Most disasters strike without warning. But dengue fever which spreads when infected mosquitos breed in monsoon puddles, is largely predictable and preventable. Densely populated Kathmandu with stagnant pools of water has all the ingredients for another outbreak like the deadly one in 2022. Last year there were about<a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon" target="_blank"> 55,000 infections and 88 fatalities</a> officially reported across Nepal in its biggest dengue outbreak yet, the real figure is probably higher. Hospitals were out of capacity, over-medication was rampant, and almost every house in Kathmandu had multiple members struck down with infection. This year, Nepal had already seen <a href="https://kathmandupost.com/health/2023/07/08/dengue-spreads-to-66-districts-one-person-dead-over-1-200-test-positive" target="_blank">over 1,000 dengue infections </a>by end-June. Starting in Dharan where one person has already died, the disease has now reached most of the 77 districts. Even so, many cases are never reported, and many recuperate at their homes. Furthermore, 80% of dengue cases are asymptomatic. “We are not even at the peak of the dengue season, and cases are already surging. It is very likely that this will further increase as rains begin to dwindle post-monsoon,” warns Sher Bahadur Pun, virologist at the Sukraraj Tropical and Infectious Disease Hospital in Kathmandu. “Nepal’s poor surveillance and record keeping also means diseases like dengue are seriously under-reported.”&nbsp; Lack of public awareness about dengue management and prevention adds to the problem. A third of dengue patients admitted to Teku Hospital last year <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak" target="_blank">did not even know</a> that the disease is mosquito-borne and spreads in the daytime.&nbsp; “At least this wasn’t the case with Covid-19, but with dengue, people struggled to adopt the correct precautions due to lack of knowledge,” explains Pun. “Even more alarming: once infected, people took strong medications like painkillers and antibiotics unaware that they are ineffective and often even harmful in dengue.”&nbsp; Although there is no specific medication for dengue, doctors recommend paracetamol to ease the fever and enough fluids to replenish the body. Dengue has no cure.&nbsp; Dengue was first reported in Nepal in 2004, but it was not until 2019 that it spread like wildfire in major urban centres. Two years of Covid lockdowns significantly reduced the caseload after the 2019 outbreak, but last year, it struck again.&nbsp; Read also: <a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon">New dengue outbreak likely this monsoon</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230717150716_97f01f95d37cc29c4c2a68ba54185635449829fa53a3064d0b83ba5714263db9.png" data-media-id="editor_4" data-image-id="20230717150716_97f01f95d37cc29c4c2a68ba54185635449829fa53a3064d0b83ba5714263db9" data-rendition-name="original" width="1072" height="577" loading="lazy" alt="Dengue graph NT"> <figcaption>Trend of dengue cases in Nepal 2006 - 2023 June, SOURCE: MoHP Situation Update</figcaption> </figure>  But even as dengue starts to spread in Kathmandu Valley, elected local officials do not seem to be too concerned. When the Ministry of Health and Population called on all local unit representatives in the Valley to discuss the outbreak on 9 July, 12 out of the 18 units <a href="https://kathmandupost.com/health/2023/07/11/dengue-search-and-destroy-campaign-to-be-launched-in-kathmandu-valley" target="_blank">avoided the meeting altogether.</a> Although there are some fumigation and dengue search and destroy campaigns <a href="https://kathmandupost.com/health/2023/07/11/dengue-search-and-destroy-campaign-to-be-launched-in-kathmandu-valley" target="_blank">set to be launched in Kathmandu</a> soon, with the monsoon already started, it may be a case of too little <a href="https://www.nepalitimes.com/banner/state-of-malaise" target="_blank">too late</a>. It should have started before the onset of the monsoon. “Though not as many as last year, we are already seeing a worrying number of mosquitoes near areas with stagnant water. And when they fly into homes, chances are the virus is already spreading from those infected,” explains Pun.&nbsp; This negligence and delay in action comes despite repeated warnings from experts. Officials knew far in advance that <a href="https://www.nepalitimes.com/news/new-dengue-outbreak-likely-this-monsoon" target="_blank">last year’s virus is still in mosquito larvae, waiting for the monsoon</a>, and yet, preventive measures, emergency preparedness, and capacity building were ignored. The risk of dengue fever will rise in the coming months of August and September, although some public health experts say serious dengue outbreaks seem to happen after a gap of two years. With climate change, mosquitos are moving up the mountains in Nepal, bringing mosquito-borne disease like malaria, encephalitis and dengue higher. The number of cases officially recorded between January and June this year is nine times higher than last year. Districts like Sankhuwasabha are on the <a href="https://edcd.gov.np/uploads/resource/64a3d5414aad6.pdf#:~:text=This%20figure%20was%20more%20than,of%20cases%20reported%20in%202019.&amp;text=As%20of%2030th%20June%2C%202023,listed%20details%20in%20Figure%202." target="_blank">top-ten list</a> for most cases reported, even though it is in the high mountains, and indicating how global warming is <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms" target="_blank">pushing mosquito breeding grounds further north.</a> Bagmati is once again the hardest-hit province, possibly due to higher population density. Read also:<a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay"> Dengue days are here to stay</a>, Sonia Awale  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20230717150716_b1a8b5c7b8e50f5e388f04a41877f2520ffa8f334c04343b357fd034d4166e6d.png" data-media-id="editor_12" data-image-id="20230717150716_b1a8b5c7b8e50f5e388f04a41877f2520ffa8f334c04343b357fd034d4166e6d" data-rendition-name="original" width="1088" height="433" loading="lazy" alt="Dengue graph"> <figcaption>Dengue cases reported by province in 2023 January to June.  SOURCE: MoHP Situation Update</figcaption> </figure>  Tackling Dengue: what does it really take? Ugonnaya Caleb-Ugwuowo recalls treating children and pregnant women struck down with dengue fever in a local hospital in Lagos. The Nigerian doctor and public health expert specialises in managing outbreaks, and says she often felt helpless at being unable to correctly diagnose and treat them due to lack of facilities. Nepal could learn from Nigeria's experience. Dengue fever is endemic in almost all states in Nigeria. “Although the country is still struggling, the challenges and epidemics Nigeria has faced over the years have shaped our understanding of what it takes to tackle outbreaks like the ones Nepal faced last year and in 2019,” says Ugonnaya.&nbsp; It starts with surveillance, she says, adding: “The government in Nepal should, as a matter of urgency, conduct dengue surveys in all provinces to assess the proportion and magnitude of different <a href="https://www.nature.com/scitable/topicpage/dengue-viruses-22400925/#:~:text=The%20Dengue%20Serotypes,antibodies%20in%20human%20blood%20serum." target="_blank">dengue serotypes</a> circulating freely. Following this, dengue should be made reportable from all local health institutions directly into the national health information system." Dengue fever for the first time, though debilitating, often does no harm. But getting it a second time with a different serotype poses a significantly higher risk of the disease progressing to haemorrhagic fever, where blood thins out and can start leaking from veins, causing potentially fatal internal bleeding. This is what makes serotype surveys so important. A <a href="https://academic.oup.com/jtm/advance-article-abstract/doi/10.1093/jtm/taad034/7087081?redirectedFrom=fulltext" target="_blank">study</a> aiming to report dengue serotypes seen in Kathmandu during last year’s outbreak showed DEN-1 and DEN-3 to be the dominant serotypes, with only negligible cases of DEN-2 reported. But such studies should be conducted nationwide, so that the risk of infection with other serotypes can be correctly determined. Sri Lanka and Bangladesh, both of which have reported elevated levels of dengue infections this year, have direct flights into Nepal. “Although the inflow of infected tourists also poses a great threat, the greater concern should be the mosquitoes in and around places where these tourists go, like airports, temples and major tourist sites,” warns Pun. If barring flights is not an option, vector control is the best way to minimise transmission. For this, fumigation and dengue search and destroy efforts should be concentrated in tourist sites first. Simple source reduction strategies like covering open water containers, using insecticides in canals, parks and fields exist, but deploying genetically modified mosquitoes to reduce the population of disease carriers can also control vector-borne diseases. Caleb-Ugwuowo adds that Nepal already has a decentralised framework of healthcare, so proper surveillance is possible. More importantly, the two previous outbreaks have given experts an idea of what needs to be done: capacity building in hospitals, sanitation and drainage facilities, public awareness, and emergency preparedness before the disease strikes. Pun agrees: “We must learn from other countries as well as from our own past experience, and act to contain this outbreak. Things will get progressively worse in the next few weeks, so there is no time to beat around the bush, especially with dengue already knocking at our doors.” Read also: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms">Mosquitoes move up mountains as the earth warms</a>, Sonia Awale

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

Dengue danger returns with monsoon

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/637235369c7e80680e0c4975jpeg.jpg" alt="" width="5827" height="3885"/><figcaption>All Photos: Suman Nepali</figcaption></figure>For the past two years, the preoccupation of the government and people of Nepal has been with the pandemic. But just as the fourth wave of Covid-19 started to subside, Kathmandu and other towns across Nepal have been hit by dengue outbreaks.For the past few weeks, Shukraraj Tropical and Communicable Disease Hospital in Teku has been crowded with patients with fever. At first, epidemiologists there thought it was a new Covid strain, but the symptoms were different: severe body ache, eye pain, high fever and nausea.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/6372353a9c7e80680e0c4976jpeg.jpg" alt="" width="2304" height="1536"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131128/6372353d9c7e80680e0c4977jpeg.jpg" alt="" width="2304" height="1536">In Kathmandu Valley, there were hotspots mostly in inner city Patan and the outskirts. Hundreds of patients have been admitted into hospitals, and the number of cases diagnosed in hospitals has surpassed 1,000 -- more than in the previous outbreak in the summer of 2019.Last year, there were only 10 patients at the Teku hospital in the second week of August last year, whereas there were 295 dengue patients just in the past week.This week, 120 dengue cases were reported in Lalitpur, 70 in Rupandehi, 110 in Kathmandu, and dozens more in Nawalparasi West and Bhaktapur, seven each in Dhading, Gulmi and Kapilvastu, six from Arghakhanchi, and five each from Tehrathum, Sindhuli and Makwanpur. There are six patients with dengue in ICU.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235419c7e80680e0c4978jpeg.jpg" alt="" width="2304" height="1536">The number of dengue patients in hospitals has now exceeded those suffering from Covid. Doctors say there are probably thousands more with dengue fever recovering or being treated at home.  Dengue is transmitted from one infected person to the next by bites of the Aedes aegyti mosquitos during the day, and is caused by four different virus sero-types. Patients infected with one serotype of the virus will not have immunity against the other three types and there can be multiple infections.  Also called 'break-bone fever' patients contract the disease 3-7 days after the mosquito bite, and the high fever usually lasts up to a week, although it leaves the weak for up to a month.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235459c7e80680e0c4979jpeg.jpg" alt="" width="2304" height="1536"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/637235489c7e80680e0c497ajpeg.jpg" alt="" width="2304" height="1536">There is no treatment for dengue, since antibiotics are not effective against viruses. Doctors recommend paracetamol to ease pains and to bring down fever, and plenty of fluids. More severe cases of dengue can result in internal haemorhage and may require hospitalisation.“People still do not believe that mosquitoes bite during the day. While sleeping at night, they adopt all the safety standards from the hammock, but they ignore it during the day," says Sher Bahadur Pun, the head of the hospital’s clinical research unit.He says that measures should be taken to avoid mosquito bites in schools and offices as well as at home. “People are aware when they are at home, but they should be most aware in schools, offices, areas where houses are under construction and there are pools of stagnant water,” he says.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/6372354b9c7e80680e0c497bjpeg.jpg" alt="" width="5905" height="3937">Pun's informal survey among patients at Teku showed that a third of them do not even know that dengue is transmitted by mosquito bites during the day. This is why the viral fever is spreading among students, with cases of entire classes of some schools being sick.Pun also warns against taking strong medications for dengue, and says that certain pain-killers and antibiotics can actually make the patients' condition worse.“Dengue causes severe body ache, so people look for strong medications for this. We have been giving cetamol for fever, which sometime does not alleviate pain like other painkillers,” says Pun. "However, using Brufen, Flexzone, Nims can be very harmful."<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131132/6372354f9c7e80680e0c497cjpeg.jpg" alt="" width="5210" height="3473">A study conducted  at Teku Hospital on the outbreak of dengue in Nepal from 2006 to 2019 found that many patients had become sicker because of prescription medicines they took without consultation, or because doctors had prescribed the wrong medicine thinking it was some other kind of fever.Recently, Pun came across a dengue patient  who was bleeding from the eyes after taking Flexzone continuously for five days. "I had never seen such a case before," he says, "patients who are being treated at home should be admitted to the hospital immediately if they have serious problems."Read more: <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/">The dangers of the dengue virus</a>, Tom Robertson

As Covid abates, Nepal sees dengue outbreak

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861ea79c7e80680e0ccddajpeg.jpg" alt="" width="799" height="536"/><figcaption></figcaption></figure>There have been few days without rain this April and May in Kathmandu. That means more disease for Kathmandu. Not COVID-19, but the virus we used to talk about -- last year's scary unknown disease, dengue.The year 2019 saw Nepal's worst ever outbreak of dengue, with 15,000 people infected, many times the previous high. Dengue was particularly bad in the Kathmandu Valley. At least six people died.The medical journal The Lancet has warned that Kathmandu could see a dengue ‘explosion’ because it has become ‘an ideal breeding ground’ for the mosquito that carries dengue -- the notorious Aedes aegypti. Already in 2020, four cases have been reported in Kathmandu, and four in Lalitpur.<a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" target="_blank" rel="noopener noreferrer">Big story of smallpox in Nepal</a>, Tom Robertson<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/viruses-past-present-and-future/" target="_blank" rel="noopener noreferrer">Viruses past, present and future</a>, Tom RobertsonDengue spiked in 2019 with outbreaks around the developing world. In recent years, Delhi, Dhaka, Ho Chi Minh City, Senegal and Singapore have faced bad outbreaks. A dengue outbreak in Delhi in 2015 inundated hospitals and clinics across the city.Dengue likes warm humid conditions. Before corona, dengue was the world's fastest growing dangerous virus, increasing four-fold in just over a decade. Two of every five people around the world, nearly 3 billion people, live in dengue risk areas where it is a leading cause of illness. Each year approximately 100 million people contract the disease, and over 20,000 die.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eaa9c7e80680e0ccddbjpeg.jpg" alt="" width="961" height="540"><figcaption> </figcaption></figure>Like malaria, dengue is actually several different diseases that we give a single name. There are four dengue viruses: Dengue 1, 2, 3, and 4. A person can catch each one, and get sick as many as four times.A first infection generally brings only mild flu symptoms, if any at all. But a second infection can cause ‘severe dengue’ with plasma leakage, bleeding, and shock. This can kill. No treatment exists for dengue, but generally symptoms can be managed.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/climate-health-emergency/" target="_blank" rel="noopener noreferrer">Climate health emergency</a>, Sonia Awale<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener noreferrer">Mosquitoes move up mountains as the earth warms</a>, Sonia AwaleDengue's main mosquito host, Aedes aegypti, is no ordinary mosquito. In a species known for death and deviousness, it has few rivals. Not many mosquitoes have so successfully defied human efforts at control, including in recent decades.Long before dengue, Aedes aegypti carried a far deadlier disease: yellow fever. During the 16th and 17th, slave ships brought yellow fever carrying A. aegypti from Africa to the Americas, devastating indigenous populations and reshaping the region's balance of power. In the early twentieth century, the A. aegypti -- yellow fever combination almost blocked the construction of the Panama Canal.Most wildlife avoid humans. Not A. aegypti. It loves us, particularly the ecological disorder we often create. The more humans, the more disturbed ecosystems, the more A. aegypti. Cities, especially disorganised cities, create ideal habitat: lots of standing water for breeding and lots of humans for feeding.Dengue's other mosquito carrier is A. albopictus.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eac9c7e80680e0ccddcjpeg.jpg" alt="" width="640" height="463"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022112916110/63861eaf9c7e80680e0ccdddjpeg.jpg" alt="" width="640" height="635"><figcaption> </figcaption></figure>The Lancet points to dengue's major causes: climate change, relentless and haphazard urbanisation, brisk trade and transit from dengue-infested areas, and poor health infrastructure. As Kathmandu grows and gets more connected to other parts of Asia, dengue spreads.Climate change has been overrated as a cause. Warming temperatures can extend the range of Aedes carriers but other causes deserve more attention. ‘Last summer’s explosion of dengue in Kathmandu Valley was <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNHqCreNEFDji4GDyS_wUW1JkpUOGA">blamed on climate change</a>,’ the Nepali Times recently noted, ‘but it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon.’The real problem is disorganised urbanisation. The A. aegypti carrier thrives in small collections of clean water in flower pots, old car and truck tyres, uncovered water containers, and even puddles. It bites people early morning and at dusk.<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener noreferrer">"Nepal is a microcosm of all of the changes in world health"</a><a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/ke-garne-attitude-kills-people/" target="_blank" rel="noopener noreferrer">K garne attitude kills people</a>, Laxmi BasnetNepal, like much of the developing world, has witnessed dramatic and disorderly urban growth in recent years, much in the lowlands along highways. ‘Nepal's Tarai," Mukesh Pokhrel recently wrote also in this newspaper, "is turning into one endless elongated metropolis.’Kathmandu itself grew four-fold between 1980 and 2010, and is one of the fastest growing cities in one of the world's fastest urbanising regions.'<a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNHqCreNEFDji4GDyS_wUW1JkpUOGA">Cities like Kathmandu are perfect breeding grounds</a> for the Aedes mosquito,' says Jeremy Farrar of the Wellcome Trust in an interview with this paper. 'Kathmandu’s climate is changing, the city is growing exponentially in a haphazard way and the mosquito loves highly dense populations of people.'<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/east-west-city/" target="_blank" rel="noopener noreferrer">East-West City</a>, Mukesh Pokhrel<a href="http://archive.nepalitimes.com/news.php?id=19301#.XtI_7y2B3-Y" target="_blank" rel="noopener noreferrer">Dengue fever</a>, Buddha BasnyatThe Lancet highlights what might happen in a dengue explosion in Kathmandu. ‘A tug-of-war might occur between the worried well and the truly sick,’ it says. ‘Hospitals might be overwhelmed and many needy patients with other diseases could be turned away.’Doctors inexperienced with the disease pose a particular worry. They could misunderstand its dynamics and cause unnecessary deaths by over-treating with unneeded antibiotics, transfusions, and excessive intravenous fluids. This has happened elsewhere.The dengue-carrying Aedes aegypti mosquito is difficult to control. Brazil eradicated it twice, in the 1950s and in the 1970s, and twice it returned. Several factors explain why: a lack of sustained careful epidemiological surveillance, insecticide resistance, the high costs of materials and wages, insufficient community participation and coordination with the health sector, and, crucially, the spread of haphazard urban development. Narrow control programs inevitably run into trouble.The World Health Organisation (WHO) stresses both micro and macro efforts to fight dengue. Individual families can put tight lids on water containers. They can eliminate breeding spots such as empty cans, bottles, and tires. It also says community engagement and building country capacity for environmental management and disease surveillance is important.“Locally adapted vector control measures such as household water storage management and, more importantly, engaging individuals and communities to manage their immediate environment are essential to controlling the spread of the disease,” says Raman Velayudhan, head of WHO’s Vector and Ecology Management Unit.School-based awareness programs, The Lancet authors noted, can help block dengue's spread. ‘Students are good learners and can be taught to effectively use repellents and mosquito nets and get rid of water collections near their homes and schools; students will then spread this information to their parents.’ Several countries have implemented successful school programs.Historian Frank Snowden sums it up: "Dengue takes full advantage of societal neglect and the absence or cessation of vector control programs."Tom Robertson, Ph D, is an environmental historian who writes about the history of malaria in Nepal. And just wrote a <a href="https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/banner/big-story-of-small-pox-in-nepal/&amp;source=gmail&amp;ust=1590920172779000&amp;usg=AFQjCNFk193f6QnfjiWqivawrVZt2FPA4A">five-part series on smallpox</a> for Nepali Times as part of his History of Disease column.

Tom Robertson

The dangers of the dengue virus

<a href="https://nepalitimes.com/here-now/waiting-for-bipin-joshi" target="_blank">Nepali student Bipin Joshi</a>, who was taken captive by Hamas on 7 October 2023, was not on the list of those freed following the end of the bombardment and fighting in Gaza.&nbsp; On Monday morning, the Israeli military notified Bipin's family and Nepal’s ambassador to Israel Dhan Prasad Pandit, that there is no evidence of him still being alive. However, Nepal's Foreign Ministry is yet to be notified by Israel's government of Bipin's status. The news came three days after a US-brokered ceasefire between Israel and Hamas came into effect, and hostage and prisoner exchanges by the two sides started Monday morning.&nbsp; Almost 2,000 Palestinians held in Israeli prisions are expected to be released by Israel in exchange for the hostages during the next phase of the peace deal between the two parties, and the bodies of deceased hostages remaining in Gaza are also expected to be returned.&nbsp; Bipin Joshi was among a group of Nepalis who had arrived in Israel in 2023 just weeks before 7 October 2023 as part of a ‘learn and earn’ program to work and earn in kibbutz farms there.&nbsp; Along with other students Joshi had been working on a farm in Kibbutz Alumim in southern Israel near Gaza. <a href="https://nepalitimes.com/here-now/war-in-israel-earthquake-and-grief-in-nepal">Ten Nepali students were killed </a>while taking cover in shelters near their farms in two separate attacks by Hamas fighters.&nbsp; Joshi’s colleagues, fellow Nepalis who survived the attack, recall gunmen lobbing two grenades into the bunker that they had taken cover in. Bipin hurled one of the grenades out, they say, but the other one exploded, killing and injuring Nepalis inside. &nbsp;&nbsp;&nbsp;&nbsp; Shortly after, Bipin was captured by Hamas along with a Thai national and led away into Gaza. CCTV footage showed Bipin alive and at a hospital in Gaza on the day of the attack itself after he was taken hostage.&nbsp; Thirty-one Thai citizens, who like Nepalis worked in farms in Israel, were taken hostage during the Hamas attack, the highest number of foreign captives in October 2023.&nbsp; <a href="https://nepalitimes.com/news/deft-diplomacy-freed-thai-hostages">Deft Thai diplomatic engagement</a> with officials from Iran, Egypt, and Qatar brought about the release of 23 of its nationals in 2023. Five more Thai nationals were released earlier this year.&nbsp; In August, Joshi’s family visited Israel at the invitation of the government and urged the international community to push for his return. Bipin’s mother Padma and sister Pushpa have been at the United Nations to lobby for his release.&nbsp; His family last week also released a video clip of Bipin briefly speaking on camera, reportedly obtained by Israel and said to be filmed in November 2023, around a month after he was taken captive. Joshi looks healthy in that video.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251013091028_d551c7f88204c52217152fb5db655bb5a5f8bf2cff1e6a055326ebf64453ff9f.png" data-media-id="editor_3" data-image-id="20251013091028_d551c7f88204c52217152fb5db655bb5a5f8bf2cff1e6a055326ebf64453ff9f" data-rendition-name="original" width="2848" height="1528" loading="lazy" alt="Bipin Joshi NT"> </figure>  More than 67,000 Palestinians have been killed during the last two years of the genocide in Gaza. About 1,200 people were killed during the Hamas attack on 7 October 2023, while more than 251, including Bipin Joshi, were taken as captives.&nbsp; This is the third ceasefire implemented in Gaza since 7 October 2023 after previous ones in November 2023 and January 2025. This 20-point deal facilitated by intermediaries US, Qatar, Turkey, and Egypt included terms for Hamas to give up its arms, and for a devastated Gaza to be governed by a Palestinian body of independent technocrats, while Israeli troops will withdraw in stages from Gaza.&nbsp; Hamas has agreed to relinquish control of Gaza, but has rejected the demand for disarmament, saying the group will demobilise but is prepared to resume fighting if Israel breaches the ceasefire.&nbsp; Following the ceasefire, Palestinians in Gaza have begun long journeys back to homes reduced to rubble by Israel’s two-year assault on the strip. The flow of humanitarian aid in the city has also increased following the peace deal.&nbsp; Israel's closure of humanitarian corridors in the past months had blocked the entry of food and medicine into Gaza, causing widespread famine. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has said that the restriction of aid into the beseiged city has left as many as <a href="https://www.unrwa.org/newsroom/news-releases/gaza-unrwa%E2%80%99s-lancet-study-reveals-alarming-surge-child-malnutrition">54,600 children acutely malnourished</a>.&nbsp; Meanwhile, US president Donald Trump landed in Israel on Monday as hostages were being released, and world leaders are expected to head to Egypt for an international summit to discuss the next steps in Gaza, Israel, and West Asia.&nbsp;

Nepali hostage in Gaza not alive: Israel

Jazz as healing music

Already trying to balance youth demands with legal provisions in the Constitution, Prime Minister Sushila Karki’s interim government faced yet another challenge over Dasain: a receding monsoon dumped unseasonal rain unleashing floods and landslides that killed at least 60, mostly in eastern Nepal.&nbsp; The government was rated positively for its early warning and the ‘visibility’ of its disaster response, with many comparing it to the inaction of the NC-UML coalition during last year’s floods.&nbsp; Government agencies and police proactively closed off hazardous sections of highways as Kathmandu was marooned from the rest of the country in the peak holiday season. Stranded passengers were taken care of, with police, army and local governments in Ilam coordinating rescue and relief efforts. Many of the problems were structural and inherited from decades of neglect and corruption in highway contracts. Shoddy bridges and encroachment of settlements along river banks have increased risk from more frequent extreme weather caused by climate breakdown. With Dasain over Tihar around the corner and the worst of the disaster behind, the Karki administration is trying to balance the separate demands of GenZ movers and shakers who installed her in office with constitutional provisions. It has not helped that the badly-mauled political parties are spoiling for a fight, and the three top leaders show little signs of stepping down. “Nepal’s movement did not happen in a democratic vacuum, so this government walks a very fine line in political legitimacy," says Bidushi Dhungel of the National Democratic Institute in Nepal. "In this fragile space, whatever the work done — or not done— by the interim government within its limited mandate, it may open up avenues for further dissent from old and new actors. They are &nbsp;caught between a rock and a hard place.” Civil society activists issued a statement on Wednesday calling on the main political parties to heed the writing on the wall and reform themselves. Signed by professor Krishna Khanal and former ambassador Keshab Mathema, the statement said: 'The main leaders of the main parties should say sorry, and voluntarily resign ... they must respect public sentiments and work to reform and transform their parties to be more accountable to the public, or risk being irrelevant.'&nbsp; Complicating matters further are the sometimes contradictory demands of various GenZ factions on punishing those responsible for the carnage and rampage of 8-9 September, Constitution and elections. Karki faces calls to immediately detain former PM KP Oli and Home Minister Ramesh Lekhak for their involvement in the massacre outside Parliament. Under pressure from GenZ delegates, Home Minister Om Aryal fired off a letter to the police to arrest Oli and Lekhak. But later at a confrontational midnight meeting at the prime minister’s residence in Baluwatar, all four security chiefs advised Karki that arresting the UML and NC ex-ministers could unleash violent confrontation on the streets. The interim government is in a bind. It has formed a committee headed by Gauri Bahadur Karki to investigate the killings last month as well as the arson and vandalism that followed. The question is: should it wait for the committee to submit its report before punishing perpetrators, or let police arrest those who can easily be identified in social media posts setting fire to Singha Darbar, the Supreme Court and other sites.&nbsp; GenZ’s Sudan Gurung faction has gone beyond its original demand to submit an 8-point ultimatum that includes the sacking of the Chief Justice and officials of the anti-corruption bureau.&nbsp; The Prime Minister is caught in the crossfire between managing the expectations of a movement that appointed her, and working within the framework of her interim government’s mandate and Constitution. But it is not just the government that faces challenges. The lack of clear consensus among youth factions and their outspoken collectives is surfacing.&nbsp; &nbsp;“This has been a leaderless and decentralised movement, and the traditional variables typically seen in a political revolt seem missing here," notes political scientist Sucheta Pyakuryal. “There is no organised structure, nor any ideological pull factor, therefore a big question is how much bargaining power does a movement like this have, and how sustainable will it be.” GenZ leaders seem to be in two main camps. Demands like the one for a directly elected prime minister, and the constitutional processes that can make for such an outcome, have emerged as a major point dividing the movement.&nbsp; Nepalis both within and outside the youth movement are watching Hami Nepal’s Sudan Gurung closely — especially after his recent interview with Al-Jazeera during which he expressed his interest to run for Prime Minister and seemed to not accept a win by political parties in the March elections.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251009201044_fcba7e92bb9a8812fd0ad4e9770d6f4d4189972de5229f91e9a832a26e388901.jpg" data-media-id="editor_0" data-image-id="20251009201044_fcba7e92bb9a8812fd0ad4e9770d6f4d4189972de5229f91e9a832a26e388901" data-rendition-name="original" width="2916" height="1000" loading="lazy" alt="One month on NT"> <figcaption>GROUND ZERO: The destroyed centre of Nepal's government with Singha Darbar (in green scaffolding), the Attorney General's Office, Supreme Court, and in the distance, Parliament building. Also seen are the nearly finished new Parliament Complex and the new Supreme Court buildings. Drone shot taken on Thursday morning. Photo: SUMAN NEPALI</figcaption> </figure>  Gurung’s participation in the NDRRMA’s disaster management meeting and manner of his interaction with officials at the event was met with both bouquets and brickbats. Interestingly, some of the criticism was youth activists themselves. &nbsp;“There's a lot of self-involvement and self-importance that seems to be guiding a fragmented young leadership, as opposed to constructively engaging in how to concretise reforms,” says Dhungel. “There seems to be very little stocktaking of what's happened in the past, and what's happened in other countries to try identify where lapses could be before they occur."&nbsp; In the absence of unified positions and level-headed leadership, the youth who spearheaded post-protest negotiations, as well as the GenZ movement in general, risk losing public goodwill already dented by the destruction of state property on 9 September. This also leaves an opening for political parties which are on the defensive and licking their wounds to capitalise on youth discord.&nbsp; Says Pyakuryal: “Post revolution, the political landscape becomes extremely unpredictable and therefore there is a risk of co-optation from several Machiavellian political actors including political parties, monarchists, as well as other forces, and that is concerning.” The immediate and visible transformation that Nepal’s youth expect will not manifest right away, and while there is a need for long-term political planning, the caretaker government must also undertake measures that have a palpable impact on the daily life of citizens. &nbsp;&nbsp; “While youth frustrations must be addressed urgently, statecraft isn’t just about fulfilling short-term goals,”says Pyakuryal. &nbsp; Many, including the youth themselves, now see the need for GenZ to have a more united stance and to move beyond making demands that the interim government cannot fulfil and start mobilising for elections — even by forming its own party.&nbsp; A strong showing in elections can enable them to enact the changes they want to strengthen Nepal’s democracy, and make future governments more accountable.&nbsp; This week, the Election Commission announced 16 November as the deadline to register new parties for the 5 March polls.&nbsp; Youth representatives have said that they want to be active participants in the political process, particularly in national-level politics. The Constitution defines ‘youth’ as being between the ages of 16-40. In the 2022 elections, the Election Commission stated that over 41% of locally-elected representatives were from ages 21-40 years.&nbsp; If young Nepalis are to contest the election outside the banner of mainstream parties, this leaves electoral aspirants little more than a month to decide whether to form a loose coalition with existing parties, a separate political party, or to contest elections independently. “This is first of a kind movement, where political language is digital, not ideological, where organising is done through online platforms and where there is no one leader spearheading the movement,”says Pyakuryal. “I don’t know if ‘anti-corruption’ or ‘political reform’ have a strong enough ideological pull to band people together in the long run.” Indeed, the RSP was formed only four months before the 2022 elections and cashed in on anti-incumbent and anti-corruption sentiments of voters — mainly driven by social media. But controversy and strife within their party means it has largely lost its public trust.&nbsp; Nepal’s September Uprising and its aftermath have shown that a majority of young people are entirely disillusioned with establishment parties and politicians, even using ‘ex-political parties’ as a phrase of reference. Any new young political figures that emerge from this movement and this election will have to work with mainstream parties in a multiparty democracy.&nbsp; &nbsp;“The reality of politics is that change is not possible without engaging with existing political institutions and actors,” says Dhungel. “To say that they do not want to engage, negotiate, or identify allies or proactively seek out input from at least the reform-minded individuals within each of those outfits is political naivety, and may lead to a lack of institutionalised reform.” However, Dhungel notes that the youth leadership would have more agency if they are clear not just on what they want to change, but about whether they are interested in active politics or civic engagement. “The window of opportunity that is fast closing is to really negotiate hard and push for internal reforms within political parties and across the electoral system,” she adds. Pyakurel also adds: “GenZ are smart and politically mature, I hope they see these loopholes. I am optimistic about the direction they take.”

One month on

7:30pm Tuesday, 9 September.&nbsp; I was driving my daughter back from a relative’s house in Baneswar where she had taken refuge after a curfew was declared the previous day while she was in school. She was riding pillion on the back of my moped. We drove past Parliament <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">where 19 people had been killed by police </a>the previous day. We passed Thapathali, where the Kantipur highrise was on fire. The sky had gone dark, and the stinging smoke made it hard to breathe. A gas cylinder exploded, and the crowd dispersed briefly. The blast provided a moment to escape the raging mob. By myself I may not have been so scared, but my daughter’s safety made me more afraid. I had never been this frightened in my journalism career, even while covering the Maoist insurgency 20 years ago. At the Tripureswor intersection there were more angry crowds. The further we got from the epicentre of the GenZ demonstration, the more elderly the protesters looked. Many were muscular gentlemen with tattooed arms. Prime Minister K P Oli had just <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">resigned</a>, but the crowd was still chanting “के पी चोर, देश छोड”. Soon, we were surrounded by an enraged mob. &nbsp;My survival instinct took over, and I started shouting “के पी चोर” and my plucky daughter screamed from behind “देश छोड”. Father and daughter waved at the &nbsp;protesters, and gave them a thumbs up. &nbsp;We finally got home, scared and smelling of burning rubber and smoke.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251007031028_c5c04095cdb6f0b24cdc2cc60bf627f49c15e0cf9b509ad149df35a2e73e1d3f.jpg" data-media-id="editor_2" data-image-id="20251007031028_c5c04095cdb6f0b24cdc2cc60bf627f49c15e0cf9b509ad149df35a2e73e1d3f" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Reporter's diary of 8-9 September"> <figcaption>A building in Baneswar was damaged by protesters. </figcaption> </figure>  ARSON AND LOOTING I was born in the remote mountains of western Nepal in Rukum, the district that was the stronghold of the Maoist guerrillas after they launched an armed struggle in 1996. I moved to Kathmandu for higher studies, and as a student witnessed the popular uprising of 2006 against Gyanendra’s absolute monarchy. I have covered violence and chaos. I have been caught in the crossfire between the rebels and state security. I covered the violent <a href="https://nepalitimes.com/here-now/nepal-s-historic-youth-dissensus">street protests</a> of the 2006 People’s Movement that ended the war, the Madhes movement and the Indian blockade of 2015.&nbsp; But never was I more scared than during the 30-minute drive home through the city with my daughter at the back of my moped.&nbsp; Last month’s protests were initially led by youth groups which had loosely banded together as GenZ to protest corruption and impunity. On 8 September, I drove to the Mandala in my trusty moped to cover the rally, some protesters were in school uniform. There was singing and chanting. Just before noon, a slightly older group of protesters peeled off from the sit-in in front of Everest Hotel, broke through the half-hearted police cordon and moved towards the intersection outside Parliament. Most of the original young demonstrators remained at the sit-in, while the grownup protesters who were clearly not a part of the GenZ, started to break the perimeter wall of the Parliament complex. The young protesters looked a bit confused about what to do next as they also neared the Parliament gates. Violence was not a part of their plan, and the infiltration had begun in earnest. A group of organised older rioters broke through the western wall, even as police were concentrated along the main south gate. These agitators seemed focused on a single mission: to burn down the Parliament building, and they went about it purposefully.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251007031032_1fcd474774c8e110e833485cf54a7e63e8c8388ec78c2b4d3ae6e830c203c183.jpg" data-media-id="editor_4" data-image-id="20251007031032_1fcd474774c8e110e833485cf54a7e63e8c8388ec78c2b4d3ae6e830c203c183" data-rendition-name="original" width="1280" height="960" loading="lazy" alt="Reporter's diary of 8-9 September NT"> <figcaption>Blood seen in Baneswar.</figcaption> </figure>  Too late, the police used water cannons to disperse those by the south gate. I went closer, my press card dangling from my neck. A tear gas canister whizzed past my head. I was not able to see clearly, and backed away to safety. The police opened fire at point blank range, killing 19 protesters. Hundreds of injured were carried to the nearby Civil Hospital. There are many video clips on social media of task force police kneeling, taking aim with SLR rifles and shooting, they show protesters being hit and falling. The riot police fled, and the Armed Police Force and Nepal Army soldiers came out, but remained close to the trucks that had transported them to the intersection. Seeing that the security forces were not stopping them, the crowd then went on an arson rampage — it became a free-for-all as government buildings were set on fire one after another. Most of the arsonists were not GenZ, they were in the mid-30s, and I heard many shouting slogans for the<a href="https://nepalitimes.com/opinion/why-the-monarchy-still-sways-nepal-s-republic"> restoration of the monarchy</a>. Others were there simply to vandalise and loot. After having chased the police away from the Parliament building, they posted pictures and videos, having the run of the premises, instigating new arrivals to continue with the arson, and also brandishing looted automatic weapons. A curfew was declared, but this did not stop the rampage throughout that evening and into the night. Unable to return home, I spent the night in a friend’s office, and returned to the Parliament area the next morning. The black asphalt was dyed red with blood. Shoes, slippers and pieces of clothing littered the street. The next day, 9 September the much-feared and expected revenge attacks ignited. There was hope that the Army would be able to protect government buildings and provide public security, but the arson, vandalism and looting went unchecked — even when the seats of government were set on fire. The military did make an appearance, but only after 10pm to enforce the curfew, but by then the mob had already gone home.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251007031032_578cfa7c9e56f6ffcf1ca9b148e114a87b5332268cf97720584b70906823c074.jpg" data-media-id="editor_6" data-image-id="20251007031032_578cfa7c9e56f6ffcf1ca9b148e114a87b5332268cf97720584b70906823c074" data-rendition-name="original" width="1200" height="1600" loading="lazy" alt="Reporter's diary of 8-9 September NT"> <figcaption>A protester receiving treatment at Civil Hospital.</figcaption> </figure>  That was the moment I asked myself: Where have the students gone? Has the GenZ movement been hijacked? I could not see any of the GenZ-ers anywhere on 9 September. It was around midday of 9 September that millennials, including from groups like Hami Nepal came forward to the media, claiming to speak for the GenZ. They claimed to have led the protests. Others claiming to be GenZ said they were for the restoration of the monarchy, but they did not look the age.&nbsp; Mobs were out of control, burning down the prime minister’s office, the Supreme Court, the CIAA and the official and private residences of ministers. Within 27 hours Nepal became a country without a government, and leaders without homes. Important official documents went up in flames with the buildings that housed them. PM Oli resigned, too late to save the day. The Army occupied itself airlifting ministers from their official residences. Former prime minister Sher Bahadur Deuba and his wife foreign minister Arzu Rana Deuba were dragged out, beaten up and their home set on fire. They were rescued and taken to an army base. It became hard to tell over the next few days if the Army was providing them security, or keeping them incommunicado in detention. The Army was negotiating with GenZ as well as pro-monarchists at its headquarters, but moved the talks to President Ram Chandra Paudel’s office on 11 September.&nbsp; Former chief justice Sushila Karki was nominated interim head of government by GenZ delegates voting on Discord, and <a href="https://nepalitimes.com/news/march-to-5-march">mandated to hold elections</a> on 5 March.&nbsp; Will that happen? Things are too fluid at the moment. And my mind is still reeling from the fear and panic of that moped ride with my daughter through rampaging mobs. Did all that really happen in front of my eyes, or was it just a nightmare?&nbsp; Bhadra Sharma is a reporter for The New York Times based in Kathmandu.