Between mid-June and mid-October alone, almost 37,500 Nepalis left for the UAE for jobs, placing it among the top destination countries. Many of these workers will likely be engaged in the delivery of the COP28 Climate Summit that will ironically be held in the UAE, the world’s fifth <a href="https://nepalitimes.com/news/nepal-s-greenwashing-in-glasgow">biggest</a> exporter of refined petroleum, with the head of the Abu Dhabi National Oil Company (ADNOC) service as conference president. Prime Minister Pushpa Kamal Dahal will lead the Nepali delegation.Migrant workers form <a href="https://worldmigrationreport.iom.int/wmr-2022-interactive/">88% of the UAE population</a>, so one cannot talk about COP28 or the UAE by ignoring migration. For Nepal, too, the climate crisis and the migration economy are linked.<a href="https://www.hrw.org/news/2023/11/21/uae-migrant-worker-abuses-linked-broader-climate-harms">New research</a> by Human Rights Watch (HRW) states that the COP28 host’s role in climate injustice goes beyond it being one of the largest fossil fuel producers and among the highest per capita emitters. It also relates to its treatment of migrant workers. HRW interviewed 151 current and former migrant workers and their families from Bangladesh, Pakistan and Nepal. Despite negligible per capita greenhouse gas emissions, the three countries are among the most climate vulnerable and have suffered extreme weather and slow-onset events linked to climate change.&nbsp; The climate impact countries like Nepal face should also be considered from the perspective of their mobile populations in the UAE and other countries. Migrant workers are exposed to extreme heat with inadequate protection, and because widespread abuse like wage theft and exorbitant recruitment fees limit the ability of workers to send home remittances, including during climate-linked emergencies. Dubai’s maximum temperature on some days <a href="https://www.khaleejtimes.com/uae/weather/uae-temperatures-cross-50oc-for-first-time-this-summer">exceeded</a> 50 Celsius this summer, and the UAE itself is vulnerable to heat stress due to atmospheric warming.The Intergovernmental Panel on Climate Change (IPCC) has said that the Gulf <a href="https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter10.pdf">states’</a> wet bulb globe temperature (WBGT) is ‘expected to approach, and possibly exceed, the physiological threshold for human adaptability (35°C) by the end of the century’. Migrant workers, including Nepalis, are disproportionately exposed.The most common heat mitigation strategy used in the Gulf including the UAE are ‘summer midday bans’ that stop outdoor work in the afternoons for a few hours. But a <a href="https://oem.bmj.com/content/80/6/347">study</a> in <a href="https://oem.bmj.com/content/80/6/347">Kuwait</a> found that despite the ban there was a substantial increase in the risk of occupational injuries associated with extremely hot temperatures. Another <a href="https://www.researchgate.net/publication/333293731_Assessment_of_Heat_Stress_Exposure_among_Construction_Workers_in_the_Hot_Desert_Climate_of_Saudi_Arabia">study </a>found that the highest heat intensity for workers in Saudi Arabia was from 9 am to noon, while the ban is in effect between noon and 3 pm. HRW’s research recommends that the UAE move away from arbitrary, calendar-based midday bans towards risk-based measures such as the WBGT.&nbsp; Heat is a health hazard. It can exacerbate pre-existing conditions, impair cognitive function, and increase the risk of workplace injuries and long-term illnesses like end-stage renal failures. Dialysis rooms across Nepal that are filled with Gulf returnees. &nbsp; HRW’s <a href="https://www.hrw.org/video-photos/interactive/2023/11/21/migrant-workers-bear-the-brunt-of-uae-extreme-heat">research</a> follows three dialysis patients who are all UAE returnees describing how they did not get support from the UAE. The Nepal government provides dialysis for free, but the cost of medicines, injections, and transportation add up. Chitrakala, the wife of a dialysis patient, Til, who accompanies him to the hospital multiple times a week for his dialysis says, “In some ways, I find it comforting to be at the hospital because in the waiting room, I realise I am not alone. It is not just my family that is facing this.”&nbsp; Another UAE returnee, Purna, says it is after he frequented the dialysis centre that he realised that kidney failure is common among migrant worker returnees. The situation will worsen in a changing climate. “The UAE is externalising their own climate risks onto migrant workers who are labouring under woefully inadequate protections. These workers often experience chronic health harms linked to extreme heat, and then return home without any compensation from the UAE and instead let countries like Nepal bear all the serious health costs like dialysis treatment,” says Michael Page of HRW.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20231124031152_7daf43db2cba93c6e81c6607aa61d07d3f3fbd4e2b338aadd2aaa4720828cb76.jpg" data-media-id="editor_9" data-image-id="20231124031152_7daf43db2cba93c6e81c6607aa61d07d3f3fbd4e2b338aadd2aaa4720828cb76" data-rendition-name="original" width="4032" height="2268" loading="lazy" alt="COP28 and migtants NT"> </figure>  There are other labour abuses like wage theft and exorbitant recruitment fees that also contribute to climate injustice, the HRW report argues. Climate emergencies back home exacerbate the mental stress of wage theft and recruitment debt as families in Nepal are in increasingly dire and even life-threatening situations.&nbsp; Workers HRW spoke to who were unable to send remittances because of labour abuses spoke of the dilemma they face: their families lose both critical financial support and the help they could have provided for urgent tasks like rebuilding damaged property had they stayed home. But for many, even exiting the UAE with outstanding recruitment debts or unpaid wages during such climate emergencies posed a challenge. Workers had to pay fees to retrieve their passports including by obtaining ‘reverse remittances’ on loan from families back home already reeling from life-threatening climate emergencies. Good migration can be transformative, but bad migration can be devastating for families. To be sure, remittances have been critical for economies of Nepal and other South Asian countries, but they do not substitute their responsibility. Historical and major greenhouse gas emitters also have a duty to support communities heavily impacted by the climate crisis. <a href="https://www.knomad.org/sites/default/files/publication-doc/migration_development_brief_38_june_2023_0.pdf">Remittances</a> are equivalent to a quarter of Nepal’s GDP, while Pakistan and Bangladesh are among the top 10 remittance recipients globally. Remittances have also been a lifeline including post-earthquake and during Covid. But these numbers mask the individual experiences of migrant workers and their families who face abuses and many of whom end up in financially worse situations than they did pre-migration. Virtually all migrant workers pay hefty fees for jobs which itself creates a huge dent on the returns to migration while excluding some of the poorest communities from even attempting to migrate. But even that does not guarantee a good job. The July 2021 <a href="https://www.icimod.org/article/the-melamchi-flood-disaster/">Melamchi flood</a> was a climate-induced disaster in Nepal, and one of its victims told HRW researchers: “During the flood, all we wanted was to save our lives. We survived, but we lost everything. The flood finished us.”His wife is headed to the UAE for a waitressing job which cost her Rs &nbsp;200,000, and borrowed at 24% annual interest. If all goes well, her first year’s salary of a mere $262 a month will just go to repay the loan. Another Sindhupalchok returnee from the UAE said, “Whether climate change or not, we have to migrate. We used to be self-sufficient but now have to buy food. Yields are lower. Insects and diseases are more common.” Climate change can be a compounding factor for longstanding emigration such as from Nepal to the Gulf, and adds to the burden of past, present and future migrant workers. The UAE is also being criticized for its restrictions on civil society and free expression during COP28. The HRW research states these affect migrant workers by limiting their ability to raise workplace concerns and seek structural, worker-centered reforms. The government’s opacity around <a href="https://pomeps.org/climate-the-environment-and-health-of-migrant-workers-lessons-from-kuwait">health data</a> hampers research for <a href="https://vitalsignsproject.org/wp-content/uploads/2023/06/Vital_signs_3_online.pdf">evidence-based</a> policymaking including for better outdoor protections, while academics and journalists tend to <a href="https://www.hrw.org/news/2021/10/01/uae-tolerance-narrative-sham-0">self-censor</a> to avoid reprisals. At the COP 28 in Dubai, Prime Minister Dahal would do well to dwell on the links between the host country and increasing climate vulnerability that Nepalis face both at home from weather extremes and heat stress at their workplaces in the UAE.

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Too hot to work

Migrant workers returning from the Gulf and Malaysia make up 40% of infertility cases at Paropakar Maternity and Women's Hospital in Kathmandu. Studies have highlighted the problem of sterility among men who have<a href="https://www.nepalitimes.com/news/caring-for-nepals-women"> returned from working abroad</a> in extreme temperatures and are prone to unhealthy lifestyles including smoking and alcohol consumption. Sarlahi resident Sanjeev Sah had gone to Saudi Arabia for work just a year into his marriage. Concerned about his wife having to raise a child alone during his absence, 32-year-old Sah and his wife postponed their plans for a baby. Three years later after his return, the couple has not been able to conceive. They sought treatment at Paropakar Hospital in Thapathali. Sah was diagnosed with azoospermia, with no measurable sperm count. “Doctors told me that working in high temperatures abroad reduced the quality of my sperm,” says Sah. Suraj Adhikari from Dhading worked in Malaysia for three years, He married at 28 but was unable to conceive with his wife and was also diagnosed with azoospermia at an infertility clinic. Adhikari worked at a construction site in Malaysia which left him little time for basics such as food and water. Despite<a href="https://www.nepalitimes.com/news/gulf-workers-need-protection-from-heat"> extremely high temperatures</a>, he often went without water for prolonged periods because it was not always available. Doctors blame his time and lifestyle for the decline in his sperm quality. “Neglecting essentials while working abroad has led to a costly and time-consuming treatment for me,” Adhikari laments.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230903040916_17d0de92dd3eb03aa0e268ca5e30187ad21900f10f86f1bc6b7e9cc7ca1d540b.jpg" data-media-id="editor_2" data-image-id="20230903040916_17d0de92dd3eb03aa0e268ca5e30187ad21900f10f86f1bc6b7e9cc7ca1d540b" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="Migrant infertility NT"> </figure>  Infertility is on the rise, globally and in Nepal. This is especially true for <a href="https://www.nepalitimes.com/banner/migration-not-a-wish-but-necessity-for-nepalis">workers returning</a> from the Gulf and Malaysia, having worked in hotter temperatures. Half of the patients with childlessness visiting the outpatient department at Paropakar Maternity and Women's Hospital every day are migrant returnees. “Working conditions with high temperatures reduces the quality and quantity of sperm in young men,” confirms Vinita Thapa, sperm specialist at the hospital. Shree Prasad Adhikari, the director of Paropakar Maternity and an infertility pathologist, notes that 25 out of every 100 couples face infertility presently, and the problem has now grown particularly among those returning from foreign employment. Two years ago, Tribhuvan University Teaching Hospital conducted tests on 186 men seeking infertility treatment at the institute. Of these, 46.2% had previously worked in the Gulf. The research report, published in the journal PubMed, revealed low sperm quantity and quality in some cases as well as a very low number of sperm capable of fertilising eggs in others. According to the WHO, one in every six adults, or 17.5% of the world’s population suffers from infertility. In Nepal, where children are seen as a form of security and add to the social prestige, infertility can have far-reaching implications. An increase in infertility could also be a contributing factor to an ultimate decline in <a href="https://www.nepalitimes.com/editorial/counting-on-nepal">population</a> together with delayed marriages. And yet, assisted reproductive technologies such as in vitro fertilisation (IVF) remain financially inaccessible and carry social stigma for many individuals.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230903040916_fc6932b9f60d4f08e3c9834b4e141afba4d939726f297f9d4f1bcd8a674ebb23.jpg" data-media-id="editor_5" data-image-id="20230903040916_fc6932b9f60d4f08e3c9834b4e141afba4d939726f297f9d4f1bcd8a674ebb23" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="Migrant infertility NT"> </figure>  A study by the Hebrew University of Israel and Mount Sinai School of Medicine in the US found that the average sperm count globally has decreased by half over the past 50 years. The study also revealed a decline in sperm quality, including a decrease in the number of sperm capable of fertilising eggs. Between the 1970s and 1990s, the rate of sperm count decline increased from 1.16% per year to 2.64% by the early 2000s. Paropakar Maternity and Women's Hospital introduced a semen storage service in June, allowing Nepalis to preserve semen and eggs if they require delayed childbirth. For instance, young individuals going abroad for a long time can <a href="https://archive.nepalitimes.com/article/nation/freezing-a-future-family-IVF-embryo-surrogacy,3881">store semen for reproduction</a> upon their return. Additionally, if the husband is absent, the wife can undergo artificial insemination using the stored semen, a technique called intrauterine insemination (IUI). In the IUI process, women are given medication and injections to stimulate egg production. Once mature eggs are produced, they are released through an injection. About 36-40 hours after releasing the eggs, a viable sperm is selected and placed into the uterus using a catheter, explains sperm specialist Thapa. The hospital is performing IUI on four to five women on a daily basis, at Rs5,000-10,000 per procedure. If pregnancy doesn’t occur after six IUI attempts, IVF is recommended. Adds Thapa: “Many are not aware but 90% of couples facing childlessness can be treated.” Since the introduction of the storage service in June, 15 couples have inquired but only two couples have agreed to store semen. The maternity home is also launching semen and egg donation programs wherein women having difficulty producing eggs can use donor eggs and the husband’s sperm. Similarly, when their husband’s sperm isn’t viable, the wife’s egg can be combined with donor semen for insemination.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230903040916_bb962f67de4e8325418117724d37ab0d9cc744195c68224e45973832aad89be1.jpg" data-media-id="editor_7" data-image-id="20230903040916_bb962f67de4e8325418117724d37ab0d9cc744195c68224e45973832aad89be1" data-rendition-name="original" width="1200" height="800" loading="lazy" alt="Migrant infertility NT"> </figure>  “The stored semen remains effective for almost six years, retaining 60% of its initial quality,” assures Thapa. But more often than not, most childless couples fail to seek medical attention on time, resorting instead to shamans, witch doctors, and other ineffective measures. <a href="https://www.nepalitimes.com/news/nepal-s-first-human-milk-bank">Paropakar </a>is the sole government facility providing effective treatment for childlessness at present. Hospitals often lack counselling services. Infertility treatment depends on the underlying cause ranging from pharmaceuticals to embryo implantation through assisted reproductive technologies (ART). Some 80-90% of childless couples can find solutions through regular treatment, says Paropakar director Adhikari. He adds that weight loss could be a solution for obese women struggling with infertility. In the case of blocked fallopian tubes, there are medications. For those with uterine tissue growth causing pregnancy complications, surgery can help their chances. But while normal medication can stimulate egg production, up to 50% of women facing infertility lack viable eggs. “Some older women might have reduced fertility despite having eggs. In such cases, medications and hormones can increase their capacity,” says Adhikari, adding that the government doesn’t need as much resources to fight infertility as much as it needs commitment. Treatment needs to be scaled up to reach all the district hospitals so that couples can easily access artificial insemination and other services while also promoting awareness and reducing the <a href="https://www.nepalitimes.com/opinion/maybe-baby">stigma associated with childlessness</a> in Nepal. The fact that migrant workers who are in every sense the backbone of Nepal’s economy don't have access to treatment means it is even more crucial that infertility, the stigma and the treatment are prioritised and effectively addressed. &nbsp;

Migrants returning from the Gulf with infertility

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Migrants returning from the Gulf with infertility