Spring 2023 was the <a href="https://www.nepalitimes.com/news/on-mt-everest-s-70th-records-and-fatalities">deadliest season on Mt Everest</a>, with 17 climbers dead or missing on the world’s highest mountain. But the trail leading to the base of the mountain also saw record numbers of trekkers and porters falling sick due to altitude sickness. An unexpectedly high number of people had to be treated at the Himalaya Rescue Association (HRA) aid post at Pheriche (4,300m) and at the Everest ER at Base Camp for HAPE (high altitude pulmonary edema).&nbsp; In an average year, the HRA aid post used to get only about 15 cases of HAPE, but this spring season alone there were an alarming 50 cases with clear-cut clinical diagnosis confirmed by field ultrasound detection of lung fluid.&nbsp; Only five of the 50 patients were foreign trekkers, the rest were Nepalis and mostly porters. Medical personnel in Pheriche are scratching their heads to figure out the reasons for this high patient load. One reason is the post-Covid backlog of trekkers and mountaineers as Nepal’s climbing industry saw a surge on the <a href="https://www.nepalitimes.com/here-now/everest-70-years-on">70th anniversary of the first ascent</a> of Everest by Hillary and Tenzing. Many of the hikers and climbers said they were also drawn to Nepal by a <a href="https://www.nepalitimes.com/review/on-screen-mountains">series of adventure films about the Himalaya</a>, including Nims Purja’s 14 Peaks: Nothing is Impossible.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230702110740_afa83e5d2e010a828bb566e909f6c004ebe50aebf5d82deabd70a503f38f725d.jpg" data-media-id="editor_3" data-image-id="20230702110740_afa83e5d2e010a828bb566e909f6c004ebe50aebf5d82deabd70a503f38f725d" data-rendition-name="original" width="1080" height="810" loading="lazy" alt="high altitude pulmonary edema"> <figcaption>Everest ER at Base Camp.</figcaption> </figure>  There was also a spurt in Indian trekkers and climbers, and one reason could be the Bollywood movie <a href="https://www.nepalitimes.com/here-now/lights-camera-action-in-nepal">Uunchai starring Anupam Kher and Ambitabh Bachchan</a> which was shot on location in the Khumbu and Manang last year. There were 50 companies guiding nearly 500 clients on Mt Everest alone, with more expeditions on Lhotse, Ama Dablam, Nuptse and other peaks. More expeditions meant more guides and support staff. There were nearly 2,500 people in May living for up to three months in the tent city at Everest Base Camp. &nbsp; There has also been a steady shift to other ethnic groups working as guides and porters in the Himalaya. Instead of Sherpa, who are in all likelihood genetically adapted to high altitude, the Rai, Tamang, even Chetris and Brahmins are more susceptible to high altitude sickness.&nbsp; HAPE can be life-threatening as the lungs drown in fluid. Unlike acute mountain sickness (AMS), which is relatively benign and common in sojourners even at lower altitudes in the Khumbu HAPE is similar to high altitude cerebral edema (HACE) in which the brain itself becomes water-logged. &nbsp; The other reason for the dramatic increase in HAPE this season could be that there was a greater disregard (possibly due to lack of awareness) for the most important risk factor for altitude illness, the rate of ascent. Many porters may have spent just one night in Namche Bazar (3,440 m) instead of 2 nights on their ascent to Pheriche and higher.&nbsp; Many scientific studies have clearly shown that spending only one night in Namche Bazar dramatically increases the risk for altitude illness. Other reasons for HAPE predisposition could be colder temperatures this spring with heavier snowfall, which meant greater physical exertion at high altitude. Whatever the reasons, this enormous increase in HAPE patients strained the resources of the HRA. Private clinics in the Khumbu region generally do not see these very sick, uninsured patients for free, so most of the 45 patients turned up at the HRA.&nbsp; “Many of the sick porters had no friends or support,” said HRA’s Gobi Bhasyal. “They were kept for at least night for observation with careful nursing care and oxygen from bottles or concentrators at the clinic.”&nbsp; Most were discharged after two days. None of the patients had health insurance and they had to rely on kind helicopter pilots who would give them a lift down to Lukla for free provided there was a western client who was paying to be rescued. &nbsp; “We not only had to look after the patients in the clinic but also find willing helicopter pilots who would allow the patient to piggy back on a paid ride,” said Thaneshwar Bhandari, HRA’s health assistant.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230702110740_18f11710dd23940a59e98c0c4508452c5f57062f9e231f5679aa3629eeaf4301.jpg" data-media-id="editor_5" data-image-id="20230702110740_18f11710dd23940a59e98c0c4508452c5f57062f9e231f5679aa3629eeaf4301" data-rendition-name="original" width="1080" height="810" loading="lazy" alt="high altitude pulmonary edema"> <figcaption>HRA Pheriche Aid Post.</figcaption> </figure>  Indeed, it is a tribute to the dedication of HRA staff that all 50 patients treated at the clinic this season recovered. The high incidence of altitude sickness was also reflected in the rise in rescue helicopter traffic in the Khumbu this season. Heli medevacs are life saving for many patients where the most important treatment is descent.&nbsp; But helicopters were also being used indiscriminately for commercial purposes in the Khumbu for dubious indications, like for a patient with diarrhoea or just fatigue. &nbsp; There more than 50 daily helicopter flights in the Khumbu this season from 6AM to 6PM. This in turn had a detrimental effect on the wilderness experience for many trekkers, and could in the long term impact on future tourism prospects.&nbsp; This year’s Everest ER was staffed by physicians Andrew Nyberg, Sachin Subedi and Suraj Bhatta, and in Pheriche by Luke Apisa, Renata Bueno and Nishant Joshi. The HRA post in Manang had Craig Kutz, Catherine McBride and Shama Bhandari. Ken Zafren from Alaska has helped select volunteer doctors for almost 3 decades. Buddha Basnyat, MD, is Medical Director of the Himalayan Rescue Association (HRA).

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

More porters sick on Everest trail

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171136/6369343e9c7e80680e03dfe5jpeg.jpg" alt="" width="2000" height="1373"/><figcaption>Photo: HRA</figcaption></figure>Kathmandu is hosting the XII World Congress on Mountain Medicine 21-24 November, and the location is indeed appropriate considering that it was in the Nepal Himalaya that modern mountain medicine made great advances in altitude illness.Acute altitude illness requires two things in order to happen: 1) a person not adjusted to high altitude, and 2) going high quickly, faster than the body has time to adjust. Before the advent of modern transportation, no one could travel high enough fast enough to get into much trouble. Altitude illness is therefore mainly a problem of modern times. The largest experience with altitude illness prior to the advent of trekking in Nepal was when the Indian Army, in the Sino-Indian war of 1962, was airlifted rapidly to over 5,000 m.Read also:<a href="https://www.nepalitimes.com/latest/high-alert/" target="_blank" rel="noopener">High alert</a><a href="https://www.nepalitimes.com/opinion/trekkers-with-the-trots/" target="_blank" rel="noopener">Trekkers with the trots</a>, David R ShlimAlthough foreigners started walking around Nepal in the early 1950’s, larger scale trekking only began in the late 1960’s. Trekkers, unaware of the risks of ascending rapidly, began to die on their treks. The number of evacuations and deaths became alarming to the fledgling trekking industry and the few agencies in operation at that time banded together to start the Himalayan Rescue Association (HRA) in 1973, organised by a former Peace Corps Volunteer named John Skow.John Dickinson, who began work at the old Shanta Bhawan Hospital in Patan in 1969, became the receiving physician for severe cases of altitude illness. He and Dr Bond, the pathologist, published the first series of autopsy findings in trekkers dying from altitude illness. This work brought the world’s attention to the problem of altitude illness in Nepal, a rather mysterious condition that stuck down perfectly healthy young people venturing into thin air. Dickinson became the first medical advisor to the HRA.Under the leadership of Tek Chandra Pokharel, Mike Cheney, Dawa Norbu Sherpa and Robert Reiffel in the early 1970’s, the HRA staffed an aid post in the village of Pheriche, at 4,300 m on the path to Everest. When I first passed through Pheriche in 1974, the post was staffed by an American nurse and a famous climbing Sherpa, Tashi. Wanting to stay in Nepal, I volunteered for the next season, and many seasons after that. I became the medical director of the HRA until 1983 when David Shlim (see his contribution alongside) became the medical director after he moved to Nepal to run the CIWEC Clinic.In Pheriche, I conducted the first studies of altitude illness in trekkers. We ended up suggesting a schedule that included rest days on the ascent to Kala Pattar. This new schedule cut the incidence of altitude illness in half but did not completely eliminate it. We demonstrated the value of Diamox (acetazolamide) in preventing altitude illness. A 1977 paper in the Lancet was the first large study of altitude illness in a civilian population, and put Pheriche on the world map as a center for altitude illness research.The HRA now operates the clinic in Pheriche and a clinic in Manang, on the Annapurna trek. These clinics have been, and still remain, the best clinical experience a doctor can get in diagnosing and treating altitude illness. The HRA is currently operated by an all-Nepali board of directors with Buddha Basnyat, a former student of Dickinson’s, as medical director.Nepalis are not immune to the effects of altitude illness. Trekking guides, porters, and climbers have all suffered, and all too frequently, died of altitude illness in the course of their jobs. Basnyat was the first to study the risk of altitude illness in Hindu pilgrims to high altitude sites in Nepal. Just because they are Nepali and have the Himalaya in their backyard does not offer immunity to the effects of low oxygen at altitude.Pilgrims to events such as the Janai Purnima Festival are generally low-altitude people who ascend far too rapidly, such as from Dhunche at 1,960m to Gosainkund Lake at 4,380m, in only 48 hours instead of a safe 4 days. The HRA provides a temporary health camp at the lake for pilgrims and treats many cases of severe altitude illness, preventing deaths and difficult evacuations.The most auspicious development in mountain medicine in Nepal is the large cadre of young Nepali physicians who are now intensely interested in high-altitude medicine. Mentored by Basnyat, these young doctors are carrying on the tradition of quality care of victims of altitude illness, research on causes and treatments, and developing systems of administering care to diverse populations. The Nepal Himalaya, and the HRA, is still a backbone of modern mountain medicine.Peter Hackett is a world renowned high altitude expert and a leading authority on altitude illness, high altitude climbing, and the effects of altitude on people living and working in the mountains.

Going to great heights to prevent altitude illness

Who is accountable for teacher-student relationships?

Chronic winter drought and decades of unmanaged forest biomass have turned wildfires into a systemic risk for Nepal. We need to re-learn to convert fire fuel in forests into fertilizer for crops.&nbsp; On 11 January, a huge forest fire spread rapidly from China into the forests of Sindhupalchok, 40km northeast of Kathmandu. The newly-opened Tatopani border checkpoint was closed. Smoke from the fire spread across central Nepal, blocking the sun.&nbsp; The fire burnt itself out within a few days, but the border stayed closed for longer. Such wildfires were once rare in mid-winter, and traditionally peaked between March and May as temperatures rose ahead of pre-monsoon showers. What is unsettling is not just the early onset of the fires, but also their scale. This shift is not accidental, the pattern has been unfolding over years due to winter drought, weakening post-monsoon moisture, and the accumulation of dry forest biomass as Nepal’s forest area doubled in the past 30 years.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009024_5f4a84bb389f9b56f4fa47d4f694adcd464eb13b192d184af0f1eb20efdfeebf.jpg" data-media-id="editor_0" data-image-id="2026022009024_5f4a84bb389f9b56f4fa47d4f694adcd464eb13b192d184af0f1eb20efdfeebf" data-rendition-name="original" width="2000" height="1055" loading="lazy" alt="Wildfire season NT"> <figcaption>A NASA FIRMS image of Nepal with red dots signifying fires in February 2025.</figcaption> </figure>  Together, these factors have made forests tinder dry in spring, just waiting for a spark. Nepal has experienced winter drought in eight of the past ten years (this winter was an exception). Winter rain and snow at higher elevations play a decisive role in maintaining surface moisture, recharging shallow aquifers, and keeping forest floors damp enough to resist ignition. When winter rains fail, forests dry out months earlier than usual. Satellite-based assessments show a steep decline in surface moisture across the middle mountains of Nepal, particularly in areas with dense forest cover but limited undergrowth management. Springs that once flowed year-round are now seasonal.&nbsp; More than half of the springs in the mid-hills have either dried up or show significantly reduced discharge, a trend closely linked to declining soil moisture and disrupted recharge zones. Dry soil does not just threaten water security — it helps the vegetation ignite. FUEL WITHOUT FUNCTION For decades, Nepal’s forests have been accumulating dry leaf litter, fallen branches, shrubs, and deadwood. Historically, this biomass was not considered waste because rural households regularly collected leaf litter for livestock bedding, which was later composted and returned to farms as fertilizer.&nbsp; Forest floors were therefore relatively clean while the mulch fertilized farms. That relationship has steadily eroded due to outmigration, changes in livestock systems, restrictions on access to community forests, and the growing availability of chemical fertilisers.&nbsp; Community forests across the country today are thick with dry twigs, branches and leaves — a highly combustible carpet. When prolonged drought dries this biomass, even a small spark from a herder’s intentional fire, a cigarette, or lightning strike can trigger massive fires.&nbsp; Under such conditions, the question is no longer whether fires will occur, but how intense and widespread they will be. Forest fires are often framed as an environmental issue concerning trees and wildlife. In reality, their impact extends far beyond forest boundaries.&nbsp; Smoke travels faster and further than flames. Fine particulate matter, especially harmful PM2.5, spreads across countries. In recent fire seasons, air quality monitors in Kathmandu have recorded air quality levels several times higher than WHO guidelines. The smoke adds to Kathmandu’s own pollution and lingers for days.&nbsp; Flights are cancelled or delayed in cities like Pokhara, and poor visibility blocks mountain views affecting tourism. Health facilities report spikes in respiratory complaints, particularly among children and the elderly. Just as wildfires have multi-sectoral causes, the impact of forest fires go beyond forests. One critical dimension remains largely invisible: the soil. The fires cause silent damage beneath the ash, and the emergency does not end when the flames subside. Beneath the surface, soil suffers long-term damage. Organic matter burns away, beneficial microorganisms die. The soil structure weakens, reducing the land’s ability to absorb and retain water. The scorched earth is more prone to erosion, increasing the risk of floods and landslides once the rains return.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009028_cc54ff056b2cac8b789cfd4d11afef9eaf943368e47b99aabd57c7b63b776cf2.jpg" data-media-id="editor_1" data-image-id="2026022009028_cc54ff056b2cac8b789cfd4d11afef9eaf943368e47b99aabd57c7b63b776cf2" data-rendition-name="original" width="1717" height="2143" loading="lazy" alt="Wildfire season NT"> <figcaption>Wildfire risk map based on the validated Random Forest model (a) Overall reclassified wildfire risk map of Nepal, (b) District level wildfire risk, and (c) Municipality wildfire risk map.</figcaption> </figure>  In many of Nepal’s agricultural areas, soil organic matter levels are already below 2% -- lower than what is needed for resilient and productive farming. Repeated fires push these levels even lower, undermining soil fertility and forcing farmers to rely more heavily on chemical fertilisers, unleashing a vicious cycle of higher costs and food insecurity.&nbsp; Climate breakdown is often cited as the primary culprit, and rightly so. Rising temperatures and erratic rainfall have intensified fire risk. But fires in Nepal are increasingly the result of human intervention.&nbsp; The response of all three levels of government remains too little, and too reactive. Each year, resources are mobilised to extinguish fires once they have already spread. Far less attention is paid to managing the fuel load within forest undergrowth that makes such fires inevitable.&nbsp; Meanwhile, forestry and agriculture policies are not coordinated, missing opportunities to address shared challenges. Forest fires are not natural disasters, but predictable outcomes of governance choices. National plans and climate pledges set an ambitious target of raising soil organic matter to 4%. The science behind this goal is solid. Higher organic matter improves water retention, stabilises yields, reduces fertiliser dependence, and enhances long-term food security. What remains unclear is the pathway.&nbsp; Where will the organic inputs come from? How will they be processed and applied safely at scale? Without practical answers, the 4% target risks remaining aspirational rather than achievable. Forest undergrowth can be turned into fuel and fertiliser. Biochar is produced by heating organic biomass in a low-oxygen environment, converting it into a stable form of carbon that can be added to soil.&nbsp; When properly produced and applied, it improves soil structure, enhances water and nutrient retention, supports microbial activity, and locks carbon into the ground for decades. In Nepal biochar addresses two interconnected problems: reducing the accumulation of combustible biomass in forests, lowering fire risk, while simultaneously rebuilding depleted soils. In doing so, it restores the broken link between forest management and agriculture.&nbsp; Done well, biochar is not merely an environmental intervention. It is an economic one, with potential to create local employment, reduce farmers’ input costs, and support climate-smart agriculture. But biochar propagation depends on improved governance. If promoted as isolated pilots or short-term projects, it will fail. What is needed is institutional clarity: standards for production and safety, quality control mechanisms, farmer extension services, and coordination across local, provincial, and federal levels.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022009028_e6e2218f38fae5b1fe81d9f99078fe01f58d04b4b3b2c41447f017c3f838a1d4.jpg" data-media-id="editor_2" data-image-id="2026022009028_e6e2218f38fae5b1fe81d9f99078fe01f58d04b4b3b2c41447f017c3f838a1d4" data-rendition-name="original" width="1536" height="2048" loading="lazy" alt="Wildfire season NT"> <figcaption>Freshly prepared biochar under control tempature (350-600°C).</figcaption> </figure>  Community forest user groups could manage biomass collection. Local governments then support safe, decentralised production units. Agricultural extension services guide farmers on application, linked to soil testing and monitoring. Such an approach would reduce fire risk, improve soil health, and generate rural livelihoods.&nbsp; Poorly produced biochar or contaminated feedstock can harm soils and human health. Without training, standards, and oversight, good intentions can backfire. Nepal needs to move beyond fire-fighting to fire prevention and confront the structural causes that make them a growing risk. It is not just a technical choice – it is one that demands political will from newly-elected leaders after March. &nbsp;&nbsp; Ngamindra Dahal is a hydrometeorologist with the Nepal Water Conservation Foundation specialising on climate and water management issues.&nbsp;

RED ALERT: Get ready for the wildfire season

Early on Monday morning, a bus from Pokhara to Kathmandu plunged off the highway in Dhading killing 19 passengers. Two weeks ago, another bus fell into the Tama Kosi in Manthali, killing 12. A few days before that a bus crash in Baitadi killed 13 people.&nbsp; In just the month before Nepal's election, more than 50 people have been killed in road traffic accidents. Most of these cannot be called 'accidents'. They are a direct result of poorly maintained highways and lack of enforcement of traffic discipline. Political parties in Nepal have rolled out their election manifestos, and voters are once again presented with a flood of promises. Page after page, these documents list megawatts and microcredit, highways and airports, jobs and investment. In these manifestos, growth is quantified, projects itemised, revenue forecast — and there are even threats to beat up contractors who do not finish their jobs. But when everything is declared a priority the stale promises are empty. The voter is left confused as to where the party’s loyalties really lie. Will any of these plans and pledges actually ever materialise and help Nepalis live longer, safer, healthier lives? The main job of any accountable government is to protect its citizens, not so much from foreign enemies but from domestic mismanagement. And this means the most basic test the new government should be made to pass is whether it can ensure basic well-being and protection for all its people. The problems of safety, health, and survival remain unresolved for most Nepalis, and are quietly eroding their lives. In the past year alone, the country’s <a href="https://nepalitimes.com/news/roadkill">roads and highways claimed more than 2,300</a> lives. An estimated 41,000 Nepalis die each year directly because of <a href="https://nepalitimes.com/here-now/what-is-invisible-is-more-dangerous">air pollution</a>, and their <a href="https://nepalitimes.com/news/air-pollution-killing-season-starts-early">lifespans are lessened by 3.4 years</a>.&nbsp; <a href="https://nepalitimes.com/editorial/poor-health">Non-communicable diseases</a> now account for well over half of total deaths in the country. And even where survival has improved, deprivation remains. Chronic malnutrition continues to haunt communities in <a href="https://nepalitimes.com/here-now/mass-migration-from-muktikot">Nepal’s western mountains</a> despite progress in maternal and child health.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260223130240_4f4ef83a31c3c4ae36ecdffb33a355e2fa3de9e98244b840a895af2d95c35ac0.jpg" data-media-id="editor_5" data-image-id="20260223130240_4f4ef83a31c3c4ae36ecdffb33a355e2fa3de9e98244b840a895af2d95c35ac0" data-rendition-name="original" width="1024" height="683" loading="lazy" alt="A life-first manifesto for Nepal NT"> </figure>  These are the lived realities of most Nepalis, and it is here that development can deliver its most immediate returns. A rising GDP, in and of itself, does not make roads safer, clean polluted air, or provide enough nutrition to children. Such outcomes demand intentional, granular policies that confront the specific, everyday problems shaping people’s lives.&nbsp; Macroeconomic growth, trade and investment are important, but these alone cannot guarantee improvements health and safety. The word ‘growth’, after all, is also synonymous with malignancy. Economic progress and human protection are correlated only when governance deliberately links them. Impact on life is the unit in which ordinary Nepalis calculate progress. What is needed, then, is a governing philosophy measurable in these same terms: a ‘life-first’ standard where every policy, budget, and reform can be understood and judged by its impact on protecting and extending human life. Such a ‘life-first’ approach would scrutinise three aspects of every policy. First, whether the policy prevents loss of life. A death is termed preventable if better, more coordinated response systems and regulations could have avoided it (vaccines, drugs, road safety, clean drinking water). A newly built six-lane highway <a href="https://nepalitimes.com/here-now/highway-accidents-are-no-accident-in-nepal">can be a death trap</a> due to poor design or lax enforcement of safety rules. If neonatal deaths continue in a district despite hospitals being present, or if malnutrition claims lives in predominantly agricultural regions, they too are failures. Preventable deaths also cluster where accountability is less direct. Just last year, <a href="https://nepalitimes.com/news/suicides-a-pandemic-within-a-pandemic">Nepal recorded 6,866 suicides</a>, with nearly 20 lives lost every day, yet these deaths fail to prompt any serious examination of governance. The same holds for fatalities linked to domestic or communal violence, alcohol and substance misuse, or ‘natural’ disasters, which register as ‘tragedies without remedy’ rather than as outcomes policy can influence. But when avoidable loss of life recurs at scale, isolated incidents become patterns, and patterns reveal systemic neglect. Saving lives, however, is only the first step, and what matters just as much is the quality of years lived. Nepal’s life expectancy now stands at 71 years, yet many citizens spend years in avoidable disability, untreated chronic illness, or mental distress. A life- first government must ask not only whether people live, but whether they thrive. Are citizens able to pursue education, work, and family life without fear of preventable harm? Do communities have access to clean air and water, nutritious food, and basic healthcare? Can a teenager anywhere in Nepal imagine a future not foreclosed by premature marriage, or untreated depression?  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20260223130240_157d72b80b82a07699b6bffbb30036b86f0f767a5674cc3db3d5c20343442940.jpg" data-media-id="editor_8" data-image-id="20260223130240_157d72b80b82a07699b6bffbb30036b86f0f767a5674cc3db3d5c20343442940" data-rendition-name="original" width="2529" height="1427" loading="lazy" alt="A life-first manifesto for Nepal NT"> </figure>  Thriving requires policies that prevent suffering and promote well-being in addition to ensuring survival.&nbsp; Finally, governance must consider graceful aging. Elderly Nepalis should not be left to navigate disease, poverty, or isolation alone. Social systems, healthcare, and community support must enable their continued participation and dignified well-being. Adopting this three-layered standard would gradually reorient how success of any new government is defined. Transportation would be judged by fatalities reduced on the roads. Electricity generation would be measured by whether households can switch from firewood dependence to smoke-free electric stoves.&nbsp; Increase in annual rice harvest must translate into better nutrition, reducing the prevalence of chronic diseases like diabetes. Accountability must follow problems rather than stop at Singha Darbar. Only then will politicians and bureaucrats eventually recognise that their work converges on the same human endpoint. Critics will argue that economies are complex, trade-offs are inevitable, and that governance cannot be reduced to a single metric.But, as Acemoglu and Robinson show in their book <a href="https://ia801506.us.archive.org/27/items/WhyNationsFailTheOriginsODaronAcemoglu/Why-Nations-Fail_-The-Origins-o-Daron-Acemoglu.pdf">Why Nations Fail</a>, the key difference between prosperity and poverty lies in inclusive institutions that empower citizens and create broad incentives for well-being.&nbsp; Extractive institutions concentrate power and wealth in the hands of a few while keeping the majority trapped in neglect. Nepal’s governance has remained a striking example of extraction. If lawmakers in the new Parliament continue to resist changes that would save and improve the lives of ordinary citizens, the same systemic rot will persist for generations to come. A life-first mentality can cut through this inertia by clarifying the moral centre of governance and reminding policymakers that behind every policy failure lies human cost. <a href="https://nepalitimes.com/here-now/epicentre-of-hunger">Every mother in Bajura</a> with a child going hungry at night, every farmer in the Madhes unable to afford medical care, and every family that has lost <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">a migrant son to kidney failure</a> understands the true <a href="https://nepalitimes.com/multimedia/dirty-dangerous-difficult-and-dehydrating">value of a life saved</a>. Life is the one metric that transcends ideology, ethnicity, and region. Centering governance on this single, focused metric, can shift an election from a contest of rhetoric to a contest of evidence. Which party ensured access to safe water and basic healthcare? Which made work at home and abroad safer and less exploitative. Which measurably extended healthy years of life for ordinary citizens? Health is wealth. By improving the healthy lifespan of citizens economic prosperity would follow naturally. A ‘life-first’ governance model would therefore compel Nepal to address the underlying structural failures across all sectors, rather than merely alleviating their symptoms. The GenZ protest that toppled the government last September was, at its core, a demand for accountability and a rejection of politics as usual. But as the country edges closer to the polls, that clarity has started to dissipate. Parties are now echoing the language of reform, but the public discourse remains dominated by promises that feel disconnected from Nepal’s most immediate and basic priorities. Every preventable death, every hungry child, and every neglected elder becomes a direct failure of governance and a moral debt the state must answer for. It is how we can make sure we keep the next government in check. The writers are Nepali GenZ students of biomedical engineering at the Hong Kong Polytechnic University.

Nepal’s life or death election

Party flags and banners wave from electric poles, houses and e-rickshaws are festooned with posters. Madhes Province is in the grip of election fever, and in a tour through four of its districts, there is the sense that any efforts by mainstream political parties at reforms have come too little too late. Among the banners, the sky blue of the<a href="https://nepalitimes.com/news/new-vs-new-in-nepal"> RSP is more prominent </a>here this time, and the rallying cry across the country for new and improved leadership is echoed on the ground. “For the people around here, whatever these old leaders are saying has become just noise,” says a lassi shop operator in Janakpur, waving a dismissive hand at flags with the NC’s tree symbol across the street. In Janakpur, UML nominee Raghubir Mahaseth was barred from canvassing door-to-door. Campaign posters of the mainstream parties have been torn from walls and replaced with RSP posters.&nbsp; In Inarwari village of Rautahat in the Madhes heartland, local elected officials whose parties have been merged into the Nepali Communist Party hope to retain enough supporters this election. But not many residents say they would vote for its candidate. &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022005024_a793e3a19cbd536fde50708c4a41b8b0d39a4716c6973feddad889097b655641.jpg" data-media-id="editor_1" data-image-id="2026022005024_a793e3a19cbd536fde50708c4a41b8b0d39a4716c6973feddad889097b655641" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Battleground Tarai NT"> <figcaption>Photos: SHRISTI KARKI</figcaption> </figure>  A first-time voter in Sarlahi’s Haripur is home on a semester break from medical school in Kathmandu, and is waiting excitedly for 5 March. “You can’t really say out loud whom you’re voting for around here,” he says, as he mimes ringing a bell. “It is time for someone new to be in-charge." In the highway town of Bardibas, an elderly teashop owner says that all she hears are calls for घण्टी, the RSP’s bell symbol. “After all, bells are rung in the house of gods,” she says. “It seems like the right choice.” The RSP wave sweeping the nation after the GenZ movement is seen in Madhes, and the PR ballots might reflect that, notes political analyst Tula Narayan Shah.&nbsp; “But the socio-cultural networks, organisational setup, and legacy of democratic movement of traditional parties might still give them a fighting chance on the first past the post ballot,” he says. &nbsp;“The door-to-door campaign style of candidates has always been more prominent in Madhes than elsewhere.”&nbsp; Villages like Dhankaul in Sarlahi-4 where <a href="https://nepalitimes.com/news/grand-split-in-nepal-s-grand-old-party">Gagan Thapa</a> of the Nepali Congress (NC) is running against incumbent Amresh Singh, is an NC stronghold. Singh won the election here twice before in 2013 and 2017 when he was an NC leader, and still had goodwill among NC voters when he ran and won as an independent during the 2022 election. “I voted for him twice before when he was in the NC, but he did not do anything for this or other villages. Once he is elected, he has not set foot here,” says Rajiv Yadav, a voter in Dhanakul. “The RSP will get more votes here than last time, but Gagan is sure to win. This village will vote for him.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022005024_26691bb5a37edf705cc197a632d0bf032f984079a838d31bcd943bc0b9c97ff3.jpg" data-media-id="editor_3" data-image-id="2026022005024_26691bb5a37edf705cc197a632d0bf032f984079a838d31bcd943bc0b9c97ff3" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Battleground Tarai NT"> </figure>  Madhes is in the spotlight this election because two prime ministerial candidates have focused their attention in the region. Balen Shah began his campaign in Janakpur (main picture, left) in January as a ‘Son of Madhes’, and Gagan Thapa chose Sarlahi-4 as his constituency over Kathmandu-4, from where he has been elected since 2013.&nbsp; The Madhes has always been the battleground for Nepal’s electoral politics, and candidates from here, like Krishna Prasad Bhattarai from Parsa, Pushpa Kamal Dahal from Siraha, Jhala Nath Khanal from Sarlahi, and Madhav Kumar Nepal from Rautahat, have all been prime ministers. Despite electing politicians to high office in Kathmandu, districts of Madhes have consistently ranked low in development and service delivery indicators, especially in basic healthcare and education. Socio-economic inequalities stemming from a lack of opportunities has also meant that Madhes districts have the highest rate of out-migration in the country.&nbsp; What is different this time is that the people of the province have a Madhesi prime ministerial candidate who will represent them in national politics, and the main competition ultimately will be between the NC and RSP prime ministerial candidates. Interestingly, voters seem to be looking beyond Madhes-based parties who have historically campaigned on identity and federalism.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026022005024_1b5c1134fb02ded72a12221200918df584b0cd003139bb2be44951efe9a65bf1.jpg" data-media-id="editor_4" data-image-id="2026022005024_1b5c1134fb02ded72a12221200918df584b0cd003139bb2be44951efe9a65bf1" data-rendition-name="original" width="1600" height="1200" loading="lazy" alt="Battleground Tarai NT"> </figure>  “Leaders of Madhes parties have glorified their struggle for votes but failed to perform on good governance at local and provincial levels,” explains Tula Narayan Shah. “Now, Balen has become a PM candidate as a face of the region, and as someone who will deliver based on his work as Kathmandu mayor.” If the RSP wins, it will be governing in the absence of provincial leadership that would play a crucial mediatory role between Kathmandu and local units. On Wednesday, RSP’s Madhes province chair Mamta Sharma resigned from the party and joined the NC. There is also some underlying tension between RSP cadre loyal to Balen Shah and Rabi Lamichhane. “It is not prudent to predict who will win the election and whether parties will deliver on promises,” says Tula Narayan Shah. “But win or lose, there is little basis at this time to believe that the RSP will be committed to making the federal system and provinces more functional.” Voters here in the heart of the federalism movement, however, are willing to give the RSP the benefit of the doubt. &nbsp;Resident Brahma Dev in Janakpur told us: &nbsp;“The RSP, like parties that came before them, deserve a chance to prove their leadership in the next five years. If they do not deliver, we can always vote them out next time.”&nbsp; On Wednesday, NC leaders unveiled the party’s 10-point election manifesto at a large rally in Janakpur (main picture, right). Gagan Thapa began by addressing a cheering crowd in Maithili, and said the NC was reformed, adding:&nbsp; “The GenZ did not reject us, they told us to change our ways.” Also on Wednesday 800km away at the other end of the country in Dhangadi, Balen Shah, in a speech that lasted just three minutes, he said: “Don’t vote for us, give us work to do.”&nbsp;

high-altitude-sickness

More porters sick on Everest trail

Going to great heights to prevent altitude illness

Who is accountable for teacher-student relationships?

RED ALERT: Get ready for the wildfire season

Nepal’s life or death election

Battleground Tarai