In a corner seat on the first floor of Bir Hospital, a middle-aged kidney patient winces in pain. Next door, a lady has nerve damage, and is unable to feel the growing wound on her sole. Two floors up, a crowd of desperate patients wait for an appointment with an endocrinologist. This week, the hospital in Kathmandu was filled with different medical complications. But many of them were related to a single disease: diabetes. “On any given day, we see up to 200 patients in our department, and more than half have to do with diabetes mellitus,” says consultant endocrinologist Manil Bajracharya at Bir. Diabetes mellitus is a condition where the body either does not produce enough insulin, or does not use it effectively, resulting in dangerously high blood sugar levels. Untreated, it can lead to life-threatening complications, including disorders of the cardiovascular system, eyes, kidneys, and nerves. In Nepal, the incidence of diabetes is on the rise, with an estimated 8.7% of adults between 20-79 living with the condition in 2021. This number was 3.6% in 2011, and is expected to reach 9.4% by 2045. “This rise most likely has to do with rapid changes in lifestyle and diet,” explains Bajracharya. “We have seen a shift from traditional cereal and vegetable-based diets to ones rich in animal products and processed foods high in fat and sugar content. This nutritional transition, combined with reduced physical activity, has significantly increased the risk of diabetes.” Bagmati Province has a five times higher prevalence of diabetes than the Karnali. Other provinces with urban centres like Gandaki and Lumbini also have a high burden of the disease. Read also: <a href="https://nepalitimes.com/opinion/comment/saving-kidneys-to-save-nepal">Saving kidneys to save Nepal,</a> Rishi Kumar Kafle  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0.jpg" data-media-id="editor_1" data-image-id="20240607150624_2deb3cabd4a1367ea0656a84e817aa0c8bcc920bb4b33bda30037272931024b0" data-rendition-name="original" width="3952" height="3021" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  “Nepalis who migrate to cities often have reduced physical activity and transition to high-calorie diets, which contribute to obesity and elevate the risk of diabetes,” says Bajracharya. City dwellers are twice as likely to develop diabetes compared to rural Nepalis. Diabetes mellitus has no cure, but it can be managed through careful monitoring, lifestyle changes, and improving medications. Many people diagnosed with diabetes live for years without experiencing serious symptoms. But Nepal has a huge gap: 43.5% of adults living with diabetes do not know that they have the disease. This means two out of every five cases go undiagnosed, and therefore untreated.&nbsp; “If diabetes isn’t detected on time, it can become life-altering, and may even be fatal,” adds Bajracharya. Raman Tamang did not know he had diabetes until a wound started growing on his foot. “I first thought it was just a normal cut. But it grew and started stinking. It got so bad that my family started avoiding me,” says Tamang. When he was brought to Helping Hands Community Hospital in Chabahil, his wound had turned chronic. A patient with long term diabetes suffers nerve damage. This results in the loss of sensation in the feet. Elevation in blood glucose also reduces the body’s ability to heal wounds. “Minor cuts, scrapes, or wounds often go unnoticed until the body can no longer heal them on its own,” explains orthopaedic surgeon Hem Limbu at Helping Hands.&nbsp; Read also: <a href="https://nepalitimes.com/here-now/junk-food-is-making-nepali-children-shorter">Junk food is making Nepali children shorter</a>, Marty Logan  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de.jpg" data-media-id="editor_3" data-image-id="20240607150624_4e61c5cb980f287da4393eaf277d0c7418dbe95ffb717bb761ffa6f25d8418de" data-rendition-name="original" width="1281" height="841" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Called diabetic foot ulcers, such wounds often persist and in the worst cases may get infected and have to be amputated. Across the globe, 85% of all amputations happen due to diabetic foot ulcers. “We have to amputate almost half of all cases of diabetic foot because many patients come too late,” adds Limbu. Not amputating the leg can lead to infections spreading to the bloodstream. Studies have shown that 19-47% of diabetic patients in Nepal also have diabetic retinopathy, where high-glucose blood damages blood vessels in the retina of the eye, impairing vision. However, less than 30% of Nepalis who have diabetes know about this risk of blindness. And an additional 50% never get their eyes checked despite living with diabetes. Diabetes also elevates the risk of kidney failure, heart disease, and stroke.&nbsp; An estimated 9,000 Nepalis under 60 died due to some form of complication attributable to diabetes in 2021. Then there are 9.2% of Nepali adults who are prediabetic with elevated blood glucose levels that could reach diabetic levels if their lifestyle does not change. “But because most don’t know they have the condition, proper screening and awareness are essential,” says Hem Limbu. Read also: <a href="https://nepalitimes.com/here-now/myopia">MYOPIA</a>, Yugeshwor Koirala  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72.jpg" data-media-id="editor_5" data-image-id="20240607150624_fcdcf19b68a2f40d6b17f9753cc6d6fa13d511dae2a4b649a665db07c9c23a72" data-rendition-name="original" width="1262" height="849" loading="lazy" alt="Diabetes in Nepalis NT"> </figure>  Screening involves a blood test, and to manage high blood sugar, patients require insulin replacement therapy through injections or an insulin pump. But insulin resistance can often be managed with dietary modifications and exercise. “Prediabetes is gaining increasing recognition as a significant health concern, and a growing number of adults are seeking assistance even for mild symptoms,” notes Bajracharya. While this trend reflects improved awareness, it is equally vital to identify prediabetes in younger adults. Developing diabetes at a young age prolongs the duration of the condition and escalates the risk of complications. Timely diagnosis and effective management can mitigate complications: reducing the risk of diabetic retinopathy by up to 95%, foot ulcers and amputations by 85%, kidney disease by 70%, and both cardiovascular disease and stroke by 50%. “Prevention is better than cure for most diseases, but for diabetes, prevention and early detection are the only cures. Once the disease advances, reversing its effects becomes exceedingly challenging, necessitating lifelong symptom management,” adds Bajracharya. “So Nepal’s challenge isn’t just about forming an action plan for diabetes awareness, screening and treatment, but about implementing it in areas where essential drugs and equipment are out of reach.” In urban cities, the challenge is different. Drugs, diagnostic services and self-monitoring equipment are accessible, but so are processed foods and sugary drinks. “After essential healthcare services are in place, preventing and managing diabetes comes down to personal choices and attitudes. Whether or not diabetes continues to surge in Nepal, therefore, depends on each individual more than anything else,” says Bajracharya. &nbsp; Read also:<a href="https://archive.nepalitimes.com/news.php?id=18379"> Diabetic dilemma</a>, Buddha Basnyat

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1250x600

1084x550

thumbnail

viewImage

A deadly sugar rush

<figure><img width="1920" height="1280" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016114/636d13aa9c7e80680e0a9934jpeg.jpg" alt=""/><figcaption></figcaption></figure>South-East Asia has achieved the fastest rate of decline in <a href="https://archive.nepalitimes.com/regular-columns/Comment/fired-up-over-tobacco,920" target="_blank" rel="noopener noreferrer">tobacco use</a> among any other region in the world in 20 years, sustaining tobacco control measures during the Covid pandemic, according to a <a href="https://www.who.int/publications/i/item/who-global-report-on-trends-in-prevalence-of-tobacco-use-2000-2025-third-edition" target="_blank" rel="noopener noreferrer">new WHO Global Report</a>.
The region was estimated to have the highest average rate of tobacco use compared to all other WHO regions, with around 432 million users, or 29% of the total population.
However, the average prevalence of smoking among men in South-East Asia went down from 50% in 2000 to 25% in 2020, while tobacco smoking among women saw a sharp decline from 8.9% to 1.6% during the same timeframe, reports the 4th WHO Global Report on Trends in Prevalence of Tobacco Use 2000-2025.
South-East Asia at present has the highest proportion of the population covered by tobacco surveillance to monitor tobacco use prevalence and tobacco control policies. With continued efforts, smoking rates in the region could reach as low as 11% by 2025. 
“Sustained political commitment and relentless efforts by countries to strengthen surveillance, expand tobacco control measures including cessation services to help users quit tobacco are some of the key reasons for success,” said Poonam Khetrapal Singh, Regional Director of WHO South-East Asia.
In Nepal, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/in-a-puff-of-a-smoke,3739" target="_blank" rel="noopener noreferrer">overall tobacco use went down</a> from 56% of the population in 2000 to 26% in 2020. Meanwhile, 2020 figures put 15% of the Nepali population over 15 years old as smokers.
However, the report lists Nepal among the only two countries in the region, along with India, that are likely to achieve the targeted 30% relative reduction in tobacco use by 2025. 
Nepal introduced its Tobacco Control and Regulation Act in 2011 and has some of the strictest smoking laws. The country is far ahead of other nations in the region with its anti-tobacco campaigns and is among few in the region to have scaled-up tobacco cessation services.
However, Nepal, which has imposed a 27% tax on the retail price of <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Kicking-butts,329" target="_blank" rel="noopener noreferrer">tobacco</a>, has the lowest rates of taxation on tobacco products in the region. The WHO recommends a minimum 75% tax share of the retail price of tobacco.
For packaging, Nepal has implemented large-sized graphic health warnings on tobacco packs, requiring that they cover 90% of the front and back of packages. Pictorial, or graphic, warnings are one measure contained in the global blueprint for fighting tobacco use: the WHO Framework Convention on Tobacco Control (FCTC). Nepal joined the treaty in 2007. 
The FCTC and MPOWER package, a set of six cost-effective and high impact measures to help countries reduce demand and supply of tobacco, contributed significantly to the implementation and effectiveness of tobacco control measures across the country.
Singh also reaffirmed WHO support to member countries towards tackling non-communicable diseases (NCDs) and <a href="http://archive.nepalitimes.com/news.php?id=18267#.YZYlumBByUk" target="_blank" rel="noopener noreferrer">controlling tobacco</a>, emphasising the importance of WHO’s ‘best buys’— a set of cost-effective interventions for the prevention and control of NCDs.
“The best buys…continue to be at the core of the Regional response, recognising the need for countries to identify &amp; implement the most effective, feasible, and affordable interventions whatever their resource setting,” said Singh.
With sustained and accelerated efforts, and using the power of innovation, countries in the region can fulfill their commitment to FCTC and to the 2030 Sustainable Development agenda, leaving no one behind, read a statement by WHO South-East Asia.
Globally, there are now 1.30 billion tobacco users compared to 1.32 billion in 2015. This number is expected to drop to 1.27 billion by 2025.  Sixty countries are on track to achieving the voluntary global target of a 30% reduction in tobacco use between 2010 and 2025, two years ago only 32 countries were on track.

Tobacco use in South-East Asia declines

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66739c7e80680e059980jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo : BIKRAM RAI</figcaption></figure>There used to be a time when the main public health threat in Nepal was from infectious diseases like <a href="https://www.nepalitimes.com/here-now/the-mosquito-that-changed-nepals-history/" target="_blank" rel="noopener">malaria</a>, encephalitis, <a href="https://www.nepalitimes.com/banner/tb/" target="_blank" rel="noopener">TB</a> and typhoid. Whether vector-borne or transmitted through contaminated air or water, the most cost-effective way to address them was through prevention. Communication was the first line of defence against communicable diseases.Things have changed. Awareness has grown because literacy rates are up. Most Nepalis now suffer from non-communicable ailments like cardiovascular diseases, <a href="https://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">diabetes</a>, <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/A-mysterious-rash-of-kidney-failures,3639" target="_blank" rel="noopener">renal failure</a> and malignancies. These need treatment in medical facilities at a time when the over-commercialisation of hospitals has made healthcare unaffordable for a majority of the population. In fact, <a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">poor health</a> is making Nepalis poorer.Read also:<a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">Is free health care possible in Nepal?</a>, S P Kalaunee<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/?p=37821&amp;preview_nonce=9ce6a7c55d&amp;preview=true" target="_blank" rel="noopener">Federalism leaves Nepal’s medical sector ailing,</a> Sewa BhattaraiAlso, communicable diseases have not been completely overcome. Diarrhoeal dehydration and other water-carried infections are still major killers. One of the reasons Nepal’s progress in reducing child mortality has stalled is because of the state’s failure to ensure adequate and safe drinking water in remote regions. In this paper we have also reported on <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener">stunting and wasting among children</a> due to malnutrition.In addition, <a href="https://www.nepalitimes.com/here-now/air-pollution-is-more-dangerous-than-smoking/" target="_blank" rel="noopener">worsening air pollution</a> has caused an epidemic of chronic obstructive pulmonary disease (COPD), which has led to lung infections in all age brackets and causing terminal pneumonia and other complications in the elderly. At current levels of PM2.5 concentration in the air, studies show, the average lifespan of city dwellers in Nepal could be reduced by up to four years.Read also:<a href="https://www.nepalitimes.com/here-now/nepal-is-a-microcosm-of-all-of-the-changes-in-world-health/" target="_blank" rel="noopener">"Nepal is a microcosm of all of the change in world health"</a><a href="https://www.nepalitimes.com/editorial/poor-health/" target="_blank" rel="noopener">Poor health</a>, EditorialNepal’s burden of non-communicable diseases and injuries has doubled in the last 25 years, with nearly 15% caused by <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a> or natural disasters. Traffic accidents are now the second biggest killer of young Nepalis. Just in the past three weeks, 90 people have been killed on highways due to poor road condition or carelessness.A vivid indication of the threat of non-communicable diseases is today’s prevalence of diabetes. South Asians are genetically more susceptible to cardiovascular diseases and diabetes, but there are now new risk factors caused by increasing rural to urban migration. While the world prevalence average for both types of diabetes is 8%, research has shown that 14% of people in Dharan suffer from the disease. Taplejung, from where many have migrated to Dharan, has a rate of only 1%. The reason is clear: increased intake of carbohydrates and a more sedentary lifestyle when people move to cities.To meet these challenges, Nepal desperately needs <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">affordable and accessible medical care</a>. At the moment, hospital treatment is neither. The poor in remote, underserved areas of the country are disproportionately vulnerable. As our report from Bajura shows, the problem is further complicated because confusion over federalism, budget and jurisdiction has left most rural government hospitals underfunded and underserved. It is imperative that the government act quickly to resolve the retention crisis caused by medical staff getting themselves transferred out of their jobs in remote areas.Read also: <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">A national health insurance is not as easy as it looks</a>, Sonia Awale<a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">This is how to upgrade Nepal's rural health</a>, Sewa BhattaraiA survey last year showed that half of all <a href="https://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028" target="_blank" rel="noopener">medical expenditure of Nepalis families</a> is out-of-pocket, and 60% of that is for treatment of non-communicable diseases and injuries. The federal government allocates only about 10% of its budget to health care, and the focus is still on communicable diseases. Donor priority is also not on non-communicable diseases and injuries. A study of government hospitals by the Nick Simons Institute shows a huge unmet need in remote areas for basic surgery like caesarean sections and orthopaedics.One bright spot ahead is the success of pilot insurance schemes being tried out in various parts of the country. In a <a href="https://www.nepalitimes.com/opinion/is-free-health-care-possible-in-nepal/" target="_blank" rel="noopener">commentary this week</a>, S P Kalaunee of Nyaya Health, an NGO that helps the government manage hospitals in Achham and Dolakha, presents a proven 60:25:15 formula of health insurance. In this arrangement, non-profits, the private sector and all three levels of government can make medical care affordable to all Nepalis, if upscaled. Under the scheme, 60% of the cost of care comes from insurance, provincial governments pay 25% and municipalities take care of the remaining 15%.Parts of the scheme are being tried out in <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">Bayalpata Hospital in Achham</a> (which last week <a href="https://www.nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award/" target="_blank" rel="noopener">won the Global Architecture Festival award</a> in Amsterdam for its design). Insurance reimbursement covers the cost of insurance-covered care, the local government allocates funds required for basic and emergency healthcare, and the provincial government pays for managing the cost of referrals beyond insurance coverage. Internationally, this has become an issue with 12 December marked as Universal Health Coverage Day.Nepal’s constitution now guarantees basic and emergency healthcare as fundamental rights of citizens, and puts the responsibility on to the state. The government  can no longer keep passing the buck on providing universal insurance for its citizens.<h2>10 years ago this week</h2>Nepali Times <a href="http://archive.nepalitimes.com/issue/480" target="_blank" rel="noopener">issue #480 of 11-17 December 2009</a> carried an <a href="http://archive.nepalitimes.com/news.php?id=16572#.XfId7ZMzaUk" target="_blank" rel="noopener">interview on page 1 with Baburam Bhattarai</a>, who was then vice-chair of the Maoist party.  Excerpts:‘From the very beginning, we have said that the basis of the federal system should be nationality. In Marxist terms, nationality means a common language, geography, economy and psychological make-up. A group of people that shares these qualities is called a nationality.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108151120/636a66769c7e80680e059981jpeg.jpg" alt="" width="392" height="600">On this basis we have proposed to constitute federal autonomous units in Nepal and we also practised this during the People’s War. Since the very beginning we have been consistent that federalism should be along the lines of nationality.’

POOR HEALTH MAKES NEPALIS POORER

For many decades it was an accepted truth that Nepal’s main public health threat was from infectious diseases, and the most cost-effective way to address that was through prevention. In other words, the first line of defence against communicable diseases was communication.Whether it was gastric infections caused by contaminated water, respiratory ailments due to cold and pollution, or diseases spread by insect vectors like malaria – the goal was to spread public awareness about prevention. Radio jingles about oral rehydration salts or acute respiratory infections in children indirectly helped save millions of lives over the years.Many of these challenges remain. Despite dramatic progress, many Nepalis still lack safe drinking water – not just in the roadless hinterland but right here in the heart of the capital. There are frequent <a href="http://archive.nepalitimes.com/article/nation/%20jajarkot-open-defecation-free,2023">cholera</a> epidemics. Children’s lungs are still affected by indoor smoke from wood fires. Malaria is on the comeback due to resistance and there is an annual epidemic of dengue and encephalitis.Yet, compounding these endemic infections, there is now an <a href="http://archive.nepalitimes.com/article/nation/Communicati-about-non-communicable-diseases,1153">increasing burden of non-communicable diseases and injuries</a> (NCDI). New lifestyle-related cardio-vascular afflictions, chronic obstructive pulmonary disease (COPD) caused by <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/every-breath-we-take-air%20pollution,3536">pollution</a>, or <a href="http://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486">mental health disorders</a> have added to the burden of disease and disability. <a href="http://archive.nepalitimes.com/article/nation/diabetes-in-south-asia,3018">South Asians are already genetically susceptible to diabetes</a>, and now there are new risk factors due to migration to urban centres. While the world average for prevalence of both types of diabetes is 8%, more than 14% of people in urban centres like Dharan have diabetes – even though the prevalence for rural Taplejung, for instance, is only 1%.A study by The Nepal NCDI Poverty Commission released this week shows that the burden of NCDIs has doubled in the last 25 years. More than half of all death and disability today are caused by NCDIs, with nearly 15% caused by injuries in conflict, natural disasters or highway accidents. <img width="900" height="802" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/636517699c7e80680e02c275jpeg.jpg" alt=""/>Being afflicted with an NCDI (or chronic disease) is more fatal in Nepal than in developed countries because of affordability and restricted accessibility to adequate medical treatment. The poor are disproportionately vulnerable. The NCDI burden in Nepal is also different than in other parts of the world – there is a higher incidence of ischemic cardiac conditions, asthma, neurological disorders, cancers caused by untreated infections and injuries, for instance.For us, the report’s main finding, and most damning inference, is about how <a href="http://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">treatment of NCDIs is driving Nepalis into indebetedness and penury</a>. The survey shows that half of all medical expenditure of families is out-of-pocket, and 60% of that is for treatment of NCDIs. This is because the government spends only 11% of its budget on health care, and only 6.4% of that is for treatment of non-communicable diseases.Despite the proven link between chronic ailments and poverty, donors still allocate only 1% of their development assistance for NCDIs.Treatment of injuries, gastro-intestinal infections, heart diseases, cancers, kidney and liver diseases are the most impoverishing NCDs for households. The report’s main conclusions are corroborated by our <a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">field report</a> from Achham and Kavre this week  about how the lack of even basic surgical facilities in district hospitals and health posts is forcing Nepalis to undertake expensive and extended trips to private hospitals in the cities.Another recent study of 39 government hospitals commissioned by the Nick Simons Institute (NSI) showed a huge unmet need in remote areas for basic surgery like caesarians, orthopaedics, and abdominal operations. Nepal’s surgery rate is well below the Lancet Commission’s target of 5,000 operations per 100,000 population. Only one-third of patients currently can reach an orthopedic surgeon within two hours of travel. <img width="640" height="456" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141144/6365176b9c7e80680e02c276jpeg.jpg" alt="">The public-private partnership models that NSI and Possible are carrying out in remote government hospitals are ways to plug this gap: ensuring minimum staffing of a MDGP physician, anaesthesia assistant, staff nurse and biomedical technician in each hospital can offer basic treatment and surgery in remote areas, reduce the need for referrals, and save household income. At present Nepal’s density of hospitals with such staffing and equipment is at 0.4 per 100,000 population, as against the Lancet Commission’s recommendation of 20/100,000.The Nepal NCDI Poverty Commission report suggests additional measures: national health care delivery should respond to the increasing burden of NCDIs by decentralising.Impoverishment of households due to the high cost of treatment should be addressed through disease-specific policies for high-cost conditions and expansion of insurance coverage.It is often said that health is wealth, but in Nepal wealth is health. That can only be changed by making treatment of chronic conditions and injuries accessible, affordable, inclusive and equitable.Read also:<a href="https://www.nepalitimes.com/banner/state-of-the-art-rural-hospital/">State of the art rural hospital</a>, Marty logan <a href="http://archive.nepalitimes.com/article/nation/national-health-insurance-not-as-easy,4028">A national health insurance scheme is not as easy as it looks</a>,  Sonia Awale<a href="http://archive.nepalitimes.com/article/nation/Communicati-about-non-communicable-diseases,1153">Communicating about non-communicable diseases</a>,  Elina Pradhan and Bigyan R Bista

Poor  health

After a week of violent and destructive protests, Nepal’s President Ram Chandra Poudel on Friday appointed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">former Chief Justice Sushila Karki</a> as a caretaker Prime Minister to lead an interim citizens' government.&nbsp; Poudel had been in <a href="https://nepalitimes.com/news/what-next-nepal">closed-door discussions since Thursday</a> with youth members who spearheaded the protests, constitutional experts, the House Speaker, and the Army Chief. There was a consensus on the choice of Karki as candidate for interim prime minister, but her swearing-in was stalled due to a disagreement about Constitutional processes for her appointment.&nbsp; Youth delegates and Karki demanded that Parliament be dissolved before the appointment of the caretaker prime minister, while President Poudel had been arguing that Parliament would be automatically dissolved once the new council of ministers announced elections. Representing the GenZ movement, <a href="https://nepalitimes.com/here-now/who-or-what-is-hami-nepal">Sudan Gurung</a> (pictured, below) is said to have insisted that dissolution of Parliament first was non-negotiable because he did not trust the political parties. He is said to have added that he would call his supporters out into the streets, and the President relented. The military’s warning earlier that an emergency would be declared if there was no agreement tonight clinched it.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3.jpg" data-media-id="editor_3" data-image-id="2025091216098_cdd409c5824b578a04f05a43280e3f475d92bf7123d3a4565b4d720768fcc1b3" data-rendition-name="original" width="1080" height="600" loading="lazy" alt="Sudan Gurung"> <figcaption>Sudan Gurung of Hami Nepali during negotiations.</figcaption> </figure>  With this, Karki becomes Nepal’s first female prime minister, exactly a decade after she became the <a href="https://archive.nepalitimes.com/article/interview/a-woman-is-as-capable-sushila-karki,3375">country’s first female chief justice in 2016</a>.&nbsp; Nepalis, still shocked by the <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">death and destruction of the past week</a>, heaved a sigh of relief at the announcement, which was greeted as a victory of youth power for political reform led by the GenZ movement. Its initial anti-corruption protest on 8-9 September <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">spiralled out of control into violence and arson</a> nationwide that claimed at least 51 lives. Several other candidates were floated for the caretaker prime minister’s post. Kathmandu Mayor Balen Shah and former head of the electricity utility Kulman Ghising were being considered, but both declined possibly because they want to contest the next national elections. Given her experience in the judiciary and zero tolerance for corruption, Karki was the favourite of various groups within the GenZ campaign.&nbsp; The site of the negotiations moved to the official residence of the president in Shital Niwas from the Nepal Army Headquarters on Thursday. The Army had come under criticism on social media and from civil society for detaining the President and not letting him speak or be a part of the negotiation.&nbsp; This fuelled public perception that the military had a soft spot for a return of the monarchy. There were widespread rumours on Thursday that king Gyanendra, who was ousted after the abolition of the monarchy in 2008, was trying to stage a comeback by piggybacking on the agitation. Writing on X, senior journalist Kishore Nepal revealed that the Chief of Army Staff Ashokraj Sigdel had allegedly asked Poudel to step aside and pave the way for the military to negotiate, to which the President is said to have replied: “I will not resign. Kill me instead and blame it on the protesters. Then you can do whatever you like.” Live broadcast of swearing in of Sushila Karki:&nbsp; <div class="embed-block"><iframe width="560" height="315" src="https://www.youtube.com/embed/53go4OxuOa0?si=Zd89QGIAX8-7Bm75" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe></div>  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d.jpg" data-media-id="editor_8" data-image-id="2025091219094_41b0f97a5925ab6969e1413636bf073ae43262893a55d9c177cb1312dea52f0d" data-rendition-name="original" width="1280" height="851" loading="lazy" alt="Sushila Karki swearing in"> <figcaption>President ram Chandra Poudel swearing in Sushila Karki as the 42nd Prime Minister of Nepal.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba.png" data-media-id="editor_9" data-image-id="2025091303098_8f2b6f98898c4cd73c271caa51b8e29d679a7385c249380aeb96d7cc2c3f6dba" data-rendition-name="original" width="1480" height="924" loading="lazy" alt="Sushila Karki PM"> <figcaption>GenZ representatives with new Prime Minister Sushila Karki after her swearing in.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029.jpg" data-media-id="editor_10" data-image-id="2025091301098_470dbca4f4d34ca4533ce4d160045ffe8e525e98380f6f1e20eb24a6236c6029" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Sushila Karki PM"> <figcaption>Sushila Karki with supporters including Genz representative Sudan Gurung of Hami Nepal and Sumana Shrestha of Rastriya Swatantra Party.</figcaption> </figure>  COURAGE AND INTEGRITY Sushila Karki served as the chief justice between 11 July 2016 to 6 June 2017, and has been known for her frugal ways. She was a firebrand judge unafraid to ruffle powerful feathers, and as chief justice was behind ruling to impeach for abuse of office a powerful head of Nepal’s anti-graft body in 2016. She wrote that he had ‘<a href="https://archive.nepalitimes.com/regular-columns/Legalese/the-end-of-karkistocracy,827">neither the moral character nor qualifications for the post</a>’. Even before she became Chief Justice, Karki was one of the two judges on the bench that convicted the sitting Minister for Information and Communication, Jaya Prakash Gupta, of corruption in 2012. Then in 2016, a bench including Karki ruled against granting amnesty to former Maoist lawmaker and convicted murderer Bal Krishna Dhungel. Karki was born on 7 June 1952 in Biratnagar. She completed her undergraduate studies at Mahendra Morang College in 1972 before obtaining a postgraduate degree in political science from Banaras Hindu University in India three years later. This was followed by a Bachelor's in Law in 1978 from Tribhuvan University, and she started her law career as an advocate a year later. In 1985, Karki worked as a teacher at Mahendra Multiple Campus in Dharan, and was jailed for participating in the 1990 People’s Movement to overthrow the Panchayat absolute monarchy. She became a senior Advocate at the Nepal Bar Association in 2008 and was appointed an Ad-Hoc Justice at the Supreme Court in January 2009.&nbsp; On Thursday, there were supporters for other candidates for the post sloganeering against Karki’s nomination outside the Army Headquarters. Some on social media were also skeptical of her connection to the Nepali Congress (NC) party. Growing up in Biratnagar Karki was close to the family of B P Koirala, Nepal’s first elected prime minister in 1960. Her husband Durga Subedi was part of a group of underground Congress activists who hijacked a Royal Nepal Airlines plane in 1973, flying it to India to snatch cash belonging to Nepal Rastra Bank in the cargo hold.&nbsp; The money was used for the party’s pro-democracy campaign. Karki has no love lost for the political establishment. In April 2017, the governing coalition under Maoist Prime Minister Pushpa Kamal Dahal <a href="https://archive.nepalitimes.com/article/editorial/lady-justice-sushila-karki,3693">submitted an impeachment motion against her</a> after the Supreme Court overturned his decision to install a favoured police chief, violating succession based on seniority. It was a political move backed by Dahal’s coalition partner Sher Bahadur Deuba of the NC who was waiting to become prime minister for the 4th time. CHALLENGES AHEAD With Karki now in charge of the interim government, she has the daunting task of forming a council of ministers made up of amorphous and disparate groups from the GenZ, technocrats, and current politicians. Karki has said she will not prevent members of her cabinet from contesting elections, which means those with electoral aspirations like Kulman Ghising, Balen Shah and Sumana Shrestha could be asked to join. Karki has her work cut out as she has to get her team members to pull in the same direction to hold free and fair elections. She also has to make sure she has the support of the military without giving the generals too much say, while also smartly maneuvering Nepal’s precarious geopolitical ties with its giant neighbours, China and India. But most of all, the new prime minister must lay the foundations to not just physically rebuild the judiciary, executive and legislature but also ensure that elections will produce a more accountable and efficient government. Read also: <a href="https://nepalitimes.com/editorial/trial-by-fire">Trial By Fire</a>, Editorial

Madam Prime Minister of Nepal

Many had never heard of <a href="https://www.haminepal.org/">Hami Nepal</a>, the organisation that is part of the GenZ movement that did not just topple the government this week, but <a href="https://nepalitimes.com/news/what-next-nepal">pushed Nepal’s political system into new, uncharted territory</a>. It was part of an organic coming together of various youth groups fed up with Nepal’s corruption, mismanagement and lack of accountability. Hami Nepal and its GenZ comrades are now part of the negotiations with the Army to form an interim government. Hami Nepal is a non-profit dedicated to supporting communities and individuals in need, guided by its motto ‘For the People, By the People’. Its core mission is to assist individuals and communities in need, particularly during emergencies and crises, with a focus on directly connecting donors with recipients, and delivering aid efficiently and transparently. It was set up after the 2015 earthquake, but was formally registered and gained recognition in 2020 during the Covid-19 pandemic. Hami Nepal is led by 36-year-old civic activist Sudan Gurung who started the organisation after he lost his own son in the 2015 earthquake.&nbsp; Leading up to the events this week, it played a central role in guiding the demonstrations, using its Instagram and Discord platforms to circulate protest information and share guidelines. Other GenZ groups used their own WhatsApp groups and other fora.&nbsp; Among the 20 or so volunteers is Ronesh Pradhan, who spoke to <a href="https://nepalitimes.com/news/nepal-s-gen-z-protest-turns-deadly">Nepali Times on 8 September </a>morning during the GenZ rally, before the violence escalated.&nbsp; “The voices of young people matter. We can’t keep being ruled by the same old men,” Pradhan said. “Our generation is the future and if there are older leaders in government, they need to be competent and accountable. We are ready to lead this country forward.” Hami Nepal’s earliest visible campaigns include donating more than 400 blankets to Bir Hospital’s Covid unit in 2022, creating a plasma and oxygen bank during the pandemic, and distributing school jackets to children in rural districts. More recently, it mounted a relief effort in response to the 2023 Jajarkot earthquake, reaching over 13,000 families with shelter, food, and medical support. The organisation was also associated with the two-month ‘Save Ghopa’ campaign, demanding effective and smooth administration of the BPKIHS (B P Koirala Institute of Health Sciences) in Dharan. The organisation was also actively engaged in providing rescue and relief during the Kagbeni and Sindhupalchok floods this year. It even sent aid to Turkey after its 2023 earthquake. After the Kavre floods last year, Hami Nepal donated solar lights. Funding for Hami Nepal comes directly from public donations, with a policy of channeling 100% of received funds for aid distribution. Volunteers self-finance administrative costs, and the group publishes detailed expenditure figures, regularly sharing updates and transparency reports through their social media and website which it launched at its Annual General Meeting in Bhaktapur last year.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88.jpg" data-media-id="editor_3" data-image-id="20250911090920_cd40c472bd7e06cc038a2d77a431cba777b6f53e4374a0216c9af2c4feb56c88" data-rendition-name="original" width="1080" height="719" loading="lazy" alt="Who, or what, is Hami Nepal?"> </figure>  Following the death of Nepali student Prakriti Lamsal at KIIT University in India earlier this year, Hami Nepal advocated for justice using its Instagram account, raising concern about the safety of Nepali students. Its advocacy platform started with rescue and relief, and Hami Nepal managed to develop a track record for efficient campaigns and transparency in Nepal’s humanitarian landscape. But its work pushed the group to realise that there was a deeper malaise in Nepali society. Its #youthsagainstcorruption campaign on social media platforms gained rapid momentum, and that led to the rally on 8 September. Read also: <a href="https://nepalitimes.com/news/nepal-s-8-september-massacre">Nepal’s 8 September massacre</a>, Shristi Karki The international #Nepobaby trend on TikTok propelled the rally even more, and young Nepalis used it to expose the scions of powerful politicians and politically-connected influencers who were exhibiting their flashy lifestyles on social media while citizens struggled with joblessness, corruption and poor service delivery. Public anger reached a tipping point when the UML-NC coalition led by Prime Minister K P Oli announced a sweeping ban on major social media platforms citing tax revenue, cyber security, and lack of content moderation. Netizens, civil society and media, however, saw it as the latest authoritarian attempt by the government to clamp down on free speech, increase surveillance of citizens and constrict Nepal’s open society. Susmita Khadka, 22, told us at the rally: “Politics is everywhere. Gen Z has the most platforms, and we want a revolution.” Leading up to 8 September, the GenZ movement disseminated information and reassured participants with volunteers readily available for help, medical support, and assistance. It put up a protest support helpline so that students needing assistance could get help. As the protests intensified, leaving at least 20 dead outside Parliament, and forcing Prime Minister K P Oli to resign, Hami Nepal shifted into a mediator role, engaging in talks with officials and seeking GenZ’s views on future leadership.&nbsp; Influencers like TikToker Nimesh Shrestha publicly backed the group, amplifying their voice in ongoing negotiations with the Nepal Army alongside other GenZ representatives. However, as the protests escalated on 9 September, <a href="https://nepalitimes.com/news/kathmandu-burns-despite-pm-resignation">resulting in massive arson and vandalism of public and private property</a>, many GenZ activists disavowed association with the attackers, saying their movement had been infiltrated. The group backtracked, with Gurung saying he was not the leader of the protests.&nbsp; Meanwhile, others accused Hami Nepal for singlehandedly speaking with the Army chief, and said that they did not represent GenZ’s collective voice. Most GenZ supporters backed <a href="https://archive.nepalitimes.com/regular-columns/Legalese/justice-in-chief,804">Former Chief Justice Sushila Karki</a> as their candidate for interim prime minister in an online group. Not everyone in the GenZ movement agrees with that choice, with support for Kathmandu Mayor Balen Shah, even though he has endorsed Karki’s appointment. Dharan Mayor Harka Sampang rushed to Kathmandu on Wednesday to push his own candidacy. Hami Nepal has supported Balen Shah to lead the country for the next five years, not just during the interim period, and have called on the public to share their posts supporting Shah to amplify the message. With the old guard gone, there is a power vacuum with multiple actors with competing interests to fill it. GenZ’s youth-led activism has brought new energy for political reform, but its real test begins now — whether it can unite Hami Nepal and other sections to negotiate with the Nepal Army.&nbsp;

Who, or what, is Hami Nepal?

As this story is being uploaded on Wednesday evening, sloganeering is going on outside the gates of the Nepal Army headquarters in Kathmandu between various GenZ groups about who should be the caretaker prime minister.&nbsp; The GenZ campaign includes Hami Nepal and several other groups that spearheaded the anti-government rally this week against corruption and neoptism. Thirty people died as the protests in Kathmandu turned violent on Monday and Tuesday. After Prime Minister K P Oli stepped down on Tuesday, Nepal has existed in a power vacuum, with no one really in charge. The Nepal Army took over security management from Monday night, and President Ram Chandra Poudel appealed to Nepali youth to come to the negotiating table.&nbsp; Thousands of GenZ youth held hours long discussions on Discord and other online fora on Wednesday, and voted to endorse former Chief Justice Sushila Karki to lead the transitional government. The group informed Chief of Army Staff Ashokraj Sigdel about their choice, but he has also been meeting leaders of at least 12 other groups claiming to be the genuine GenZs. Among them are royalist and other groups that many saw as having infiltrated the GenZ rally on Monday in which 20 people were killed while trying to storm Parliament.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d.jpg" data-media-id="editor_0" data-image-id="20250910170936_4efefa67f54228154d316ca692838c3d0c078f5f9ec96ea68cfc4ca740f4df4d" data-rendition-name="original" width="640" height="387" loading="lazy" alt="Sushila Karki"> <figcaption>Photo: SHAHIDUL ALAM</figcaption> </figure>  On Tuesday, disparate groups joined the arson and looting that ended up gutting Singha Darbar, the Parliament and Supreme Court buildings and attacks on party offices, media, schools and private residences across the country. The original GenZ disavowed involvement.&nbsp; 'Nepal's 2015 Constitution does not envision any transitional or emergency provisions to address a state of political and constitutional vacuum. For now, the President, per Article 273 of the Constitution, can exercise emergency powers in light of the current situation,’ wrote former National Human Rights Commissioner Mohna Ansari on social media on Wednesday evening. The President can declare a state of emergency per Article 273 of the Constitution, but that must be endorsed by a two-third majority of Parliament within a month, after which it will be in effect for three months. ‘Former Chief Justice Sushila Karki is the best option to address the adverse circumstances prevailing in the nation. The President must heed the Constitution and take the next steps in a manner that is transparent, keeps the public informed, and is in the national interest,’ Ansari added.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf.jpg" data-media-id="editor_1" data-image-id="20250910140912_019d62de4b62a366299a27d1276e931a7dadefcc674441e7fb3acd503970efaf" data-rendition-name="original" width="8000" height="5760" loading="lazy" alt="Nepal in ashes"> <figcaption>Photos: KAMAL PRASAI</figcaption> </figure>  The Gen Z movement itself appears fragmented and without distinct leadership, both before the anti-corruption protests on 8 September and in the aftermath of the two-day protests.&nbsp; Various groups are said to have met or waited to meet the Gen Sigdel on Wednesday. The Army told others claiming to be GenZ and raising slogans against Karki’s candidacy to appear at the army headquarters on Thursday.&nbsp; Nepalis had floated the names of some of Nepal’s more acceptable public figures to lead a caretaker government, including Kathmandu mayor Balen Shah. But Shah told the Army chief he endorsed Sushila Karki’s nomination. <div class="embed-block"><iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2FbalenOfficial%2Fposts%2Fpfbid02M9CBZiWETz4qocKaYUG6ZSZ4ARNcq231V8edJJVGQhPLmpSRMdv1mTWM2q7mJijjl&show_text=true&width=500" width="500" height="256" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowfullscreen="true" allow="autoplay; clipboard-write; encrypted-media; picture-in-picture; web-share"></iframe></div> The names of former NEA chief Kulman Ghising and ex-education minister Sumana Shrestha of the RSP had also been proposed.&nbsp; Polls conducted on social media to gauge public sentiment show a significant number are open to Sushila Karki taking charge of a transitional government. Both Shah and Shrestha are not so keen, and are probably waiting to contest elections.&nbsp; Meanwhile, Nepal’s young reform campaigners largely seem to reject the idea of handing leadership to RSP chair Rabi Lamichhane who was retrieved by supporters on Tuesday from Nakhhu jail after eight months of incarceration for embezzling depositers of cooperatives. But even as GenZ held discussions with the Army chief to decide on the interim government, other interest groups have continued to engage as well. Erstwhile royalist businessman Durga Prasai, posted a photo of himself with Sigdel on social media and professed that he has 'no interest' in leadership and would accept whomever GenZ youth chose. The job of the caretaker government, whoever leads it, will primarily be to hold free and fair elections for a new leadership which will then face the challenge of reestablishing Nepal’s democratic institutions.&nbsp; “The course of events showed that the movement has gone beyond Constitutional remedy,” political analyst Krishna Khanal told BBC Nepali following erstwhile Prime Minister Oli’s resignation on Tuesday. “There needs to be a middle-ground solution that will be acceptable to the people who took to the streets while upholding the existing constitutional process.” Various GenZ collectives have issued demands that include the dissolution of Parliament and the formation of a new civilian government, which analysts say are antithetical. Constitutional experts have suggested that the youth opt for a solution that allows for new leadership to move forward under the current Constitution.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29.jpg" data-media-id="editor_3" data-image-id="20250910140912_e6bf05bfe95f519e05ab8d9016587211b241340fd23a0f9ae728e74747fc5f29" data-rendition-name="original" width="8064" height="6048" loading="lazy" alt="Nepal in ashes"> </figure>  One option, they say, is for the President to appoint any prime minister from the existing Parliament under Article 76(5) if all other measures fail, who would then have the authority to appoint up to 25 non-elected ministers for six months. This can be a way for that temporary leadership to hold elections within the mandated time frame. The existing Constitution can then be amended to accommodate the aspirations of the Nepali youth after the election.&nbsp; But any conditions put forward by GenZ youth that requires a new Constitution might set Nepal back years, warn some experts. The 2015 Constitution was the result of nearly 10 years of negotiations and strife, and the formation of another charter will mean that Nepal will head into decades more of rotating governments and political instability. For now, Nepali youth need to unite to decide by Thursday who leads the country into the next phase.&nbsp;

What next, Nepal?

Edited: The paragraph about K P Oli's whereabouts has been deleted. On Wednesday morning, orange flames are still leaping out of the windows of Singha Darbar. Fire trucks which could finally make their way in, were trying to douse the fires. Most of the ministries inside Singha Darbar, including the Prime Minister’s Office, are charred hulks. Singha Darbar’s imposing west facade built by Chandra Shumsher Rana 117 years ago and the hall where he met visiting foreign envoys was destroyed in the 2015 earthquake. It was restored last year to its original splendour with stained glass windows and an ornate ceiling. After demonstrators entered the central government secretariat on 9 September they set the entire complex on fire. Dozens of SUVs and cars that were smashed and burnt litter the parking lot.&nbsp; Across to the south at the Supreme Court, a fire truck belonging to Kathmandu Metropolitan City is trying to put out the flames. The building is still smoking, and hundreds of case files have gone up in flames. There is now also a threat from escaped prisoners from jails all over the country.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786.jpg" data-media-id="editor_0" data-image-id="20250910100936_fd21ff82606c8ab6ec729b3758edb70e7f4498004d71ba7a857a86c9fb75f786" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Supreme Court sustained heavy damages following Tuesday's arson.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628.jpg" data-media-id="editor_1" data-image-id="20250910100932_6c36bde0847f90934f6a40086a92573c1eec8f2967a4ddc59d79a56c08495628" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army cleaning up the debris outside the main gate of Singha Darbar.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529.jpg" data-media-id="editor_2" data-image-id="2025091010098_f4c7d857ae1111968223d20ad02bda6ac0127a3fe4caaa779b35d0e8f07b3529" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The grand staircase leading to the upper balcony of the Parliament building.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46.jpg" data-media-id="editor_3" data-image-id="20250910100916_39154c14faa25b5a8838f75c9cb4aa7505f228bd344e19c8e29209cebfb25d46" data-rendition-name="original" width="6526" height="4350" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>Nepal Army armoured car guarding the Baneswor intersection outside Parliament.</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4.jpg" data-media-id="editor_4" data-image-id="20250910100916_1dabfef07b909c916aa462b7c0bb62a1db96ebe4f0b52d61f71140edffd429f4" data-rendition-name="original" width="6677" height="4451" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The row of electric vehicle showrooms in Thapathali were all torched with the cars inside.</figcaption> </figure>  Interestingly, the under construction Supreme Court, and the newly-built Parliament Complex are untouched. The current Parliament is housed in the Birendra International Convention Centre (BICC) built by the Chinese in 1993, and was the first target of protesters on 8 September. Outside its gates was where 20 students were shot and killed as they tried to storm the gates. After Tuesday’s mayhem, Kathmandu’s streets are now under control of the Nepal Army which has imposed a nationwide curfew. K P Oli was whisked out of his official residence in Baluwatar on Tuesday.&nbsp; Tuesday and Wednesday saw additional 8 casualties, including policemen who were lynched in Tinkune and Budanilkantha.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf.jpg" data-media-id="editor_5" data-image-id="20250910100916_1e93335333741ec809cff95e27e7b714bfea6af527c94c6f74f7cbd311562bbf" data-rendition-name="original" width="6539" height="4360" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>The parking area of the Department of Roads with a row of charred cars (also below).</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30.jpg" data-media-id="editor_6" data-image-id="20250910100920_a3e5a54cf11411c8b81a7b2a01c0f43bff451f343b7b2ce35de70d5719f35d30" data-rendition-name="original" width="7008" height="4672" loading="lazy" alt="Raising Nepal from the ashes"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa.jpg" data-media-id="editor_7" data-image-id="20250910100920_e75830d7d0e87dc8c451be3caccf1f00ef858b8299a20fe8c7dc8805d83a82aa" data-rendition-name="original" width="6726" height="4484" loading="lazy" alt="Raising Nepal from the ashes"> <figcaption>A police vehicle set on fire by demonstrators at Patan Darbar Square on Tuesday.</figcaption> </figure>  The Army is negotiating with the president and representatives of the GenZ campaign that includes Hami Nepal group that organised the protests to form a new government. Kathmandu Mayor Balen Shah and former Supreme Court Chief Justice Sushila Karki have been named as potential candidates to lead the new government The Civil Aviation Authority of Nepal has decided to keep Kathmandu airport closed for all domestic and international flights ‘until further notice’. Update: The video of a flight attendant speakling on social media has now been found to be fake. The error is regretted.&nbsp;