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News of suicides are always followed by reports on how mental health issues need to be addressed—the insinuation being suicide can be prevented if there is greater awareness about anxiety, depression and other such conditions and efforts are made to normalize afflictions of the mind as any other health issue. While that might be true, it’s also important to acknowledge and work on the stressors—violence, discrimination, societal isolation, financial difficulties et al.—that give rise to mental health problems, eventually driving some people to suicide. 

According to Nepal Police data, 7,141 people committed suicide in the fiscal 2020/21, up from 6,252 the year before. The common rationale behind the spike was that the Covid-19 pandemic and the subsequent lockdowns took a toll on people’s mental wellbeing. But experts say the pandemic only exacerbated what has been a major public health issue for years. Suicide, they say, has been one of the leading causes of death in Nepal, with the number of cases increasing every year. What’s more, they agree that because of under-reporting the actual number of cases is way higher than what the police records show. 

According to Manju Khatiwada, undersecretary, National Human Rights Commission (NHRC), suicide has thus far been a neglected problem in Nepal. Often, families of those who commit suicide don’t want to accept that maybe there was an underlying problem. It’s something our society wants to brush under the carpet. There aren’t any national level plans and policies to make people aware of mental health issues or to tackle the various factors that ultimately lead to them. 

“It’s high time we studied why people commit suicide and address the root cause. So far, it’s been cloaked as a mental health problem and we all know what a taboo that is in our society,” says Khatiwada. Suicide, she adds, often stems from a violation of basic human rights. In an apathetic society like ours with rigid norms, each individual’s right to a dignified life is perhaps the last thing that occurs to most people while passing sweeping judgements and discriminating others on the basis of caste, sex, economic background and such. Society neither realizes nor cares about the implications of its actions on people’s mental health. 

Under the surface

Parbati Shrestha, project coordinator at Transcultural Psychosocial Organization Nepal, says not much has been done to prevent suicides. The cases that we hear of are just the tip of the iceberg, she says. Scratch the surface and you will find many social issues that could potentially be suicide triggers. She, like Khatiwada, sees the need to discuss and investigate every suicide and find out the cause behind it. Only when there are more discussions on the factors behind suicides will we be able to inch our way into solving the massive problem it is. 

“When someone commits suicide, we blame the person and condemn the act. We don’t look into our actions to see if we had, knowingly or unknowingly, created an unfavorable environment for them,” says Shrestha, adding many societal issues need to be fixed in order to provide people healthy coping mechanisms and be in a place to seek help, if needed. 

The problem, experts agree, is also that people can’t openly talk about what’s bothering them like, for instance, money woes, marital discord, abuse, postpartum depression, etc. They fear being blamed and stigmatized—for not doing enough or being strong enough. The problem festers, says Shrestha, and sometimes people see no way out other than ending their lives.

Nepal Police spokesperson Basanta Bahadur Kunwar says suicide cases shot up during the pandemic. Though the pandemic undoubtedly impacted people’s mental health, we can’t also ignore that there were many hidden issues that surfaced and snowballed out of people’s control. 

Blue Diamond Society’s president and rights activist Pinky Gurung agrees. The LGBTIQA+ community has always struggled with multiple issues—from identity crisis to lack of familial and/or partner support. The pandemic only made them glaringly obvious. That coupled with isolation and uncertainty was traumatic. Many people in the community, who already felt lonely and disrespected, couldn’t bear it any more. So far, 24 people of the community have committed suicide and around 15 more have attempted it since the start of the pandemic. 

“People in our community aren’t loved, even by their own families, and this leads to a lot of hurt. You need to understand that the sadness they feel is a reaction to that pain. Talking to someone or seeking medical help is the last thing on their mind. Frankly though, even if they opened up, does anyone even care?” asks Gurung. 

Studies show the LGBTIQA+ community is at higher risk of anxiety, depression, post-traumatic stress disorder, and even suicide. The triggers of these mental health conditions are often lack of family support and dignity as well as the ostracization and humiliation they face on a daily basis. Despite the findings of the studies, Gurung laments that nothing has been done to tackle the issue. There is also zero awareness about mental health in the LGBTIQA+ community, she says. 

Integrated approach

Of late, there have been some positive developments though. This is the first time the United Nations has made recommendations to Nepal to look into the causes of suicide and work on them, says undersecretary Khatiwada. It has recommended that Nepal develop and implement a national strategy and action plan for the prevention of suicide. It has also highlighted the need for reliable data collection and addressing the social stigma associated with suicide.

Psychiatrist Dr Kanchan Dahal says suicide is complex, that there isn’t one particular reason why people get to the point where death seems like the only answer. But, often, the driving force is some sort of trauma and a sense of helplessness that comes with it. Also, for some, it might be an impulsive decision, while for others, it could be something that was planned for a while. The fact remains that behind every decision lies immense stress—be it physical, mental, or emotional—and the inability to see a way out of it. 

“The pandemic affected people in ways we can’t even begin to imagine. Some were locked at home with their violent spouses. People were worried about whether they would be able to feed their families. There was also the stress of not knowing how to cope with this discomfiting experience,” says Dr Dahal. Many in the low- and middle-income groups lost their jobs, and families that relied on remittance were left without any income. There was extreme food scarcity. What was unfortunate here, adds Dr Dahal, is that the government didn’t come to people’s aid. He believes many suicides could have been prevented had the government come up with a proper plan to mitigate the sufferings of daily-wage earners. 

“I’m not negating the fact that people might need help to deal with mental health illnesses and that there should be more awareness and acceptance of these issues. But we also need to focus on the circumstances that lead to mental health problems,” says Dr Dahal. Another thing that’s needed is sensitive reporting of suicide, without divulging details of cases. Otherwise, suicide is glorified, giving people ideas. 

All said and done, a major responsibility also lies on families to be attuned to the changing moods and behavioral patterns of their loved ones. We also have to emphasize the importance of healthy relationships and learning to control our emotions. NHRC’s Khatiwada stresses the need to change our socialization process, which, in its current state, she adds, is the root of all evil.  

“We need to understand the importance of the live-and-let-live principle, whereby no one is subject to unwarranted stress and shame. Suicide prevention needs an integrated approach where many larger factors must be considered but a good place to start is definitely in our homes,” says Khatiwada. The need of the hour, she adds, is a non-hostile environment where people feel accepted and valued. 

The unanimous opinion was that we live in a very stressful environment that isn’t conducive to growth and sound mental state. The conversation around mental health, though crucial, can only help so much when the social ills that lead to them are sidelined. 

As the country continues to witness sporadic Covid-19 outbreaks, China has been loath to reopen its borders. Mistrust in China of other countries and their vaccination status is sky-high. Authorities are terrified of allowing foreigners—who have been projected in Chinese media as rather blasé about Covid-19 precautions—and incurring public backlash. 

During the start of the Covid-19 outbreak in China in December 2019, some Nepali students enrolled at Chinese universities were already in Nepal for their winter vacation. Others soon followed suit. But nearly 19 months after leaving China over 3,000 students are still stuck in Nepal with neither Nepali nor Chinese officials informing them when they can return.

Despite the emergence of various variants of coronavirus, people around the world have resumed their daily lives by following health protocols. Even international students, who had returned home from different countries, went back to their colleges and universities months ago. But that’s not the case with Chinese university students.

On July 1, ApEx had reported on the dire situation of Nepali students stuck at home. Unfortunately, their status remains much the same. An international online protest, #TakeUsBackToChina, which was gaining traction at the time, also seems to have fizzled out.

International students have sent open letters to President Xi Jinping to be allowed back in, and signed a petition seeking UN intervention. In Nepal, too, students have repeatedly written to resident Chinese Ambassador Hou Yanqi, to no avail.

In 2010, President Xi had labeled international students as “forever, a friend of China”. But his government’s action suggests otherwise, these stranded students say.

Rista Deuba, a second-year engineering student and a Chinese Scholarship Council beneficiary, fears her scholarship may be at risk. The scholarship has to be periodically renewed, but it has been 19 months since the last renewal. “In these months, I had to renew it twice but I couldn’t. I don’t know if my scholarship is still valid.” Meanwhile, she has had to pay full fees; council officers assure her she will get the money back after the renewal.

Most Nepali students chose China because of its scholarship scheme. With that on the line, they are in a dilemma. Deuba’s colleague Monica Pudasaini says she would have studied in Nepal on full payment if she knew she had to pay to attend Chinese university. Courses in China are more expensive than they are in Nepal and those who were not expecting to pay are short of options.

Deuba, for instance, is more concerned about likely future payments instead of her classes. She wants Nepali officials to facilitate conversation with their Chinese counterparts. “I am only asking for assurance that my scholarship is secure, nothing else,” she adds. Without the scholarship, she is in no position to pay her full dues.

During the lockdown, some students have already completed their theoretical courses, while others still struggle online. Many need to return to their college soon to complete their internships and practical exams, which can’t be done online. 

When Chinese authorities did not heed the students’ call, they had urged the Nepal government to send a diplomatic note to China to allow the students to return. Medical students of the 2015 and 2016 batches have announced protests, asking to be allowed to complete their internships in Nepal. 

After waiting for 18 months, the 2014 batch was permitted to take up internships at Nepali hospitals, but others are still left in the lurch. 

Dipendra Rauniyar, a member of the 2016 batch, says, “We are just asking for an internship, and even on that score, our government doesn’t care.” For over three weeks he and his batch-mates have been picketing the Nepal Medical Council. “Students from other countries are also stuck, but their respective governments have been helping them in every possible way,” he shares.

Similarly, another campaigner for the return of Nepali students, Roman Khatiwada, is disappointed at the Nepal government’s lack of initiative to secure their future. “Our seniors lost 18 months, almost 75 percent of their internship time. We don’t want to do that,” he adds. “Here we are ready to help the government meet the country’s health needs and yet they don’t listen to us.”

Even though China was the virus epicenter, its officials soon had the contagion under control. And as migrant workers were allowed into China from select countries, the hopes of students were raised as well. But then only South Korean students were allowed back into China. 

Khatiwada’s Chinese friends inform him that the decision to bring back Koreans students was not a popular one in China, as they are now being accused of importing new Covid-19 cases. “All this means that I am not very hopeful of a swift return,” he adds.

Li Bin, the Vice-Minister of the National Health Commission in China, has noted in a press brief that Guangzhou, Shenzhen, and Ruili have witnessed local clusters of the imported Delta variant. “The recent waves have reminded us we cannot relax our pandemic control measures,” he said. Chinese border restrictions could thus be in place for at least another year.

Rishab Mahato, another medical student, says, “This is a time of summer break at Chinese universities and it would thus have been the best time for us to return.” If students could enter China before September, they would have time for quarantine too before the start of their classes.

But Rauniyar reckons that is unlikely and suspects the earliest students like him could be recalled would be after the 2022 Winter Olympics in Beijing, which is in February. He was also told by his Chinese contacts that foreign students would be allowed back in when all the Chinese got their jabs.

Meanwhile, Greshes Acharya of the China University of Geosciences doesn’t know how to renew his visa. “It’s been a year since our visa expired, but there is no way to renew it,” he rues. Visa renewals require an offer letter from the university, which has been impossible to get. 

Although Deuba has some hope, Pudasaini doesn’t think she will ever return to China and is already exploring alternatives in Nepal.

(The names of some students have been changed at their request)

Nepal Police data shows that, in 2020/21, 4,222 men and 2,919 women committed suicide, of whom 764 were minors. The actual figure is at least three times higher, say experts ApEx spoke to. Suicide cases are under-reported, with families and communities trying to hide the fact, mostly because of the societal stigma attached to mental health. We would rather blame the victim for a ‘lapse of judgement’ rather than admit there might have been something simmering beneath the surface. It’s the social equivalent of the ostrich effect.

According to a survey conducted by Danphe Care, a Kathmandu-based healthcare management company, 60 to 70 percent youths suffer from some sort of mental health issue, be it panic attacks, anxiety or depression. Out of this, 10 percent were found to be suicidal. Kabin Maleku, program coordinator at Danphe Care, says a lot of people who suffered from mental health problems after the 2015 earthquakes experienced a relapse during the Covid-19 pandemic and the subsequent lockdowns.

While addressing mental health issues is paramount, we also need to pay attention to the various factors that promote anxiety, depression, and other mental health conditions. The focus also needs to be on creating a favorable environment that curbs mental health disorders.

Padma Prasad Ghimire, chairman of SAMMAN, a non-profit, says issues like poverty, violence, and discrimination have to be tackled on a national level to control and stop suicide. Suicide, he says, has deep social and economic implications and Nepal government must treat it as an emergency. Currently, priority isn’t given to suicide prevention. Alongside normalizing mental health as any other physiological issue, Ghimire sees the necessity of being on problem-solving mode. By that, he means tackling issues that could potentially trigger mental health problems.

The consensus among experts was that a lot of work needs to be done in different areas to even come close to understanding what drives people to commit suicide. That is where we must start, says undersecretary of National Human Rights Commission, Manju Khatiwada, adding, suicide is treated as a social malady and people would rather not discuss it. That in itself, she says, hints at deep-rooted problems that must be urgently addressed.

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A French national banned from entering Nepal after overstaying his visa has been found to have entered Nepal using a different passport three months after his deportation.

Fitte-Rey Herve Laurent first came to Nepal on 20 July 2019. The 49-year-old from Oursbelille in southern France then overstayed his visa for 525 days before going to the Department of Immigration to get it renewed.

Department officials arrested Laurent for overstaying and he was deported on 22 December 2020, with a ban on entry into Nepal for a year. Officials don't know what activities the French man was involved in during his stay in Nepal.

Laurent returned to Nepal on 15 March 2021, this time with a new passport. This time also, he did not get his visa renewed but overstayed for over three months. Again, no one knows what he was up to during the period.

On June 20, he visited the immigration department to get his visa renewed. "We arrested him (Laurent) immediately and are investigating his engagements in Nepal during the period he overstayed his visa," says investigating officer Baikuntha Regmi.

Officials immediately identified Laurent and registered a case against him at the Kathmandu District Court. This time the court banned him from entering Nepal for two years. Department officials believe Laurent is not back in France.

Laurent claims to be an expert in beekeeping and came to Nepal to work in agriculture, officials say. But then foreigners on tourist visas can't be involved in any business.

Although the Ministry of Home Affairs has formed a body to monitor the activities of foreigners in Nepal, its work hasn't been effective. Foreigners have time and again been found to have breached the terms of their visa by indulging in various illegal activities.

That a banned person could enter Nepal with a different passport has also raised questions about the screening system used at the Tribhuvan International Airport. There might be others who are using the loophole in the system to come to Nepal even if they are banned from doing so, officials argue.