<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f09c7e80680e0a5febjpeg.jpg" alt="" width="2048" height="1365"/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>For the first time in weeks, Nepal recorded more than 3,000 new cases on 20 July. There were 25 deaths. The country is on the tail end of what has been a deadly second wave, but the rate of decline in infections and mortality has stalled.Public health officials blame it on <a href="https://www.nepalitimes.com/banner/kathmandu-covid-19-lockdown-relaxed/" target="_blank" rel="noopener noreferrer">sudden reopening following two-months of lockdown</a> in which many mingled without masks, low vaccination rate, and minimal testing and tracing.While some experts say Nepal and India are now safe against another major surge of the Delta variant that was largely responsible for <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the second wave</a>, others warn of a third wave if safety measures are not enforced.The Delta mutant is now ravaging Indonesia, and spreading across Europe and North America. And scientists say it has affected mostly countries and regions with low vaccination rates.“The third wave is a matter of when not if. And if we don’t vaccinate as many people as soon as possible, there will be a continued threat of more dangerous variants, and we will be repeating the whole cycle,” warns Buddha Bansyat, a physician at the Patan Academy of Health Sciences.So far, Nepal has fully vaccinated 1,158,130 people, 3.6% of its total population. Some 10% Nepalis have received the first dose of either AstraZeneca Covishield, Chinese Sinopharm VeroCell or <a href="https://www.nepalitimes.com/latest/johnson-johnson-in-nepal/" target="_blank" rel="noopener noreferrer">single-shot Johnson &amp; Johnson</a> jabs.Another 8 million doses of various Covid-19 vaccines are expected by September – some purchased from China, more doses from COVAX, as well as a direct grant from Japan. This should take the total fully vaccinated population near 20%, which together with antigen positive population could cushion the impact of a possible third wave.“We have now moved on from vaccinating <a href="https://www.nepalitimes.com/here-now/spared-at-first-elderly-hit-hard-by-covid-19/" target="_blank" rel="noopener noreferrer">the elderly</a> and frontline workers to groups less at risk of the Covid-19, and we have more vaccines in the  pipeline,” says Shyam Raj Uprety, head of government's Covid Vaccine Strategy. “We have applied to buy 10.5 million more doses of vaccines from the COVAX at a subsidised rate.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f39c7e80680e0a5fecjpeg.jpg" alt="" width="448" height="537"><figcaption> </figcaption></figure>Indian public health experts have projected the third wave to hit that country in late August. What happens in India usually follows in Nepal within 12-13 days, and if that is true this time too, Nepal cannot be  unprepared like in March.“If the vaccination program progresses as smoothly as it is happening now compared to the first two surges, the third wave might not be as significant if it happens at all. By Dasain, a significant chunk of Nepalis should have been vaccinated,” explains Sameer Dixit of Centre for Molecular Dynamics Nepal.Apart from vaccines, in case of a sudden surge, hospitals need to be ready with sufficient beds and ICUs, oxygen, life-saving medical equipment, drugs and <a href="https://www.nepalitimes.com/here-now/helping-nepalis-breathe-again/" target="_blank" rel="noopener noreferrer">functioning oxygen plants</a>. Hospitals must also prepare their paediatric wards since the third wave could affect a younger population.Since the peak of the <a href="https://www.nepalitimes.com/banner/we-knew-the-tsunami-was-approaching/" target="_blank" rel="noopener noreferrer">second wave</a> when there were close to 10,000 new cases a day and over 200 daily fatalities, international donors have been supplying essential medical equipment to Nepal.The Health Ministry received 385 ventilators and 970 oxygen concentrators in May June from various donors. District hospitals at local levels have also received direct supplies from aid agencies. These should be in running  condition and on standby instead of being stockpiled in Kathmandu, say doctors interviewed for this report.With the <a href="https://www.nepalitimes.com/latest/vaccines-start-trickling-into-nepal/" target="_blank" rel="noopener noreferrer">vaccine supply chain less constrained</a>, there is now a debate about reprioritising the doses and a more strategic distribution of supply. Some experts have suggested a ‘firewall strategy’ wherein densely populated cities are fully vaccinated to reduce transmission, and to revive  the economy that will in turn restore jobs.Equitable vaccination is ideal, but in epidemiological terms inoculating a thinly-spread population is not the best use of limited doses. Inoculating  younger adults mean they are less likely to carry the virus and transmit it to <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">children</a>, the largely unvaccinated group. Even within cities, the focus must be on the urban poor in congested areas.“Moving forward, we must now prioritise crowded cities and highly mobile groups for vaccination to help blunt the effect of another wave and save as many lives as possible,” says Sher Bahadur Pun, a virologist at Teku Hospital.However, epidemiologist Lhamo Yangchen Sherpa worries that focusing in cities may mean the underserved are neglected. “While reprioritising, our strategy should be such that the supply isn’t misused and the neediest aren’t missed out.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151116/636d07f59c7e80680e0a5fedjpeg.jpg" alt="" width="2048" height="1366"><figcaption> </figcaption></figure>At present VeroCell and J&amp;J vaccination drives are running in parallel across Nepal. Soon, the Japanese grant of 1.4 million <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/" target="_blank" rel="noopener noreferrer">AstraZeneca</a> will be used to inoculate the elderly who have been waiting for four months for their second doses.Social media is rife with speculation about the jabs and who should and shouldn’t get it, leading to widespread confusion and vaccine hesitancy. People are also comparing the efficacy level of one vaccine against the other.“Let’s take any vaccine available, they do what they are supposed to do, prevent deaths and hospitalisations in most cases,” says Buddha Basnyat.  “I encourage people with heart conditions, cancer and liver diseases to vaccinate, they are high-risk group, as well as pregnant women.”According to Public Health England, Covid-19 vaccines have so far  prevented 13,200 deaths and 39,700 hospitalisations in the United  Kingdom, even while the country sees a surge in Delta variant cases.As Nepalis inoculate against SARS-CoV-2, people are starting to forgo <a href="https://www.nepalitimes.com/opinion/staying-safe-in-2021-and-beyond/" target="_blank" rel="noopener noreferrer">safety measures</a> even if the majority of the population remains unvaccinated. They are back on the streets taking part in political rallies and conducting crowded indoor meetings. Jam-packed and poorly- managed vaccination centres could themselves be super spreaders.Says Sameer Dixit: “In midst of vaccines, variants and new surges, we cannot forget masks and physical distancing, it is still our first line of  defence against the coronavirus.”

Sonia Awale

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Vaccines, variants and a third wave

<figure><img width="960" height="640" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110151112/636d06c19c7e80680e0a5f7fjpeg.jpg" alt=""/><figcaption>Photo: AMIT MACHAMASI</figcaption></figure>The 1.5 million doses of the Johnson &amp; Johnson vaccines by the United States under the global COVAX facility has arrived in Kathmandu via a Qatar Airways flight on Monday morning. With this, the US has now become the largest single-country donor of Covid assistance to Nepal.
US ambassador Randy Berry and Health Minister Krishna Gopal Shrestha were at the airport to receive the consignment, a total of 1,534,850 doses. A formal handover took place later at Prime Minister K P Oli's residence in Baluwatar.
“These vaccines will not only save lives and help Nepal emerge from this pandemic, but they will also help to recover economic losses and regain the opportunity to safely visit with our friends, families, and neighbours,” said Berry speaking at the arrival ceremony.
The Health Ministry is considering inoculating migrant workers waiting to leave for their jobs at the destination countries with the single-shot jab given that they can’t return or wait for the second dose. A preliminary report also suggests that people in the 50-54 age group will receive the shots. There has been no official confirmation yet. 
It is yet unclear if the J&amp;J vaccine is part of the 2,000,000 allocated by the COVAX for 20% of Nepal’s population. The World Health Organisation’s COVAX initiative has so far delivered 348,000 doses of the Covishield AstraZeneca vaccines to the country and is sending its next consignment to Kathmandu by August.
The 1.5 million J&amp;J doses are a part of the 7 million pledged by President Joe Biden to South Asian countries last month, of the 1 billion doses from the G-7 promised at a summit in the UK last month.
The Biden Administration has already shipped 1.5 million doses of the Moderna shots to Pakistan and the first consignment of the 2.5 million it set aside for Bangladesh. The United States also announced 500,000 doses of Moderna jabs to Bhutan.
According to the US embassy, since the beginning of the pandemic, the United States has delivered nearly $70 million for Covid-19 assistance to Nepal. This includes $55 million mobilised by USAID for oxygen cylinders, breathing devices, Covid-19 testing, contact tracing, treatment, personal protective equipment, and infection prevention.
Similarly, the United States Department of Defense has provided over $7.3 million for isolation and disaster camps, oxygen cylinders, oxygen concentrators, and non-invasive breathing and oxygen therapy devices, telemedicine equipment, handwashing stations, and medical equipment and gear for health clinics and health care workers.
The United States has also pledged $4 billion to support COVAX with the purchase and delivery of Covid-19 vaccines to 92 low- and middle-income countries.

Johnson & Johnson in Nepal

<figure><img width="720" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121152/636b95289c7e80680e06f23fjpeg.jpg" alt=""/><figcaption>Migrant workers, including Nepalis, in Kuwait after being vaccinated. A Nepali worker gets his jab (right). Source: Ram Bahadur Basnet</figcaption></figure><img width="720" height="960" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121152/636b952b9c7e80680e06f240jpeg.jpg" alt="">In February 2020, Nepali migrant worker Min from Sindhupalchok was excited to visit Nepal after completing two years working in Kuwait. More than a year later, he is still here, due to a Covid-19 travel ban by Kuwait.  He could have returned by taking an indirect route via the UAE since there were no direct flights from Nepal. But since quarantining in the UAE was too costly, he decided to wait for travel restrictions in Kuwait to be lifted. “Now it looks like new rules regarding mandatory vaccination in Kuwait will further delay my return,” says Min.Another worker in Kuwait is Lila from Chitwan. He had spent 15 years there, but has been stuck ever since he came home for a break. Lila’s employer in Kuwait is getting impatient.Stories of stranded migrants are common, but with new vaccination requirements by destination countries, the situation has only become even more uncertain. “From 1 August, Kuwait will allow entry of non-citizens <a href="https://www.khaleejtimes.com/coronavirus-pandemic/covid-19-kuwait-to-allow-fully-vaccinated-non-citizens-entry-from-august-1" data-saferedirecturl="https://www.google.com/url?q=https://www.khaleejtimes.com/coronavirus-pandemic/covid-19-kuwait-to-allow-fully-vaccinated-non-citizens-entry-from-august-1&amp;source=gmail&amp;ust=1625121388603000&amp;usg=AFQjCNGRqFuLUOQyHv8xigeCvXBJcBO4MA">only if they are fully vaccinated</a> by one of the four vaccines: Pfizer BioNTech, Oxford/AstraZeneca, Moderna and Johnson &amp; Johnson,” says Nepal’s ambassador to Kuwait, Durga Bhandari. None of these vaccines are currently available in Nepal, and other countries that send workers to the Gulf also face the same problem. Saudi Arabia is also set to impose similar vaccination requirements from 1 August. Until then, those who are not vaccinated have to undergo quarantine for a week. While Qatar is allowing Nepali passengers with mandatory institutional quarantine, there has been no announcement regarding vaccines yet. Nepal is currently banned <a href="https://www.hindustantimes.com/business/uae-ban-on-flights-from-india-pakistan-and-12-other-countries-to-continue-101624791232360.html" data-saferedirecturl="https://www.google.com/url?q=https://www.hindustantimes.com/business/uae-ban-on-flights-from-india-pakistan-and-12-other-countries-to-continue-101624791232360.html&amp;source=gmail&amp;ust=1625121388603000&amp;usg=AFQjCNGNiLYfuDmDxMx29zavs0qeaH_35w">by the UAE</a> and <a href="https://www.arabianbusiness.com/culture-society/463675-bahrain-to-ban-travellers-from-india-pakistan-sri-lanka-bangladesh-nepal" data-saferedirecturl="https://www.google.com/url?q=https://www.arabianbusiness.com/culture-society/463675-bahrain-to-ban-travellers-from-india-pakistan-sri-lanka-bangladesh-nepal&amp;source=gmail&amp;ust=1625121388603000&amp;usg=AFQjCNEAlpu8KOlC-kc1Zsa4tH4PqRrmLg">Bahrain</a> for public health reasons. The UAE has approved Sinopharm, Pfizer, Sputnik V and Oxford-AstraZeneca, and has imposed double vaccination mandate to South Africa, Nigeria and India, which will likely be applied to Nepalis as well once the ban is lifted, according to UAE-based travel entrepreneur Krishna Bhusal. As the Gulf countries ramp up their vaccination drives and set ambitious targets for universal vaccination, they have started to <a href="https://gulfnews.com/world/gulf/saudi/saudi-arabia-bans-access-to-shopping-malls-for-unvaccinated-1.79888953" data-saferedirecturl="https://www.google.com/url?q=https://gulfnews.com/world/gulf/saudi/saudi-arabia-bans-access-to-shopping-malls-for-unvaccinated-1.79888953&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNGatchZ14YZDxeTeuO6gYsybD3TyQ">require proof of full vaccination</a> for all activities including workplace visits, public events, restaurants and malls. Nepal, on the other hand, is bearing the brunt of the global vaccine inequality with a dismal vaccination rate of 2.6%. It is uncertain when outgoing migrants will get their turn, and as they wait, how many will lose lucrative opportunities or have visas or contracts expire. “Even without these flight bans and the new vaccination requirements, it has been difficult for workers with expensive quarantine and testing costs,” says labour recruiter Saroj Pokharel.  <figure><img width="1280" height="720" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121152/636b952d9c7e80680e06f241jpeg.jpg" alt=""><figcaption> </figcaption></figure>It can cost from $800-$2,000 for institutional quarantine in Qatar depending on the standard of facilities, and many employers are reluctant to cover these expenses which get passed down to workers.  “The only way out is widespread vaccination, but at the rate we are progressing, I do not see the foreign employment sector recovering anytime soon,” Pokharel says. Quarantine costs are about $1,000 in Saudi Arabia as well. “Employers <a href="https://www.facebook.com/nepalembassysaudiarabia/photos/pcb.4383977018335352/4383976668335387/" data-saferedirecturl="https://www.google.com/url?q=https://www.facebook.com/nepalembassysaudiarabia/photos/pcb.4383977018335352/4383976668335387/&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNEmtN1gYwebB1uttNn6azamjkR9Ew">are required to foot the bill</a> and have to commit in writing in the job demand approval letter that they will bear the costs of quarantine. The Saudi authorities will also notify employers regarding this rule,”  says Nepali Labour Attaché Prem Upadhaya at the Consulate in Jeddah. However, given that workers are desperate it is likely that they will pay for it covertly, no matter how high the cost, or how inconvenient.  The rules on quarantine and vaccines do not just involve Nepali workers, and other countries face the same problem. In response, <a href="https://www.khaleejtimes.com/coronavirus-pandemic/covid-overseas-filipino-workers-now-priority-for-vaccinations-in-philippines" data-saferedirecturl="https://www.google.com/url?q=https://www.khaleejtimes.com/coronavirus-pandemic/covid-overseas-filipino-workers-now-priority-for-vaccinations-in-philippines&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNHnyJI2Ct6KhHvrodMix3HHdQo45A">the Philippines</a> has put its overseas contract workers in the ‘essential’ category alongside health staff which moves them up in the vaccination priority list.  <a href="https://www.thedailystar.net/bangladesh/news/migrant-get-pfizer-moderna-vaccines-2119989" data-saferedirecturl="https://www.google.com/url?q=https://www.thedailystar.net/bangladesh/news/migrant-get-pfizer-moderna-vaccines-2119989&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNELsJNafXsHgtlEvgStbVvrBX2UQQ">Bangladesh</a> will prioritise workers heading to Kuwait and Saudi Arabia for the Pfizer vaccines that it received as part of the global COVAX initiative. It is set to receive 2 million doses of the <a href="https://www.newagebd.net/article/142013/bangladesh-to-get-25m-doses-of-moderna-covid-vaccine-from-usa-soon" data-saferedirecturl="https://www.google.com/url?q=https://www.newagebd.net/article/142013/bangladesh-to-get-25m-doses-of-moderna-covid-vaccine-from-usa-soon&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNFbi4BS2QNvFQRAy-CH1Y9JsT1W0Q">Moderna vaccine</a> from the United States through COVAX. The country also has a scheme to reimburse quarantine costs of workers to Saudi Arabia.  In Pakistan, Saudi-bound expats <a href="https://edition.cnn.com/2021/06/28/asia/pakistan-expatriates-vaccination-center-intl-hnk/index.html" data-saferedirecturl="https://www.google.com/url?q=https://edition.cnn.com/2021/06/28/asia/pakistan-expatriates-vaccination-center-intl-hnk/index.html&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNFJRRpihnsIY9ucUrvaWzFkopcjsw">broke into a vaccination centre</a> in Islamabad after fears that the AstraZaneca vaccines would run out. Prime Minister Imran Khan has asked Saudi Arabia and other countries to accept the WHO-approved Chinese vaccine with which Pakistan is inoculating its population.  <a href="https://www.dailynews.lk/2021/06/28/local/252607/slbfe-arrange-covid-jabs-free-foreign-job-seekers" data-saferedirecturl="https://www.google.com/url?q=https://www.dailynews.lk/2021/06/28/local/252607/slbfe-arrange-covid-jabs-free-foreign-job-seekers&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNHjFonIPKoFSEU0CaUMXKxyigNsCA">Sri Lanka</a> has also announced free vaccines for those with confirmed overseas jobs, but is also dependent on the Sinopharm Chinese vaccine, which is not accepted by key destination countries.  In <a href="https://telanganatoday.com/relief-for-nris-as-saudi-approves-covishield" data-saferedirecturl="https://www.google.com/url?q=https://telanganatoday.com/relief-for-nris-as-saudi-approves-covishield&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNExwn7EkYkTzX80oqjEd5UFS0uLTw">India</a>, many migrant workers are stranded because their vaccine certificates refer to Covishield, and not Oxford AstraZeneca. However, Saudi Arabia finally recognised Covishield as equivalent to AstraZeneca after diplomatic dialogue. Vaccination camps have been set up for outgoing students and workers, although <a href="https://www.thehindu.com/news/cities/Tiruchirapalli/vaccination-camp-for-people-with-plans-to-go-abroad/article34889852.ece" data-saferedirecturl="https://www.google.com/url?q=https://www.thehindu.com/news/cities/Tiruchirapalli/vaccination-camp-for-people-with-plans-to-go-abroad/article34889852.ece&amp;source=gmail&amp;ust=1625121388604000&amp;usg=AFQjCNHEBvKQtQVlQtUD1cKoW-dlOYF1RA">demand far outweighs supply</a>. In Nepal, however, there is growing frustration with the lack of progress in sourcing vaccines. Says Sujit Shrestha of NAFEA (Nepal Association of Foreign Employment Agencies): “We need a way out because there is demand in these countries for Nepali workers. The government should get vaccines and prioritise outgoing workers, or coordinate with destination countries to provide quarantine and vaccines for workers. For many Nepali families, foreign employment is the only source of income.” After a few months of slow and uneven recovery of emigration, the second wave impacted both new and current Nepali workers. But even with cases falling and limited flights allowed, there is uncertainty because of the vaccines.  It is not just about whether Nepal can inoculate outgoing workers soon, but also whether the vaccination provided is accepted by the destination country.  Saudi Arabia has a demand for 40,000 Nepali workers that are waiting to be filled. In Kuwait, employers are struggling with labour shortages. This is in addition to thousands stranded in Nepal while on holiday like Min and Lila, who are at risk of losing their jobs overseas. Says Kuwait-based Nepali Ram Bahadur Basnet: “If flights normalise and the issue of vaccinations gets sorted out, Nepalis will be able to find attractive opportunities here.”  Some names have been changed. Additional reporting by Hom Nath Giri.

Upasana Khadka

Job-seekers now also jab-seekers

On Tuesday, leader of the monarchist RPP once again gathered on Kathmandu’s streets to deliver fiery speeches, but this time there was no arson and looting and no need for riot police to fire live rounds or tear gas.
RPP leaders demanded the release of their members including vice-president Rabindra Mishra and MP Dhawal Shamsher Rana were arrested during the violent <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">28 March protests at Tinkune </a>which left two dead. 
They denounced the current leadership of the main parties, demanding the <a href="https://nepalitimes.com/editorial/nepal-party-reincarnating-hindu-monarchy">restitution of Nepal as a Hindu kingdom</a>. They also said the government was responsible for the fatalities on 28 March because it provoked its rally with a tear gas attack even before it started.
It has now been revealed that the police fired at least 100 live rounds from high powered assault rifles at the crowd. Twenty-one of the 120 injured received bullet wounds, and most of them were bystanders and people trying to reach home. 
Tuesday protest on the Ring Road in Balkhu was much more subdued, and comparatively fewer RPP supporters showed up. The arson and vandalism in the previous protest appears to have cost some support for <a href="https://nepalitimes.com/news/the-ghost-of-monarchy-returns-to-haunt-nepal">former king Gyanendra </a>especially for the anointment of medical tycoon and bank defaulter <a href="https://nepalitimes.com/news/street-politics">Durga Prasai </a>as ‘commander’ of the Tinkune rally.
Some monarchists acknowledge Gyanendra’s mistakes when was king 2001-2008, but say he has had a lot of time to reflect on his shortcomings and seems more disciplined and committed. His supporters have tried to build on nostalgia among some Nepalis for<a href="https://nepalitimes.com/news/why-invest-in-nepal"> domestic stability </a>and international respect that <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">the monarchy</a> commanded. 
“Nepalis were promised better service delivery, opportunities for the underserved, as well as better, more honest use of state resources, but the <a href="https://archive.nepalitimes.com/news.php?id=16992">people in leadership </a>have not been able to deliver on their commitments,” says RPP leader Prakash Chandra Lohani. “The gap between their rhetoric and reality has widened, the people feel betrayed, and the respect Nepali people had previously had for them has changed to revulsion.” 
Indeed, many commentators have warned the three main parties and their <a href="https://nepalitimes.com/editorial/politics-as-usual">serial prime ministers</a> who have ruled Nepal for much of the past 30 years should address rising public anger with them, and see the writing on the wall.
‘<a href="https://nepalitimes.com/news/nepal-government-changes-again">The UML, NC and Maoists</a> must introspect about their conduct,” warns Gunaraj Luitel, editor of Nagarik, in an op-ed this week. ‘These leaders for life may save themselves from simmering public anger, but they will not be able to save the system. The monarchist wave can only be dispelled when citizens are assured of <a href="https://nepalitimes.com/here-now/nepal-s-local-election-gives-power-back-to-people">better governance</a> through <a href="https://nepalitimes.com/latest/real-world-training-for-youth-leaders">younger leaders</a>, and reforms.’ 
Rifts between radical royals who are gunning for a return to <a href="https://nepalitimes.com/here-now/mob-movement-and-mayhem">Panchayat-style absolutism </a>and moderate monarchists who favour a constitutional king have also weakened the movement somewhat. The split between the RPP and RPP-Nepal cost the royalists numbers in Parliament in 2022, and both parties denounced the violence last month, albeit shifting the blame on the government.
The irony is that the same royalists who want to scrap the republican Constitution had formed electoral alliances with the UML during the 2022 elections. RPP-Nepal chair Kamal Thapa contested the 2022 election with the UML. Thapa has not taken part in the last two rallies, saying he will only be a part of a movement under a national flag, and not a RPP party banner.
For his part, the RPP’s Rajendra Lingden is said to be hesitant to censure some of his party’s more radical royalists for fear of fissure within his ranks, despite his aversion to Durga Prasai’s role. 
Analysts have questioned why <a href="https://nepalitimes.com/news/old-is-still-gold-in-nepali-politics">supporters of the monarchy </a>have decided to reestablish an institution that would not ultimately have executive decision-making power. There are doubts about whether authoritarian-minded Gyanendra will be satisfied being a <a href="https://archive.nepalitimes.com/news.php?id=13957">ceremonial king</a>. 
Read also: <a href="https://nepalitimes.com/news/nepal-s-deja-vu-on-black-friday">Nepal’s déjà vu on Black Friday</a>, Sonia Awale
"The Nepali people will not accept <a href="https://nepalitimes.com/here-now/forgotten-woman-who-sheltered-communist-activists">an absolute monarchy </a>at this point of time, and both the public as well as <a href="https://archive.nepalitimes.com/news.php?id=8371">king Gyanendra</a> are fully aware that there is no other possibility beyond a constitutional monarchy," asserts the RPP’s Lohani. “The traditional monarchy’s institutional capacity might have been enough to meet the needs of feudal Nepal, but an absolute monarchy is impossible both in concept and practice in the context of <a href="https://archive.nepalitimes.com/regular-columns/Economic-Class/waiting-for-an-industrial-revolution,784">modern day Nepal</a>.”

New year revolutions

Besides multiple <a href="https://nepalitimes.com/news/republicans-and-royalists-on-nepal-s-streets">street demonstrations </a>that gridlocked Kathmandu’s traffic for the past weeks, public discourse in Nepal has also been dominated by dangerously <a href="https://nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking">high air pollution levels</a>. Caused mostly by hundreds of <a href="https://nepalitimes.com/news/wildfire-season-starts-early-in-nepal">forest fires </a>raging across the country, the smoke contains suspended soot particles that harms <a href="https://nepalitimes.com/opinion/playing-with-poison">human health</a>. Thursday’s rain have cleared the air somewhat, and many people will soon forget how bad the air quality was. But the time to address the roots of next summer’s fire season is now.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524.jpg" data-media-id="editor_4" data-image-id="20250411060440_d1a119716a9031aadfdd611d299348d436842d376a03e664b8d773957a237524" data-rendition-name="original" width="502" height="540" loading="lazy" alt="Wildfires"> <figcaption>EXTINGUISHED: Forest fires raging all over Nepal in the week after 3 March (above) reduced air quality, creating a public health hazard in Kathmandu and across the country. Each red dot is a fire detected by infrared sensors on the NASA Fire Information for Resource Management System (FIRMS) satellite. But the rain on Thursday doused most of the fires (below) with more rain forecast over the weekend.</figcaption> </figure>  The reason everyone was talking about air pollution was because the<a href="https://nepalitimes.com/banner/nepal-is-going-up-in-smoke"> smoke from wildfires</a> was visible. But much more toxic are the invisible and odourless <a href="https://nepalitimes.com/news/nepal-doubles-its-carbon-footprint">gases from vehicular and industrial emissions </a>which have always been there. The theme of World Health Day on 7 April this week was ‘Healthy Beginnings, Hopeful Futures’ dedicated to <a href="https://nepalitimes.com/opinion/comment/saving-more-mothers-and-babies">preventing maternal and newborn deaths</a>. It is estimated that in Nepal, 30% of neonatal mortality can be blamed on air pollution. But that is only part of the story. Harmful as fine particulate matter is to human health, carbon monoxide, nitrogen dioxide, ground-level ozone and other gases in vehicular emissions are more hazardous to health. While the concentration of suspended particulate matter tinier than 1.5 microns (PM2.5) is closely monitored, these toxic gases are invisible, not measured much, and the public is not aware about the dangers they pose. Surface ozone is produced by the interaction of various gases found when <a href="https://nepalitimes.com/news/fossil-fuels-poison-air">burning fossil fuels</a>. Besides being poisonous, ground level ozone contributes up to 0.23°C to <a href="https://nepalitimes.com/here-now/nepal-s-mountains-are-melting">global warming</a> because it is also a greenhouse gas. A new policy brief by the Clean Air Fund titled The Case for Action on Tropospheric Ozone blames surface ozone for a half a million premature deaths every year, 54.8% of which are in South Asia. Ozone also stunts plant growth and reduces crop yields by 26% globally, and 11% loss in <a href="https://nepalitimes.com/news/economic-benefits-of-saving-the-ecology">forest productivity</a>, the report adds.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85.jpg" data-media-id="editor_11" data-image-id="20250411060456_aa02a923f8b27544ae54d0220162678f5bbb5eeb8fc3c466173c22c49b3e9a85" data-rendition-name="original" width="998" height="724" loading="lazy" alt="Gas Chambers"> </figure>  Read also: <a href="https://nepalitimes.com/here-now/bad-air-and-polluted-politics">Bad air and polluted politics</a>, Sonia Awale Ground-level ozone is not emitted directly into the air like other gases, but is formed when oxides of nitrogen (NOx), carbon monoxide (CO) and volatile organic compounds (VOCs) released from automobile tailpipes or industry smokestacks react chemically with each other in the presence of sunlight. The main source of carbon monoxide in Kathmandu Valley are its 1.2 million two-wheelers. “Usually the concentration of carbon monoxide is 200-500 parts per billion (ppb), this has increased up to 3,000 in Kathmandu. Meanwhile, ground-level ozone has gone from 70-80 ppb to 150 ppb,” says Ravi Sahu, regional air quality specialist with the Kathmandu-based International Centre for Integrated Mountain Development (ICIMOD).&nbsp; Sahu says <a href="https://nepalitimes.com/news/no-smoke-without-fire-p7vb9dcj">rampant forest fires of the past weeks</a> have also added to carbon monoxide and ozone in the air, not just the fine particles that make up the visible smoke. He adds, “There isn’t much awareness about <a href="https://nepalitimes.com/banner/poisoning-the-air-we-breathe">ground-level ozone and carbon monoxide</a>, we need to urgently look into it.” A distinction must be made between good and bad ozone. Stratospheric ozone protects living beings from harmful ultraviolet (UV) radiation from the sun.&nbsp; Tropospheric ozone can again be separated into two types: ozone in the free atmosphere which is a greenhouse gas much more potent than carbon dioxide, and ground-level ozone which has adverse impacts on health and agriculture. ‘Cutting tropospheric ozone presents a unique challenge as it requires smart and fast action across multiple greenhouse gases and air pollutants, as well as multiple economic sectors,’ notes the Clean Air Fund's policy briefing. ‘It is a growing and neglected problem that needs an integrated approach on both a local and global level to tackle climate change and air pollution together.’ Dying young There was a time when Nepal made it to international news bulletins only if there were fatalities on Mt Everest. Now, Kathmandu’s bad air frequently makes headlines all over the world. This past week, the concentration of PM2.5 that harms human health was up to 40 times the WHO recommended guideline — adding to the poisonous gases already present from vehicle emissions. The Department of Environment says 40% of the pollution in the past weeks was from wildfires sparked by nearly 6 months without substantial rain over central Nepal. Most of the rest is from vehicular and industrial emissions from Kathmandu itself and across the southern border. NASA’s Fire Information and Resource Management System (FIRMS) which issues daily maps of fires, showed hundreds of blazes raging across Nepal on Wednesday, mainly in Chitwan, Parsa and along the East-West Highway.&nbsp; “If we look at the figures for the last few years, it is clear that wildfires have become the biggest source of air pollution, they are seasonal but have overtaken vehicular emissions,” says urban planner and environmentalist Bhushan Tuladhar. “Forest fires, stubble burning, and open burning of garbage are the bigger problems now. Nepal, India, Bangladesh, and Pakistan are at risk every year, we shouldn’t further delay in finding solutions,” warned air quality expert Bhupendra Das during an event on air pollution organised on 7 March by the Nepal Forum of Environmental Journalists (NEFEJ).&nbsp; Indeed, studies have shown that in winter 60% of the air pollution over Kathmandu is transboundary from the south, and in November it is compounded by smoke from crop residue burning by farmers in India and Pakistan blown in by prevailing winds. Forest fires are a regular pre-monsoon occurrence in Nepal, often intentionally set by farmers and herders to stimulate new grass growth for livestock. Winter rains have failed for eight of the past ten years, and this means the fires often spread out of control. The other reason for the increase in wildfires is the doubling of forest fires to 46% of the country’s area in the past 25 years. But this has happened simultaneously with outmigration, with some mountain districts losing 30% of their population between 2011-2021. With less pressure on forests for fodder and firewood, the undergrowth of community forests is loaded with dry fuel just waiting for a spark. The bowl-shaped topography of Kathmandu, Pokhara and other valleys further concentrates pollutants as they are trapped by surrounding mountains. But a year with a high number of wildfires is usually followed by a year or two with fewer incidents. For example: there were 6,537 fires in 2021 but the following year the number was down to 1,528. There were 5,216 fires last year, this year the number has already reached 1,800, and the trend is likely to be broken. Heavy rains forecast for the coming days are expected to douse some of the fires and clean up the air. But the damage has been done: Kathmandu residents of all age groups this week crowded clinics and hospitals with burning eyes, itchy throats, difficulty breathing, headaches, and dizziness. But in the longer term, soot particles that are tiny enough to jump the blood-air divide in lung capillaries do not just cause Chronic Obstructive Pulmonary Disease (COPD), asthma, but also cancers, heart attacks, strokes, birth defects and other chronic diseases. The latest Air Quality Life Index (AQLI) report by the University of Chicago shows that the annual concentration of PM2.5 in Kathmandu’s air rose from 17.87µg/m3 in 1998 to 31.33µg/m3 in 2022. Air pollution has got worse by 75% in Kathmandu in 25 years. During this time, air pollution has reduced the average life expectancy of Kathmandu’s residents by 3.5 years. According to the Health Effects Institute in Boston, dirty air is among the biggest public health concerns in Nepal killing over 42,100 a year. The adverse impact of high levels of air pollution is not limited to public health, it is seriously affecting tourism. Operators in Pokhara this week said that there were many negative online posts by visitors unable to see the famous panorama of Machapuchre and the Annapurnas even from Sarangkot. Aviation is also affected, as planes have to circle sometimes for hours burning a lot of fuel because of runway visibility being below minima at Kathmandu airport. The higher fuel cost is just passed down to customers, making air tickets in and out of Kathmandu some of the highest in the world. Kathmandu, with a population of four million, has not implemented a concrete policy to curb toxic air despite having formulated various action plans and repeated commitments by the government to protect the environment and control air pollution. The Department of Environment’s 2017 Air Quality Management Action Plan for Kathmandu put forward a policy to reduce air pollution caused by vehicles which was approved by the Cabinet, but has yet to be put to practice. The action included the immediate implementation of the Euro 5 emission standard to reduce pollution emitted by vehicles. However, Nepal has not even been able to implement Euro 4 standards so far. India, meanwhile, has already moved forward with the implementation of the Euro 6 standards. Says Ravi Sahu: “Air pollution in Nepal is not just about air pollution, it has ties to tourism, aviation, the economy so we must be prepared for annual conditions like forest fires, and this requires urgent interdisciplinary collaboration.” &nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742.jpg" data-media-id="editor_15" data-image-id="20250411050452_821d09e283d8a590f1369bfb71b9b7fc6d950726e0651ea86c6488d04deb1742" data-rendition-name="original" width="839" height="784" loading="lazy" alt="Silent Killers"> </figure>  &nbsp;

What is invisible is more dangerous

82 in २०८२

Here in the mountains of far-western Nepal, the biggest threat to life and limb is gravity. Women collecting fodder fall from trees, boys grazing goats fall off cliffs, heavily loaded tractors plunge from dirt roads carved out of steep slopes. There is nothing to be done about those who die on the spot. But for the severely wounded there is only one hospital: Bayalpata. And it is there that <a href="https://www.youtube.com/watch?v=CJzWlnYd0ZM&amp;t=8s" target="_blank">orthopaedic surgeon Mandeep Pathak</a> is the last hope for many wounded people. Pathak, 42, is too modest to tell us how many lives he has saved over the past 10 years he has worked at Bayalpata. But hospital records show he has performed more than 4,000 operations in the past decade, many of them so patients did not suffer permanent physical disabilities. Pathak also did 800 major life-saving surgeries in that time. “I treat patients with injuries, but I wish I could also treat poverty,” Pathak says, emerging from Bayalpata’s surgical theatre one recent afternoon. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/CJzWlnYd0ZM?si=s_rkbU4YDaw87gqH" 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> Sudurpaschim Province in Nepal’s far-west is far away from everything: from Kathmandu, from adequate medical care, from food security, and far from the reach of government services. It has suffered state neglect for centuries, its men mainly migrating to India for seasonal work to families who depend on subsistence agriculture. Pathak remembers the searing sadness he felt when a patient once told him, “Doctor, I sold the last of my rice to pay to come here, please give me a medicine that I can take on an empty stomach.” Pathak was born in Kathmandu, and after getting his MBBS from Kathmandu University, he got an MD from The Philippines. At a time when many Nepali doctors and staff nurses were emigrating, Pathak did not just return to Kathmandu but decided to go to one of the remotest districts in Nepal to serve those most in need. The hospital was established in 2009 in the village of Bayalpata, and has been managed by the non-profit <a href="https://www.nyayahealthnepal.org/" target="_blank">Nyaya Health Nepal (NHN)</a> as a public-private partnership treating 100,000 patients a year for no fees at all. NHN is now preparing to hand over the running of the hospital to the Sudurpaschim provincial government so its <a href="https://nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health" target="_blank">model of hospital management</a> can be replicated.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae.jpg" data-media-id="editor_4" data-image-id="20250414130456_b59dabd4604a24426a55fe91c0e5866b5029858bdb4c4028c331557aeb5408ae" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Bayalpata hospital"> <figcaption>Bayalpata hospital in Achham.</figcaption> </figure>  People from not just Achham but surrounding districts, and from as far away as Humla, bring patients to Bayalpata, sometimes walking for days. Some with complicated pregnancies are brought in stretchers, young children with broken arms walk into the emergency, and sometimes there are mass casualties when a tractor or bus falls off a road. And Pathak is always there with his team performing triage, and doing orthopaedic surgeries that would be difficult even in Kathmandu. Recently, his team did a hip replacement at <a href="https://nepalitimes.com/banner/state-of-the-art-rural-hospital" target="_blank">Bayalpata Hospital</a>. Mild mannered, modest, soft-spoken, hard-working, professional are the words families of patients who have been treated at <a href="https://nepalitimes.com/here-now/nepal-s-rural-lifeline" target="_blank">Bayalpata Hospital </a>use to describe Mandeep Pathak. But the surgeon is too busy to let all this get to this head.&nbsp; Asked why he does not emigrate like his peers or get a lucrative position at a private hospital in Kathmandu, Pathak answers simply, without a trace of self-importance, “I do not think I could get the satisfaction or sense of fulfilment anywhere else.” When travelling to attend medical congresses overseas or visit family in Kathmandu, Bayalpata has other doctors to take care of patients, but many wait patiently till Pathak returns for their consultation or surgery.&nbsp; When he returns from seminars abroad after learning the latest skills, Pathak’s suitcases are not full of clothes or presents, but titanium bone implants, external fixation rods, or intramedullary nails to be used in <a href="https://nepalitimes.com/news/altruistic-healthcare-models-in-nepal" target="_blank">surgeries at Bayalpata</a>.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80.jpg" data-media-id="editor_8" data-image-id="2025041414040_5356278472c1eb2b9e4af1d593d6234cc8dc5e5161a8c614197c01abefadbd80" data-rendition-name="original" width="2048" height="1368" loading="lazy" alt="surgery"> </figure>  Before Bayalpata Hospital was established, most people suffering broken bones had to travel down to Dhangadi or Nepalganj for treatment. No more. Although Pathak’s specialisation is orthopaedic oncology, he is mostly treating fractures and rejoining broken bones.&nbsp; Now as Bayalpata’s Hospital Director, Pathak also has administrative and fundraising duties. He has to take the 10-hour ride down to Dhangadi often to meet various Sudurpaschim ministries to release the hospital’s budget — that is sometimes more difficult than the most complicated surgery. Recently, he had to cancel an appointment with the Chief Minister to rush back to Bayalpata because there was a patient who needed emergency surgery. “I told myself, let me save this patient first, then I will try to save the hospital,” he recalls.&nbsp; Once, when he had to be away for a month on emergency surgery training in the US, the family of a 90-year-old woman who had dislocated her hip after falling from a staircase was waiting for him to return. Her son told Pathak: “Doctor, either put her out of her suffering, or cure her.” Pathak told him it was too dangerous to operate at her age, but the son said his mother was in so much pain it was worth the risk. The operation was touch-and-go, but it was successful. The woman who had been brought in on a stretcher, walked out of the hospital three days after the operation.&nbsp; A few months later, a 27-year-old woman was brought into the ER bleeding profusely from an arm mangled by a thresher machine. Even in that state, she was breastfeeding her baby. Pathak welled up seeing this display of selfless motherhood, as he wheeled her into surgery. She needed three operations, but now has full use of her hand. <div class="embed-block"><iframe width="700" height="415" src="https://www.youtube.com/embed/xJdxLD0hBqo?si=mOpM2R_DsYL88Lfg" 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> It is the sense of achievement from such recovery that keeps Mandeep Pathak here in this isolated village in the middle of nowhere. Bayalpata Hospital has not just saved lives, it also saves families from poverty because they do not have to take sick relatives to expensive city hospitals.&nbsp; In January, a woman was brought to Bayalpata with both hands broken. She said she had taken a fall, but Pathak did not believe her. When alone in the surgery, she finally admitted that her husband had beaten her.&nbsp; It was her husband who had brought her to hospital for treatment, but she refused to file a police report. Pathak quietly put both her arms in casts, thinking about the poverty, patriarchy and injustice in society that he is unable to treat.