centre could train their staff.

He clicks forward on a slide to show a female patient brought in two months ago with her buttocks and thighs burned. “The wound was deep, it was not going to heal on its own. She needed some kind of graft.”

If surgeons at a regional facility were properly trained, they could have done the graft. Instead, the patient waited for one month before coming to Kirtipur. 

Nakarmi is looking for funding for a 70-bed national burn care centre at Kirtipur Hospital, where patients can be isolated from the risk of infection that comes with sharing space in general wards.

Another MP, Bindabasini Kansakar, is herself a survivor of an acid attack by a spurned suitor in 2013. She registered a Bill in Parliament last year that includes specialised burn units in all government hospitals with 100+ beds, and in some private hospitals and medical colleges in Kathmandu.

She is also calling on the government to create a fund to give immediate financial support to victims and their families, discounts for women and children, especially from poorer communities, as well as training for health staff, twice yearly awareness programmes at local levels, and strong penalties to deter acid attacks and intentional burn injuries.

Parliament’s delay in passing the Bill is ‘deeply frustrating, especially given my personal experience,’ Kansakar wrote to us. 

‘I know first-hand the physical, emotional, and financial struggles burn victims endure. Delays mean more victims are left without proper care, financial support, or legal protection,’ she added. ‘If burns affected wealthier or more influential communities, the response might have been swifter. This inequality is precisely why the Bill is so crucial — to ensure justice and support for all victims, regardless of their social standing.’

Burn incidents are the second most common injury in rural Nepal, according to the World Health Organization, and researcher Kamal Phuyal says that making just a handful of simple adjustments to everyday life could prevent most major burns.

Before Covid-19, he ran a research project in three municipalities in the mountains, hills and Tarai. After six months gathering data, the team told locals to make changes in their communities to prevent burns.

For the next two and a half years, Phuyal worked with health staff, female community health volunteers and other locals. In that time, the number of major burns in the three districts dropped from 21 to zero for two years running.

The most effective change was to stop people from cooking on the ground. “If you can put the cooking stoves just three feet (1m) off the ground, 50% of burns can be eliminated,” explains Phuyal. 

Nakarmi says that 70% of patients at Kirtipur Hospital, too, got burn injuries in the kitchen. “It should be the safest place to be, but it is the most unsafe,” she adds.

Phuyal says local representatives were convinced by his findings and, especially in Makwanpur, eager to make changes. In a training session at Sushma Koirala Memorial Hospital (SKMH) last October, he expected local governments to approve construction of a house only if the plans included putting the cooking space 1m off the ground, to reduce burn incidents.

But Covid-19 hit, the project ended, the officials were replaced after elections, and the work lost momentum. Today, no local government seems to have moved forward on burn prevention.

During the training session at SKMH, the hospital’s deputy director, Rojina Shilpakar, described some of the burn cases at the facility in recent months.

In Dailekh district, two boys were severely burned while collecting fodder. “The parents all thought that they would die so they didn’t take them for medical help. But after two weeks they survived and the story was posted on social media.”

The hospital reached out and arranged for both boys to be brought to Kathmandu, one to Kirtipur Hospital and the other to SKMH, with burns on 40% of his body. “He was emaciated, just flesh and bones, covered in herbal medicine that looked like mud,” recalls Shilpakar.

If he had been brought for treatment quickly, he could have recovered sooner, she adds. But he was malnourished, and contractures had developed where one part of the body sticks to another, preventing movement.

“We couldn’t take him to the operating room right away because of his malnourished condition. He had to gain some weight, increase his haemoglobin levels. Even skin grafts were not taken properly, so it affected the healing,” explains Shilpakar.

Poverty prevents many families from seeking care, although both facilities will not turn away burn cases for lack of money. SKMH paid the bills for the Dailekh boys' treatment, including an eight-month hospital stay. Now seven, the youngster has already had a follow-up surgery and is likely to need more operations as he grows.

Smaller hospitals outside Kathmandu often do not not accept severe burn cases, and instead send them immediately to a larger facility. “If the patient dies within a few hours, they will be blamed, So they just try to push them away,” adds Shilpakar.

SKMH has been training health workers from across the country to treat burns since 2012. This includes countering the prevalent belief at the time that burn victims should not be given fluids. Patients would reach the centre dehydrated, and then go into acute kidney failure. Some with a high percentage of burns die.

Those cases have decreased in the last few years because health workers have been trained, including to give fluids to patients.

The treatment at the Cleft and Burn Centre has become much more effective since it opened in 2014. Says Nakarmi: “Back then we could not save anyone who had 40% burns or greater. Now we can save half of victims with 40% burns, and if someone has 60% burns, they have a 15% chance of survival. We aim to save half of patients with 60% burns.”

The centre developed a six-day training for health staff on burns care for workers from facilities country-wide, but funding was provided by USAID and has been cut. There is no replacement in sight.

Recent increase in government support for burns treatment seems to have been sparked by the case of MP Bhandari. In October, the government announced free treatment for patients from the poorest families. 

“But there is a little catch,” says Nakarmi. “The treatment of destitute burn victims, are supposed to be covered right? But everyone else also wants to get support. A lot of Nepali people are not destitute, but they are poor. We just try to cover their costs as much as possible.”