<figure><img width="3700" height="1900" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/637208159c7e80680e0b54cajpeg.jpg" alt=""/><figcaption></figcaption></figure>The coronavirus disease is one of the most well-documented health crises of recent times, with its correlation to almost every sector in society -- including the <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">mental cost</a> of prolonged lockdowns and the stress during the pandemic. Studies have linked a higher prevalence of anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.But for the first time, <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0262958&amp;fbclid=IwAR3GhEvU6qnCjQuwR-HEye8Jk3foYOofrmAgpLCgHZEhjm9r_2PWAOpZCBE" target="_blank" rel="noopener noreferrer">a new study</a> squarely links the rise in suicide ideation with the pandemic in Nepal. Police records also show a spike in suicides and self-harm cases in the past two years.Suicide cases had been rising even before the pandemic with 5,509 in 2018 and 5,898 in 2019. However, it jumped to 6,968 during the first year of the pandemic in 2020 — putting the <a href="https://www.nepalitimes.com/banner/nepal-sees-spike-in-suicides-during-pandemic/" target="_blank" rel="noopener noreferrer">suicide rate</a> at 23.9 per 100,000 population.‘The yearly increase in the suicide rate from 2019 to 2020 is 16%, which is more than threefold higher than a yearly increase in the suicide rate from 2018 to 2019 (5%),’ states the paper published on PLOS ONE last month.Titled ‘Association between COVID-19 pandemic and the suicide rates in Nepal’ and conducted by Binod Acharya, Keshav Subedi, Pramod Acharya and Shweta Ghimire, research analysed a total of 24,350 suicides in four years from July 2017 to June 2021 based on Nepal Police data.It investigated changing <a href="https://www.nepalitimes.com/latest/the-other-pandemic-mental-health/" target="_blank" rel="noopener noreferrer">suicide rates</a> in Nepal during the Covid-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trends in the suicide rate.Males had a higher suicide rate (26.9 per 100,000) than females (16.5 per 100,000), but suicide rates went down over the last two years among males, but was sustained for a longer duration among females. <img width="542" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/637208189c7e80680e0b54cbjpeg.jpg" alt=""><img width="533" height="600" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/6372081b9c7e80680e0b54ccjpeg.jpg" alt="">For example, all the pandemic months except April and May of 2020 and February and March of 2021 had a significantly higher suicide rate compared to the same months in 2019. In comparison to the same month in 2019, July 2020 (just after the first lockdown) had the highest increase in the suicide rate with an increment of 55%.Researchers have pointed out limited or lack of economic resources, public health infrastructure and awareness about mental health as leading factors for the increase in suicides in Nepal during the pandemic.Nepal is one of the countries with highest suicides rates in the world according to the World Health Organization (WHO). The 2021 Nepal Health Research Council (NHRC)’s National Mental Health Survey found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) at a high of 7.2% among Nepalis. During the study period of this latest survey, the highest proportion of the suicides were observed in Bagmati province (5,709; 23.4%), followed by Province 1 (5,161; 21.2%), Lumbini (4,757; 19.5%), Madhes (3,053; 12.5%), Gandaki (2,369; 9.7%), Sudurpaschim (2,176; 8.9%), and Karnali (1,125, 4.6%).But Sudurpaschim and Karnali provinces, two of the provinces with the lowest Human Development Index (HDI), had the highest increase in suicide rates associated with the Covid-19 pandemic.‘Sudarpaschim and Karnali regions are also known to have a historically high proportion of seasonal <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">migrant workers</a> in India. People in this region could have experienced additional distress as their migrant family members lost their jobs in India because of the business closure and lockdown,’ states the study.Alternatively, Province 1 which has the highest HDI and relatively low poverty rate among seven provinces has had consistently high pre-Covid-19 suicide rates, but had the smallest increase during the pandemic.Official data shows that Nepal registered an early increase in the suicide rate and mental health problems during the pandemic. Many factors come into play: lack of financial stimulus packages in the beginning, irresponsible media reportage about the virus, conflicting messages by authorities and the s<a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">ocial stigma of being infected</a> all added to the psychological stress in the public.Restrictions during the pandemic also meant that mental health patients were unable to get timely consultation and medication, further aggravating their condition. ‘Public health interventions to the pandemic, especially the severe ones like lockdowns and business closure, should incorporate economic safety nets and mental health service delivery mechanisms catered to geographic, socio-economic differences and needs,’ recommend the researchers. <img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114101116/6372081d9c7e80680e0b54cdjpeg.jpg" alt="">Suicides are preventable and treatment of mental health disorders can save lives. A comprehensive suicide surveillance system to maintain detailed suicide and attempt statistics within the jurisdiction of public health agencies rather than just the law-enforcement agencies can be a start.Addressing the underlying cause of <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">mental health problems</a> is still the most effective way to prevent suicides. This requires increased awareness and education through various platforms including social media, mass communication and school curriculum, which will in turn also help reduce the stigma associated with psychological disorders. Besides consultation and medication, family support plays a crucial role in healing people with trauma, depression or psychosis. Telemedicine, in particular, has been essential in preventing self-harm during the pandemic but these services need to be scaled up to cover the whole country.The paper concludes: ‘The Covid-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.’Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166

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Suicides: a pandemic within a pandemic

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2c9c7e80680e0a0b73jpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure><ul><li>Two years ago after going through a bad relationship, a 36-year-old Kathmandu-based doctor started getting suicidal thoughts. During the long months of lockdown, he would be on the rooftop and imagine jumping off to end it all. But before long he realised that he was causing self-harm, and sought help. He was diagnosed with depression, eight months into treatment he is rid of suicidal thoughts and is back to his outgoing ways.</li> <li>The bubbly young woman used to be the life of every party, but few of her friends and relatives realised what was going on inside her mind. As the pandemic hit, she started having violent thoughts about harming others and herself. The 22-year-old tried to deal with it herself, but two months ago she sought help from a mental health doctor. She was diagnosed with Obsessive Compulsive Disorder (OCD) and started treatment. Looking back, she advises others to also seek professional help in time.</li> <li>The young woman felt worthless, lacked confidence, avoided crowds and had self-inflicted cuts on her arm. Her inability to come in terms with her sexuality aggravated her sense of insecurity. When the pandemic foiled her plans, she blamed everything on herself, she felt irritated and uncertain, stopped attending virtual classes and her eating habits changed. She finally sought help for her depression and she is now under regular psychiatric counselling and medications. Grounding exercises in particular have helped her overcome self-harm and feelings of inadequacy. “I am okay now,” she says.</li></ul>As the pandemic turns lives upside down, there has also been a global <a href="https://www.nepalitimes.com/here-now/post-pandemic-mental-health-epidemic/" target="_blank" rel="noopener noreferrer">outbreak of mental health disorders</a>, and Nepal has reported a rise in suicides. However, as these cases show, professional counselling and medication can save lives.Recoveries rarely make news, only suicides do.“Most of my patients who attempted suicide have gone on to lead normal lives after they get treatment, and oftentimes they look back to their mental health crisis as nothing more than a lapse of judgment,” says psychiatrist and researcher Rishav Koirala.There has been a sharp rise in <a href="https://www.nepalitimes.com/latest/have-suicides-increased-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">suicides in Nepal</a> since the Covid-19 pandemic in March 2020 and subsequent lockdowns. Nepal Police data shows that in the last 12 months, there have been 7,141 reported deaths due to suicides nationwide, up from 6,252 the year before.Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organisation-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666Centre for Mental Health and Counselling Nepal Toll-free: 16600185080, Hotline: 1145Koshish Toll-free helpline: 166001-22322 (Bagmati Province)Patan Hospital Helpline: 9813476123National Suicide Prevention helpline operated by Mental Hospital Lagankhel and TPO: 1166<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc2e9c7e80680e0a0b74jpeg.jpg" alt="" width="640" height="475"><figcaption> </figcaption></figure>In a survey last year, <a href="http://www.tponepal.org" target="_blank" rel="noopener noreferrer">Transcultural Psychosocial Organisation (TPO) Nepal</a> which works with mental health compared five years of suicide data for March-July to see if there was any change during the lockdowns in 2020 and 2021.The results are revealing: suicides have been increasing steadily at an average rate of 8.5% every year, but it spurted to 19.4% in the first four months of the lockdown. Researchers also conducted key informant interviews across Nepal, who reported witnessing an increase in <a href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener noreferrer">suicidal behaviours</a> in the community as well as health facilities.“We now have both quantitative and qualitative evidence that mental health problems have increased following the pandemic,” says TPO Nepal’s executive director Kamal Gautam. “And given that the majority of suicides are caused by psychological problems, we can say that Covid-19 has significantly contributed to its increase.”Mental health professionals have long been warning of an epidemic of psychological disorders following the Covid-19 crisis. They have reported an increase in anxiety, depression, post-traumatic stress disorder (PTSD), hypochondria, obsessive disorders and psychotic symptoms among the general population in the last two years.Economic collapse, job loss and slashed income due to the pandemic as well as <a href="https://www.nepalitimes.com/latest/in-nepal-lockdown-a-domestic-violence-spike/" target="_blank" rel="noopener noreferrer">increased domestic and sexual violence</a> and added workload during the lockdowns have all acted as contributing factors. In addition, those afflicted do not have normal social interactions that used to be a safety valve during more normal times.Moreover, many patients on treatment and medication have relapsed due to the limited access to health services, counselling and psychotropic drugs during the pandemic, and in many cases because of Covid phobia.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc319c7e80680e0a0b75jpeg.jpg" alt="" width="1052" height="690"><figcaption> </figcaption></figure>Up to 80% of suicides have mental health disorders as an underlying cause. A significant portion of cases are also a result of impulsive behaviour.Experts agree that the official <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener noreferrer">numbers on suicides are vastly underestimated</a> due to a lack of suicide registry. Official figures are based solely on police data and post-mortems, and because of stigma associated with mental health, many families also often refrain from revealing the actual cause of death.Official records also do not take into account <a href="https://www.nepalitimes.com/here-now/in-the-minds-of-nepals-migrant-workers/" target="_blank" rel="noopener noreferrer">suicides of Nepali migrant workers overseas</a>, mainly Malaysia and South Korea. Similarly, suicides among those in the LGBTIQ community who have lost their limited sources of livelihood during the pandemic have been largely neglected.“Reported cases alone are not conclusive, but given that we now have a year and a half long trend and data, we have seen a significant increase in mental health disorders, and can assume that pandemic has played a crucial part in the rise in the number of suicides,” adds Rishav Koirala.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.who.int/news-room/fact-sheets/detail/suicide" target="_blank" rel="noopener noreferrer">More than 700,000 people die by suicide</a> every year around the world, that is one in every 100 deaths -- more than HIV, malaria, breast cancer, or war and homicide. And for every suicide, there are many more who make attempts to end their lives.Nepal is among the countries with the highest suicide rates in the world and consistently ranks within the WHO’s top 10 list. The Nepal Health Research Council (NHRC)’s <a href="http://nhrc.gov.np/wp-content/uploads/2020/09/Factsheet-Adults-1.pdf" target="_blank" rel="noopener noreferrer">National Mental Health Survey</a> published earlier this year found the prevalence of suicidality (current suicidal thoughts, lifetime suicidal attempt and future likelihood of suicidal thoughts) to be high at 7.2% among Nepalis.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc339c7e80680e0a0b76jpeg.jpg" alt="" width="1464" height="752"><figcaption> </figcaption></figure>The first of its kind survey in Nepal interviewed 15,088 participants and was carried out before <a href="https://www.nepalitimes.com/opinion/coping-with-anxiety-in-new-lockdown/" target="_blank" rel="noopener noreferrer">the pandemic</a> from January 2019 to January 2020. The study revealed that 10% of Nepal’s adult population had mental health problems in their lifetime with 4.3% experiencing some disorders at present.Mood disorders and neurotic and stress-related disorders were among the most common <a href="https://www.nepalitimes.com/latest/tackling-nepals-mental-health-pandemic/" target="_blank" rel="noopener noreferrer">psychological problems among Nepalis</a>. The prevalence of lifetime disorders was found the highest in Province 1 (13.9%), in the age group 40-49 years (13.3%) and among males (12.4%). As for current disorders, Bagmati scored the highest (5.9%) as well as those in the age group 40-49 years (6.3%) and females (5.1%).These figures correlate with Nepal’s suicide data of the past five years. Despite fewer attempts, men accounted for 57% of total suicides, against 43% of women. Among minors, however, more girls died by suicide, which experts ascribe to possible victimisation and a higher prevalence of borderline personality disorder among younger females.Suicide deaths are also disproportionately distributed across Nepal with Province 1 recording 65 deaths per 100,000 populations. Lumbini and Gandaki follow closely with 58 and 52 per 100,000 respectively. Traditionally neglected by the state and economically disadvantaged Karnali, Far West and Province 2 regions have lower suicide rates.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc369c7e80680e0a0b77jpeg.jpg" alt="" width="2287" height="1816"><figcaption> </figcaption></figure>More people are dying of suicides in urban centres such as Kathmandu Valley and Ilam district, which reported 32 and 38 suicide deaths respectively per 100,000 populations last year against Rautahat’s 18 and Humla’s 6.This is in direct contrast with the global trends where 77% of suicides occur in low and middle-income countries. Unemployment and poor economic condition have long been associated with a high risk of suicides, but only up to a certain point, as proven by recent data. Japan, <a href="https://www.nepalitimes.com/here-now/dead-end-of-the-korean-dream/" target="_blank" rel="noopener noreferrer">South Korea</a> and Hungary with their higher per capita GDPs have some of the highest suicide rates in the world.“Poorer nations have weaker education and health systems, which translates into delayed or even lack of diagnosis but poverty is not a sole factor for suicides,” says Kamal Gautam. “Suicide is complex and there are multiple factors at play which means a linear approach to prevention would be incomplete, it needs an integrated approach.”Addressing underlying mental health disorders is the most effective way to prevent suicides. This means increased awareness and education about psychological disorders, which in turn can help <a href="https://www.nepalitimes.com/here-now/all-in-the-family/" target="_blank" rel="noopener noreferrer">reduce societal stigma</a>. An introduction to and discussion on mental health in the school curriculum can further sensitise the public.In addition to medication and counselling, societal structure and family dynamics is an important support system for individuals suffering from psychosis, trauma and depression. Telemedicine in particular has been essential in preventing self-harm during the pandemic-induced restrictions but mental health services need to be scaled up across the country.On the other hand, a strict regulation must be implemented on the <a href="https://www.nepalitimes.com/here-now/suicide-by-pesticide-in-nepal/" target="_blank" rel="noopener noreferrer">availability of pesticides</a>, an easy means of suicide for many. Access to alcoholic products must also be supervised with Nepalis known to self-medicate to cope with stress and trauma, in turn increasing the risk of self-harm and suicide.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141124/636cfc399c7e80680e0a0b78jpeg.jpg" alt="" width="1280" height="853"><figcaption> </figcaption></figure>But most of all, analysing suicide attempts can be a powerful tool for prevention. On average, there are six attempts behind every suicide. Up to 80% of people with suicidal ideation reveal their intention to either a family member, friends or their doctors within a month before their attempt.“We forget that even before the pandemic suicide rates were very high in Nepal and while the pandemic might have added to the problem, the figures alone don’t mean anything if we fail to also study suicide attempts to find a stronger link between the prevalence and the contributing factors,” says Rabi Shakya, psychiatrist and director of Patan Academy of Health Sciences.He adds: “Historically, there have been more suicides after than during the crisis due to the long-term socioeconomic impacts. So we must start preparing for the pandemic of mental health problems including suicides post-Covid. Our health care workers must be trained and fanned out across the country.”Nepalis are not new to mental health problems induced by a crisis. The 10-year-long Maoist insurgency killed 17,000 people but many more continue to suffer from <a href="https://www.nepalitimes.com/here-now/the-mental-scars-of-violence/" target="_blank" rel="noopener noreferrer">PTSD, depression, anxiety and distress</a>. A 2017 report published in the journal Lancet found as high as <a href="https://archive.nepalitimes.com/article/nation/stigma-and-silence-mental-health-nepal,3486" target="_blank" rel="noopener noreferrer">37.5% of the general public</a> had some form of psychological disorder.The <a href="https://www.nepalitimes.com/here-now/its-all-in-the-mind/" target="_blank" rel="noopener noreferrer">2015 earthquake</a> further added to Nepal’s epidemic of mental disorders. Survivors who had narrow escapes or lost family members reported increased panic attacks, anxiety and trauma.But <a href="https://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener noreferrer">conflicts, disasters</a> and pandemics have shined a light on mental health with an increased national and foreign investment in prevention and management. With larger chunks of the population impacted, there is now more acceptance and the field is starting to get the priority it warrants.Says Rishav Koirala, WHO focal person for mental health post-2015 earthquake: “The best way to prevent suicides is to address underlying psychological disorders and crises, despite adding to the burden has helped normalise them because many more people can now relate and understand that they are treatable.”

Sonia Awale

Nepal sees spike in suicides during pandemic

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b70369c7e80680e060067jpeg.jpg" alt=""/><figcaption>A customer buys a bottle of pesticide over a counter in Kathmandu. Photo: MONIKA DEUPALA</figcaption></figure>Of the 25,308 <a href="https://archive.nepalitimes.com/article/nation/down-and-out,3158" target="_blank" rel="noopener">suicides</a> recorded by the police in Nepal in the past five years, poisoning was the method of choice of 6,213 and pesticides were the most common form of poison used. Suicide by <a href="http://archive.nepalitimes.com/news.php?id=17916#.XhbkaVUzaUk" target="_blank" rel="noopener">pesticides</a> is the easiest, cheapest and the quickest way to kill oneself in Nepal.A <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4542-y" target="_blank" rel="noopener">2015 study in Chitwan</a> showed that 90% of all poisoning cases resulted from deliberate ingestion of pesticides. Hospital and forensic data over the years reveal that pesticide self-poisoning kills at least 1,000 people in Nepal annually.“Pesticides are in fact a far greater threat than what police records show. There are many people who make the attempt and survive due to insufficient dose or medical treatment,” says Ravi Shakya, a mental health specialist at Patan Hospital. “If we also count attempted suicides, pesticide is the most preferred method of suicide in Nepal.”Read also: <a href="https://www.nepalitimes.com/here-now/nepals-suicide-rate-vastly-underestimated/" target="_blank" rel="noopener">Nepal's suicide rate vastly underestimated, </a>Sewa BhattaraiShailesh Thapa Chhetri of Nepal Police agrees: “Previously, hanging used to be the most common method of suicide, as people had the easiest access to ropes. Now, access to pesticides is even easier. Almost every household has pesticides, whether to kill cockroaches or to spray in the farms.”Do not shy away from seeking help. If you, or anyone you know, would like to speak to a trained mental health professional, please contact:TUTH Suicide Hotline: 9840021600Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005Mental Health Helpline Nepal: 1660 0133666And as the import of pesticides increases, the hazardous chemicals will only be more accessible for self-harm. The Ministry of Agriculture and Livestock Development claims that Nepal’s pesticide consumption is 396g per hectare but research by the Netherlands-based Wageningen University shows it to be <a href="https://www.nepalitimes.com/from-the-nepali-press/banned-pesticides-are-widely-used-in-nepal/" target="_blank" rel="noopener">2.9kg per hectare in vegetable patches</a>. “Pesticides that kill people are readily available in the market, they do not need prescriptions and anyone can buy it,” says Dilli Ram Sharma, former Director General of the Department of Agriculture. “To make matters worse, farmers <a href="https://archive.nepalitimes.com/article/nation/pesticide-laced-vegetables-continue-to-poison,1555" target="_blank" rel="noopener">always go for the most toxic ones</a> that kill all pests at once.”Read also: <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/latest/suicide-watch/" target="_blank" rel="noopener">Suicide watch</a> <figure><img width="1500" height="844" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101116/636b70399c7e80680e060068jpeg.jpg" alt=""><figcaption> </figcaption></figure>A <a href="http://www.forensic.gov.np/assets/upload/images/pdf/Trends-of-clinical-toxicology-cases-in-Nepal.pdf" target="_blank" rel="noopener">2014 National Forensic Science Laboratory study</a> that looked at the trends of clinical toxicology cases in Nepal from 2002-2012 showed that of the total poisoning cases due to insecticides, 71% were by ingesting the organophosphorus compounds Metacid (Methyl parathion) and Nuvan (Dichlorovos). Pyrethroid, carbamate and organochlorine were also used. Some of these pesticides are actually banned in Nepal, but available over the counter. A Central Police Forensic Science Laboratory study conducted over the past three years shows organophosphorus compounds and aluminium phosphide as the most common active ingredients in poisoning cases. Data from seven tertiary hospitals across Nepal found Celphos (aluminium phosphide used to kill rodents) as the most common pesticide in those admitted for poisoning. The <a href="https://www.centrepsp.org/" target="_blank" rel="noopener">Centre for Pesticide Suicide Prevention</a> in collaboration with the University of Edinburgh and Nepal Public Health Foundation is collecting three years worth of hospital and forensic data to analyse self-poisoning. Prof Michael Eddleston of the University of Edinburgh is the principal investigator and was recently in Nepal. “I don’t think it’s ever possible to use pesticide safely. You have to make pesticides non-toxic to humans, animals and the environment. We are trying to identify the problematic pesticides that are killing people here and provide that information to the concerned authorities so that they are banned and replaced with safer pesticides,” Eddleston told Nepali Times.The Nepal Public Health Foundation is also organising a two-day national conference (9-10 January) focussed on <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/rooftop-gardens-kathmandu,1415" target="_blank" rel="noopener">healthy farming</a> and reducing pesticide use.Indeed Bangladesh, Korea and Sri Lanka have shown that removing highly hazardous pesticides from <a href="https://archive.nepalitimes.com/article/nation/heavy-pesticide-use-and-low-consumer-awareness-affecting-public-health,1394" target="_blank" rel="noopener">agricultural practice</a> is key to preventing suicide deaths without affecting agricultural output. The good news is that some of the most toxic pesticides are being banned in Nepal. In 2019, when the Centre for Pesticide Suicide Prevention pinpointed Dichlorvos and 3g tablets of aluminium phosphide as the most common causes of pesticide suicide in Nepal, the Plant Quarantine and Pesticide Management Centre placed a ban on both the pesticides, to be enforced after a grace period of two years for the chemicals already on the market.  Similarly, before Metacid (Methyl parathion) was prohibited in 2006, up to 68% of Nepalis killing themselves were using the chemical. After the ban, this figure came down to 8%.“Prevention is better than cure and that is exactly what pesticide ban does. And this has a double benefit: it reduces suicide death while also bringing down the rampant use of pesticides in agriculture, leading to a decline in pesticide residue,” adds Sharma, who retired after banning the two pesticides.Despite the ban, however, the smuggling of pesticides across the open border with India remains a challenge, and experts call for crossborder cooperation to fight it.  Says Rakesh Ghimire of Teaching Hospital: “Control of pesticides especially in agricultural areas is important, but as important is pesticide information centres and treatment when the poisoning happens.”

Suicide by pesticide in Nepal

As this report is uploaded, the latest results in Nepal’s election show that the Rastriya Swatantra Party (RSP) is headed for an even bigger sweep than most had predicted.
The RSP was leading by large margins in 49 of 165 constituencies, &nbsp;with the UML, NC and NCP trailing far behind. Prominent political figures from the old parties like K P Oli, Minwndra Prasad Rijal, Ishwar Pokhrel, Bishnu Prasad Poudel, Bimalendra Nidhi all seem headed for defeat.
It does look like the RSP’s bell election symbol is ringing right across Nepal — from cities to the remotest districts in the mountains and plains. The party’s blue colour is sweeping the land.
The Nepali people seem to have sent a clear message that they were throughly dissatisfied with the chronic failure of the three main parties to work in the national interest to create jobs and deliver development. It was also an expression of lingering outrage over the the 8 September massacre outside Parliament. &nbsp;
It now looks almost certain that Balendra Shah will get to be Nepal’s next, and youngest, prime minister. Hopefully he will be leading a cabinet of competent and honest technocrats. It remains to seen how the power equation between Shah and the RSP’s leader, Rabi Lamichhane will play out.
Lamichhane is out of jail on bail for fraud cases which he has called political vendetta by the previous regime. Both he and Shah are charismatic and ambitious. Their working relationship will determine Nepal's political stability and whether it can avoid the political cronyism of the past.
This election was not just about casting votes. It was about standing up to principles and a value system, and respecting the hopes and aspirations of Nepal’s youth. It to push for transparent government and against impunity — including for the gunning down of young Nepalis in cold blood.
<div class="embed-block"><iframe src="https://election-geo-dashboard.pages.dev/" width="100%" height="600" frameborder="0"> </iframe>Live election results as winners of candidates are announced.</div>
CAN DO MAN
Shah got mixed reviews as mayor. He was impulsive and ad hoc, but most people inKathmandu and beyond liked his can-do attitude and unconventional style which stood in sharp contract to the legacy leaders. Over his three year mayorship he showed more maturity and planning capacity.&nbsp;
But he always ran headlong into opposition from the federal government over his urban planning and other initiatives to make Kathmandu more liveable. Coming from a civil and structural engineering background, he was involved in building low-cost housing after the 2015 earthquake.
But his public persona is more tied to his irreverent rap lyrics that stood up for the marginalised underprivileged in society, while exposing the high-handedness and apathy of the state. But this also exposed contradictions because he also used his own municipal guards to beat and chase away street vendors and squatters.
But there is no doubt that a combination of the sharp messaging in his rap videos amplified by the algorithms of social media ignited Nepal’s youth to rise up. It was more about optics and emotion than policy and strategy.
He studied Kathmandu district for five years, visiting experts in every field before announcing his independent candidacy for mayor in 2022. Many like me in his own constitunecy did not know who he was and where he came from.
He is a year younger than my architect son, and I saw in him a reflection of my own son’s commitment to serving the nation. I voted for him to be mayor despite his sometimes erratic behaviour, which could be attributed to his youth.
The best sign of his strategic planning, which unsettled septuagenarian and octogenarian politicians, is the he did not grab the first easy option of becoming prime minister in September when GenZ activists offered him the post.&nbsp;
Joining RSP was a masterstroke, as was his challenge to Oli in Jhapa to project national branding. He needed a party platform and Lamichhane needed a popular prime ministerial persona since he himself could not hold the post.
Shah has shown the capacity to take risks when he believes the value justifies the action for the country. Now, he will have to show more strategic thinking on a national scale, as well as understand the delicate geopolitics of Nepal.&nbsp;
He must rise above the kind of crude social media posts that earned him followers on X, but did nothing to erase his erratic and impulsive image.&nbsp;
Some assume that behind his trademark RayBan shades is a closet dictator, and his past remarks about Hitler are still up on social media. He has in the past shown impatience with criticism, unleashing supporters on social media to troll detractors.&nbsp;
Even so, the public seems willing to place their hope on an educated young man with integrity and a proven record for planning at the helm. By tomorrow it will be clear whether the hope Nepalis have held has been fulfilled, and the coming years will show if the RSP will lead Nepalis to a better future.
The voters seem to have shown the door even to the NC despite the fact that under Gagan Thapa, the party had turned a new leaf. A strong government under Prime Minister Balendra Shah heading a carefully selected cabinet and a strong opposition of the NC, UML and other parties for check and balance may be just what we need for a stable Nepal.&nbsp;
Nepalis have collectively always shown maturity in elections. This time they have given a resounding endorsement for integrity and for good governance.

Bells ring all over Nepal

Nepal conducted its post-GenZ movement early election on Thursday in a peaceful and orderly manner, although turnout was below average in most districts. In fact, some constituencies saw voters reject the election, including in Arghakhanchi and Mustang.&nbsp; Preparation for the polls had to be done hurriedly after the September protests, with little time for political parties to work on their manifestos and campaign. But the election did push most parties to field younger, fresher and untainted candidates. This was more a <a href="https://nepalitimes.com/news/old-vs-new-vs-new">personality-driven election for the next prime minister</a> than a traditional parliamentary poll. The three main parties had pre-emptively announced their prime ministerial candidates although the chief executive is supposed to be decided by the largest party in the House.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_00809e41288d8dd46d1c8915e8e39fba09892049cfda37ba347e4b23989e94c0.jpg" data-media-id="editor_1" data-image-id="2026030514034_00809e41288d8dd46d1c8915e8e39fba09892049cfda37ba347e4b23989e94c0" data-rendition-name="original" width="2048" height="1366" loading="lazy" alt="Nepal elections"> <figcaption>Balendra Shah</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_d288f2cbe05c9c1376e315ea4f24528c5ee63766c978657aee8848eb9f87f4ea.jpg" data-media-id="editor_2" data-image-id="2026030514034_d288f2cbe05c9c1376e315ea4f24528c5ee63766c978657aee8848eb9f87f4ea" data-rendition-name="original" width="1600" height="1066" loading="lazy" alt="Nepal elections"> <figcaption>Gagan Thapa</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_3e2c1c4595b3aa3a4b0c6ca80aa6243e7c5c6e5d232c9295a380c565f85bd233.jpg" data-media-id="editor_3" data-image-id="2026030514034_3e2c1c4595b3aa3a4b0c6ca80aa6243e7c5c6e5d232c9295a380c565f85bd233" data-rendition-name="original" width="2048" height="1365" loading="lazy" alt="Nepal elections"> <figcaption>K P Oli</figcaption> </figure>  Going by the noise on social media sites, there seemed to be overwhelming support for the Rastriya Swatantra Party (RSP) and its prime ministerial hopeful, former Kathmandu mayor <a href="https://nepalitimes.com/here-now/political-rap">Balendra Shah</a>. Standing against him in his home turf was K P Oli, of the UML who was forced to resign after the 9 September protests. Although the UML was fielding a tried and tested leader, the Nepali Congress (NC) has tried to carry forward the GenZ aspiration for change by putting forward its new party leader Gagan Thapa as its prime ministerial candidate. The lower-than-average turnout appears to have been driven by several factors: a public that is apathetic towards the older parties but is not yet convinced by the capability of the new. Limited time campaigning, and the over-idealistic manifestos of the parties does not seem to have fired up the electorate.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_50394032b053d433ed039aeb6d2c00a491d2a56b48a67e55e27fbffe7e4c7fe4.jpg" data-media-id="editor_5" data-image-id="2026030514038_50394032b053d433ed039aeb6d2c00a491d2a56b48a67e55e27fbffe7e4c7fe4" data-rendition-name="original" width="1280" height="854" loading="lazy" alt="Nepal elections"> <figcaption>Photos: ADITYA KHARE</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_84677be963084003c9a3d3fec0b8f95ab9b9db08c160f08c82aa03b02cb81260.jpg" data-media-id="editor_6" data-image-id="2026030514038_84677be963084003c9a3d3fec0b8f95ab9b9db08c160f08c82aa03b02cb81260" data-rendition-name="original" width="1280" height="854" loading="lazy" alt="Nepal elections"> </figure>  The low turnout is also a reflection of massive outmigration from rural districts, and the requirement that voters had to go to their own home constituencies to vote. And since the Election Commission could not organised ballot by mail or online voting, most of the estimated 4 million voters abroad also could not cast their ballots. To be sure, Nepalis abroad do represent an anti-incumbent vote bloc, and they have influenced families and friends back home through social media. The trend towards RSP and younger candidates is therefore a rejection of the old, and a protest vote against the legacy parties rather than full support for the new ones. Many migrants who were coming back to vote were also stuck in West Asia after the war broke out between Iran and Israel-US. Airlines have had to make drastic rerouting plans, and at least 21,000 flights have been cancelled. The conflict will affect petroleum imports including LPG and aviation fuel, if it continues any longer. Although our reliance on fossil fuels is declining, thanks to the increased electrification of transport and cooking, the shortage might be the first crisis for the new government of Nepal to tackle.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_986438337f2af271ab33d267560b8a25691a72292aae074488dc8e77f27cf9c1.jpg" data-media-id="editor_7" data-image-id="2026030514038_986438337f2af271ab33d267560b8a25691a72292aae074488dc8e77f27cf9c1" data-rendition-name="original" width="2048" height="1536" loading="lazy" alt="Nepal elections"> <figcaption>Polling in Sangjya. Photo: SHRISTI KARKI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514038_dd2624707dae59f3b32fdebb402a3edfbfe99a4031f4f43dd4522ef7c58bfab0.jpg" data-media-id="editor_8" data-image-id="2026030514038_dd2624707dae59f3b32fdebb402a3edfbfe99a4031f4f43dd4522ef7c58bfab0" data-rendition-name="original" width="1523" height="2030" loading="lazy" alt="Nepal elections"> <figcaption>Photo: SUDIKSHA TULADHAR</figcaption> </figure>  There were 18.9 million registered voters nationwide, and the 60% turnout this time follows a declining trend, possibly making it the lowest in Nepal's polling history. In the first federal election in 2017, the turnout was an impressive 67%, which dipped to 61% in the 2022 election, although it was slightly higher in the municipal election. The EC has started counting the votes on Thursday evening and hopes to have the winners of the FPTP candidates out within 24 hours, however the tallies of the Proportional Representation ballots for the parties may take up to a week.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_8ff38b016d3cb75f27343ebe5d826f9201bfefffb6147dcbb0c415071ceb472d.jpg" data-media-id="editor_9" data-image-id="2026030514034_8ff38b016d3cb75f27343ebe5d826f9201bfefffb6147dcbb0c415071ceb472d" data-rendition-name="original" width="1616" height="1080" loading="lazy" alt="Nepal elections"> <figcaption>Ballot boxes being collected. Photos: AMIT MACHAMASI</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_6e6f6a792db2790533b7ef261e51dbdc07745ee96b80eaa8edc5abab4c7cfd21.jpg" data-media-id="editor_10" data-image-id="2026030514034_6e6f6a792db2790533b7ef261e51dbdc07745ee96b80eaa8edc5abab4c7cfd21" data-rendition-name="original" width="1616" height="1080" loading="lazy" alt="Nepal elections"> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2026030514034_75951a6583c17a741e3f9bd1abb796bbefed335cb6e694e5cddf519bfd0b9ed4.jpg" data-media-id="editor_11" data-image-id="2026030514034_75951a6583c17a741e3f9bd1abb796bbefed335cb6e694e5cddf519bfd0b9ed4" data-rendition-name="original" width="1616" height="1080" loading="lazy" alt="Nepal elections"> </figure>  Many have praised the interim prime minister installed six months ago by the GenZ movement, former chief justice <a href="https://nepalitimes.com/news/mission-nearly-accomplished">Sushila Karki</a> for conducting the polls on time as promised—a task that looked impossible until a few months ago, especially considering how Sri Lanka and Bangladesh suspended their electoral processes for a long time following their own youth uprisings. Balen Shah also took to his social media to commend Karki. He wrote: 'हजुरको नेतृत्वमा आज लोकतन्त्रले जितेको छ । <a href="https://www.facebook.com/hashtag/%E0%A4%86%E0%A4%AE%E0%A4%BE?__eep__=6&amp;__cft__[0]=AZYlGAeGzdXOS93cs8uOYTfW2l5YtXypnOpQOwFwdzWQQ2X_sLcqe_tqk518ULo-ftJnT5sCeT83L5zqMhzL09YgqxYLxDTzkHRSXiEtegetmKjz0ZbMz54cS2KFOKvPtqdHCZn4J6N0i4IvRDSXgHcCdLLd3kQYflb-Popks3zpA3O9Pqd4_Yh9efVCtMUPumJdN0l-y32bQLREPIMYm_mnJDYHbgoUy9iRUGMu1IOGHQ&amp;__tn__=*NK-y-R" target="_blank">#आमा</a>' (Democracy has won under your leadership. #mother). After casting her vote from Kathmandu on Thursday, Karki said: “I have fulfilled my responsibility towards the nation, let us hope the people’s wish for stability and prosperity will be fulfilled by the new elected government.”

Nepal votes with below average turnout

After Thursday’s election, Nepalis are in a wait-and-watch mode. The Election Commission says counting ballot papers will be expedited this time, and the results for the First-Past-The-Post (FPTP) will start being declared within days. In 2022, it took three weeks for the final results to be tallied.&nbsp;
But winning an election is only half the challenge for the parties, forming a government under parliamentary politics is like a complicated mathematical equation.&nbsp;
In 2022, the Nepali Congress (NC) emerged as the biggest party, winning 89 seats. But the UML with 78 seats and the Maoists with 32 formed a minority government. In fact, Sher Bahadur Deuba did not become PM then despite leading the biggest party in Parliament.
This time, there is an unmistakeable Rastriya Swatantra Party (RSP) wave led by its prime ministerial candidate, Balendra Shah. Besides his own popularity, Shah represents change which most Nepalis are clamouring for after decades of corrupt and feckless coalitions that did not deliver.&nbsp;
The past months of campaigning has seen massive youth engagement on social media through memes, AI clips, and viral images. Digital content that appeals to emotion rather than policy debate between candidates shape electoral outcomes in Nepal and elsewhere. &nbsp;
Shah represents GenZ aspirations, and was their candidate for prime minister. It was only when he declined that Sushila Karki was nominated. None of the political parties in the recent past -- new, old, or revolutionary — have won enough seats to go it alone.&nbsp;
The most recent majority government was formed by the short-lived Communist Party of Nepal after the UML-Maoist merger in 2022. But that rare two-thirds majority collapsed after a power struggle between K P Oli and Pushpa Kamal Dahal. The only party to have won a majority was the NC in the 1991 and 1999 elections. But it is near impossible for it to repeat this success now, even with Gagan Thapa's rebranding of the party.&nbsp;
We have compiled these possible scenarios for election outcome in order of likelihood:
RSP gets a majority
RSP hits the magic 138 to form a government entirely on its own. Balendra Shah wins Jhapa-5, and becomes the new prime minister at 35, the youngest ever to hold the office in Nepal. But danger lurks: there could be a personality clash between Shah and Lamichhane who are both equally ambitious. History could repeat itself.&nbsp;
RSP wins but does not get a majority
RSP is likely to sweep the most votes, but what if it does not secure enough seats for a majority? It would need a coalition partner and Nepali Communist Party (NCP) under Pushpa Kamal Dahal could fit the bill, but only if it has the numbers. The RSP is not likely to team up with the UML or NC.
The NCP is relatively untainted by the 8 September events, and also has former UML defectors like Madhav Kumar Nepal and Bhim Rawal who could bag their rural vote banks. After all, there are no permanent foes in politics. If the royalist RPP and Tarai-based Janata Samajwadi have enough seats, those could be options for the RSP. &nbsp;
NC is second
The NC under the new leadership of Gagan Thapa could become the second biggest force and form a government with RSP in a power-sharing deal with Shah. This would be the most stable scenario since the RSP and NC have competent and idealistic young technocrats. Thapa himself embodies a strong combination of both old and new politics to navigate the system for more efficient government. But then Thapa and the RSP's Rabi Lamichhane do not get along.
NC and NCP form a majority
If the NC becomes the largest party but not by a big margin, it could join up with the NCP and Ujyalo. Teaming up with the UML would likely face backlash with the party and outside. If Gagan Thapa becomes prime minister he will face internal pressure from both Deuba loyalists. Same old story.
Minority coalition of NC, UML and NCP
RSP becomes the first party but does not get a majority, paving the way for the three legacy parties to cobble together a minority government. While this is possible in Nepal’s parliamentary system, such a scenario is likely to lead to more instability and dissatisfaction among young Nepalis demanding change, and even trigger street unrest. &nbsp;

The magic 138

Of the nearly 19 million eligible voters in next week’s election in Nepal, an estimated 5 million are abroad and cannot cast their ballots. Many others within Nepal must travel to their home districts, and might decide not to because of the cost.
Flights into Kathmandu these days are full of global Nepalis returning just to vote, but almost as many are leaving for overseas jobs. Most of those coming or going are in the 20-40 age group, and a majority want Nepal to see a change in leadership.
Bangladesh held an election this month in which citizens overseas could vote by mail.&nbsp;
“Bangladesh made maximum use of technology not just for campaigning but also for polling itself. We could have also managed this, so people within Nepal did not have to travel to their home districts to vote,” says Mohna Ansari, former head of Nepal’s National Human Rights Commission who was an election observer in Bangladesh.
A 3-day holiday has been declared so people can travel to their home constituencies to cast ballots. Even if there was not enough time to manage ballots for overseas Nepalis, it could have been done for Nepalis within Nepal.
Former Chief Election Commissioner Bhojraj Pokharel reckons that physical voting in countries with a large Nepali diaspora would have been a logistical nightmare, but in the PR system, using electronic voting machines or paper ballot could have been piloted in some places. It is not possible to manage the entire voting process until we introduce the internet voting system.
“First of all, there needs to be political will to bring the policy and be ready to undertake that level of investment and it is not a one-time cost,” Pokharel says. “A government formed by the GenZ could have atr least issed an ordinance ensuring this right, piloted out-of-country voting where possible, which could have built pressure for the future Parliament and the government. It would have given people hope. It is a lost opportunity.”
All major political parties called for voting rights for global Nepalis in their manifestos, but these very leaders blocked legislation allowing it despite a 2017 Supreme Court ruling out of fear that it would be anti-incumbent.&nbsp;
<h2>Why so late?</h2>
Bangladesh delivered election results in just one day, but the final results of Nepal's last local polls in 2022 including that of Kathmandu constituencies took nearly a month.
Acting Chief Election Commissioner Ram Prasad Bhandari said this week that the results of the First-Past-The-Post (FPTP) ballot counting would “likely” be published within 24 hours of the poll closing at 5PM on 5 March. But many are skeptical.
“I wonder if we lack the capacity or know-how to announce results as quickly as possible,” says Mohna Ansari.
Former Chief Election Commissioner Pokharel says manual ballot paper counting in Nepal is inherently slow because of the large numner of political parties and/or candidates on the ballot, the counting mechanism, the political behaviour of the candidates/parties and some managerial issues during counting.
“Our present policy is to count all the ballot papers at the returning officers' officies, located at the district headquarters. It requires collecting ballot boxes safetly first. This takes time, and there have been cases of ballot boxes being damaged or stolen during transport. In a few highly difficult, geographically remote polling centres, we use a helicopter or transport. But sometimes, accommodating the party and candidates' representatives remains challenging,” explains Pokharel. A solution could be counting ballots at the very booths where they are cast.
Another reason for the delay is simply the number of political parties, and the need for each ballot paper to be examined by booth representatives for consensus. In close races, the smallest difference can lead to tense situations, further delaying results, even though counting centres are protected by metal fencing so there is no disruption.
After this, then it is the turn of Proportional Representation (PR) ballots to be counted. Weeks pass by the time the results of candidates and parties are tallied and verified. But the most common delay is because election officers think ballot counting is a nine-to-five job.&nbsp;
“The efficiency of poll station officers is most important, and they are incentivised for this,” says Ansari, adding that counting can even start within an hour after voting closes.
In remote areas, local resources could be mobilised to make counting quicker, but there is a crisis of trust, adds Ansari.&nbsp;
That could be easily solved with electronic voting which the EC implemented in the 2008 polls but discontinued because political parties felt the machines could be hacked or manipulated.