<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114121112/637222f59c7e80680e0c0327jpeg.jpg" alt="" width="760" height="486"/><figcaption>Govinda KC, Nepal’s crusading surgeon and health activist, plastering a patient’s ankle at the Mugu District Hospital on Sunday. He saw 177 patients for free in five days before travelling on to Jumla on foot. Photos: ACHYUTRAJ BHANDARI</figcaption></figure>Nepal’s  crusading surgeon and health activist Govinda KC has been on hunger strike 19 times since 2012, demanding medical education  reform and equitable healthcare. After retiring from his government job, KC has served patients in all 77 districts and other disaster-stricken countries. He is currently at Khandbari District Hospital in Sankhuwasabha where Nepali Times caught up with him.Excerpt from the conversation:Nepali Times: What is the state of healthcare in Nepal?Govinda KC: Most citizens from both urban and rural areas do not have access to healthcare. Many patients are too poor to afford quality treatment, and those who can not get quality care.The law specifies that 70 types of medicines should be available free of cost in district hospitals, 50 in primary health centres, and 35 in health posts. That is not the case in practice.Some government hospitals even charge money for medicines that are supposed to be free. And hospital fees are just too expensive, so they end up dying, being disabled for life, or sinking deeper into poverty.Health facilities in many rural districts are under-equipped, under-staffed and many patients have to return home without treatment. There are no big hospitals there to begin with, and even the urban poor cannot afford priate city hospitals.Doctors, nurses and office assistants have stuck around in government hospitals only because they are bound by contract. Some hospitals are led by junior non-physicians, making a chaotic and inefficient system.So, where is the problem? The problem in providing basic healthcare arises when the local representatives and  politicians do not work to provide it. When the 2015 constitution was announced, I was in satyagraha. My only demand was that our representatives be treated in health facilities in the same place as their voters. That demand was not fulfilled.The Constitution guarantees the citizen's right to health, but elected politicians do not care about health reforms. They are too busy getting rich overnight by commodifying education and health.I have been fighting to have hospitals and schools in every village, but people prefer to open hospitals in the city. Locals can have access to specialist services at a hospital in their village. This can also help to produce doctors, nurses and public health workers in the provinces. But no one is willing to do that. Politicians are on the payroll of the medical mafia.Do you regret going through all those hunger strikes? Many of my demands were not met. Some promises have been made, but not been implemented in practice. But some have been addressed, like the Medical Education Act was formed after multiple satyagraha. Then the Medical  Education Commission was formed.Before the Act, MBBS entrance exams were conducted by colleges and institutes in their own way, but now it is regulated by the Medical Education Commission.Only those who pass the entrance exams are now eligible for government scholarships and can pick their own college. Action is taken against private institutions if they do not follow the regulationsNow, medical colleges are selected based on their infrastructure, equipment and human resource.  Fees have also  dropped from Rs7-9 million to Rs4.2 million. Medical school is a lot cheaper now, especially for students who are unable to get scholarships.Government medical schools charged up to Rs10 million for  specialised education. Now, students do not have to pay, but get paid instead. After getting an MD they also need to serve for two years in a place assigned by the government. These contract doctors run the country’s healthcare todaySo, the hunger strikes have not been in vain. One of my demands was to have one government medical college in every province. At present, the Karnali Institute of Health Sciences is in operation in Jumla, and the physical infrastructure of Geta Medical College in Dhangadi has been completed. One medical college is soon opening in Dadeldhura after my hunger strike.Despite this, some goals have been lost to the challenges posed by the alliance of political  parties with the mafia. The construction of the Rapti Institute of Health Sciences in Dang was halted due to obstruction from local leaders, and a medical college in  Bardibas due to land acquisition issues.What policies should the government focus on now?First of all, access to basic services, human resources, equipment and medicine should be extended to people in rural areas and the urban poor. If primary health centres and district and provincial hospitals are improved, then 80-90% of patients do not have to  come to Kathmandu for treatment. The government needs to add more human resources to meet the current demand for healthcare.There should be a 15-bed operational hospital in each municipality. Hospitals should also be made free for people to have quality healthcare. The government should take actions against hospitals that operate without meeting proper standards.Additionally, the Medical Education Commission, Nepal Medical Council and other organisations should appoint qualified applicants, not political activists. In fact, the practice of hiring contract-based employees should be eliminated. Contract doctors have a higher chance of fleeing if they are not given temporary incentives to stay.Despite the huge demand for rural doctors, the Public Service Commission opens only 20 seats for doctors each year. This has to change.Any more hunger strikes?I am committed to campaigning for medical education reforms. Along with health and education, we are also fighting for good governance and social justice, without which reform is impossible.I also want to serve in remote areas, which is why I am here in Okhaldhunga. I will fight for people in all parts of the country to have quality, free, affordable and equal access to healthcare as guaranteed by the Constitution for as long as I can.Read more: <a href="https://www.nepalitimes.com/latest/govinda-kc-treats-patients-in-remote-nepal/">Govinda KC treats patients in remote Nepal</a>, Achyutraj Bhandari

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"Nepalis are dying because they are poor”

<img width="3724" height="2151" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c729c7e80680e0bd491jpeg.jpg" alt=""/><a href="https://archive.nepalitimes.com/news.php?id=12452#.YlFKe9NBxH0">Goitre</a> was once so <a href="https://www.nepalitimes.com/latest/from-pandemic-to-epidemic-to-endemic/">endemic</a> in Nepal that it was considered a sign of beauty. Entire villages across northern Nepal that relied on <a href="https://www.nepalitimes.com/banner/the-salt-of-the-earth/">Tibetan rock salt</a> suffered from iodine deficiency, and cretinism was widespread.Read also: <a href="https://www.nepalitimes.com/banner/the-salt-of-the-earth/">The salt of the earth</a>, Jag Bahadur BudhaUnlike sea salt which contains adequate iodine, the micronutrient mostly evaporates from rock salt, and people who used it were affected by <a href="http://archive.nepalitimes.com/news.php?id=9144#.YlFK49NBxH0">iodine deficiency</a>. Those suffering from it had throats disfigured with large growths.A successful public-private partnership between the government, Salt Trading Corporation and aid agencies <a href="http://archive.nepalitimes.com/news.php?id=9144#.YlFK49NBxH0">iodised salt</a> under the brand आयो नुन and this all but eradicated visible goitre — it went down from 55% in 1965 to only 0.4% in 2007. This is one of Nepal’s public health success stories.However, in solving one problem, we may have created another. The country is now facing thyroid disorders caused in part by excess iodine intake. Recent studies show an increasing prevalence of thyroid disorders, even among younger Nepalis.A 2019 community-level survey in five districts found the prevalence of thyroid disorders at 4.32%. Nearly three-fourths of those were subclinical hypothyroidism, 13.7% primary hypothyroidism and another 13.7% were hyperthyroidism.Hypothyroidism is when the thyroid gland does not produce enough hormones. In hyperthyroidism, on the other hand, the gland is overactive and produces too much hormones. Subclinical conditions do not need immediate treatment.The figures for hospital-based surveys are much higher. In a paper published in 2015 based on 5,230 cases from Teaching Hospital in Kathmandu, 29% were diagnosed with thyroid disorders. Higher prevalence was found in the 31-45 age group.However, experts are cautious about pinpointing excess iodine in the diet as the only cause for thyroid disorders.“The prevalence of thyroid disorders has indeed increased in the last 10-15 years, but this could also be a result of better diagnosis even in rural areas,” says endocrinologist Ansumali Joshi.The recommended daily intake of iodine is 150 micrograms, but is higher for <a href="https://www.nepalitimes.com/here-now/saving-one-nepali-mother-at-a-time/">pregnant and lactating women</a>. <img width="477" height="544" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114111144/63721c759c7e80680e0bd492jpeg.jpg" alt="">A 2016 survey showed that 67.5% of households in Nepal have excessive iodine intake in food. School-age children were classified in the ‘excessive’ range, pregnant women in ‘adequate’ and women of childbearing age in ‘more than adequate’. Iodine intake was higher in the central and western parts of the country and the Tarai.“Iodised salt has reached every corner of Nepal and because there is excessive use of salt in food items, logically people are overdosing on iodine,” says cardiologist Prakash Regmi. “Excessive salt intake is already a leading cause of <a href="https://archive.nepalitimes.com/news.php?id=18115#.YlFMNtNBxH0">heart</a> and <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639">kidney diseases</a>. And excess iodine is now adding thyroid dysfunction which can affect the brain and the nerves.”After the 2016 assessment, the government reduced iodine content in salt from 50PPM (parts per million) to 30PPM. Experts say it might be time to reduce it further, or even add the micronutrient in some other food item.Misinterpretation of iodine ‘overdosing’ could also send out the wrong message, they warn, leading to the public avoiding iodised salt, and thus reverse Nepal’s successful eradication of iodine deficiency.Other factors affecting thyroid glands include viral infections and endocrine disrupters like <a href="https://www.nepalitimes.com/latest/biodegradable-plastic-launched-in-nepal/">plastics</a> and certain chemicals. Thyroid disorders can also be hereditary. Covid-19 has also been associated with thyroid inflammation, resulting in hyperthyroidism or thyroiditis.Untreated hyperthyroidism can lead to ‘thyroid storm’, a very rare but life-threatening condition in patients often referred to Kathmandu hospitals due to <a href="http://archive.nepalitimes.com/news.php?id=4980#.YlFMxNNBxH0">lack of treatment facilities</a> elsewhere.“We know either too much or too little about thyroid disorders. But there is a general lack of clear understanding, I have a lot of patients who visit me all panicking about their thyroid test results,” says endocrinologist Jyoti Bhattarai. “But there is a spectrum to thyroid diseases, and many do not need treatment. Subclinical hypothyroidism is one example.”Read also: <a href="http://archive.nepalitimes.com/news.php?id=18379#.YlFJb9NBxH0">Diabetic dilemma</a>, Buddha Basnyat There are groups more at risk: pregnant women and those planning to conceive who should take thyroid function tests to prevent possible premature birth, miscarriage and even stillbirth. Women unable to conceive should also be screened.And ideally, all newborns should also take a test because early diagnosis of a congenital hypothyroidism can almost entirely prevent mental disability. Another risk factor is obesity.“Growing up in the mountains I had several family members afflicted with goitre. We have made much progress since then, but it is time to change our focus and study the prevalence of thyroid disorders today,” says Pokhara-based physician Bikash Gauchan. “It affects multiple systems and patients experience a wide range of symptoms with implications on both <a href="https://www.nepalitimes.com/latest/the-other-pandemic-mental-health/">mental</a> and <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">physical health.</a>”Endocrinology and the study of hormones used to concern only the well-to-do. Public health in Nepal was all about preventing infectious diseases which afflicted the poor. Today, the lines are blurred, and Nepal needs treatment for chronic diseases of the vital organs like the lungs, heart, kidney and stomach for all sections of society.Says Jyoti Bhattarai: “The field of endocrinology in Nepal needs much more commitment and investment. While hormonal dysfunctions including thyroid disorders are often not immediately fatal, they can significantly affect one’s quality of life.” Read more: <a href="https://www.nepalitimes.com/latest/why-do-so-many-nepalis-have-high-blood-pressure/">Why do so many Nepalis have high blood pressure?</a> Sonia Awale

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Either too little, or too much iodine

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a664f9c7e80680e059974jpeg.jpg" alt="" width="1200" height="793"/>Around the world, in rich countries and poor, financing healthcare is one of the biggest challenges. In poor countries, it becomes a life-or-death issue.Over 40% of global healthcare expenses are still covered by patients and their families, and more than half the world’s population lacks access to essential health services. Medical bills push 100 million people into extreme poverty every year.Nepal has taken remarkable strides in healthcare in past decades despite internal conflict and instability, but <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical care is still unaffordable</a> or inaccessible to most. More than half the healthcare expenditure of Nepalis is still covered out of pocket. Nearly a third of families spend over 10% of their annual income on medical care.Read also: <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa Bhattarai <a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/" target="_blank" rel="noopener">State of the art rural hospital</a>, Marty LoganThursday, 12 December, is Universal Health Coverage Day, an important date to remind ourselves of the next steps we need to take to achieve healthcare for all. The 2015 constitution of Nepal declares basic and emergency healthcare as fundamental rights of citizens, putting the responsibility of financing such care on the state. Following federalism, municipal governments have got the responsibility to manage basic and essential care. A national health insurance bill has been passed and is being implemented.The state guarantees quality healthcare without financial burden on citizens, for which the insurees pay Rs3,500 per year for a family of five, and receive care worth Rs100,000. This is expected to reduce the burden of out of pocket and catastrophic expenses, while the government covers the premium for citizens under the poverty line.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance scheme is not as easy as it looks</a>, Sonia Awale<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialThere is also a provision for free essential drugs and free treatment for patients with cardiovascular disease, cancer, spinal injuries, renal ailments and sickle cell anaemia, through the Disadvantaged Citizens Medical Treatment Fund.None of these initiatives is being implemented fully yet, but with federalism Nepal has a chance to build an accountable and sustainable healthcare system. The country therefore needs to focus on the following areas to manage health financing to meet the targets of the Sustainable Development Goals:<ul><li>Increase public sector healthcare investment to at least 7% of annual national budget. This should also be targeted towards reducing external aid.</li> 	<li>Empower people for self-care and make treatment more strategic and efficient as the burden shifts from communicable to non-communicable diseases.</li> 	<li>Focus on primary health care and improve services at the first point of care with comprehensive, accessible and community based care.</li> 	<li>Coordinate multisectoral policy action involving education, agriculture and social behaviour.</li> 	<li>Launch a priority national campaign to spread insurance coverage. Enrollment can be top-down starting with all government officials and then the public at large.</li></ul>A mixed financing model using tax-based funds through the treasury, and premium-based funds through health insurance can work for public, private, community, and other hospitals that run under the state-non-state partnership. An example of state- non-partnership is Bayalpata Hospital in Achham district, managed through a public-private partnership between the ministry of health and population and the non-profit Nyaya Health Nepal, where insurance reimbursement covered over 60% of the hospital’s operating costs.The hospital provides healthcare with no user fees. The care is extended from hospital to communities using a network of community health workers. How can care delivery with no user fee sustain? Can Nepal afford to provide such care to its entire population?It is possible. The country should effectively implement the national health insurance program, and strategically invest tax based funding. In the mixed financing model, for a ‘district level hospital, insurance can cover 60% of healthcare operating costs, and tax-based funding can take care of the rest. But to ensure effectiveness, the tax-based investment will need to be unrestricted and tied to audited performance indicators. The cost of care should also incorporate the extension of hospital-based services into communities in the catchment area.Bayalpata Hospital serves both as a primary care facility and also as a referral hospital. In this case, the tax-based contribution can be split into the three government tiers, with the federal government providing support for infrastructure, and provincial and local governments covering the cost of basic healthcare, and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/Nation-Crowdfund-globally-act-locally,490" target="_blank" rel="noopener">Bayalpata Hospital</a> provides basic and referral care, and its tax-based contribution can be split into the three government tiers, with the federal government providing support for basic infrastructure and provincial and local governments covering the cost of basic and referral care not covered by the insurance.Insurance reimbursement then covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage.The proposed model has a 60:25:15 ratio to pay for health care, with 60% from insurance and provincial and local governments paying 25% and 15% of the cost. When the benefit package increases to cover the cost of healthcare without capitation, the share of health insurance coverage percentage will increase significantly, thereby reducing the tax-based direct public sector investment.S P Kalaunee is Executive Director of Nyaya Health Nepal, which manages Bayalpata and other public hospitals in partnership with the ministry of health and population.

Is free health care possible in Nepal?

After a week of violent and destructive protests, Nepal’s President Ram Chandra Poudel on Friday appointed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">former Chief Justice Sushila Karki</a> as a caretaker Prime Minister to lead an interim citizens' government.&nbsp; Poudel had been in <a href="https://nepalitimes.com/news/what-next-nepal">closed-door discussions since Thursday</a> with youth members who spearheaded the protests, constitutional experts, the House Speaker, and the Army Chief. There was a consensus on the choice of Karki as candidate for interim prime minister, but her swearing-in was stalled due to a disagreement about Constitutional processes for her appointment.&nbsp; Youth delegates and Karki demanded that Parliament be dissolved before the appointment of the caretaker prime minister, while President Poudel had been arguing that Parliament would be automatically dissolved once the new council of ministers announced elections. Representing the GenZ movement, <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">Sudan Gurung</a> (pictured, below) is said to have insisted that dissolution of Parliament first was non-negotiable because he did not trust the political parties. He is said to have added that he would call his supporters out into the streets, and the President relented. The military’s warning earlier that an emergency would be declared if there was no agreement tonight clinched it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3.jpg" data-media-id="editor_3" data-image-id="2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3" data-rendition-name="original" width="1080" height="600" loading="lazy" alt="Sudan Gurung"> <figcaption>Sudan Gurung of Hami Nepali during negotiations.</figcaption> </figure>  With this, Karki becomes Nepal’s first female prime minister, exactly a decade after she became the <a href="https://archive.nepalitimes.com/article/interview/a-woman-is-as-capable-sushila-karki,3375">country’s first female chief justice in 2016</a>.&nbsp; Nepalis, still shocked by the <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">death and destruction of the past week</a>, heaved a sigh of relief at the announcement, which was greeted as a victory of youth power for political reform led by the GenZ movement. Its initial anti-corruption protest on 8-9 September <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">spiralled out of control into violence and arson</a> nationwide that claimed at least 51 lives. Several other candidates were floated for the caretaker prime minister’s post. Kathmandu Mayor Balen Shah and former head of the electricity utility Kulman Ghising were being considered, but both declined possibly because they want to contest the next national elections. Given her experience in the judiciary and zero tolerance for corruption, Karki was the favourite of various groups within the GenZ campaign.&nbsp; The site of the negotiations moved to the official residence of the president in Shital Niwas from the Nepal Army Headquarters on Thursday. The Army had come under criticism on social media and from civil society for detaining the President and not letting him speak or be a part of the negotiation.&nbsp; This fuelled public perception that the military had a soft spot for a return of the monarchy. There were widespread rumours on Thursday that king Gyanendra, who was ousted after the abolition of the monarchy in 2008, was trying to stage a comeback by piggybacking on the agitation. Writing on X, senior journalist Kishore Nepal revealed that the Chief of Army Staff Ashokraj Sigdel had allegedly asked Poudel to step aside and pave the way for the military to negotiate, to which the President is said to have replied: “I will not resign. Kill me instead and blame it on the protesters. Then you can do whatever you like.” Live broadcast of swearing in of Sushila Karki:&nbsp; <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/53go4OxuOa0?si=Zd89QGIAX8-7Bm75" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d.jpg" data-media-id="editor_8" data-image-id="2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d" data-rendition-name="original" width="1280" height="851" loading="lazy" alt="Sushila Karki swearing in"> <figcaption>President ram Chandra Poudel swearing in Sushila Karki as the 42nd Prime Minister of Nepal.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba.png" data-media-id="editor_9" data-image-id="2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba" data-rendition-name="original" width="1480" height="924" loading="lazy" alt="Sushila Karki PM"> <figcaption>GenZ representatives with new Prime Minister Sushila Karki after her swearing in.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029.jpg" data-media-id="editor_10" data-image-id="2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Sushila Karki PM"> <figcaption>Sushila Karki with supporters including Genz representative Sudan Gurung of Hami Nepal and Sumana Shrestha of Rastriya Swatantra Party.</figcaption> </figure>  COURAGE AND INTEGRITY Sushila Karki served as the chief justice between 11 July 2016 to 6 June 2017, and has been known for her frugal ways. She was a firebrand judge unafraid to ruffle powerful feathers, and as chief justice was behind ruling to impeach for abuse of office a powerful head of Nepal’s anti-graft body in 2016. She wrote that he had ‘<a href="https://archive.nepalitimes.com/regular-columns/Legalese/the-end-of-karkistocracy,827">neither the moral character nor qualifications for the post</a>’. Even before she became Chief Justice, Karki was one of the two judges on the bench that convicted the sitting Minister for Information and Communication, Jaya Prakash Gupta, of corruption in 2012. Then in 2016, a bench including Karki ruled against granting amnesty to former Maoist lawmaker and convicted murderer Bal Krishna Dhungel. Karki was born on 7 June 1952 in Biratnagar. She completed her undergraduate studies at Mahendra Morang College in 1972 before obtaining a postgraduate degree in political science from Banaras Hindu University in India three years later. This was followed by a Bachelor's in Law in 1978 from Tribhuvan University, and she started her law career as an advocate a year later. In 1985, Karki worked as a teacher at Mahendra Multiple Campus in Dharan, and was jailed for participating in the 1990 People’s Movement to overthrow the Panchayat absolute monarchy. She became a senior Advocate at the Nepal Bar Association in 2008 and was appointed an Ad-Hoc Justice at the Supreme Court in January 2009.&nbsp; On Thursday, there were supporters for other candidates for the post sloganeering against Karki’s nomination outside the Army Headquarters. Some on social media were also skeptical of her connection to the Nepali Congress (NC) party. Growing up in Biratnagar Karki was close to the family of B P Koirala, Nepal’s first elected prime minister in 1960. Her husband Durga Subedi was part of a group of underground Congress activists who hijacked a Royal Nepal Airlines plane in 1973, flying it to India to snatch cash belonging to Nepal Rastra Bank in the cargo hold.&nbsp; The money was used for the party’s pro-democracy campaign. Karki has no love lost for the political establishment. In April 2017, the governing coalition under Maoist Prime Minister Pushpa Kamal Dahal <a href="https://archive.nepalitimes.com/article/editorial/lady-justice-sushila-karki,3693">submitted an impeachment motion against her</a> after the Supreme Court overturned his decision to install a favoured police chief, violating succession based on seniority. It was a political move backed by Dahal’s coalition partner Sher Bahadur Deuba of the NC who was waiting to become prime minister for the 4th time. CHALLENGES AHEAD With Karki now in charge of the interim government, she has the daunting task of forming a council of ministers made up of amorphous and disparate groups from the GenZ, technocrats, and current politicians. Karki has said she will not prevent members of her cabinet from contesting elections, which means those with electoral aspirations like Kulman Ghising, Balen Shah and Sumana Shrestha could be asked to join. Karki has her work cut out as she has to get her team members to pull in the same direction to hold free and fair elections. She also has to make sure she has the support of the military without giving the generals too much say, while also smartly maneuvering Nepal’s precarious geopolitical ties with its giant neighbours, China and India. But most of all, the new prime minister must lay the foundations to not just physically rebuild the judiciary, executive and legislature but also ensure that elections will produce a more accountable and efficient government. Read also: <a href="https://nepalitimes.com/editorial/trial-by-fire">Trial By Fire</a>, Editorial

Madam Prime Minister of Nepal

Many had never heard of <a href="https://www.haminepal.org/">Hami Nepal</a>, the organisation that is part of the GenZ movement that did not just topple the government this week, but <a href="https://nepalitimes.com/news/what-next-nepal">pushed Nepal’s political system into new, uncharted territory</a>. It was part of an organic coming together of various youth groups fed up with Nepal’s corruption, mismanagement and lack of accountability. Hami Nepal and its GenZ comrades are now part of the negotiations with the Army to form an interim government. Hami Nepal is a non-profit dedicated to supporting communities and individuals in need, guided by its motto ‘For the People, By the People’. Its core mission is to assist individuals and communities in need, particularly during emergencies and crises, with a focus on directly connecting donors with recipients, and delivering aid efficiently and transparently. It was set up after the 2015 earthquake, but was formally registered and gained recognition in 2020 during the Covid-19 pandemic. Hami Nepal is led by 36-year-old civic activist Sudan Gurung who started the organisation after he lost his own son in the 2015 earthquake.&nbsp; Leading up to the events this week, it played a central role in guiding the demonstrations, using its Instagram and Discord platforms to circulate protest information and share guidelines. Other GenZ groups used their own WhatsApp groups and other fora.&nbsp; Among the 20 or so volunteers is Ronesh Pradhan, who spoke to <a href="https://nepalitimes.com/news/nepal-s-gen-z-protest-turns-deadly">Nepali Times on 8 September </a>morning during the GenZ rally, before the violence escalated.&nbsp; “The voices of young people matter. We can’t keep being ruled by the same old men,” Pradhan said. “Our generation is the future and if there are older leaders in government, they need to be competent and accountable. We are ready to lead this country forward.” Hami Nepal’s earliest visible campaigns include donating more than 400 blankets to Bir Hospital’s Covid unit in 2022, creating a plasma and oxygen bank during the pandemic, and distributing school jackets to children in rural districts. More recently, it mounted a relief effort in response to the 2023 Jajarkot earthquake, reaching over 13,000 families with shelter, food, and medical support. The organisation was also associated with the two-month ‘Save Ghopa’ campaign, demanding effective and smooth administration of the BPKIHS (B P Koirala Institute of Health Sciences) in Dharan. The organisation was also actively engaged in providing rescue and relief during the Kagbeni and Sindhupalchok floods this year. It even sent aid to Turkey after its 2023 earthquake. After the Kavre floods last year, Hami Nepal donated solar lights. Funding for Hami Nepal comes directly from public donations, with a policy of channeling 100% of received funds for aid distribution. Volunteers self-finance administrative costs, and the group publishes detailed expenditure figures, regularly sharing updates and transparency reports through their social media and website which it launched at its Annual General Meeting in Bhaktapur last year.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88.jpg" data-media-id="editor_3" data-image-id="20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88" data-rendition-name="original" width="1080" height="719" loading="lazy" alt="Who, or what, is Hami Nepal?"> </figure>  Following the death of Nepali student Prakriti Lamsal at KIIT University in India earlier this year, Hami Nepal advocated for justice using its Instagram account, raising concern about the safety of Nepali students. Its advocacy platform started with rescue and relief, and Hami Nepal managed to develop a track record for efficient campaigns and transparency in Nepal’s humanitarian landscape. But its work pushed the group to realise that there was a deeper malaise in Nepali society. Its #youthsagainstcorruption campaign on social media platforms gained rapid momentum, and that led to the rally on 8 September. Read also: <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">Nepal’s 8 September massacre</a>, Shristi Karki The international #Nepobaby trend on TikTok propelled the rally even more, and young Nepalis used it to expose the scions of powerful politicians and politically-connected influencers who were exhibiting their flashy lifestyles on social media while citizens struggled with joblessness, corruption and poor service delivery. Public anger reached a tipping point when the UML-NC coalition led by Prime Minister K P Oli announced a sweeping ban on major social media platforms citing tax revenue, cyber security, and lack of content moderation. Netizens, civil society and media, however, saw it as the latest authoritarian attempt by the government to clamp down on free speech, increase surveillance of citizens and constrict Nepal’s open society. Susmita Khadka, 22, told us at the rally: “Politics is everywhere. Gen Z has the most platforms, and we want a revolution.” Leading up to 8 September, the GenZ movement disseminated information and reassured participants with volunteers readily available for help, medical support, and assistance. It put up a protest support helpline so that students needing assistance could get help. As the protests intensified, leaving at least 20 dead outside Parliament, and forcing Prime Minister K P Oli to resign, Hami Nepal shifted into a mediator role, engaging in talks with officials and seeking GenZ’s views on future leadership.&nbsp; Influencers like TikToker Nimesh Shrestha publicly backed the group, amplifying their voice in ongoing negotiations with the Nepal Army alongside other GenZ representatives. However, as the protests escalated on 9 September, <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">resulting in massive arson and vandalism of public and private property</a>, many GenZ activists disavowed association with the attackers, saying their movement had been infiltrated. The group backtracked, with Gurung saying he was not the leader of the protests.&nbsp; Meanwhile, others accused Hami Nepal for singlehandedly speaking with the Army chief, and said that they did not represent GenZ’s collective voice. Most GenZ supporters backed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">Former Chief Justice Sushila Karki</a> as their candidate for interim prime minister in an online group. Not everyone in the GenZ movement agrees with that choice, with support for Kathmandu Mayor Balen Shah, even though he has endorsed Karki’s appointment. Dharan Mayor Harka Sampang rushed to Kathmandu on Wednesday to push his own candidacy. Hami Nepal has supported Balen Shah to lead the country for the next five years, not just during the interim period, and have called on the public to share their posts supporting Shah to amplify the message. With the old guard gone, there is a power vacuum with multiple actors with competing interests to fill it. GenZ’s youth-led activism has brought new energy for political reform, but its real test begins now — whether it can unite Hami Nepal and other sections to negotiate with the Nepal Army.&nbsp;

Who, or what, is Hami Nepal?

As this story is being uploaded on Wednesday evening, sloganeering is going on outside the gates of the Nepal Army headquarters in Kathmandu between various GenZ groups about who should be the caretaker prime minister.&nbsp; The GenZ campaign includes Hami Nepal and several other groups that spearheaded the anti-government rally this week against corruption and neoptism. Thirty people died as the protests in Kathmandu turned violent on Monday and Tuesday. After Prime Minister K P Oli stepped down on Tuesday, Nepal has existed in a power vacuum, with no one really in charge. The Nepal Army took over security management from Monday night, and President Ram Chandra Poudel appealed to Nepali youth to come to the negotiating table.&nbsp; Thousands of GenZ youth held hours long discussions on Discord and other online fora on Wednesday, and voted to endorse former Chief Justice Sushila Karki to lead the transitional government. The group informed Chief of Army Staff Ashokraj Sigdel about their choice, but he has also been meeting leaders of at least 12 other groups claiming to be the genuine GenZs. Among them are royalist and other groups that many saw as having infiltrated the GenZ rally on Monday in which 20 people were killed while trying to storm Parliament.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d.jpg" data-media-id="editor_0" data-image-id="20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d" data-rendition-name="original" width="640" height="387" loading="lazy" alt="Sushila Karki"> <figcaption>Photo: SHAHIDUL ALAM</figcaption> </figure>  On Tuesday, disparate groups joined the arson and looting that ended up gutting Singha Darbar, the Parliament and Supreme Court buildings and attacks on party offices, media, schools and private residences across the country. The original GenZ disavowed involvement.&nbsp; 'Nepal's 2015 Constitution does not envision any transitional or emergency provisions to address a state of political and constitutional vacuum. For now, the President, per Article 273 of the Constitution, can exercise emergency powers in light of the current situation,’ wrote former National Human Rights Commissioner Mohna Ansari on social media on Wednesday evening. The President can declare a state of emergency per Article 273 of the Constitution, but that must be endorsed by a two-third majority of Parliament within a month, after which it will be in effect for three months. ‘Former Chief Justice Sushila Karki is the best option to address the adverse circumstances prevailing in the nation. The President must heed the Constitution and take the next steps in a manner that is transparent, keeps the public informed, and is in the national interest,’ Ansari added.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf.jpg" data-media-id="editor_1" data-image-id="20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf" data-rendition-name="original" width="8000" height="5760" loading="lazy" alt="Nepal in ashes"> <figcaption>Photos: KAMAL PRASAI</figcaption> </figure>  The Gen Z movement itself appears fragmented and without distinct leadership, both before the anti-corruption protests on 8 September and in the aftermath of the two-day protests.&nbsp; Various groups are said to have met or waited to meet the Gen Sigdel on Wednesday. The Army told others claiming to be GenZ and raising slogans against Karki’s candidacy to appear at the army headquarters on Thursday.&nbsp; Nepalis had floated the names of some of Nepal’s more acceptable public figures to lead a caretaker government, including Kathmandu mayor Balen Shah. But Shah told the Army chief he endorsed Sushila Karki’s nomination. <div class="embed-block"><iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2FbalenOfficial%2Fposts%2Fpfbid02M9CBZiWETz4qocKaYUG6ZSZ4ARNcq231V8edJJVGQhPLmpSRMdv1mTWM2q7mJijjl&show_text=true&width=500" width="500" height="256" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowfullscreen="true" allow="autoplay; clipboard-write; encrypted-media; picture-in-picture; web-share"></iframe></div> The names of former NEA chief Kulman Ghising and ex-education minister Sumana Shrestha of the RSP had also been proposed.&nbsp; Polls conducted on social media to gauge public sentiment show a significant number are open to Sushila Karki taking charge of a transitional government. Both Shah and Shrestha are not so keen, and are probably waiting to contest elections.&nbsp; Meanwhile, Nepal’s young reform campaigners largely seem to reject the idea of handing leadership to RSP chair Rabi Lamichhane who was retrieved by supporters on Tuesday from Nakhhu jail after eight months of incarceration for embezzling depositers of cooperatives. But even as GenZ held discussions with the Army chief to decide on the interim government, other interest groups have continued to engage as well. Erstwhile royalist businessman Durga Prasai, posted a photo of himself with Sigdel on social media and professed that he has 'no interest' in leadership and would accept whomever GenZ youth chose. The job of the caretaker government, whoever leads it, will primarily be to hold free and fair elections for a new leadership which will then face the challenge of reestablishing Nepal’s democratic institutions.&nbsp; “The course of events showed that the movement has gone beyond Constitutional remedy,” political analyst Krishna Khanal told BBC Nepali following erstwhile Prime Minister Oli’s resignation on Tuesday. “There needs to be a middle-ground solution that will be acceptable to the people who took to the streets while upholding the existing constitutional process.” Various GenZ collectives have issued demands that include the dissolution of Parliament and the formation of a new civilian government, which analysts say are antithetical. Constitutional experts have suggested that the youth opt for a solution that allows for new leadership to move forward under the current Constitution.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29.jpg" data-media-id="editor_3" data-image-id="20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29" data-rendition-name="original" width="8064" height="6048" loading="lazy" alt="Nepal in ashes"> </figure>  One option, they say, is for the President to appoint any prime minister from the existing Parliament under Article 76(5) if all other measures fail, who would then have the authority to appoint up to 25 non-elected ministers for six months. This can be a way for that temporary leadership to hold elections within the mandated time frame. The existing Constitution can then be amended to accommodate the aspirations of the Nepali youth after the election.&nbsp; But any conditions put forward by GenZ youth that requires a new Constitution might set Nepal back years, warn some experts. The 2015 Constitution was the result of nearly 10 years of negotiations and strife, and the formation of another charter will mean that Nepal will head into decades more of rotating governments and political instability. For now, Nepali youth need to unite to decide by Thursday who leads the country into the next phase.&nbsp;

What next, Nepal?

Edited: The paragraph about K P Oli's whereabouts has been deleted. On Wednesday morning, orange flames are still leaping out of the windows of Singha Darbar. Fire trucks which could finally make their way in, were trying to douse the fires. Most of the ministries inside Singha Darbar, including the Prime Minister’s Office, are charred hulks. Singha Darbar’s imposing west facade built by Chandra Shumsher Rana 117 years ago and the hall where he met visiting foreign envoys was destroyed in the 2015 earthquake. It was restored last year to its original splendour with stained glass windows and an ornate ceiling. After demonstrators entered the central government secretariat on 9 September they set the entire complex on fire. Dozens of SUVs and cars that were smashed and burnt litter the parking lot.&nbsp; Across to the south at the Supreme Court, a fire truck belonging to Kathmandu Metropolitan City is trying to put out the flames. The building is still smoking, and hundreds of case files have gone up in flames. There is now also a threat from escaped prisoners from jails all over the country.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786.jpg" data-media-id="editor_0" data-image-id="20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Supreme Court sustained heavy damages following Tuesday's arson.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628.jpg" data-media-id="editor_1" data-image-id="20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army cleaning up the debris outside the main gate of Singha Darbar.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529.jpg" data-media-id="editor_2" data-image-id="2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The grand staircase leading to the upper balcony of the Parliament building.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46.jpg" data-media-id="editor_3" data-image-id="20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46" data-rendition-name="original" width="6526" height="4350" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army armoured car guarding the Baneswor intersection outside Parliament.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4.jpg" data-media-id="editor_4" data-image-id="20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4" data-rendition-name="original" width="6677" height="4451" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The row of electric vehicle showrooms in Thapathali were all torched with the cars inside.</figcaption> </figure>  Interestingly, the under construction Supreme Court, and the newly-built Parliament Complex are untouched. The current Parliament is housed in the Birendra International Convention Centre (BICC) built by the Chinese in 1993, and was the first target of protesters on 8 September. Outside its gates was where 20 students were shot and killed as they tried to storm the gates. After Tuesday’s mayhem, Kathmandu’s streets are now under control of the Nepal Army which has imposed a nationwide curfew. K P Oli was whisked out of his official residence in Baluwatar on Tuesday.&nbsp; Tuesday and Wednesday saw additional 8 casualties, including policemen who were lynched in Tinkune and Budanilkantha.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf.jpg" data-media-id="editor_5" data-image-id="20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf" data-rendition-name="original" width="6539" height="4360" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The parking area of the Department of Roads with a row of charred cars (also below).</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30.jpg" data-media-id="editor_6" data-image-id="20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa.jpg" data-media-id="editor_7" data-image-id="20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa" data-rendition-name="original" width="6726" height="4484" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>A police vehicle set on fire by demonstrators at Patan Darbar Square on Tuesday.</figcaption> </figure>  The Army is negotiating with the president and representatives of the GenZ campaign that includes Hami Nepal group that organised the protests to form a new government. Kathmandu Mayor Balen Shah and former Supreme Court Chief Justice Sushila Karki have been named as potential candidates to lead the new government The Civil Aviation Authority of Nepal has decided to keep Kathmandu airport closed for all domestic and international flights ‘until further notice’. Update: The video of a flight attendant speakling on social media has now been found to be fake. The error is regretted.&nbsp;