Nepal: High-risk waste removal - Doctors of the World

Nepal: High-risk waste removal

 

Present in Nepal for thirty years, particularly through emergency responses to support a population regularly affected by violent earthquakes, Doctors of the World now assists a community whose work poses direct health risks: waste collectors.

 

The noise is deafening, the smell unbearable. At dawn, the sun already scorches the Kathmandu Valley, casting shadows of hundreds of figures hurrying across the towering mountains of trash at the landfill. Amid the relentless ballet of bulldozers and trucks unloading the capital’s waste, waste collectors, absorbed in their work, take significant risks to sort through the piles as quickly as possible, salvaging items they can sell for a small income.

Here, everyone fears accidents, but there are many other dangers, such as exposure to toxic or sharp materials,” explains Jano Dangol, a representative of the waste collectors’ association, Sasaja.

 

Lower Caste

 

In Nepal, the waste management system is complex, and this line of work is looked down upon by society. It falls to the most marginalized groups—whether Indian migrants or members of the so-called “lower castes,” also known as Dalits or Untouchables. These individuals, relegated to the lowest rung of the social hierarchy, are ignored, stigmatized, and often subjected to violence.

People don’t want to talk to us or even touch us,” says Madan Pandit, a door-to-door waste collector. Only a small minority are employed by municipalities and therefore receive some equipment. “The rest are informal workers living in extreme precarity, without any safety assurances or stable income,” laments Abdul Saboor Khan, General Coordinator of Doctors of the World in Nepal.

The hazards they face are numerous—cuts, infections, burns, poisoning, exposure to tetanus and transmissible diseases, as well as bone and muscle injuries. Yet access to healthcare is very limited. “Nepal has a fairly effective health insurance system to cover basic health needs,” Abdul Saboor explains, “but it is financially out of reach for the vast majority of these informal workers.” This major barrier is compounded by a lack of support tailored to their specific issues and, in some cases, reluctance from healthcare providers to treat them.

 

A New Healthcare Model 

 

In 2015, when the Nepali government introduced the concept of UHPCs (Urban Health Promotion Centers)—a new model of local healthcare centers designed to serve the most vulnerable and relieve the burden on the country’s seven hospitals—Doctors of the World saw a real opportunity for health inclusivity. However, due to a lack of resources or political will, little progress was made in the ensuing years.

In 2019, the organization took the initiative to establish the first UHPC in Kathmandu. “The idea was to demonstrate the effectiveness and relevance of such structures and provide the methodology to the government for replication across the country,” recalls Abdul Saboor. “But we insisted on one condition: that these centers include services tailored to the specific health needs of waste collectors.”

Today, while the center serves around 15,000 neighborhood residents, it has become especially crucial for informal waste collectors, who receive free care and follow-ups there. This personalized service has been a game-changer, says Aastha Lamichhane, a nurse at the UHPC: “They are aware of the immediate risks of their work but much less so of the indirect consequences. They are so busy surviving that healthcare often gets delayed, worsening their issues. We make an effort to be proactive in their follow-ups, such as systematically and freely vaccinating adults against diphtheria and tetanus.”

A permanent connection is maintained with local waste collectors’ associations, such as Sasaja, with whom Doctors of the World organizes field awareness activities.

 

A Successful Model 

 

The experiment has been a resounding success: the city of Kathmandu has taken over management of the UHPC and, convinced of its effectiveness, is now working to replicate the model in 32 neighborhoods across the capital.We continue to support the dissemination of these UHPCs, directly assisting five of them, while also aiding other paramedical health centers in Kathmandu and Nepalganj to bring care closer to waste collectors and other marginalized groups,” explains Abdul Saboor Khan.

 

A Fight for Rights 

 

In Nepalganj, a border town with India where Doctors of the World supported the opening of another UHPC, waste management has been the responsibility of the Balmiki caste for over 500 years.Originally, we weren’t allowed to take any other job. Even today, we still can’t eat or worship alongside people from other castes,” says Jagdish Balmiki, a member of the community.

Faced with this entrenched stigma, Doctors of the World works to help these communities organize and advocate for their rights in the long term. “Since we began uniting our voices, we feel more respected, which greatly aids negotiations to improve our working conditions,” says Jagdish Balmiki. In Kathmandu, the organization Sofai Yoddha has emerged to champion the cause of Nepali recyclers on international platforms.

For Abdul Saboor Khan, working hand in hand with the affected communities is a source of hope. “Nepal’s healthcare system is evolving sustainably. Challenges remain, but we are determined to overcome them.”

 

Photographs:

© Christophe Da Silva