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Nepal is fighting a surge in dengue cases, a potentially deadly disease once unheard of in the country's high-altitude Himalayan regions, as climate change and urbanisation nurture fever-bringing mosquitoes in new zones.

Only a single case of dengue was recorded in Nepal in 2004. Two decades later, thousands of cases are being reported across the country.

Once confined to tropical regions in the country's plains, dengue-carrying mosquitoes have begun breeding in the valleys and even cool mountainous areas, reaching elevations where its bite was once unknown.

Twelve people have died and more than 28,000 people have been infected this year, including 18 cases in Solukhumbu district, home to Mount Everest.

Doctors say the real number might be higher, as not everyone is tested.

"It should not be seen here at all," Suman Tiwari, district health chief for Solukhumbu, which sits at an altitude of some 2,500 metres (8,202 feet).

"What is surprising is that some people with no travel history have also tested positive for dengue".

In the worst cases, dengue causes intense viral fevers that trigger bleeding, internally or from the mouth and nose.

The capital Kathmandu, at an elevation of approximately 1,400 metres (4,600 feet), has seen over 4,000 cases.

"Unfortunately, it is expanding itself geographically," said Sher Bahadur Pun, a doctor at Kathmandu's Sukraraj Tropical and Infectious Disease Hospital.

"Once upon a time, it was just seen in a certain area, but it is moving up towards mountainous regions, even up to the Himalayan foothills."

In some districts, hospitals have been overwhelmed with dengue patients suffering from crippling fevers, body aches and rashes.

"In the last decade, it has grown exponentially," Pun said.

"After every outbreak, the number of infected people has increased... and my experience is that after every outbreak, it has become more deadly."

In October, the UN health agency said the number of reported dengue cases worldwide has approximately doubled each year since 2021, with over 12.3 million cases, including more than 7,900 deaths, reported in just the first eight months of 2024.

WHO chief Tedros Adhanom Ghebreyesus called the global spread an "alarming trend".

Experts say changes in temperature and rainfall patterns driven by climate change and urbanisation are creating favourable conditions for Aedes aegypti, the mosquito responsible for transmitting dengue.

That means it can survive and breed at higher elevations.

Narayan Gyawali, a virologist who specialises in zoonotic diseases, said that urbanisation and increased mobility of people were also driving the dengue surge.

"When microclimates are established with urbanisation in new areas, internal temperatures become warm and there is humidity," Gyawali said.

"A favourable environment is created for breeding and survival."

This is the third consecutive year that Nepal has seen a dengue outbreak -- an apparent shift from cyclical patterns where outbreaks are expected every two to three years.

The country's worst outbreak was in 2022, with 88 deaths and nearly 55,000 cases, according to government figures.

Last year, 20 people died, with more than 50,000 cases.

"Dengue used to be reported in a cyclical trend, but in the last few years, it has been seen every year," said Gokarna Dahal of the Health Ministry's Epidemiology and Disease Control Division.

"Our preparation now is to fight with it every year".

Dahal said it was an "injustice" that a developing country like Nepal -- which makes a minimal contribution towards the burning of fossil fuels driving the planet's warming -- should shoulder greater impacts of climate change.

Meenakshi Ganguly, from Human Rights Watch, said that while the primary responsibility to protect its public's health lies with Nepal, countries most responsible for global emissions also have an obligation.

"Those countries which are primarily responsible for global emissions need to do a lot more to protect people in countries like Nepal from the consequences of global warming," Ganguly said.

"Combatting mosquito-borne diseases like dengue, which are spreading fast to new areas, needs to be part of that." AFP

Ten years ago, Nepali mountain guide Dawa Tashi Sherpa was fighting for his life after being hit by an avalanche on Everest which was then the deadliest disaster on the world’s highest mountain.

The accident, which killed 16 Nepali guides on 18 April 2014, shone a spotlight on the huge dangers they face to let high-paying foreign clients reach their dreams.

Without their critical work to carve out climbing routes, fix ropes, repair ladders and carry heavy gear up the mountain, few foreign visitors could make it to the daunting peak’s top.

A decade ago, a wall of snow barrelled through the Nepali guides as they heaved heavy kit up the treacherous high-altitude Khumbu icefall in the freezing dark.

The force of the avalanche tossed Dawa Tashi about 10 meters down, injuring his rib cage, left shoulder blade and nose.

Dawa Tashi, then aged 22, recalled his friends who died. Three of their bodies were never recovered.

“I was lucky to survive,” he told AFP. “In the hospital, whenever I tried to sleep, they would appear in front of my eyes.”

The disaster led to protests for improved benefits and conditions for the guides, and an unprecedented shutdown on the peak for a season.

‘Tipping point’

It sparked a debate about compensation for the families of injured or killed Nepali guides and mountain workers.

Many are forced to rely on the charity of Western climbers—despite being employed by expedition companies and being fundamental to the multimillion-dollar industry’s success.

“It was very difficult back then,” said Nima Doma Sherpa, who lost her husband Tsering Onchu, 33, in the avalanche.

“What can you do when the main pillar of your house is not there? The children were small, and I was worried how I will educate them and how we will sustain ourselves.”

The government reaps hefty revenues from the lucrative climbing industry—in the last season in 2023, it earned more than $5m from Everest fees alone.

Soon after the 2014 accident, it pledged a meager $400 to the families of those killed to cover funeral expenses.

The offer was rejected by angry Nepalis, whose families received only $10,000 then in life insurance.

The resulting furious dispute, with Nepalis clamoring for better death and injury benefits from the government, saw days of tension at the base camp.

Sherpa guides, grief-stricken over the deaths of their colleagues, threatened to boycott climbing, throwing mountaineers’ plans into disarray and canceling the season.

“It was a tipping point for young Sherpas who were frustrated,” said Sumit Joshi of expedition operator Himalayan Ascent, who lost three guides from his team in the avalanche that year.

Since then, his Everest teams have not climbed on the anniversary date.

“Ten years on, there is an improvement in their working conditions and the respect that they command,” he said.

Safety standards needed

In 2014, the protesters at Everest base camp made several demands.

They included an improvement in insurance payouts and a relief fund from mountain royalties.

“We were advocating for the Nepali climbers, ensuring they can get as much benefit as possible,” said Ang Tshering Sherpa who headed the Nepal Mountaineering Association at the time.

“But not all demands could be met as there were limitations.”

The insurance payout was increased by 50 percent to Rs 1.5m ($11,250) if someone is killed.

Helicopters are now allowed to fly in supplies to higher camps, decreasing the number of trips Nepalis make across the treacherous Khumbu icefall.

Nepali companies have displaced foreign operators to bring in the majority of climbers, and pay and conditions have improved for guides at larger firms.

But, guide Mingma G Sherpa said, little else has changed.

“They protested, but it was limited to the base camp,” he said. “The main thing is that the government policies are still not good... we really need to set a standard for climbers to make the mountains safer.”

‘Wives don’t agree’

In 2015, a powerful earthquake triggered an avalanche that killed 18 people at Everest’s base camp before the climbing season began.

Last year’s season started with the death of three Nepali climbers carrying expedition supplies, after they were hit by glacial ice fall and swept into a crevasse.

Mingma G Sherpa said many local guides have quit the industry.

“The number of Sherpas has gone down significantly. Now companies have to go look for Sherpas. In the past, Sherpas would have to go around looking for work,” he said.

“We want to go to climb because we know the environment there, but the family members don’t want to send. The mothers and wives don’t agree.”

Survivor Dawa Tashi, who began trekking when he was just 11, still guides climbers and returned to Everest in 2021.

He is preparing to guide six Americans up the 6,461-meter-tall central Mera peak.

“There were improvements after the disaster, but it is not enough,” he said, pointing to the $11,000 fee each foreigner pays to the government to climb Everest.

“The government... should make a fund to safeguard the manpower,” he said.

“The clients would also happily pay it, knowing that it will be used to take care of their team.” 

AFP