Occupational Medicine in Nepal: A Critical Need for Workers' Health and Safety

Nepal has a vast diaspora of migrant workers who contribute significantly to the country's economy. However, this economic reliance comes at a devastating cost: thousands of workers return home in coffins, victims of preventable occupational hazards. In June 2024, the International Organisation for Migration reported that migrant workers sent home USD 11 billion in remittances, accounting for 26 per cent of Nepal's GDP. Yet, this economic contribution is overshadowed by the grim reality of worker health and safety. In 2023, 1,346 Nepali migrant workers returned in coffins, and over 2 million work in the Gulf and Malaysia, with another 2.5 to 5 million estimated in India. The Sustainability Journal revealed that 46.4 per cent of Nepali migrant workers suffer from severe physical and mental health issues, including musculoskeletal pain, heart disease, hearing, vision, and skin problems.

Key Takeaways:

Nepal has a critical shortage of occupational medicine specialists, with less than 100 trained professionals in the entire country, leaving a significant gap in addressing work-related health issues.
In the absence of formally trained professionals, the burden has fallen on general and internal medicine physicians, who have admirably stepped up to manage occupational health concerns despite limited specialized training.
Occupational medicine can play a transformative role in reversing the neglect of workers' health and safety, particularly among migrant workers.
Pre-employment health assessments conducted by trained occupational physicians can help identify medical conditions that may make workers unfit for specific jobs.
A brief orientation provided by the assessing physician should be mandatory, educating each worker on potential hazards and prevention strategies specific to their roles.
Pre-departure, worker-specific preventive manuals would further enhance preparedness and reduce unintended risks.
The benefits of occupational medicine extend beyond individual health, including reducing absenteism, improving productivity, and saving on long-term healthcare costs.
Integrating occupational medicine domestically across sectors can improve employees' well-being and their performance.
Pre-employment health assessments made by occupational physicians have been shown to reduce sickness absence by 22 per cent and improve work ability by 38 per cent.
Physical and ergonomic initiatives are crucial, with fatigue increasing long-term sickness absence by 35 per cent.
Nepal has introduced stricter health checks for migrant workers, including comprehensive tests and regulated fees, to reduce preventable deaths.

Statistics:

Over 2,500 Nepalis migrate abroad for employment every day, mainly to the Middle East, Malaysia, and East Asian nations.
Over 2 million Nepalis work in the Gulf and Malaysia, with another 2.5 to 5 million estimated in India.
Migrant workers sent home USD 11 billion in remittances in June 2024, accounting for 26 per cent of Nepal's GDP.
1,346 Nepali migrant workers returned in coffins in 2023, many victims of preventable occupational hazards.
46.4 per cent of Nepali migrant workers suffer from severe physical and mental health issues, including musculoskeletal pain, heart disease, hearing, vision, and skin problems.
56 per cent of returnees experience anxiety disorder, 23 per cent depression, 6 per cent suicidal ideation or attempts, and 11 per cent chronic mental illness.
Nearly 31 per cent of kidney patients are migrant workers who are under 40 years of age.
Almost 10,000 Nepali workers have died abroad in the past decade, including over 2,100 in Qatar alone.

Sources:

International Organisation for Migration, June 2024
Sustainability Journal, September 2024
Journal of BPKIHS, August 2020
Scandinavian Journal of Work, Environment and Health, 2019
Journal of Occupational and Environmental Medicine, 2008
Health Affairs, 2010
Journal of Occupational and Environmental Medicine, 2019