In Kathmandu's National Kidney Center, young Nepalese men returning from grueling jobs in the Middle East are increasingly battling chronic kidney disease caused by relentless heat and dehydration. Doctors link this silent epidemic to climate change and exploitative labor conditions in the Gulf. Simple preventive measures could avert many cases, yet protections remain inadequate.
The National Kidney Center in Kathmandu operates three dialysis sessions daily, treating up to 165 patients who must visit three times a week for life, according to Dr. Rishi Kumar Kafle, who founded the clinic 28 years ago. "Otherwise they will die," Kafle said. Among recent patients, over 20 percent of the 138 admitted in the past six months had worked in the Gulf, where more than 1 million Nepalese migrants toil alongside millions from Asia.
Surendra Tamang, 30, exemplifies the crisis. At 22, he moved to Qatar for six years of 12-hour shifts assembling scaffolding in heat reaching 50 degrees Celsius. In 2023, symptoms like shortness of breath and swollen hands led to a diagnosis of end-stage kidney failure; his employer sent him home. "I’m weak, I can’t do anything," Tamang said after a session in early October. Nepal's 7.5 percent migrant workforce, mostly men aged 20-29, faces exploitation including withheld wages, passports, and unsafe conditions.
Chronic kidney disease (CKD) affects 674 million worldwide, with 90 percent in low-income areas lacking care, per the World Health Organization. A 2022 study ties high temperatures and demanding labor to surging CKD, projected as the fifth leading cause of premature death by 2050. In Brazil, each 1 degree Celsius temperature rise boosted renal hospitalizations by nearly 1 percent from 2000-2015. New York data showed 2-3 percent more renal visits on extreme heat days. "When there are heat waves, our emergency rooms become busy taking care of people with kidney injury," said Dr. Meera Nair Harhay of Drexel University.
A forthcoming University of Gothenburg report on 404 Kathmandu patients found one-third of male dialysis cases linked to work in hot climates like Saudi Arabia, Qatar, and Dubai. These men start dialysis 17 years earlier on average. Heat stress causes dehydration, straining kidneys' fluid and waste regulation. Globally, 70 percent of workers face excessive heat yearly; the Gulf warms twice the global average.
Nurse Deepa Adhikari notes the toll: "The patients are financially, physically, and emotionally stressed." Cases like 41-year-old Buddhi Bahadur Kami, who painted tanks in Saudi Arabia for 11 years, and 46-year-old Kul Bahadur Dulal, a decade-long truck driver there, highlight the pattern. "I had made a lot of money, but it’s all gone to paying for treatment," Dulal said.
Dr. Barrak Alahmad of Harvard calls it a "double whammy of climate change" on migrants, who face disasters at home and heat abroad. Gulf oil wealth funds projects like stadiums, yet worker protections lag. Qatar's 2021 rules ban work above 32.1 degrees Celsius wet bulb temperature and mandate checks, but enforcement is weak. In Nicaragua, La Isla Network's interventions—more breaks, shade, hydration—cut kidney injuries by 70 percent and raised productivity 19 percent. "When a solution is sitting there that’s a big win-win," said founder Jason Glaser.
Kafle urges prevention: early screenings and Gulf-funded care. "Treatment is not the answer. Prevention is." Nepal's health budget pales against Saudi Arabia's, leaving clinics underfunded.