<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410118/637205c69c7e80680e0b28d5jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: SONIA AWALE</figcaption></figure>The last Sunday in January is World Leprosy Day. Since 2006, I have issued an annual Global Appeal to End Stigma and Discrimination against Persons Affected by Leprosy, supported by influential individuals and organisations around the world.Amid the coronavirus pandemic, which has shown how easily fear and anxiety about a disease can fuel prejudice, I believe this call to eliminate <a href="http://archive.nepalitimes.com/news.php?id=711#.YfYlNi2B3ow" target="_blank" rel="noopener noreferrer">stigma and discrimination</a> is more important than ever.Leprosy, also known as Hansen’s Disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae. It mainly affects the skin and peripheral nerves and is one of the oldest diseases in human history. Yet each year, around 200,000 new cases are reported globally.In Nepal, 2,304 new cases were reported in 2020 and it is one of 23 countries on the WHO’s priority list for leprosy. Most cases are found in Madhes Province bordering India.Today an effective treatment exists in the form of multidrug therapy (MDT) and with early detection and treatment, the disease can be cured without complications. But if treatment is delayed, <a href="http://archive.nepalitimes.com/news.php?id=39#.YfYl-S2B2b8" target="_blank" rel="noopener noreferrer">leprosy can cause progressive impairment</a> and lead to permanent disability.There are an estimated 3-4 million people living with some form of disability due to leprosy. This fact, together with deep-seated fears and misperceptions about this age-old disease, has subjected persons affected by leprosy and even their family members to severe discrimination, which continues to this day.Since becoming WHO Goodwill Ambassador for Leprosy Elimination in 2001, I have visited some 120 countries to see the situation for myself. This has led me to think of leprosy in terms of a motorcycle: the front wheel symbolises curing the disease, and the back wheel represents eliminating discrimination. Unless both wheels are turning together, we will not reach our ultimate goal of zero leprosy.As regards to the front wheel, efforts against the disease, including new case detection, have been badly disrupted by the spread of the novel coronavirus and efforts to prevent transmission. In 2020, the number of new cases reported was down to 37% year on year, according to the WHO, largely due to the impact of Covid-19.Concerning the rear wheel, I have worked hard to have leprosy recognised internationally as a human rights issue since the early 2000s, when I first approached the Office of the UN High Commissioner for Human Rights. One result has been the adoption in 2010 of a UN General Assembly on elimination of discrimination against <a href="http://archive.nepalitimes.com/news.php?id=15213#.YfYl_y2B2b8" target="_blank" rel="noopener noreferrer">persons affected by leprosy</a> and their family members.But the real measure of success will be when principles and guidelines accompanying the resolution are fully implemented. Because of the pandemic, however, awareness-raising efforts in many areas have stalled, and some people have found that Covid-19 is exacerbating the discrimination they already experience as persons affected by leprosy.This is why last August I launched a <a href="https://www.shf.or.jp/en/dont-forget-leprosy-campaign/" target="_blank" rel="noopener noreferrer">campaign called ‘Don't Forget Leprosy’</a> to ensure that leprosy and the needs of those affected by the disease are not overlooked, even amid the pandemic. The campaign stresses the importance of early detection and treatment, as well as the need to eliminate stigma and discrimination.The term 'don't forget' covers many things: that leprosy still exists, that people affected by leprosy and their families still face social prejudice, and that there are healthcare professionals doing their best in difficult circumstances to provide needed services.In Nepal, a country I have visited many times over the years, what has impressed me has been the strong cooperation I have found between the <a href="http://mohp.gov.np/eng/program/communicable-disease/leprosy-control-program" target="_blank" rel="noopener noreferrer">Ministry of Health and Population</a> and leprosy NGOs. They make the most of their respective strengths and complement each other’s efforts, and in this way have helped to advance measures against leprosy throughout the country.Working in partnership with the ministry’s leprosy control program, <a href="https://tlmnepal.org/blog/anandaban-hospital/" target="_blank" rel="noopener noreferrer">Anandaban Hospital</a> near Kathmandu, Lalgadh Leprosy Hospital &amp; Services Center in Janakpur and the Green Pastures Hospital in Pohkara provide both medical and social support. They provide treatment and rehabilitation, and assist with reintegration into the community.I would also like to give a mention to the leprosy center established in Surkhet with the support of the Sasakawa Health Foundation, operated with the dedicated effort of local people and contributing to community medical care.Nepal has also pioneered a <a href="https://www.nepalitimes.com/banner/new-treatment-offers-hope-for-nepals-leprosy-patients/" target="_blank" rel="noopener noreferrer">revolutionary treatment for leprosy wounds</a> saving money and prolonged pain for the patients. The technique called Leukocyte Platelet Rich Fibrin (LPRF) originally devised for dental surgery accelerates the healing of tissue and is now being used widely in the country to treat hard-to-heal skin lesions of diabetes and leprosy patients.Over the past 50 years we have come a long way toward our goal of a world free from leprosy and the discrimination it causes. We must not allow the progress we have made to be undone by the impact of <a href="https://www.nepalitimes.com/here-now/omnipresent-omicron-starts-to-lose-its-edge/" target="_blank" rel="noopener noreferrer">the Covid-19 pandemic</a>.Together with my annual Global Appeal and the activities that partner organisations will be carrying out for World Leprosy Day this year, I hope it will put the disease back in the spotlight and show that our work to end the medical and social problems related to leprosy is not yet done.Please add your voice to the campaign and make this a collective effort. Together we can be heard loud and clear: “Don’t Forget Leprosy.”Yohei Sasakawa is WHO Goodwill Ambassador for Leprosy Elimination as well as the Japanese Government Goodwill Ambassador for the Human Rights of Persons Affected by Leprosy. He is the chair of The Nippon Foundation.

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During the pandemic, don’t forget leprosy

https://www.youtube.com/watch?v=kJLBI7sim0M&amp;feature=youtu.beA revolutionary treatment for open wounds has dramatically reduced the healing period of <a href="http://archive.nepalitimes.com/news.php?id=711#.XSckw-szaUk" target="_blank" rel="noopener">leprosy patients in Nepal</a>, saving them money and prolonged pain. The new procedure has huge implications internationally, as it reduces the medical cost for treating patients with chronic open wounds.The technique, called Leukocyte Platelet Rich Fibrin (LPRF), was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089057/" target="_blank" rel="noopener">devised for dental surgery</a> by Nelson Pinto of Chile and has proven to accelerate the healing of tissue. Now, it is also being used to treat hard-to-heal skin lesions of <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018" target="_blank" rel="noopener">diabetes</a> and leprosy patients.“LPRF has shown miraculous results in the treatment of chronic wounds in Nepal,” says dental surgeon Sushil Koirala who is pushing the new treatment in government hospitals. “It does not need special equipment, is cheap and, so simple even paramedics and nurses can perform it.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f009c7e80680e04fce5jpeg.jpg" alt="" width="1400" height="1050"/><figcaption>SECOND CHANCE: Surgeon Indra Bahadur Napit guides a paramedic during a session of LPRF on a patient with leprosy at Anandaban Hospital. Pic: KUNDA DIXIT</figcaption></figure>There are three specialised leprosy hospitals in Nepal: Ananadaban in Lele, Green Pastures in Pokhara, and Lalgadh in Dhanusa. Anandaban Leprosy Hospital 16 km south of Kathmandu has been trying out LPRF on patients with excellent results.Leprosy is a biblical disease in which bacteria called Mycobacterium leprae damages the patient’s nerves and causes the fingers, toes and limbs to go numb, leading to further injuries. Leprosy is treated with antibiotics, but some patients suffer antigen reaction and need long-term rehabilitation.One of the patients at Anandaban is Phelit Sahi, who was ostracised by her community in Jumla because she had leprosy and had been living in a cave for 25 years. Reporters who had gone to cover a local event in a helicopter found out about her, and flew her to Kathmandu for treatment.Every week, doctors draw 80cc of blood from her and place it in a special centrifuge for 12 minutes. The clear plasma separates from the red corpuscles and is compressed to form a high-density fibrin clot which is applied to her wound.“She is among more than 100 patients that we have treated with LPRF, and we have gained enough experience in this technique to lead the way for the world,” says surgeon Indra Bahadur Napit at Anandaban, who presented his results at WHO in Geneva.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f039c7e80680e04fce6jpeg.jpg" alt="" width="1400" height="933"><figcaption> </figcaption></figure>Raju Lama was 27 when he was diagnosed with leprosy, but because of late diagnosis, his fingers and toes were deformed, and he had to abandon his job. Doctors recommended amputating his right leg, but became the first patient to get LPRF treatment. He is happy with his “ragat upachar” (blood treatment) and says after several LPRF procedures his wounds are healing much faster.Ram Kumari Sah and her husband from Janakpur have been living with leprosy for decades. She does not feel pain in her hands and legs and often hurts herself. Her lesions become infected and never healed. This week, she was waiting for her turn at the LPRF ward in Anandaban.The hospital’s LPRF pilot study has shown that 97% of the cases healed completely within seven weeks. The results are so encouraging that news of this revolutionary treatment has spread through word of mouth. A dozen patients, currently at Anandaban were referred by hospitals in India. A team of Nepali doctors is also training doctors in Burma, Bangladesh and Nigeria.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f069c7e80680e04fce7jpeg.jpg" alt="" width="1400" height="1003"><figcaption> </figcaption></figure>The new treatment is expected to add to Nepal’s success in reducing the prevalence of leprosy from 21 cases per 10,000 in the 1980s to less than 1 today. Nepal was officially declared leprosy-free in 2010 when the prevalence rate came down to 0.79%.However, in recent years, the prevalence rate is creeping up again, and was 0.94% in 2018. More than 3,000 new patients are diagnosed with leprosy every year, with most of the cases found in Province 2. Experts say this could be a result of active case finding and may not mean that the prevalence is increasing.Leprosy is curable with multidrug therapy but many do not get treatment on time. The incubation period is five years on average and symptoms may occur within a year, but can also take as long as 30 years to become visible, making the disease difficult to diagnose, and the delay leads to nerve damage and deformities. Leprosy is transmitted through the air during close and frequent contact with untreated cases.“Leprosy can afflict anyone but there is a correlation between the disease and poverty,” explains dermatologist Mahesh Shah. “If one’s immune system is strong, the bugs do not do any damage. But poor hygiene and nutrition increases susceptibiltity. Neglected people from neglected countries suffer from leprosy the most.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0a9c7e80680e04fce8jpeg.jpg" alt="" width="1400" height="1169"><figcaption> </figcaption></figure>Up to 40% of patients undergoing multidrug treatment develop a reaction, and need long-term hospitalisation. Since the patients are poor, most private hospitals are not interested in treating them. At Anandaban, treatment is free as it is supported by government grants and charities.Since 1% of cases suffer from relapse in Nepal, active door-to-door case finding is important to meet the WHO target of zero leprosy transmission by 2030.Even more daunting is to counter societal stigma and ostracisation of leprosy patients. Family members regard the disease as punishment from the gods, and even some medical interns and nurses refuse to touch patients despite patients being on antibiotics and unable to spread the disease. Nepal’s laws still allow husbands to divorce their wives if they have leprosy.“It is a complicated disease made even more so by stigma and ignorance,” says Napit, “but with LPRF, we now have a powerful weapon in our arsenal. A vaccine would be the final solution, but no one cares about leprosy. All the funding goes for diseases like HIV.”   <h2>Miraculous healing</h2>When Nelson Pinto’s favourite horse broke its leg, he had two options: either put it down or amputate its leg. The Chilean dentist decided on a third option.He drew some blood from the horse, spun it in a centrifuge to separate the autologous fibrin matrix which is rich in platelets, and applied the plasma to the horse’s wound. After a few weeks, the horse was cantering again.Pinto knew about the technique because Leukocyte Platelet Rich Fibrin (LPRF) was developed for dental implant treatment. The surgeon was so convinced that the new process would be useful in treating chronic open wounds that he embarked on a global crusade to spread its use.Pinto convinced fellow-dentist from Nepal, Sushil Koirala, whom he met at an international conference, to adopt the technique. Since then, Koirala has been trying to convince the government and private hospitals to adopt the procedure, but without much success. However, Anandaban Leprosy Hospital in Lalitpur has seen phenomenal improvements in the healing time of lesions among its patients. (See adjoining report above)LPRF is now used to treat diabetic wounds, lesions caused by leprosy, localised <a href="http://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> and surgical wounds, and with this, healing time is often cut in half. It is also being used in cosmetic surgery to remove wrinkles and rejuvenate the skin. The reason why it is so effective, Pinto explained during a trip to Nepal last month, is because it is completely natural and autologous, which means a patient is not receiving any foreign tissues or chemicals.And the treatment is cheap. A similar treatment used in Europe, which involves a kit manufactured by a multinational pharmaceutical company, costs $3,000 per patient. LPRF costs only $30. But it seems as though private hospitals are not interested in this treatment as patients heal so quickly. Many doctors are also not enthusiastic because LPRF can be administered by a paramedic or a nurse.Says Sushil Koirala: “The reason they don’t like it is because there is no money in it. LPRF only uses the patient’s blood and there are no chemicals or equipment involved for multinational companies to make money out of.”Koirala’s Punyaarjan Foundation has donated centrifuge machines to a few hospitals in Nepal including the Sushma Koirala Memorial in Sankhu, Anandaban Leprosy Hospital, Bir Hospital in Kathmandu and to three hospitals in Burma with varying degrees of acceptance.The Bible relates how Jesus Christ miraculously and instantaneously cured ten lepers at the gates of Jerusalem. LPRF may not cure leprosy lesions as quickly, but the procedure is nearly as miraculous.<h2>Life after leprosy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108131140/636a4f0d9c7e80680e04fce9jpeg.jpg" alt="" width="1400" height="1050"><figcaption> </figcaption></figure>Kumar Tamang, 47, is putting the final touches on his painting of an elephant with a bejewelled crown and a howdah. He dips his paintbrush on a palate and paints the border bright red. His fingers are numb and deformed by leprosy, yet he has been painting for 25 years. His love for Mithila art is on full display on the walls, pillars and ceiling of Shanti Sewa Griha, a leprosy clinic set up by the German charity, Leprahilfe, in 1992.Nearby, in a dark corner, is 50-year-old Nathuni Barai from Nawalparasi, who also has deformed fingers which he uses deftly to draw intricate patterns on a letter pad. Both Tamang and Barai are former patients at <a href="http://archive.nepalitimes.com/news.php?id=15213#.XSckyeszaUk" target="_blank" rel="noopener">Shanti Sewa Griha,</a> making a livelihood from products that Leprahilfe buys from fundraising. Their families live nearby, and their children attend a school set up by the charity.Now, nearly three decades after the clinic was set up, Shanti Sewa Griha runs a school and orphanage in Budhanilkantha, an organic farm in Sundarijal and a rehabilitation centre near Pashupati.As the number of patients grew, they were trained in painting, tailoring, quilt making, carpentry and jewellery making as a form of livelihood. Bags, uniforms, paintings, stationery and decorative items are sold as souvenirs to raise money for the upkeep of the shelters and to pay former patients.“This is a form of operational therapy which tries to break the vicious circle this disease has formed,” said Marianne Grosspietsch, one of the founders of Leprahilfe. “Our goal is to create hope in Nepal.”In 1974, Grosspietsch adopted a young boy named Puskar Limbu who had leprosy like the rest of his family. She took the boy to her home in Germany, treated his leprosy and sent him to school. Limbu went on to pursue a successful career in graphic design in Germany and is a grandfather himself today.Children of former leprosy patients have also gone on to become nurses and doctors.Kalpana Pariyar (pictured above) was 14 when she was diagnosed with leprosy before there was serious nerve damage to her fingers. She grew up in the shelter and married fellow-patient Krishna Majhi, whom she took care of until he died eight years ago. She now has a college going daughter and an eight-year-old son.“I have spent my entire life here. This is my home, this is where I made my life and found peace,” says Pariyar, looking up from her sewing machine on which she was weaving dhaka fabric.Sonia Awale

Sonia Awale

New treatment offers hope for Nepal’s leprosy patients

Imagine a high-end fair trade tea brand from Nepal that has done everything right, with ethical sourcing practices and international certifications. It has built a loyal base of socially conscious, premium customers in an export market and focuses on quality over quantity. Then one day, a government in the export market introduces a new ‘listing criteria’ that requires exporting a certain amount of tea to at least three countries in the past five years. But this was never a numbers game, it was about a niche market of socially responsible tea lovers. Suddenly, fair trade tea companies are restricted from exporting tea to that country. Pretty unfair for the company, for consumers, for the tea sector. More importantly, for tea farmers and families benefiting from fair standards. The overseas labour industry is facing a similar risk as recruiters, including those that have adopted ethical standards, may soon be barred from finding workers for Malaysia. On 27 October, the Malaysian Ministry of Foreign Affairs sent letters to five countries including Nepal, Bangladesh, Burma, Pakistan and India to ‘rationalise the number of licensed private recruitment agencies permitted to facilitate recruitment and placement of workers to Malaysia’.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141040_050274dddc6cf10224b0ad9283eec7b3bc3c0acd650543a808a8ea473ecf40db.jpg" data-media-id="editor_0" data-image-id="20251030141040_050274dddc6cf10224b0ad9283eec7b3bc3c0acd650543a808a8ea473ecf40db" data-rendition-name="original" width="961" height="1135" loading="lazy" alt="Malaysia recruitment"></figure>  The letter includes 10 criteria for private recruiting agencies including at least five years of operating experience, deployment of 3,000 workers in the past three years of operation, experience sending workers to at least three countries, a 10,000 sq m office maintained for three years, valid licenses and good conduct certificates, five employer testimonials, and operating their own training and accommodation centres. Two conditions stand out as potentially harmful to Nepal’s ethical recruitment movement. First, although the letter cites a minimum of 3,000 workers, it says three years in the heading and five in the body text. A big enough difference to affect a significant number of recruiters from making the cut, but problematic regardless. Second, the requirement to send workers to at least three countries disproportionately impacts responsible recruiters in Nepal and elsewhere. Turning the selection of workers into a numbers game is dehumanising. Responsible recruiters deprioritise volume, focus on quality of jobs even when business sustainability comes under threat as ethical opportunities that do not require workers to pay any feed and ensure greater transparency are difficult to come by. Sending workers is further impacted by a series of external shocks. For example, in the Malaysian context Nepal banned emigration to Malaysia for two years followed by the Covid pandemic, and then Malaysia’s decision to stop the intake of foreign workers for the last two years.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141040_b1b88b3ae2e94c6bc077529ac6f2a4e380a385ee9a22219edfed25067c9d25a1.jpg" data-media-id="editor_1" data-image-id="20251030141040_b1b88b3ae2e94c6bc077529ac6f2a4e380a385ee9a22219edfed25067c9d25a1" data-rendition-name="original" width="595" height="841" loading="lazy" alt="Malaysia recruitment"></figure>   <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141040_2cf252908d18aaf09c875002eef2d92ab45897a56b560addd2dc02311725c8a7.jpg" data-media-id="editor_2" data-image-id="20251030141040_2cf252908d18aaf09c875002eef2d92ab45897a56b560addd2dc02311725c8a7" data-rendition-name="original" width="590" height="238" loading="lazy" alt="Malaysia recruitment"></figure>  Many ethical recruiters have focused on Malaysia because it is a more common labour market for responsible recruitment than other destinations like the Gulf. There is no credible justification to why responsible recruiters well regarded by scores of Malaysia-based multinational companies and with decades of experience should be ‘disqualified’ for not diversifying. Finding jobs for Nepalis in new markets is difficult given fierce competition, challenges identifying companies which follow the employer-pays principle, lack of networks and shortcomings in marketing strategies. These factors hit responsible recruiters harder because profit-motivated employers are often unwilling to cover the costs and fees associated with workers’ recruitment. “The volume of deployment does not determine a recruiter’s capability or the quality of services provided,” says Sujit Shrestha of the Nepal Association of Foreign Employment Agencies (NAFEA). Nepal recently scrapped the licensing renewal requirement that mandated sending at least 100 workers a year as it was impractical. The new Malaysian criteria is similar in nature, he added. The ball is now in Nepal’s court at a time when the interim government does not even have designated heads in the Foreign Ministry and the Ministry of Labour, Employment Employment and Social Security. When rumours about the Malaysian action started circulating, NAFEA had raised the issue, but was assured that this was not an attempt to set up a syndicate.  <figure><img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251030141044_83c8a174ef116603f747d1cd254c4d353e8b855a41fb99feec54e701f5fc4c3f.jpg" data-media-id="editor_3" data-image-id="20251030141044_83c8a174ef116603f747d1cd254c4d353e8b855a41fb99feec54e701f5fc4c3f" data-rendition-name="original" width="3456" height="5184" loading="lazy" alt="Malaysia recruitment"></figure>  How will governments and recruiters in other origin countries now respond? There is precedence from Bangladesh. Dhaka-based journalist at the Daily Star, Porimol Palma who says, “Earlier, the Malaysian authorities had selected 101 Bangladeshi recruiters unilaterally, despite Bangladesh’s call for a syndicate-free recruitment mechanism.” Between 2022-2024, 450,000 Bangladeshis were recruited under this system with workers paying between $4,500 and $6,000, even though the legal limit was $750. Palma attributes part of the high fees workers had to pay were for commissions or bribes to recruitment syndicates. Adrian Pereira heads the North South Initiative in Malaysia says: “The criteria seems a bit fishy, as they do not appear to address the actual problems in the the recruitment of foreign workers. Some of the criteria seem to encourage a system of monopoly or syndicate rather than a rights-based approach. Every government has the right to set criteria for recruiters, but conventions and ILO (International Labour Organization) standards on recruitment exist. It looks like we’re back to square one.” Whether migrant origin countries including Bangladesh and Nepal accept the terms sent without reservations or push back in good faith remains to be seen. In an ideal world, a collective stance should put workers’ needs and welfare at the centre. How rational is the proposed ‘rationalising strategy’? What aspects of it are promising to curb recruitment abuse and what merits serious reconsideration? Even if the move from the Malaysian side is well-intentioned to address rampant malpractices migrant workers face, Nepal should deliberate on the conditions set, the collateral damage especially on the responsible actors and small but capable recruiters. Alternate options that might serve everyone better before rushing to respond with a chosen list by 15 November. If the proposal is accepted, how would it be done in a transparent and accountable way? It is noteworthy that Indonesia was not listed even though it has the most workers in Malaysia among the 16 countries that send migrants to Malaysia. The Responsible Business Alliance (RBA), the ILO, the International Organization for Migration (IOM), and certification programs like On the Level (OTL) also need to use their leverage to ensure that recruiters, including those they have trained or certified on ethical recruitment principles, are not penalised. This is more than just about protecting the ethical recruitment movement, but raising even more basic questions: Who can legally be a recruiter in Nepal? There are already obligations like hefty security deposit and minimum office requirements. But requirements to have building facilities with ‘accommodations’ or ‘testing centres’ are not among them. There are 1,150 plus players in Nepal’s recruitment sector, with a few hundred engaged in the Malaysian market. A unilateral selection criteria could risk foul play, or lead to unintended, unfavourable consequences. To be sure, overseas recruitment in Nepal is known for ‘settings’, corruption, dog-eat-dog competition, and collusion. The profiteering is out of control, often at the expense of workers. But the solution does not lie in stifling the industry with criteria like deployment volume, building worker accommodations or expanding office floors. The focus should instead be on enforcing rules and laws in both countries that govern the industry, and the Malaysian labour agreement that has not been renewed since October 2023. Meddling in the industry in ways that harms fair competition and ethical actors means workers suffer. The only issue that should be taking precedence is: how will Malaysia’s 10-point criteria and planned arrangement affect migrant workers? We have seen how for identical Malaysia-based jobs, one worker might pay zero while another pays up to Rs400,000, depending on the employer and recruiter. It is unclear if the 10-point selection criteria rewards the employer. As a longstanding host country for Nepali migrants, Malaysia deserves credit for nurturing the small but growing ethical recruitment industry here. Export-oriented companies in Malaysia need responsible recruitment partners and have mentored recruiters to strengthen their practices and move away from worker-paid models. The business case for ethical recruitment standards has led many recruiters in Nepal to pivot with many now in various stages of transition from traditional to hybrid or purely ethical practices. This progress needs to be acknowledged and built upon. Large, well-networked recruiters with large physical assets and high volume of workers seem to be the winners of Malaysia’s 10-point criteria after two years of waiting for the Malaysian market to reopen. Responsible recruiters endure long periods of minimal or no deployments that threatens their survival. The letter now sitting on the desk of the interim government in Nepal deepens the concern: rather than just failing to recognise or reward responsible recruiters, does the international recruitment market actually punish them? Upasana Khadka heads Migration Lab, a social enterprise aimed at making migration outcomes better for workers and their families. Labour Mobility is a regular column in Nepali Times.

Who gets to recruit for Malaysia?

Public anxiety about immigration has become a powerful political currency across many liberal democracies. In Australia, as elsewhere, legitimate concerns about housing and economic fairness can be, and increasingly are exploited by anti-democratic actors who frame migration not as a policy issue but as a cultural threat.&nbsp;
When these narratives move from online spaces to public rallies, they do more than divide opinion; they erode the social trust and pluralism on which democracy depends. Understanding how populist and far-right movements weaponise migration debates is crucial to recognising the early challenging signs of liberal democracy.
Immigration has become one of the most politically charged issues in Australia, not only because of the numbers but because of its entanglement with cost-of-living pressures, housing shortages, and rent spikes.&nbsp;
The latest Household, Income and Labour Dynamics in Australia (HILDA) <a href="https://www.unimelb.edu.au/newsroom/news/2025/september/how-we-live-latest-hilda-data-gives-insight-into-a-changing-australia">data</a> shows rising household financial stress as Australian households spending more on rent and income tax. These changes likely reflect a mix of economic and policy factors but create a lot of room for people to hold inaccurate and occasionally contradictory attitudes on these issues.&nbsp;
While net overseas migration has started to decline from its post-pandemic peak, public concern remains high, amplified by populist rhetoric. Some surveys have <a href="https://www.theguardian.com/australia-news/2025/feb/04/australians-want-less-migration-but-oppose-cutting-international-student-numbers-study-finds">revealed</a> a nuanced picture: most Australians want lower migration overall but oppose cutting international student numbers, and support targeted skilled migration to address workforce gaps.&nbsp;
As former Home Affairs Minister Clare O’Neil <a href="https://minister.homeaffairs.gov.au/ClareONeil/Pages/how-australia-broke-its-migration-system.aspx">argued</a> in 2023, Australia’s migration system is “broken and un-strategic”, not delivering for business, for migrants, or for the larger population. This is a situation that frustrates both sides of the debate and makes immigration an easy political flashpoint.
The recent <a href="https://marchforaustralia.org/">March for Australia</a> rallies turned these anxieties into street-level mobilisation. Tens of thousands <a href="https://www.bbc.com/news/articles/czjmre371l1o">protested</a> at what they called ‘mass immigration’, while far-right groups seized the opportunity to inject xenophobic slogans and calls for ‘remigration’ into the public space. These demonstrations were not only about visa caps or housing and jobs; they became performances of who is entitled to belong.&nbsp;
When immigration is framed not as a policy question but as a cultural test of Australianness, it risks shrinking the demos, the very community that democracy is meant to represent.
What made the March for Australia so striking was not only its size but its composition. Recent investigative reporting <a href="https://www.theage.com.au/politics/victoria/don-t-mention-hitler-and-you-re-sweet-the-great-march-for-australia-deception-20250909-p5mtlc.html">revealed</a> that neo-Nazi groups were not merely present at the March for Australia rallies but played a role in covertly organising them. They amplified messaging online, coordinated attendance, and sought to mask their involvement to broaden appeal.&nbsp;
This highlights that democratic erosion is rarely spontaneous; it requires actors who deliberately exploit social grievances, mistrust, and polarisation to mobilise anger for their anti-democratic ends. The banners reading ‘<a href="https://www.theguardian.com/commentisfree/2025/sep/01/how-do-i-feel-safe-after-march-for-australia-anti-immigration-protest-ntwnfb">Stop Immigration</a>’ revealed that public hostility towards migrants, <a href="https://www.afr.com/politics/federal/pressure-mounts-for-price-to-apologise-to-indian-australians-20250908-p5mt7x">particularly</a> from the Indo-Pacific, is growing.
For many migrants, these displays are more than conceptual debates about white national identity. They are experienced emotionally. Writing shortly after the rallies, Melbourne-based writer Jafrin Kabir <a href="https://www.theguardian.com/commentisfree/2025/sep/01/how-do-i-feel-safe-after-march-for-australia-anti-immigration-protest-ntwnfb">reflected</a> that she had never felt so foreign on Australian soil. She pays taxes and inflated rents, contributes skills in the national interest, cheers for the Tillies and calls Melbourne “home”, yet suddenly felt unsafe because of the origin and colour of her skin.&nbsp;
Similarly, Chinese national interviewed by media outlet <a href="https://www.scmp.com/news/china/diplomacy/article/3325127/i-feel-insecure-chinese-nationals-australia-blindsided-anti-immigration-marches">reported</a> cancelling weekend plans and feeling “blindsided” by the scale of the marches.
Scapegoating migrants especially in times of economic stress is an age-old phenomenon and is not just limited to Australia. Across the democratic world, from the United States to the UK and parts of Europe, hostility toward migrants and minorities has become a route for anti-democratic forces. Populist actors often <a href="https://www.theguardian.com/australia-news/2025/mar/27/peter-dutton-keeps-blaming-migration-for-the-housing-crisis-but-can-it-really-be-that-simple">use</a> cultural anxiety and demographic change to justify illiberal and undemocratic measures, claiming to restore order while actually dismantling checks and balances.
By analysing democratic decay, scholars like Lydia Khalil at the Lowy Institute, <a href="https://interactives.lowyinstitute.org/features/democratic-erosion/">argue</a> that democracies rarely break down at once. Instead, they incrementally weaken through vicious cycles: declining trust in institutions, entrenched division based on hate, the normalisation of political violence, and the bit by bit removal of norms and guardrails.&nbsp;
Though some of the conditions are present in Australia to be exploited by anti-democratic actors, for example, almost two-thirds of Australians believe their leaders intentionally mislead them, according to the <a href="https://www.edelman.com/au/trust/2025/trust-barometer">2025 Edelman Trust Barometer</a>, &nbsp;but their presence is not determinative.
Australia’s democratic guardrails remain strong: independent courts, transparent elections run by the AEC, and a free press continue to hold power to account. Federalism and active civil society further diffuse power and create space for contestation.&nbsp;
But if public trust continues to erode and social divisions deepen, these safeguards will come under strain. Early recognition and action are crucial to ensure that today’s street-level hostilities do not translate into institutional regression.
Preventing such outcome requires a socially embedded understanding of migration, an understanding that goes beyond simplistic optimistic and pessimistic views. Policy makers should go beyond Push-Pull models, functionalist and neoclassical and historical-structural theories.&nbsp;
Consulting the work done by <a href="https://www.guilford.com/books/The-Age-of-Migration/Haas-Castles-Miller/9781462542895#:~:text=International%20Population%20Movements%20in%20the%20Modern%20World,-Hein%20de%20Haas">Hein de Haas</a> et-el, migration should be conceptualised as an intrinsic part of broader processes of development, social transformation and globalisation rather than a 'problem to be solved'. We need more nuanced views that have an eye for the complexity of migration processes and the diversity of its causes and impacts.
Sohail Akhtar is a Melbourne- based researcher focusing on governance, public policy, and migration. He contributes to Lowy Institute Sydney.
This article was issued by the Toda Peace Institute and is being republished from <a href="https://toda.org/global-outlook/2025/is-street-level-hostility-a-challenge-to-liberal-democracy-reflections-from-australia.html">the original</a> with their permission.

Is street-level hostility a challenge to liberal democracy?

Intricately painted Buddha, Aryatara, Krishna, and Parvati gaze serenely at visitors at the Kathmandu Art Gallery under muted amber lights. Moving from one artful devotion to the next, a quiet, profound connection to the divine envelopes the visitor. This transcends art to the realm of the spiritual. &nbsp; The gallery’s latest exhibition, Masters of Devotion, features art by 22 artists all from Bhaktapur. They also include Ajay Karmacharya, Purna Prasad Hyoju, Nhuche Kaji Bajracharya, Rajani Sinkhwal, Shashi Dhar Sainju, Surya Bahadur Chitrakar and Sundar Sinkhwal from the Khowpa Paubha Chowmi Pucha. Paubha are religious and devotional art depicting deities and mandala that date back to the 7th century, when Newa artists began to paint images of the gods on cloth. For the artists who practice this craft, the art form is as meditative as it is meticulous.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251025041028_de34b51d48bcee50ae391301e2ff1890be7ecba3df7e563537c273818825aad5.jpg" data-media-id="editor_0" data-image-id="20251025041028_de34b51d48bcee50ae391301e2ff1890be7ecba3df7e563537c273818825aad5" data-rendition-name="original" width="1280" height="960" loading="lazy" alt="art review "> </figure>  The exhibition at the newly-opened space Kathmandu Art Gallery coincides with the festival season and is a collection of extravagant works done in mineral and stone colour, sakura and gouache. The vintage art space is located at Babar Mahal Revisited and is a fitting accompaniment to the paubha featured in the exhibit.&nbsp; Sundar Sinkhwal’s vividly painted Harihara is among the more eye-catching works. “Half of the painting is Shiva and half is Vishnu, hence the name Harihar,”explains Sinkhwal. “Together with their consorts Parvati and Laxmi, I have painted Uma-Maheswor and Laxmi-Narayan.” Nandi and Garuda, the vehicles of the two gods, complete the vibrant painting.&nbsp; In contrast, for his piece titled Lakshmi, Sinkhwal shrouds his canvas in dark colours to paint Kuber, the deity revered as the custodian to the wealth in the Hindu pantheon, accompanied by two khyak apparitions —one black, the other white— both mythical creatures in Newari folklore.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251025041032_1bde6de442b742c300bb8c9278ea8886445aa8df47076fd9aa362ce1f8bef903.jpg" data-media-id="editor_1" data-image-id="20251025041032_1bde6de442b742c300bb8c9278ea8886445aa8df47076fd9aa362ce1f8bef903" data-rendition-name="original" width="1280" height="960" loading="lazy" alt="art exhibition"> </figure>  “The black khyak is considered inauspicious, while white ones are a symbol of good luck,” explains Sinkhwal. Purna Prasad Hyoju has used mineral paint on canvas for a powerful depiction of Ardhanareswar, the composite form of Shiva and his consort Parvati.&nbsp; “I drew inspiration from the Newari Swasthani story about the separation of Shiva and Satidevi,” says Hyoju. Legend has it that Shiva, unwilling to part from his consort, reincarnated as a unified dual gender form of himself and Parvati. Hyoju has painted goddess Parvati in bright yellow, in homage to one of her other manifestations, Gauri, which means radiant.&nbsp; Meanwhile, Ratna Gopal Sinkhwal’s Kurkula Devi, done in stone pigment, is radiant on the cotton canvas. “Kurkula Devi is a tantric goddess whose traces are found in the Sadhana Mala,” says Sinkhwal. “The stone pigment is what makes the goddess look like she is gleaming.” One of Sinkhwal’s other works draws from stories in the Mahabharat to depict Bhimsen, Draupadi, Dushasan and Akash Bhairav in confrontation, expressions fierce.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251025041028_72eea52c8504eccb8b3be7cd4cef616dfb8efd821e8b1e1ae8f440f10782be11.jpg" data-media-id="editor_2" data-image-id="20251025041028_72eea52c8504eccb8b3be7cd4cef616dfb8efd821e8b1e1ae8f440f10782be11" data-rendition-name="original" width="1280" height="854" loading="lazy" alt="art exhibition"> </figure>  The opening of the exhibition last week also featured a music session, during which some of the artists sang traditional songs. Their voices joined the rhythm of the madal and melody of the harmonium, adding warmth to the crisp autumn evening.&nbsp; Each painstakingly detailed paubha reflects the artists’ devotion to divinity and mythology, as well as their heritage. Masters of Devotion showcases the work of veritable masters of their craft, and is a must-visit for art connoisseurs and devotees alike. Says the gallery’s Sangeeta Rana Thapa: “It is our honour to celebrate the artists’ work—to stand among pieces that embody both devotion and mastery, and to witness a tradition that continues to inspire us.” Masters of Devotion Kathmandu Art Gallery Baber Mahal Revisited Until 22 November

Artful devotion

<a href="https://myrepublica.nagariknetwork.com/news/dhm-forecasts-above-average-rainfall-and-temperatures-for-2025-monsoon-28-10.html">This year, </a>Madhes Province received less rainfall than was forecast by the &nbsp;Department of Hydrology and Meteorology (DHM), reducing groundwater recharge of shallow aquifers which are the lifeline for domestic use and irrigation.&nbsp; The crisis was serious enough for the government to officially declare a drought emergency during the monsoon, with the province declared a '<a href="https://kathmandupost.com/national/2025/07/23/cabinet-declares-madhesh-province-a-disaster-crisis-zone?">disaster-hit zone</a>' in July.&nbsp; The monsoon scarcity hit farmers hardest, a majority of whom depend on rainfall for agriculture. Data from Dhanusa’s <a href="https://add.madhesh.gov.np/noticefiles/%E0%A4%A7%E0%A4%BE%E0%A4%A8-%E0%A4%B0%E0%A5%8B%E0%A4%AA%E0%A4%BE%E0%A4%87%E0%A4%95%E0%A5%8B-%E0%A4%B5%E0%A4%BF%E0%A4%B5%E0%A4%B0%E0%A4%A3-%E0%A5%A4-1752227917.pdf">Agriculture Development Directorate</a> shows that only 33% paddy plantation was completed by mid July, in comparison to <a href="https://kathmandupost.com/money/2024/07/31/fastest-transplantation-rate-sows-hope-for-bumper-paddy-harvest?">92% planting the same time last year</a>. Only 49% of agricultural land in Nepal is irrigated — farmers in the rest of the arable land rely on rainfall, private wells and groundwater extraction. During the dry seasons and droughts, water insufficient groundwater recharge worsens the water crisis.&nbsp; Nearly 88% of households depend on groundwater in Madhes Province which has about 100,780 shallow tube wells and 60,660 deep tube wells. But in recent times, the tube wells and hand pumps have dried up every year.&nbsp; This shortage disproportionately impacts low income families and small-scale farmers, who have no other alternative to irrigate their land. And because paddy accounts for up to 7% of Nepal’s economy, Madhes’ water crisis is not confined to within the province, but has serious implications on the national economy.&nbsp; Underground water Groundwater extraction for irrigation began in the <a href="https://jvs-nwp.org.np/wp-content/uploads/2018/09/Water-Nepal-A-historical-Perspective.pdf">1970s, </a>shallow and deep tube wells for irrigation were introduced with support from development partners. By the 2021 agriculture census, <a href="https://agricensusnepal.gov.np/upload_file/files/post/1731650149_1221316497_Agriculture%20Census%202021_District%20Summary%20Report_by%20Province.pdf">groundwater irrigated land had increased </a>to 41.7%, up from &nbsp;<a href="https://agricensusnepal.gov.np/upload_file/files/post/1694250757_1312300734_National%20Sample%20Census%20of%20Agriculture%202021_22%20(National%20Report).indd.pdf">29.8% in 2011.</a>&nbsp; A lack of strong policies and regulation to monitor unchecked extraction has meant that with the exception of some parts of Kathmandu Valley, domestic users, subsistence and commercial farmers, restaurants, hotels and industries across Nepal can draw any quantity of groundwater from desired depths and location. While the dependence on drilling for water has risen due to limited expansion of surface water infrastructure, there has been little attention to groundwater recharge. This competing use of groundwater threatens the fundamental right to drinking water.&nbsp; The ecologically sensitive Chure and Bhawar watershed play a crucial role in groundwater recharge. However, deforestation and indiscriminate riverbed mining has severely reduced its recharge potential over the years. In addition, widespread monoculture plantation of fast-growing non-native eucalyptus trees, replacing native sissoo and sal trees has compounded the crisis. Eucalyptus, a water intensive species indigenous to Australia, was introduced in the Bhawar region in 1978 for supplying wood. The Tarai’s recurring water crisis is not only climatic. Years of fragmented planning, inadequate budget allocation for groundwater management, as well as limited intra- and inter-government policies and coordination have contributed to the disaster just as much as droughts and floods caused by changing weather patterns. The United Nations said decades ago disasters are not natural, and they occur when we fail to prepare.&nbsp; Groundwater management is <a href="https://www.opmcm.gov.np/download/%e0%a4%86%e0%a4%af%e0%a5%8b%e0%a4%9c%e0%a4%a8%e0%a4%be-%e0%a4%b5%e0%a4%b0%e0%a5%8d%e0%a4%97%e0%a5%80%e0%a4%95%e0%a4%b0%e0%a4%a3%e0%a4%95%e0%a5%8b-%e0%a4%86%e0%a4%a7%e0%a4%be%e0%a4%b0-%e0%a4%a4/?wpdmdl=8990&amp;refresh=683b8df54ffef1748733429">the shared responsibility of federal, provincial and local</a> governments, but there is a lack of <a href="https://www.iwmi.org/blogs/stakeholders-in-nepal-work-together-to-enhance-collective-action-for-municipal-groundwater-management/">integrated planning, &nbsp;budgeting, data sharing</a>, and collective action for groundwater extraction and recharge.&nbsp; Sustainable groundwater use in the plains requires inclusive and equitable practices that combine water science-informed interventions with a long-term cross-disciplinary approach.&nbsp; Groundwater is mainly available either in shallow unconfined aquifers that are close to the surface and directly linked to rainfall and rivers, and deep confined aquifers between semi permeable or impermeable ground layers. Locating and mapping such aquifers would help us find what depth they lie at, how much water they hold, what we can do to recharge them and how much time recharging would take—enabling sustainable use of groundwater. Construction of surface water projects such as the Sun Kosi Marine Diversion Multipurpose Project, which serves a dual purpose of expanding irrigation and recharging groundwater, must be expedited.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251027071020_a9442084bc412998d3e7417cf0d057cae8a2b98f5e47ac1a8cc0630612ff2a55.jpg" data-media-id="editor_9" data-image-id="20251027071020_a9442084bc412998d3e7417cf0d057cae8a2b98f5e47ac1a8cc0630612ff2a55" data-rendition-name="original" width="1778" height="1000" loading="lazy" alt="Mitigating the Madhes water crisis NT"> <figcaption>Photo: ONION FILMS / IWMI</figcaption> </figure>  Such infrastructure have a conjunctive use recognised by the National Irrigation Master Plan 2019 and the National Irrigation Policy 2023, wherein farmers can rely on canals for irrigation during monsoon and groundwater during dry seasons.&nbsp; Nature-based solutions such as rainwater harvesting, managed aquifer recharge techniques, restoration of wetlands and retention ponds, and floodwater reservoirs, particularly in ecologically sensitive regions like the Chure Bhaban, should be explored. &nbsp; The management of green water — the water stored in soil and vegetation — is equally as critical as that of blue water (rivers, canals, and groundwater). Green water is lost through evapotranspiration, which contributes to nearly half of the rainfall on land. Deforestation, soil degradation, poor land use practices, and loss of wetlands contribute to the disruption of the evapotranspiration cycle, affecting rainfall patterns and groundwater recharge. Solutions Rising temperatures compound this situation by increasing evapotranspiration. Soil water conservation, vegetation cover, wetland restoration, and nature friendly land use practices must therefore be prioritised. Water-efficient technologies and practices including drip irrigation use of sprinklers, mulching, and soil fertility improvement should be scaled up.&nbsp; At the same time, we must promote irrigation techniques and technologies along with crop choices and cropping patterns that give more yield per drop of water so that food production and water conservation go hand in hand. &nbsp; The government provides subsidised electricity for irrigation starting at Rs2.3/unit, some local governments are even supplying power for free. While such subsidies support farmers and increase productivity, &nbsp;it also poses serious risk of over extraction of groundwater.&nbsp; Flat subsidies in electricity or solar irrigation must be replaced by targeted subsidies in order to balance domestic and agricultural needs with ecological conservation. The 2015 <a href="https://kvwsmb.gov.np/public/uploads/board_act_&amp;_rules/rule-1.pdf">directive for groundwater licensing</a> developed per the Drinking Water Management Board Act 2006 for Kathmandu valley prohibits groundwater extraction from shallow aquifers for commercial and industrial uses. The directive also has provisions for licensing, and renewals, and mandates for license holders to contribute to groundwater recharge. The Madhes needs similar context-specific policies to address its groundwater crisis and safeguard water rights. Shallow aquifers in the region should be prioritised for domestic use while <a href="https://link.springer.com/chapter/10.1007/978-981-10-3889-1_11">deep aquifers, which are still underutilised, should be tapped</a> in a sustainable manner for commercial, industrial and large scale irrigation and drinking water projects.&nbsp; While <a href="https://www.frontiersin.org/journals/human-dynamics/articles/10.3389/fhumd.2023.1181734/full">technical solutions</a> are important, they are not enough to solve Madhes’ water crisis. Nepal’s Constitution and the Local Governance Operation Act 2017 empower local governments for water management in their constituencies. But beyond the letter of the law, local units require community tailored groundwater policies, regular groundwater monitoring and up-to-date data, and investment in local recharge initiatives such as retention ponds, restoration of wetlands, and rainwater harvesting. Coordination between all three tiers of government is crucial, particularly among agencies that pertain to drinking water, water resources, irrigation, agriculture, land use, environment, climate change, and urban development. &nbsp; Heeding indigenous knowledge will be crucial to understanding the water crisis in Madhes and initiating solutions that will fit the context and needs of the region. Local engagement in groundwater monitoring can help to create self -aware, accountable, cost effective and participatory groundwater management practices.&nbsp; To ensure water security in Madhes, we thus need inclusive governance, coherent policies, active engagement of citizens, integration of local and indigenous knowledge and a principle of equity that puts people at the centre. &nbsp; Sumitra KC, a policy and governance researcher in natural resources management, is the National Researcher at the International Water Management Institute (IWMI), Nepal. Manohara Khadka, PhD, an expert in natural resources management, gender equality, and social inclusion, is the Country Representative of IWMI, Nepal.