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In 2006, Radha Shrestha and her mother suffered severe third-degree burns when a gas cylinder exploded in their one-bedroom home. Their treatment began only on the third day when they were shifted to Sushma Koirala Memorial Hospital (SKMH) in Sankhu. Shrestha’s mother passed away and she was discharged after 39 days. 

Doctors attending to them said her mother’s death could have been prevented had she received immediate medical attention. Nearly two decades on, the situation remains much the same. Most hospitals in Nepal are still ill-equipped to handle burn cases, causing inevitable delays in case of emergencies. 

Dr Binod Karn, associate professor of plastic surgery at Nepalgunj Medical College, says the government hasn’t given much attention to burn care. A few NGOs and INGOs conduct awareness and training programs and give medical assistance, and that’s about it. 

Burns are the second most common injuries in Nepal. They are the most debilitating too. Treatment often lasts years, with victims requiring multiple surgeries. There are roughly 50,000 injuries and 21,000 deaths due to burns every year. Nepal is ranked number one in the list of countries with the highest rate of mortality by fire-related accidents.

Burn cases are mostly accidental and sometimes even homicidal and suicidal. In winter, most burn cases are 50-plus women who sit with their backs to the fire to keep themselves warm. In summer, electrical burns among metal workers are the most frequent cases. Suicidal and homicidal cases in Nepal are frequently related to dowry. Sometimes, women, frustrated by nagging and abuse, set themselves alight but usually, it’s the in-laws who burn them.

Most burn cases are referred to Kathmandu. Dr Karn says Nepalgunj Medical College can handle cases with 20 percent burn. Anything above that is either referred to Kirtipur Hospital or SKMH in the capital city. Many patients can’t afford the transport cost. Treatment is expensive. The survival rate, he says, is also low. A patient with a 20 to 30 percent burn has only a 20 to 30 percent chance of survival. 

“Burn treatment is complex and most hospitals aren’t equipped for it,” says Dr Karn. There should be a separate hospital or at least a dedicated burn unit in each hospital. The medical staff also needs burn-focused training. He says every province should have at least one proper burn unit or hospital. “We can save many lives if there were at least three burn units in Nepal to begin with—one for provinces one and two; one for three and four; and one for provinces five, six, and seven,” he says. 

Dr Santosh Bikram Bhandari, a burn, plastic, reconstructive, and cosmetic surgeon at SKMH, says the hospital handles over 100 burn cases every month. Though it has a separate burn ward and the government provides an allowance for free burn treatment, they are not enough to cater to all the needs of burn patients. 

Experts say most burn cases emanate from the lower socio-economic strata. The families from these strata cannot afford expensive surgeries that follow an incident. There have been cases of families taking loans or selling their meager assets to fund treatment—driving them deeper into poverty.  

Dr Bhandari says there is a lack of awareness on the management of burn injuries among the public as well as medical personnel. Poverty, he says, is the biggest strain. Many people simply don’t have access to alternatives to firewood. Saris catching fire while cooking is a common occurrence in rural areas. 

“Lack of knowledge on fire safety as well as first aid is appalling. People have wrong concepts about what to do after a burn injury and that often makes it worse,” says Dr Bhandari. 

The government remains oblivious to the sufferings of burn victims. After Nepali Congress leader Chandra Bhandari and his mother were injured in a gas cylinder explosion, burns became a much-discussed topic at ministerial meetings, says Dr Bhandari, with the authorities promising to give everything needed to establish a state-of-the-art burn care unit at SKMH. But the talks, he adds, soon fizzled out and nothing happened. 

Dr Prakash Budathoki, spokesperson for the Ministry of Health and Population, says the government’s priority is communicable diseases and other ailments that regularly claim more lives. But burn cases are also on their radar. They have separated a budget for the burn ward at Bir Hospital. The ministry is also working on a plan to run awareness programs and training in all seven provinces.

Dr Bhandari, however, insists that the government isn’t serious about burns. Despite repeated lobbying for better policies to ease the load of burn treatment, the government has done little. “It’s not difficult to have a separate burn treatment fund if the government is willing,” he says. 

Burns, in Nepal, are usually the result of gas explosions, petroleum-related incidents, and electrical malfunctions or accidents. The government can bring a policy where one rupee extra is charged per cylinder and fuel refill, and 0.1 percent of the total electrical bill is levied on each customer—and all of it goes to building a national burn treatment fund. “The government can easily make burn treatment accessible and save lives if it wants to,” says Dr Bhandari. 

Archana Ranjit, a nursing officer at Tribhuvan University Teaching Hospital, has years of experience working with burn patients. She agrees with Dr Bhandari and says government involvement is crucial in tackling burn cases as they require extensive care and facilities. “When patients are forced to move from one hospital to the next due to the lack of all necessary facilities under one roof, there is a delay in treatment, which is sometimes fatal. In the case of burn injuries, the earlier the victim gets treated, the better the chances of survival and healing after surgery,” says Ranjit. 

In today’s world, content creation involves more than just having a meaningful thing to say or a relevant issue to speak on. The formal, editing and designing aspect of the content is also important to creators. With more avenues for formal control, social media websites can expect to grow in user-base, and creative engagement with those websites might also take place for longer durations. 

Popular apps like Snapchat and Tiktok (recently banned in Nepal) are examples where editing and designing videos is a user-centric process. Such a process allows users to feel more ‘in charge’ of their content, and thus motivates them to create more. A service which withheld such creative control would not prove as satisfying to users, even if it allowed wide dissemination of their content. 

The uptake of such apps and services in the Nepali public can be attributed not only to the opportunity to raise voice but also to show one’s skills in communication and expression. Views, reactions and comments reward and recognize the ability to present in media in tandem with the words and ideas presented. In short, not just what you say but how you say it is more important than before. 

It is in part due to the disabling of ‘expression’ (how one says something) and not just curtailment of content (or ‘speech’—what one says) that there has been an outcry over the loss of freedoms since the popular TikTok app got banned by the Nepal government. Freedom of expression is concerned with more than just publishing of the content. It is concerned with how proactively one arrived at that content. Users want the government to see that doing an investigation and/or processing available data in depth are instances of the meaningful work behind an act of expression published online.

Synthetic media

A technology which has been prevalent since the advent of computers, but which has grown significantly more sophisticated today, is ‘synthetic media.’ It is about to make content creation even more exciting. Synthetic media is any media (in visual, audio and/or text format) that has been made using computers. Of late, Artificial Intelligence has been used to create synthetic media. For example, in text-based synthetic media services (ChatGPT is an example), a textually articulated idea can be transformed into a news article or essay that  the service produces by itself.

In the near future, creation of sophisticated synthetic media will be inexpensive and efficient. This bodes well for certain sections of Nepali society. Small-businesses can create advertisements for their products using synthetic media, thereby sidestepping a costly production process. In a different case, teachers can use synthetic media to present their ideas more clearly. For one, if preliminary ideas are acquired with relative ease due to the use of synthetic media in presenting, then the more technical and cutting-edge education can also be made part of the curriculum.

Extremely pertinently for Nepal’s case, synthetic media can help with public messaging on critical issues such as health and discrimination. Development organizations can create videos that are able to vividly represent the problems that they want to address. Effective communication of such societal problems would enable communities themselves to deliberate and enact solutions. 

In all, a positive picture

With the use of synthetic media, Nepal’s media landscape is likely to be both representative of a diversity of voices and rich with meaningful expression. But, the potential to create meaningful content needs to be harnessed more strongly in our case. At the very least, there is a need to look carefully to see whether a rural-urban gap is developing in the production of content. 

To gain a more organized outcome from a technological resource, the particular roles that it can play for particular groups needs to be explored clearly first. Thereafter, policies must be made with a clear goal of supporting positive outcomes for each of the groups using the technology.

Nepal, predominantly characterized by its hilly terrain, with hills covering 80.7 percent of the land, boasts numerous valleys and lakes, resembling natural view towers.

During my recent visit to Los Angeles, situated at the foothills of California, specifically Norwalk and Riverside, I marveled at the landscapes. Riverside, nestled at the base of hills, offers well-constructed trails that allow people to ascend and enjoy panoramic views of various cities. From atop one of these hills, I beheld the picturesque landscapes of Riverside, Moreno Valley, San Diego, Ontario, Los Angeles, and beyond. These cities, surrounded by hills on one side and the Pacific Ocean on the other, create a captivating spectacle.

Similarly, in Nepal, regions such as Kathmandu Valley, Pokhara, Surkhet, and Dang are embraced by hills, presenting a tremendous opportunity for the tourism industry. Nepal has the potential to develop trails providing access to these hills. By investing in road construction and cable cars, millions of visitors could be enticed to explore these elevated terrains. The breathtaking views of cities and the Himalayas from these natural view towers can be a significant attraction, much like the view towers of southern California. Constructing hiking trails on these hills can be achieved at a minimal cost, exemplified by the natural view towers in Pokhara, offering stunning vistas of the lake city.

However, the challenge lies in the lack of awareness and vision among Nepali rulers and decision-makers regarding how and where to allocate scarce resources. Random decision-making appears to be the norm, with little role for expert input. Political leaders often operate with self-interest, leading to decisions that benefit a select few. The absence of a coherent national agenda for development is evident, and questioning the actions of political parties seems futile.

Nepal can draw inspiration from iconic landmarks like the Hollywood Gate, which serves as a view tower for Los Angeles. Similarly, a hill in San Diego, housing an army camp, functions as a view tower offering stunning perspectives of the city and the Pacific Ocean.

Nepal is in a learning phase, acknowledging imperfections and seeking improvement. While mistakes are inevitable, the ability to learn from them is paramount. The prevailing egoism among rulers takes precedence over self-sacrifice, a fundamental quality for fostering a healthy and prosperous economy. Unfortunately, self-interest permeates Nepalese society, giving rise to nepotism, favoritism, and corruption. Policy decisions often legitimize these practices, hindering positive progress.

In contrast to constructing view towers, Nepal could invest in an eight-foot-wide road along the hills, facilitating trekking to hilltops. Redirecting resources from constructing towers to building footpaths around the hills of Kathmandu Valley could create a network of accessible viewpoints. Numerous spots could serve as small view towers, allowing people to appreciate the scenic beauty of the Kathmandu Valley hills. This strategic approach could offer a more sustainable and immersive experience for both locals and tourists.

The COP28 has concluded with an agreement that signals the beginning of the end of the fossil fuel era by laying the ground for a swift, just and equitable transition, underpinned by deep emissions cuts and scaled-up finance.  The global stocktake is considered the central outcome of the climate conference, as it contains every element that was under negotiation and can now be used by countries to develop stronger climate action plans due by 2025. Another key takeaway of the conference is parties reached a historic agreement on the operationalization of loss and damage fund and funding arrangements—the first time a substantive decision was adopted on the first day of the conference.  

In the COP28, Nepal effectively raised the issues of impact of climate change on Nepal’s Himalayan belt and other issues. As highlighted by Prime Minister Pushpa Kamal Dahal at the conference, Nepal is already bearing the brunt of adverse climatic impact though the country’s contribution to global emissions is negligible. To cope with climate change, Nepal has prepared several policy documents and research reports on the sectoral impacts of climate change. One of the key areas of focus is climate-proofing of infrastructure. 

For that, Nepal needs a huge amount of finance. Experts are of the view that Nepal must adapt its development pathway to a changing climate. The key areas which are being affected from global warming include agriculture and food security; forest and biodiversity; water resources and energy; rural and urban settlements; industry and transport; physical infrastructure; tourism and cultural heritage; health; and drinking water and sanitation.

Consider some recent climate-induced disasters and its impact on infrastructure. The Melamchi flood in 2021 washed away the entire human settlements and other public infrastructure such as bridges, school buildings, roads and health posts. 

There is no shortage of policy and documents but there is a serious gap of finance to fund the climate resilient infrastructure. Nepal has implemented a Green, Resilient, and inclusive Development (GRID) approach. The National Climate Change Policy 2019, 2022 Solid Water Management Policy, the 2022 Forest Regulation, and 2022 Land Use Regulation has offered some policy framework. Nepal’s Nationally Determined Contribution (NDC) plans for a prosperous, climate-resilient society with ambitious adaptation and mitigation targets. The National Adaptation Plan (NAP) includes a comprehensive set of programs until 2050 that aim to boost adaptive capacity and resilience. For the effective implementation of NAP, Nepal needs $47.4bn to implement priority programs up to 2050. Nepal will contribute $1.5bn and external support totaling $45.9bn is required.

The 2021 Long-Term Strategy (LTS) raised the ambition by setting a 2045 net-zero mitigation target. The effective implementation of Nepal’s climate ambitions is key, but significant challenges exist in terms of limited financial resources, a weak business environment, administrative inefficiencies, weak vertical and horizontal coordination among institutions, and low capacity, especially at local levels, the World Bank Report published in 2022 states. The 15th periodic plan of Nepal government states that a long-term strategic plan will be formulated for the implementation of the Paris Agreement on climate change and the nationally determined contribution roadmap will be modified and implemented as needed. The plan further states that infrastructure related to disaster risk management will be developed in order to adapt to climate change; and appropriate technologies to address the impacts of climate change on agriculture, water, and energy resources will be identified, protected, promoted, and disseminated.

The Country Climate and Development Report prepared by the World Bank in 2022 outlines four priority system transitions that are fundamental to addressing the risks that climate change poses to Nepal while also providing opportunities for improving the quality and sustainability of economic development. They are improving systemic resilience of rural landscapes including food, freshwater, and forest systems to boost adaptation, livelihoods, and food security; harnessing Nepal’s significant hydropower opportunities; managing urbanization and environmental quality to build resilience and improve health; and strengthening Nepal’s low-carbon, resilient connectivity—particularly roads—to improve the country’s growth and services.

According to the Ministry of Forest and Environment (2021) infrastructure, water, and tourism are among the key sectors sensitive to climate extremes. Besides, agriculture is also an economically exposed sector that is vulnerable to climate extremes. According to Vulnerability and Risk Assessment and Identifying Adaptation Options, a report prepared by the Ministry of Forest and Environment, transport infrastructure in Nepal are impacted by floods, mass wasting, debris flow, sedimentation, and rise in groundwater levels, rain, and windstorms.

Common problems include the collapse of industrial buildings and properties; increased exhaustion of infrastructure; silting of drains; increased instability of land through the weakening of riverbanks, hill toes or land subsidence; inundation; and submergence of infrastructures.  The report further says that related impacts consist of high costs for maintenance and repair; limited community access to jobs, schools, and hospitals; and large economic losses. Nepal is experiencing 0.056°C increase in temperature annually, whereas the precipitation patterns are changing with a shift in onset and withdrawal of monsoon and reduction in winter monsoon. As a party to the Paris Agreement, Nepal submitted its Nationally Determined Contribution which has envisioned post 2020 adaptation actions through National Adaptation Plans.

Nepal is one of the first countries to receive support from the Green Climate Fund to carry out a process to formulate and implement NAP. The GCF support NAP process, which has been delivered by the United Nations Environment Programme (UNEP), was formally launched on November 23, 2018 by the Minister for Forests and Environment. In light of the new federal structure and considering the alignment with the new National Climate Change Policy-2019, the NAP process is being formulated through a multi-stakeholder approach building on the experiences from National Adaptation Programme of Action and Local Adaptation Programme of Action and adopting gender responsive ‘Leave-no-one-behind’ principle. The NAP is considered as a primary instrument to translate new climate change policy into action.

Dr Maheshwor Dhakal, joint secretary, Ministry of Forest and Environment, says though it is crucial to address the climate crisis, most of the ministries are weak to take ownership of the policy and set the priorities. He adds that there is a need for capacity building in understanding climate change problems, fixing the priorities, making plans and implementing them. 

According to Dr Dharma Upreti, head of climate and resilience at Practical Action South  Asia Office, Nepal currently has a policy but no specific mechanism for monitoring and evaluation. This has direct impacts on critical infrastructure such as health posts, hospitals, schools and other infrastructure.  

Failure to develop climate and disaster proofing infrastructure could result in huge loss of lives and damage of properties. Therefore, climate risk needs to be integrated into the planning and implementation process which is becoming a component of fundamental human rights of the people. The World Bank report states that climate action at the provincial and local government levels is lacking. However, there are opportunities to strengthen local climate action, including by operationalizing coordination mechanisms, developing a climate capacity building plan for all levels of government, and establishing a system to track progress toward NDC and NAP targets, supported by enhanced data generation at all levels of government, the report says.

To manage climate risk and achieve an integrated path toward GRID, the report says, Nepal needs to prioritize three key enablers: scale up finance for resilience and low-carbon development; strengthen household and community resilience; and strengthen governance for climate change and DRM.  The report is of the view that Nepal’s climate adaptation needs are substantial, but investment requirements need to be further defined and prioritized. The government estimates financing needs through 2050 of nearly $50bn for its NAP, nearly $200bn for its LTS, and $36bn for its NDC until 2030, the report says. These initial assessments vastly exceed the country’s fiscal resources and domestic savings mobilization. As a result, major efforts are needed to prioritize public investments and improve the regulatory environment to attract private investment. Development finance can help catalyze these necessary changes, according to the report.

The health impact of climate change is alarming. A report prepared by the Ministry of Forest and Environment has found a clear link between climate change parameters and health outcomes.  According to Ram Chandra Khanal, program director of Nepal CRS company, climate change has increased the risk of maternal and infant mortality due to extreme weather events. 

Due to disasters like landslides and floods, he says both men and women will have limited access to contraception and this will lead to unintended pregnancy. Khanal adds that women also need to travel long distances for drinking water which in result had an effect on their reproductive health. 

From 2005 to 2018, the baseline status of climate-sensitive diseases in Nepal showed that cases of heart and respiratory diseases were on the rise. In Dhankuta, Kailali, Dhading, and Kathmandu, annual variations in the number of heart disease patients were positively correlated with maximum temperature. In the Tarai, an increase in mean temperature caused an increase in drought events and warm days, which led to a rise in respiratory diseases. In the Hill region, an increase in cold wave events led to an increase in respiratory disease cases. In Achham and Kalikot, rainfall and maximum temperature were both positively linked with water-borne diseases. 

For over 13 years, the frequency of drought occurrences was linked to the number of undernutrition cases per 100,000 people. In Kailali and Kanchanpur, the annual variations of vector-borne diseases and maximum temperature were positively related.  In Kapilvastu, the yearly sum of under nutrition patients was positively related to the yearly precipitation, while the under nutrition of those from Dolakha, Kanchanpur, Rolpa, and Sarlahi was positively related to the annual mean temperature.  The report findings suggest that climatic extreme events and hazards put the population and healthcare infrastructure at risk.

In order to ensure the health facilities for all, it is imperative to protect the physical infrastructure such as roads, highways, health posts. Robust and climate resilient infrastructure should be in place for the swift response in the natural disasters. 

In conclusion, it is not only about the big mega infrastructure that should be climate proofed. Government should come up with concrete policy and measures on how it can encourage or support the community and individual people on how they can build climate-proof infrastructure. 

The year 2022 is recorded as the hottest year on record and global warming is likely to go up which means even the current houses need to be rebuilt in a way of withstanding either extreme heat or extreme cold. And, it is obvious that absence of climate-proof measures seriously impacts the health of common people and it particularly hits the women, poor and vulnerable community. It is imperative that the Nepal government should prepare a national strategic plan to deal with these issues.