The United States Medical Licensing Examination (USMLE) is a test that those who want to practice medicine in America have to pass. A growing number of Nepalis have been taking the test to emigrate to the US.&nbsp;
Last week, USMLE invalidated test results of some 800 Nepali doctors because of ‘unusual score patterns or variations’.
‘The USMLE program has identified a pattern of anomalous exam performance associated with Nepal, which challenges the validity of test results for a group of examinees,’ its statement said.&nbsp;
Essentially, USMLE was accusing Nepali doctors of having prior knowledge of questions. This sparked outrage among Nepalis in the United States who say it tainted the country's image, and besides there is no way the test questions can be ‘leaked’.&nbsp;
<a href="https://nepalitimes.com/here-now/nepali-doctors-love-for-urdu-poetry">Ramu Kharel</a> is an emergency medicine physician and assistant professor at Brown University. He told us, "We care for the integrity of the program, and do not condone cheating in any form but the decision is not backed by strong evidence and creates biases when there is already a lot of brewing anti-immigrant sentiment.”
Kharel reached out to the USMLE director who told him it was ‘an ongoing investigation’.
“And yet they put out a blanket statement that has tarnished an entire country’s image as well as the credibility of practicing Nepali doctors who have done a lot of good work in the US.”
Several international doctors in the United States back this up, saying irregularities should have been addressed individually instead of singling out a whole country.
‘Some folks are using incidents of what they call “unusual USMLE Scores" to vilify the whole immigrant community who are resilient, hardworking, and knowledgeable as local doctors are. Let's not generalize the acts of a few to whole country and to emigrants,” X'ed Sadiq Naveed, psychiatrist in Hartford, Connecticut.
<div class="embed-block"><blockquote class="twitter-tweet">Some folks are using incidents of &quot;unusual USMLE Scores&quot; to vilify whole IMG community. IMGs are as resilient, hardworking, and knowledgable as AMGs are. Let&#39;s not generalize the acts of a few to whole country and the IMG community.&mdash; Sadiq Naveed (@SadiqNaveed) <a href="https://twitter.com/SadiqNaveed/status/1753917839289753714?ref_src=twsrc%5Etfw">February 3, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
<div class="embed-block"><blockquote class="twitter-tweet">USMLE Score Invalidation: In my opinion mistakes of some mustn&#39;t lead to singling out of an entire country🇳🇵. ECFMG &amp; USMLE could have handled the situation better by a making a more generalized statement rather than naming a particular country. &quot;Culprits should be punished… <a href="https://t.co/h7AnANubE6">pic.twitter.com/h7AnANubE6</a>&mdash; Dr Ahmad Rehan Khan (@AhmadRehanKhan) <a href="https://twitter.com/AhmadRehanKhan/status/1754145466608955585?ref_src=twsrc%5Etfw">February 4, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
&nbsp;Ahmad Rehan Khan, psychiatrist based in Virginia also tweeted: ‘In my opinion mistakes of some mustn't lead to singling out of an entire country. ECFMG &amp; USMLE could have handled the situation better by a making a more generalized statement rather than naming a particular country.’
Kharel started a <a href="https://www.change.org/p/call-for-usmle-to-redact-and-change-the-statement-regarding-applicants-from-nepal?recruiter=1329972259&amp;recruited_by_id=12774da0-c307-11ee-8897-7bad97cd7eca&amp;utm_source=share_petition&amp;utm_campaign=share_for_starters_page&amp;utm_medium=copylink">petition calling on USMLE to redact or change the statement</a>, and has over 2,500 signatories already. He has approached the Nepali physicians' group in the US as well as the America Nepal Medical Foundation seeking legal counsel.
“The damage is already done, but USMLE at the very least needs to immediately revise its statement and issue a formal apology,” says Kharel. “The truth is that Nepalis are generally well-liked here."&nbsp;
A week before the USMLE statement, <a href="https://nepalitimes.com/here-now/grass-is-greener-overseas-for-nepals-doctors">Nepali Times published a report about doctors emigrating</a> to the US, UK, Canada, Australia and the Gulf, leading to a shortage of specialists in Nepal and weakening an already fragile medical system.
Nepal has an annual turnover of nearly 2,500 MBBS graduates, yet the country faces a severe shortage of doctors. The Nepal Medical Council says 36% of doctors have emigrated, but that seems to be an undercount. &nbsp;
Between April-December 2023, 1,025 physicians left Nepal. Since 2020, 1,578 doctors have emigrated to the UK, and 888 to the US.&nbsp;
There are many push factors, but the lack of professional fulfilment in Nepal is the biggest. Equally strong is the pull of the American dream, with even unskilled Nepalis paying up to Rs6 million to human traffickers to take the illegal backdoor to the US.
<a href="https://archive.nepalitimes.com/news.php?id=19560">Emigrating doctors</a> may earn more than in Nepal, but international medical graduates in the US often do not get to practice specialised medicine of their choice, and are relegated to long hours as general physicians.&nbsp;
“Nepali doctors are emigrating essentially for thankless, blue-collar jobs,” says Bishal Dhakal, cardiac surgeon and founder of Health At Home in Kathmandu. “They do not make a lot of money by American standards and are doing jobs that American doctors do not want to do. Which is why Nepalis being accused of cheating is so tragic.”
Even so, the <a href="https://www.medscape.com">Medscape medical news website</a> on 1 February states that selling and buying USMLE questions online have become rampant with test questions selling for anywhere from $300 to $2,000.
An Indian doctor Ahmad Ozair at Johns Hopkins says his suspicions were aroused when he saw several students from one medical school in Nepal, posting on social media about scoring up to 280-plus.
‘The statistical probability that you would have three or more candidates in the same year, scoring in the 99th percentile worldwide, from a small geographical area is extremely low,’ Ozair <a href="https://www.medscape.com/viewarticle/us-board-discloses-cheating-grads-say-problem-rampant-2024a10002aj">said to Medscape</a>.&nbsp;
Others say the USMLE recall of Nepali test takers was not an ordinary one, and there is photographic evidence of questions leaked at exam centres.&nbsp;
The fact that Nepal’s university exams have regular scandals of ‘question outs’ gave credence to accusations of Nepali cheaters.&nbsp;
J. Bryan Carmody, nephrologist based in Virginia, also took to Twitter to write: ‘This isn’t the usual low-quality “USMLE recalls” - and instead involves screenshots/photos of real questions, taken at test centers by proctors (or after the proctors were paid to look away).’
<div class="embed-block"><blockquote class="twitter-tweet">The cheating in this case involved “prior unauthorized access to secure exam content.” This isn’t the usual low-quality “USMLE recalls” - and instead involves screenshots/photos of real questions, taken at test centers by proctors (or after the proctors were paid to look away).&mdash; Bryan Carmody (@jbcarmody) <a href="https://twitter.com/jbcarmody/status/1752891546553213219?ref_src=twsrc%5Etfw">February 1, 2024</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
Medical educator Conrad Fisher of MedQuest Test Prep questioned in an X post the high performance of Nepalis: ‘Of 138 with &gt;275 applying to my program, 86% are Nepali. Of the top 100 applicant scores 92% are Nepali.’
But Bishal Dhakal says Nepalis are used to practicing for exams based on past tests, and it is unfair for USMLE to call it cheating just because of high scores. “If there is an issue with exam centres, that should be dealt with separately without dragging the whole country into it," he adds.
An increasing number of Nepali doctors passing USMLE tests with high marks seems to be making some international graduates in America insecure. He adds, "We are sending our smartest doctors to America, and that didn’t sit well with those benefiting from the Subcontinent quota. A small country is being singled out." &nbsp;

Sonia Awale

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Cheated out of the American Dream

In 2009, Samir Lama completed his MBBS and then passed all three stages of the United States Medical Licensing Examination (USMLE), making him eligible to practice in the US. However, he returned to Nepal in a year, opting to serve his own people instead. Lama pursued a three-year residency in General Medical Practice at the Teaching Hospital in Kathmandu sponsored by the Nick Simons Institute and was later placed at the District Hospital in Piuthan under a three-year contract. Eventually, at a medical college in Chitwan, Lama’s monthly salary was Rs80,000, a relatively meagre sum for someone with three years of post-MD work experience. Dissatisfied, he established his own polyclinic in Chitwan. But today, he is based in Britain, working as a resident physician in general practice. “There are difficulties living and working in Nepal,” Lama tells us by phone. “Becoming a doctor through civil service is difficult, and a physician’s life is financially challenging even in private practice.” In 2017, Murari Barakoti completed a one-year fellowship in Interventional Cardiology, and preferred to work in Singapore and the Maldives rather than stay in Nepal. He blames the lack of expertise-based remuneration in Nepal for his decision.&nbsp; “In the Maldives, doctors get ten to twenty times the pay they would normally get in Nepal,” says Barakoti, who is among 1,100 Nepali doctors working in the Maldives today. Ironically, many students from Maldives come to Nepal’s medical colleges for their education. Sandesh Parajuli, a government scholarship recipient for MBBS in Pakistan, worked for two years at Gandaki Provincial Hospital after he returned. In 2020, he took the medical officer exam at Lumbini Provincial Hospital, and the results are still pending. Tired of waiting, Parajuli completed his USMLE online and is now in the US. He says, “There is a sense of fulfilment serving patients in my own country, but the working environment in Nepal for doctors is not conducive. Of my 20 closest friends, only one is still working in Nepal.” It is generally known that young Nepalis are leaving the country by the tens of thousands every year for undergraduate studies in Australia, Canada or Japan. Less well known is this haemorrhage of doctors and nurses. <div class="embed-block"><iframe title="Specialists" aria-label="Grouped Bars" id="datawrapper-chart-3jT6V" src="https://datawrapper.dwcdn.net/3jT6V/1/" scrolling="no" frameborder="0" style="border: none;" width="600" height="492" data-external="1"></iframe></div> The depletion of medical personnel has further weakened the country’s already fragile healthcare system, and added to the shortage of specialists. Despite an annual turnover of 2,000 to 2,500 MBBS graduates, Nepal faces a severe shortage of doctors, especially in remote parts of the country. The Nepal Medical Council (NMC) has nearly 35,000 registered doctors, including 10,588 specialists. But there is no exact figure for working professionals. A 2015 study by the Council reported that approximately 36% of doctors are working abroad, but the actual proportion is estimated to be much higher.&nbsp; Doctors planning to leave are mandatorily required to present a Good Standing Certificate (GSC), and the Medical Education Commission issued 1,025 GSCs just between April to December 2023. Commission sources say the demand for GSCs has surged in the past four years.&nbsp; The majority of Nepali doctors have chosen to migrate to the UK, with 1,578 physicians acquiring certificates since 2020. The US is the second most popular destination, with 888 Nepali doctors moving there to practice in the same period. Opportunities in Australia, UAE, Canada, and Qatar are also on the rise. Sanjeev Sapkota, president of the Non-Resident Nepali Association (NRNA), estimates that of its total membership, 5,000 are doctors and medical specialists. Many others who have migrated have not bothered to become NRNA members. Worryingly, government scholarship recipients make up a rising number of migrant physicians — depriving state-run hospitals in the country of specialists. Some doctors seek improved working conditions, while others, frustrated with unemployment or exploitation in Nepal’s private hospitals, choose to start anew. They are attracted by the promise of higher earnings, and a better future for their families. 1:150,000 Completing an MBBS degree generally takes six years, and those studying on government scholarships are obligated to work in a rural hospital for an additional two years. During this period, they have no time for further study or to sit for civil service exams. However, once the commitment is fulfilled, they are left without a paying job. “Despite some incentives for further studies after MBBS, many graduates struggle because of low salaries and uncertain future prospects,” says Shambu Khanal of the Lumbini Provincial Hospital.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240128110120_63d9c40da537cbdad3dc2307a31623607227185a5768b1999359f53cc6c17b88.jpg" data-media-id="editor_1" data-image-id="20240128110120_63d9c40da537cbdad3dc2307a31623607227185a5768b1999359f53cc6c17b88" data-rendition-name="original" width="2500" height="1667" loading="lazy" alt="Nepali healthcare NT"> </figure>  Postgraduate study opportunities are also hard to get due to limited annual seats of around 2,000. Additionally, a small number of subject-specific seats further complicates matters, particularly for those candidates below the top 500, barring them from pursuing preferred medical disciplines. Without government support, individuals must bear all expenses themselves, discouraging many more aspiring Nepali doctors from pursuing MD/MS degrees. This in turn is leading to a chronic shortage of specialists in Nepal. The 'Human Resources for Health (HRH) Projection in Nepal, 2079-2087' reveals a deficit of 5,779 specialists, with the annual production growth rate falling short at 6.41%, thus widening the gap in the doctor-to-population ratio. At present, there is only 1 doctor for every 850 people in the Kathmandu Valley which is better than the WHO-recommended 1 per 1,000. But this ratio goes down to 1 per 150,000 in remote districts. &nbsp;Despite depopulation of the mountain districts, there is a dire need to retain qualified medical staff in rural Nepal. The absence of diverse medical expertise, coupled with government oversight of emerging disciplines, leaves returning professionals with no acknowledgment or motivation. The country therefore faces a critical shortage of specialised doctors, particularly in cardiology, surgery, gynaecology, and neurology. A recent study by the Medical Education Commission showed a shortfall in surgeons: there are only 660 when the country needs a minimum of 808. Medical generalists face a similar deficit, with just 349 working actively against the 1,115 required. The study also foresees a demand for 1,223 medical generalists in 7 years, factoring in population growth. Doctors in specialised services in new fields face challenges due to inadequate infrastructure and equipment. Even those willing to work in government hospitals struggle to secure positions.&nbsp; Dharmagat Bhattarai, who is specialising in paediatric clinical immunology and rheumatology, says there is an urgent need for specialised doctors, especially for diagnosing and treating rare diseases in children. “After MBBS, graduates work as interns in hospitals for a year. Although hospital administrators assign them duties, they do not get adequate compensation,” says Bijay Parajuli, who specialises in pediatric critical care, rheumatology, congenital heart diseases, and neurosurgery. He adds: “In Pakistan, I received a monthly stipend of Rs44,000 after MBBS while interns in Nepal are getting only Rs9,000.” <div class="embed-block"> <iframe title="Total ‘Good Standing’ certificated from NMC" aria-label="Interactive line chart" id="datawrapper-chart-N0vyK" src="https://datawrapper.dwcdn.net/N0vyK/1/" scrolling="no" frameborder="0" style="border: none;" width="600" height="400" data-external="1"></iframe></div> Resident doctors pursuing MD/MS face a similar fate. Overworked doing hospital health check-ups, filling prescriptions, and handling ward responsibilities, their studies are often hampered—and all this for poor pay. While countries like the USA, UK, and Canada waive tuition fees for MD/MS programs, resident doctors in Nepal have to struggle for better remuneration. A government hospital resident earns an average of Rs48,000 monthly. However, those working in private medical colleges are compelled to work for less than Rs20,000. Some doctors say residents in private hospitals often have to work for 36 hours straight, multiple times a month. Vishad Dahal, an internal medicine student at Kathmandu Medical College, faced suspension for questioning a 20 extra-curricular health camp. His suspension has now been revoked. NMC’s &nbsp;'Regulations for Postgraduate Medical Education (MD-MS Programs) 2017' states that postgraduate residents should not be assigned duty for more than 24 hours per week. Typically, it takes an average of 12 years to complete MD, even after graduation. This means most doctors would not have finished their studies even in their early 30s. Moreover, the cost of private medical education is expensive and often exceeds Rs10 million. And after all that, there is still no job security, not to mention the years it takes to recover the investment. This prompts many to consider working or studying abroad. “The rise in Nepali doctors moving abroad demands urgent attention. While it may seem routine at first glance, the trend can potentially cause a scarcity of experts,” admits Shri Krishna Giri, past president of the Medical Education Commission. He adds: “Restricting doctors from seeking opportunities overseas may not be a practical solution. The challenge lies in finding a nuanced approach that recognises and addresses the multifaceted factors contributing to this exodus.” &nbsp; With additional reporting by Yugottam Koirala.

Grass is greener overseas for Nepal's doctors

India and Pakistan are twins separated at birth. Tensions between them have been at a hair trigger ever since independence and has erupted into full scale conflict at least four times in the past 80 years.
The 22 April terrorist attack in Kashmir that killed 25 Indian tourists and a Nepali citizen, threatens to escalate tension between the two nuclear-armed nations. India has squarely blamed Pakistan for the attacks, and Prime Minister Narendra Modi has given his military “operational freedom” to respond. Pakistan has said it has credible intelligence of an Indian military strike and its officials have promised a “full spectrum” response — a code for a <a href="https://nepalitimes.com/editorial/thinking-the-thinkable">nuclear retaliation</a>.
For Nepal, the killing of its national in the Pahalgam attack comes as another stark reminder that in conflicts from Afghanistan to Iraq, from <a href="https://nepalitimes.com/opinion/how-to-agree-an-armistice-in-ukraine">Ukraine</a> to Israel, <a href="https://nepalitimes.com/news/10-nepalis-from-one-town-fighting-in-ukraine">Nepalis are getting caught in the crossfire</a>. The last time full-scale fighting broke out between <a href="https://nepalitimes.com/opinion/peacemongers-at-india-pakistan-border">India and Pakistan</a> on Kargil in 1999, at least 22<a href="https://nepalitimes.com/here-now/india-s-trial-by-fire-for-soldiers-from-nepal?%27%5C%22="> Nepalis fighting for the Indian Army</a> were killed in action.
Three of Nepal’s immediate neighbours (China, India, Pakistan) have nuclear weapons, and they do not have good relations. With China supplying weapons, <a href="https://nepalitimes.com/editorial/war-and-warming">missile technology</a> and other support to Pakistan, this triangular friction could set off a regional conflagration.&nbsp;
<a href="https://www.nature.com/articles/s43016-022-00573-0" target="_blank">Research at Rutgers University</a> has calculated that even a week-long tactical nuclear exchange between India and Pakistan would throw up so much smoke and debris into the atmosphere that it would block out the sun for years, and lead to a collapse of the <a href="https://nepalitimes.com/news/grow-nourish-sustain-together-world-food-day">global food system</a>. This does not take into account the radioactive fallout that prevailing winds would blow up to <a href="https://nepalitimes.com/here-now/lives-on-the-line-in-the-himalaya">the Himalaya</a>, contaminating glaciers that are the sources of <a href="https://nepalitimes.com/here-now/saving-what-is-left-of-himalayan-rivers">Asia’s main rivers</a>.
The impact of <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>on High Asia was already ringing alarm bells about its <a href="https://nepalitimes.com/news/himalayan-icecap-melting-faster-than-thought">shrinking ice cap</a> reducing the dry season flow of water downstream. Water was going to be the next strategic commodity, geopolitical experts warned, and the next wars in Asia would be over water.
That water war is already happening. India retaliated to the Kashmir attack by suspending the <a href="https://www.nytimes.com/2025/04/24/world/asia/india-pakistan-indus-waters-treaty.html" target="_blank">Indus Waters Treaty</a> of 1960 mediated by the World Bank that has withstood at least three wars between India and Pakistan. The treaty gives India control over the three eastern tributaries of the Indus (<a href="https://en.wikipedia.org/wiki/Beas_River" target="_blank">Beas</a>, <a href="https://en.wikipedia.org/wiki/Ravi_River" target="_blank">Ravi</a> and <a href="https://en.wikipedia.org/wiki/Sutlej" target="_blank">Sutlej</a>), while Pakistan got water from the Indus and two of its western tributaries (<a href="https://en.wikipedia.org/wiki/Indus_River" target="_blank">Indus</a>, <a href="https://en.wikipedia.org/wiki/Chenab_River" target="_blank">Chenab</a> and <a href="https://en.wikipedia.org/wiki/Jhelum_River" target="_blank">Jhelum</a>.
Pakistan was assured of 70% of the annual flow, and India could use a reasonable amount of water for<a href="https://archive.nepalitimes.com/news.php?id=15231"> irrigation and hydropower</a>. &nbsp;Within days of its threat, India stopped water flowing down to Pakistan from the Chenab river and is reportedly preparing to do the same on the Jhelum.
The sabre-rattling has reached a crescendo. Besides threats and counter-threats there are also symbolic drills, with the Indian Air Force practicing landing on an expressway in Uttar Pradesh by its Rafale, Su-30 and Jaguar fighter jets to demonstrate ‘operational readiness’. In response Pakistan test-fired its Abdali ballistic missile that can carry a nuclear warhead and has a range of 450km.&nbsp;
The danger is that with ultra-nationalist rhetoric and the beating the war drums by both sides, India’s government and Pakistan’s military may have to ‘do something’ to appease domestic public opinion. But any tactical strike, an artillery exchange, or territorial incursion could quickly escalate out of control.
Expecting an Indian retaliation for the Pahalgam killings, Pakistan is using<a href="https://nepalitimes.com/opinion/interfaith-collaboration-for-nuclear-disarmament"> nuclear deterrence </a>and warning of “catastrophic consequences”. The two neighbours came close to a nuclear exchange in 2019 after an attack on the Indian military in Kashmir, and prompt international intervention led by the United States cooled tensions.&nbsp;
This time, the <a href="https://nepalitimes.com/news/trump-shock-wave-hits-nepal">Trump administration</a> is too distracted and not as engaged. Pakistan has denied it was responsible for the terrorist attack and called on Washington to stop a possible Indian retaliation. India and Pakistan have stopped overflights by each other’s airlines, and some international carriers have even stopped flying over Pakistan fearing an air war.
Washington, Beijing, the UN and the EU have all urged restraint. Iran, which has good relations with both India and Pakistan has sent its foreign minister to urge both countries not to go into a tit-for-tat war. Iran has its own nuclear flashpoint to worry about with tensions in Israel, &nbsp;Yemen and Syria.
India and Pakistan both share similar problems of joblessness, <a href="https://nepalitimes.com/here-now/why-nepal-s-poverty-rate-is-stuck">poverty </a>and <a href="https://nepalitimes.com/here-now/climate-change-new-threat-to-nepal-s-rhinos">environmental threats</a>. Neither side needs the threat of a senseless war, and we in the neighbourhood do not need it either.&nbsp;
Kunda Dixit
This Editorial is brought to you by <a href="https://nepalitimes.com/" target="_blank">Nepali Times</a>, in collaboration with <a href="https://inpsjapan.com/en/" target="_blank">INPS Japan</a> and <a href="https://sgi-peace.org/" target="_blank">Soka Gakkai International</a>, in consultative status with UN ECOSOC.

Nukes in the neighbourhood

The streets of Patan are alive this month with lavender jacaranda trees under rain-washed skies as <a href="https://nepalitimes.com/banner/the-red-god-rises-again-in-patan">the chariot of Rato Matsyendranath</a> is pulled across town. This is the festival of the rain god, and inevitably the heavens opened up and pre-monsoon showers pelted the chariot as it started being pulled in Pulchok last week. Thousands of devotees, onlookers and the chariot procession organisers thronged the streets on the first day last week. The rhythmic cymbals and drums exuded a vibrant energy as the enormous four wheels turned and the chariot lurched.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688.jpg" data-media-id="editor_1" data-image-id="2025051007050_81df97744db16f732a419dc1f1579d235ce3df37642b078f50b83bd4bd026688" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  The<a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Red-rain-god,3141"> red rain god</a> has Hindu and Buddhist antecedents, alternatively called Bungadya and<a href="https://nepalitimes.com/here-now/kathmandu-s-gravity-defying-chariot-festival"> Karunamaya</a> — reflecting Kathmandu Valley’s syncretic mixture of the two religions.&nbsp; “Bungadya is a profoundly <a href="https://nepalitimes.com/opinion/12-full-opinion/marketing-the-intangible">intangible form of heritage</a>,” explains heritage expert Monalisa Maharjan. “It embodies traditional knowledge,<a href="https://nepalitimes.com/multimedia/reviving-nepal-s-craft"> artisanal skills passed down through generations</a>. Local communities and specific families have specified roles in being custodians of the heritage, ensuring their survival over the centuries.” There are many legends and stories about this annual tradition. Lichhavi king Narendra Dev is supposed to have brought Rato Matsyendranath from Assam to Kathmandu Valley to convince Guru Gorakhnath to lift a spell that created a two-year drought in Kathmandu.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a.jpg" data-media-id="editor_6" data-image-id="20250510050520_347a9a398f8a9abc4a7fb4e2774fde8264cccbdce8bdab23851ab3f0e73c3e8a" data-rendition-name="original" width="1503" height="1000" loading="lazy" alt="Divine chariot"> </figure>  Matsyendranath was Gorakhnath’s mentor, and upon seeing him, the serpents were released, unleashing the rains. The chariot festival honours the return of this life-giving rain. The deity is seen as an icon for thriving agriculture, t<a href="https://nepalitimes.com/here-now/before-the-next-monsoon">he arrival of monsoon</a> showers, and the welfare of the community. Read also: <a href="https://nepalitimes.com/opinion/the-reign-of-the-god-of-rain">The reign of the god of rain</a>, Vidhu Prakash Kayastha Till this day, the Rato Matsyendranath festival is no ordinary celebration. Patan does not sleep for a month as the chariot is pulled through various neighbourhoods. It unfolds at a state level with the president (formerly the king) attending the climax of the Bhoto Jatra in Jawalakhel later this month.&nbsp; The intergenerational transmission of tradition is unique in the world, and the reason the festival is one of the most vibrant cultural expressions that thrives despite inroads of modernity. The other unique aspect is that it is a transnational festival, binding Patan with Guwahati in the Indian state of Assam.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a.jpg" data-media-id="editor_9" data-image-id="2025051005058_8bc685ada13045d863b28e3eed91c931da2b510714586af6fd7eb5d1e298a24a" data-rendition-name="original" width="1000" height="1503" loading="lazy" alt="Divine chariot"> </figure>  “Unlike Nepal, where the deity commands grandeur and devotion, many in Assam are unaware of Rato Matsyendranath,” says Khagen Sharma of Gauhati University, which convened <a href="https://nepalitimes.com/news/nepal-assam-connection-revived">a symposium in February in Guwahati on the rain god</a>. Attending was a delegation led by Lalitpur Mayor Chiribabu Maharjan, organisers of the festival, and builders of the chariot. After the symposium, a committee was formed to explore and revive the tradition in Assam as well. Although the team had planned to visit Nepal this month, logistical challenges delayed the trip. Still, there are plans to build a Guru Matsyendranath statue in Assam to reestablish regular worship practices in the Guwahati shrine.&nbsp; The vines used to build the chariot in Patan are sourced from the jungles of Assam. But Sharma notes that in recent years unclear regulations have blocked the official import of the vines, although they are still brought to Nepal informally. The <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/makers-of-machhindranath,2204">chariot making</a> has also had a taste of modernisation in recent times. In the past, even a single nail or piece of steel was avoided. But over time, the wooden structure, particularly the shaft between the wheels, has been replaced with bronze. When that too proved unstable, metal clamps were introduced, which have become a pragmatic compromise.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93.jpg" data-media-id="editor_12" data-image-id="20250510050524_b2a819a5791612f14c81d30fc393dbd3f99f0c64b90a9110e8b0855d944bfa93" data-rendition-name="original" width="1500" height="998" loading="lazy" alt="Divine chariot"> </figure>  Another welcome change is the focus on safety. Builders climbing the chariot’s tower now wear harnesses and there are efforts in crowd control. The most visible change in recent years has been the involvement of Patan’s enthusiastic youth in the festival — the tradition is now passing to a new generation. Says Matsyendranath expert Vidhu Kayastha: “There is more energy, the young people in red t-shirts this year were very organised, these modern touches aren’t diluting our culture, they’re keeping it alive in new forms.” He adds, “We are <a href="https://nepalitimes.com/here-now/searching-for-a-homeland-away-from-home">reconnecting with our roots</a>, we have more resources, more awareness than ever before. We must not be swept away by western values that may not serve us, and in some ways, cause more harm than good. We must revive our own culture.”&nbsp;

Divine chariot

In 2025, two seemingly disconnected acts of violence shattered the illusion of stability in the region. In March, <a href="https://www.ft.com/content/16f7f947-1e96-4206-9844-891378adc683" target="_blank">militants hijacked a passenger train</a> near the Bolan Pass in Balochistan, executing soldiers in cold blood. A month later, <a href="https://www.nytimes.com/2025/04/22/world/asia/kashmir-terrorist-attack.html" target="_blank">gunmen in Kashmir’s</a> Pahalgam Valley massacred tourists. 
In both Islamabad and New Delhi, <a href="https://www.aljazeera.com/news/2025/4/25/were-cursed-kashmiris-under-attack-across-india-after-pahalgam-killings" target="_blank">the reaction was reflexive:</a> condemn the violence, <a href="https://www.economist.com/asia/2025/04/22/india-and-pakistan-could-come-to-blows-over-kashmir" target="_blank">blame external enemies</a>, declare the situation contained. But South Asia’s leaders are not fighting terrorists alone. They are fighting the consequences of their own betrayals.
Across <a href="https://www.bbc.com/news/world-asia-26272897" target="_blank">Balochistan</a>, <a href="https://www.bbc.com/news/world-south-asia-11693674" target="_blank">Kashmir</a>, <a href="https://www.crisisgroup.org/asia/south-asia/india/346-finding-way-out-festering-conflict-indias-manipur" target="_blank">Manipur</a>, and beyond, decades of <a href="https://www.amnesty.org/en/projects/enforced-disappearance-in-south-asia/" target="_blank">enforced disappearances</a>, broken promises, and brute militarisation have hollowed out the social contracts meant to hold these nations together. The grievances that drove rebellions from the 1940s through the 1990s – demands for dignity, recognition, and political agency – were never meaningfully addressed. They were buried beneath asphalt and propaganda, paved over by development projects and security checkpoints.
States may claim victory. But their victories are mirages, dissolving the moment anyone looks too closely. South Asia’s unfinished wars are not relics of a violent past. They are live ammunition, loaded into the future.
<a href="https://www.theguardian.com/world/2025/mar/24/he-only-wanted-revenge-the-bloody-insurgency-in-balochistan-gaining-lethal-momentum" target="_blank">Balochistan</a> has been at war with Pakistan for most of its modern history. Rich in gas, minerals, and coastline, the province has been plundered for decades under the language of national development. 
Projects like the <a href="https://eastasiaforum.org/2020/11/26/pakistans-three-evils-cpec-and-good-governance/" target="_blank">China-Pakistan Economic Corridor (CPEC)</a> promise progress but deliver exclusion: minerals are mined, ports are secured, but Baloch homes are raided. 
The insurgency endures not because of foreign conspiracies, as Islamabad endlessly insists, but because the Pakistani state remains incapable of seeing its <a href="https://thebalochistanpost.net/2025/01/enforced-disappearances-in-balochistan-in-december-2024-tbp-report/" target="_blank">Baloch citizens</a> as anything other than a security problem to be managed.
In <a href="https://www.forbes.com/sites/ranisingh/2016/07/12/kashmir-in-the-worlds-most-militarized-zone-violence-after-years-of-comparative-calm/" target="_blank">Kashmir</a>, the Indian government claims to have <a href="https://www.nytimes.com/2023/03/08/world/asia/kashmir-village-defense-committees.html" target="_blank">“normalised” the valley</a> after revoking its autonomy in 2019. It <a href="https://www.cfr.org/global-conflict-tracker/conflict/conflict-between-india-and-pakistan" target="_blank">looks a lot like occupation</a>. Soldiers outnumber local leaders, dissent is criminalised, internet shutdowns suffocate public life. Tourism campaigns and investment summits cannot erase a generation raised under curfew and surveillance.
<a href="https://www.bbc.com/news/world-asia-india-66260730" target="_blank">Manipur’s descent into ethnic bloodshed</a> in 2023 exposed another fault line Delhi prefers to ignore. Long-simmering tensions between the Meitei and Kuki communities erupted into violence that shattered any illusions of northeastern integration. The central government’s delayed, politicised response made clear what many Manipuris had always suspected: they are citizens of India only when convenient.
Even the <a href="https://msf.org.au/rohingya-worlds-largest-stateless-population" target="_blank">Rohingya, stateless and exiled from Myanmar</a>, find themselves entangled in South Asia’s ethnonationalist calculus. Fleeing genocide, they are criminalised anew in Bangladesh and India – trapped between the countries that reject them and the memories that refuse to let them go.
South Asia’s states have excelled at suppressing rebellion. But failed at extinguishing the reasons rebellions rise in the first place. And the wars South Asia tries to forget at home have found new life abroad.
Across <a href="https://www.abc.net.au/news/2024-06-17/modis-indian-government-accused-of-spying-silencing-critics/103974414" target="_blank">Canada, Australia, Britain, and the United States</a>, diasporic communities have become memory-keepers and, increasingly, <a href="https://www.business-standard.com/world-news/khalistan-supporters-hold-protest-outside-indian-consulate-in-vancouver-123092600087_1.html" target="_blank">the agitators</a> for the struggles their home states would rather erase.
Khalistan flags fly outside Indian consulates in Vancouver and <a href="https://www.tribuneindia.com/news/punjab/perturbed-over-waving-of-khalistani-flags-at-an-event-in-melbourne-india-warns-australia-of-khalistan-separatists-and-their-links-with-terror-groups-458320/" target="_blank">Melbourne</a>. Tamil activists march through London, demanding accountability for the <a href="https://www.aljazeera.com/news/2024/5/19/grim-reminder-sri-lankas-tamils-mark-15-years-since-end-of-civil-war" target="_blank">massacres in Mullivaikkal</a>. Kashmiri protests in Washington and New York refuse to let India’s crackdown slip into diplomatic amnesia.
For host countries, these movements pose uncomfortable questions. Freedom of expression collides with fears of extremism. Clashes erupt between communities carrying wounds that their new homelands.
Meanwhile, South Asian states pursue their adversaries across borders. India faces allegations of <a href="https://www.nbcnews.com/news/world/canada-says-india-home-minister-ordered-campaign-against-sikh-activist-rcna177972" target="_blank">targeting Sikh activists for assassination in Canada</a> and the <a href="https://www.npr.org/2024/10/27/g-s1-29561/sikh-separatist-assassination-india" target="_blank">United States</a>. Pakistan continues to court Kashmiri separatists abroad while crushing Baloch dissent at home. <a href="https://apnews.com/article/sri-lanka-tamils-civil-war-dead-5b372b0bba567837c5a4d94250040e7d" target="_blank">Sri Lanka</a> lobbies furiously to brand Tamil diaspora organisations as fronts for terrorism, even as it stonewalls investigations into its own wartime atrocities.
The old insurgencies have not been defeated. They have been globalised. South Asia’s governments have long mistaken silence for stability.
In Punjab, India broke the back of the <a href="https://www.cnn.com/2023/10/06/india/india-canada-sikh-khalistan-analysis-intl-hnk/index.html" target="_blank">Khalistan insurgency</a> through brute force. The fields grew green again, the trains ran on time. But the wounds were never closed, the <a href="https://www.dw.com/en/why-is-indias-khalistan-separatist-movement-on-the-rise/a-65081729" target="_blank">movement’s heart beats</a> not in Amritsar but in Brampton and Surrey.
In Sri Lanka, the <a href="https://www.academia.edu/4738983/The_Man_Who_Destroyed_Eelam" target="_blank">military crushed the Tamil Tigers</a> with <a href="https://www.newyorker.com/magazine/2011/01/17/death-of-the-tiger" target="_blank">overwhelming brutality in 2009</a>. <a href="https://www.scmp.com/week-asia/politics/article/3264148/we-want-our-children-back-sri-lankan-families-still-demanding-justice-their-missing-loved-ones" target="_blank">Tamil families still search for their missing</a>, still mourn their dead – and still organise across the diaspora for justice that remains undelivered.
In Kashmir, Delhi boasts of new <a href="https://www.aljazeera.com/opinions/2023/2/4/kashmir-is-bleeding-its-economy" target="_blank">highways and investment corridors</a>, showcasing the region as a trophy of unity. But when the visitors leave and the cameras are packed away, <a href="https://harvardlawreview.org/print/vol-134/from-domicile-to-dominion-indias-settler-colonial-agenda-in-kashmir/" target="_blank">the checkpoints, the raids, and the quiet despair remain.</a>
Victory parades fade. Grievance endures. Suppressing insurgency may end battles. It does not end the ideas that fueled them. In a region where <a href="https://www.nytimes.com/2025/04/23/world/asia/kashmir-attack-india-pakistan.html" target="_blank">history is rarely past</a>, and memory is rarely voluntary, states that rule through repression are only ever buying time. And often, not very much.
South Asia’s unfinished wars are not accidents. They are the inevitable consequences of states that confuse conquest with consent, and erasure with reconciliation. They cannot legislate memory out of existence.
Every <a href="https://www.bbc.com/news/articles/c15qyyzz89lo" target="_blank">disappeared son in Balochistan</a>, every <a href="https://medium.com/the-wvoice/the-half-widows-in-kashmir-fef80c6b88e9" target="_blank">half-widow in Kashmir</a>, every <a href="https://www.doctorswithoutborders.org/what-we-do/focus/rohingya-refugee-crisis" target="_blank">refugee child born stateless in a Rohingya camp</a> carries forward the memory of betrayal – a memory that outlives soldiers, politicians, and peace accords alike.
The region’s future will not be decided by GDP figures or infrastructure projects alone. It will be decided by whether its governments can summon the political courage to face the truths they have long suppressed – or whether they will continue down a path <a href="https://theconversation.com/india-is-using-the-g20-summit-to-further-its-settler-colonial-ambitions-in-kashmir-205166" target="_blank">where forgetting is demanded</a>, and rebellion becomes inevitable.
Shyam Tekwani is a professor at the Daniel K. Inouye Asia-Pacific Center for Security Studies in Hawaii. This <a href="https://dkiapcss.edu/nexus_articles/ghosts-at-the-border-south-asias-unfinished-wars/" target="_blank">article</a> was originally published on <a href="https://dkiapcss.edu/security-nexus/" target="_blank">DKI APCSS Security Nexus.</a> The views expressed in this article are those of the author and do not reflect the official policy or position of DKI APCSS, the Department of Defense, or the US Government. The appearance of external hyperlinks does not constitute endorsement by the United States Department of Defense (DoD) of the linked websites, or the information, products, or services contained therein. DoD does not exercise any editorial, security, or other control over the information you may find at these sites.

Balochistan to Kashmir

Most Nepalis thought they had seen the last of it after <a href="https://nepalitimes.com/news/11-56-25-april-2015-wkc9q2an">the 25 April 7.8 magnitude </a>earthquake ten years ago. But the Himalaya had more surprises in store. On 12 May, another 7.3 magnitude tremor that some said was an aftershock, but was strong enough to itself be a major earthquake, struck Dolakha.&nbsp; Not many people had heard of Singati till then — a cluster of houses by the Tama Kosi River along a narrow gorge that is the roadhead to Rolwaling Valley.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d.jpg" data-media-id="editor_1" data-image-id="20250508110520_57b6e316656851f71eca56ca6f98d9bbcc820c1a00d62af3c990725b4361244d" data-rendition-name="original" width="1000" height="1500" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e.jpg" data-media-id="editor_2" data-image-id="20250508110520_016534fb2b6a79957402281cda768efb83a146786377e39e11df3e251d37159e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  It was here that dozens were killed on 25 April in the first earthquake. Hundreds of <a href="https://archive.nepalitimes.com/article/nation/Singati-rising-from-rubble-rebuilding,3703">Singati survivors</a> had lined up for food and relief supplies in the morning of 12 May when the second earthquake triggered a rock slide that buried a nearby camp. At least 50 people were killed. &nbsp; Three hours later, a US Marine Corps UH-1Y Venom helicopter landed in a nearby cornfield to pick up the wounded, and flew off. The aircraft lost contact with air traffic control in Kathmandu and its wreckage was located high on Kalinchok four days later. Six American servicemen, two Nepal Army soldiers, and five wounded civilians from Singati were killed. Today, Singati bears little physical scar of the multiple tragedies that struck the town ten years ago. Most <a href="https://nepalitimes.com/multimedia/bungamati-builds-back">houses have been rebuilt</a> as urban-style concrete structures, and Singati has become an economic hub on the road leading up to several hydropower plants and a<a href="https://nepalitimes.com/banner/off-the-beaten-trek-in-nepal"> popular trekking destination</a>.&nbsp; The town looks less like a village and more like a suburb of the Dolakha district headquarter of Charikot, 47km away.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2.jpg" data-media-id="editor_6" data-image-id="20250508110520_196f341d1df1403ba133e5dfeb837eec20d7cbcb4c8c56b17cc5598810de5df2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e.jpg" data-media-id="editor_7" data-image-id="20250508110524_ae66c4a92430f67db51b5e11e017059eedfbac4cb18c8e073f2a50cca1fe904e" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> </figure>  “The demand for construction material, cement, iron rods and bricks peaked after the earthquakes,” says Suresh Khadka, who owns a hardware business here and now supplies material to the 456MW Upper Tama Kosi hydropower project that is undergoing repairs after it was damaged by a landslide last year. The demand for cement boomed since most residents believe, not necessarily correctly, that <a href="https://nepalitimes.com/banner/in-a-disastrous-state">cement houses are safer</a>. Although Khadka did well selling construction material after the earthquake, he worries that most new structures do not follow seismic-resistant building codes.&nbsp; The construction boom financed by bank loans has in turn forced many from Singati to <a href="https://nepalitimes.com/banner/making-overseas-migration-better">migrate overseas for work</a> so they can service their debt.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2.jpg" data-media-id="editor_10" data-image-id="20250508110524_50caa4530bd5ff9120cf7ab70a62173846d337ef448ff8bac339f3faa375a9e2" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Suresh Khadka</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83.jpg" data-media-id="editor_11" data-image-id="20250508110520_ef8b7d3993fc3b5df852bbf952feb3fbabc96d6883b0d5eb74ee5c60f4123b83" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Phu Doma Sherpa (right)</figcaption> </figure>  “My family had no choice but to borrow money to rebuild our home since the government compensation was not enough, and ten years later we are still paying off the loan,” says Phu Doma Sherpa, 60. Because of the shortage of qualified masons and proper seismic engineering, <a href="https://nepalitimes.com/here-now/structural-problems">many of the buildings are of questionable building standards </a>and the traditional architecture has been abandoned, admits Kul Bahadur Budathoki, deputy chair of the municipality. “But these buildings were more expensive than what the government grants could cover, many people here are heavily in debt and the men have <a href="https://nepalitimes.com/here-now/every-day-is-closer-to-pay-day">migrated to the Gulf to pay their loans</a>,” Budathoki says.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480.jpg" data-media-id="editor_14" data-image-id="20250508110520_32f89e97b7e757fc9286c0bbb671f48ea8d4468e9634fa646d7247c650ad8480" data-rendition-name="original" width="1501" height="1079" loading="lazy" alt="Climate magnifies earthquake risk in Nepal village NT"> <figcaption>Kul Bahadur Budathoki</figcaption> </figure>  Singati is in a multi-hazard zone. The <a href="https://archive.nepalitimes.com/article/nation/Singati,3091">12 May 2015 earthquake </a>could have led to the collapse of Nepal’s largest glacial lake, <a href="https://nepalitimes.com/here-now/stairway-to-heaven">Tso Rolpa</a>, upstream. Due to global warming, the glacier has turned into an expanding lake 3.5km long, and its collapse would have unleashed a catastrophic Himalayan tsunami down the Tama Kosi Valley, with Singati directly in its path. Singati has literally risen from the ashes of 2015, with its residents beginning to recover from the trauma and financial toll. But it is not out of danger as <a href="https://nepalitimes.com/news/climate-breakdown-linked-to-thame-flood">climate breakdown </a>magnifies the risk from future earthquakes.