Preventing suicide by pesticide in Nepal

This article discusses suicidal behaviour. If you have questions on self-harm or feel suicidal, Nepal’s national Suicide Prevention helpline is 1166. Use this link to find an international helpline.

Last year, my phone rang late at night. A colleague from a Kathmandu hospital was on the line, his voice sounded urgent. The patient was a 17-year-old boy who had ingested enough lethal pesticide to end life.

What was more shocking was not just his age, but the fact that this pesticide was banned in Nepal four years ago. On paper, it should no longer exist in the market. In reality, the banned substance is still available, sold discreetly to avoid regulators. But it is within easy reach of those in despair.

Despite the doctors’ best efforts, the boy could not be saved. His death left a family shattered, a community grieving. Another life lost to a poison that should not even be on the shelves?

The pesticide in question is aluminium phosphide, commonly sold in tablet form to protect stored grain from pests. It releases highly toxic phosphine gas when ingested, and it is this lethality that makes it one of the most common agents of self-harm in South Asia, including Nepal.

A 2021 study supported by the Center for Pesticide Suicide Prevention at the University of Edinburgh showed aluminium phosphide as one of the most common agents for pesticide deaths in Nepal.

Recognising the negative effect of highly hazardous pesticides to the environment and human health, the Ministry of Agriculture and Livestock Development has banned 26 pesticides since 2001, including small aluminium phosphide tablets and dichlorvos in August 2019, and paraquat and chlorpyrifos in December 2024. 

However, enforcement is weak. 

Pesticide poisoning is not an isolated health issue, it is a national crisis. In 2023-24, the total reported deaths from suicide in Nepal peaked at 7,223 — the highest number ever recorded. On average, 20 Nepalis die by suicide every day. 

Some 15% of these deaths were caused by the ingestion of toxic substances, and nearly 95% of those involved highly hazardous pesticides. In rural areas, where most cases occur, pesticides are often more accessible than healthcare or counselling.

To be sure, pesticide-related suicide deaths have generally declined over the past few years, falling from 1,276 in 2020-21 to 932 in 2022-23. Last year, there was a slight increase to 952, but the overall trend shows a significant and sustained public health improvement. 

Deaths from dichlorvos poisoning have decreased markedly, research shows. However, fatalities linked to aluminum phosphide have not declined significantly.

Behind every number is a story: a young student overwhelmed by exam pressure, a farmer drowning in debt, a mother caught in a family dispute. In moments of despair, access to a lethal poison often determines whether a person survives or dies.

Research worldwide shows that restricting access to highly hazardous pesticides significantly reduces suicide deaths, without increasing the use of other methods.

Suicide is complicated, influenced by mental health issues, family problems, and financial stress. But the method makes all the difference. In Nepal, many pesticide-related suicides are impulsive, carried out in moments of crisis when lethal pesticides are within reach. 

When a deadly poison is easy to get, survival is unlikely. If it is removed, people may still try to harm themselves, but their chances of survival are much higher. This chance can be the difference between life and death, despair and recovery.

Preventing suicide in Nepal requires action on many fronts: strictly enforcing pesticide bans and holding violators accountable, closely monitoring pesticide sales and stocks, supporting poison centres to help doctors treat poisoning cases quickly, providing community mental health services to find and assist people at risk, and raising public awareness to reduce stigma around mental health and encourage families to seek help.

The crisis in Nepal reflects a broader global challenge. The World Health Organization estimates that pesticides account for nearly one in five suicides worldwide. Low-and middle-income countries bear the heaviest burden, particularly in agrarian societies where pesticides are stored in homes.

As we mark the World Mental Health Day on 10 October, Nepal has both an urgent responsibility and an opportunity to show leadership. By committing not just to policy but to real enforcement, Nepal can save thousands of lives in the years to come.

It is unacceptable that young Nepalis continue to die from poisons that should no longer exist in our communities. Regulators, policymakers, health workers, and civil society must work together to close the gap between law and practice.

The 17-year-old boy from Bagmati should have had his whole life ahead of him. Instead, he is now just another statistic in Nepal’s preventable tragedy of pesticide suicides. For him and countless others like him, we must ensure that deadly poisons are truly off our shelves.

Rakesh Ghimire, MD, is a clinical pharmacologist and assistant professor at Institute of Medicine in Kathmandu. He is the recipient of the 2025 Mrigendra Raj Pandey Young Health Research Award.