New York, HRW – Nepali authorities should urgently bolster public health systems that struggled during a dengue fever outbreak in recent months, Human Rights Watch said today. Dengue and other mosquito-borne diseases are projected to becomemore widespread and severe in Nepal as a result of warming temperatures linked to climate change.

As of November 20, 2022, there had been over 52,557 reported dengue cases in Nepal since the beginning of the year, and 60 deaths attributed to the disease, according to government statistics. There have also been large outbreaks in neighboring regions of India. Dengue is a mosquito-borne virus that can cause a range of symptoms. In critical cases, people with dengue can require hospitalization and urgent platelet transfusion. According to the Intergovernmental Panel on Climate Change (IPCC), the world’s leading authority on climate science, “at high elevations in Nepal, there is high confidence that climate change has driven the expansion of vector-borne diseases that infect humans.”

“As temperatures are rising, the federal government and local governments need to work together to protect people from the growing threat posed by outbreaks of disease,” said Meenakshi Ganguly, South Asia director at Human Rights Watch. “The governments of countries that have been most responsible for the emissions that are driving climate change should support Nepali efforts, including with access to vaccines.”

Wealthy countries, whose greenhouse gas emissions are mainly responsible for climate change, should live up to their climate finance commitments and do more to support Nepal in responding to climate-based disasters, Human Rights Watch said.

According to the climate change panel, temperatures in the Himalayan region have increased faster than average global rates, and are projected to continue to rise faster than the global average. The panel also warned that “viruses like dengue, chikungunya, and Japanese encephalitis are emerging in Nepal in hilly and mountainous areas.”

When people who have been infected with dengue are infected a second time with a different variant, severe symptoms can develop, leading specialists to believe that Nepal is vulnerable to even more serious outbreaks in the near future. Doctors also fear that the Zika virus, which can cause infants to be born with microcephaly, could be spread in Nepal in the future by the same mosquitos.

Like dengue, Zika is transmitted predominantly through the bite of an infected Aedes aegypti mosquito. The virus can also be transmitted during pregnancy from a woman to her fetus and through unprotected sexual activity. Infected people are often asymptomatic or experience mild symptoms, such as fever, muscle and joint pain, conjunctivitis, and rash.

Zika is associated with serious neurological complications, particularly when a pregnant person becomes infected and the fetus is exposed in utero. In February 2016, the World Health Organization (WHO) declared a global public health emergency in response to Zika. The virus had been detected in 89 countries and territories around the world.

Nepal has had annual dengue outbreaks since 2006. The previous largest outbreak was in 2019, with almost 18,000 recorded cases. The 2022 outbreak, almost three times as large, also recorded cases over a longer season. Whereas in previous years dengue cases were found at lower altitudes, in 2022 dengue has spread to at least 76 of Nepal’s 77 districts, including high altitude regions.

“This is related to climate change, because the rate of warming is much greater at higher altitudes,” said Dr. Megnath Dhimal, a government public health expert and contributor to the IPCC report. “We need to enhance our infrastructure and capacity for future outbreaks. The most [climate]-vulnerable countries are developing countries like Nepal.”

Doctors Human Rights Watch interviewed said that the true number of infections is likely to be several times higher than the official statistics. Urban environments are particularly susceptible to dengue outbreaks, according to the WHO, because the mosquitoes carrying it breed “mostly in man-made containers including buckets, mud pots, discarded containers and used tyres, [and] storm water drains.” The mosquitos fly only around 500 meters in their lifetime, so are more dangerous in densely populated areas.

While available treatments are limited, the main method of controlling the disease is to eradicate the mosquitos that spread it, especially by targeting larvae in stagnant water. Although there have been public information campaigns and attempts to clean up potential breeding sites, there is criticism that the government’s response has been inadequate. “Basic things are taken very lightly,” said a senior government health official. “It can be done much better than this.”

The Nepal government developed a “National Adaptation Plan 2021-2050,” to respond to climate change, which envisages spending $500 million to strengthen preparedness and response to climate sensitive diseases by 2030. However, experts who spoke to Human Rights Watch said there was a lack of coordination and implementation between central government and local government units, and that international health agencies had not delivered effective support. “Ad hoc activities [to combat dengue] are implemented, but very few effective interventions are implemented,” said Dr. Keshab Deuba, an infectious disease epidemiologist. “Very few activities are happening at the community level that would control these cases.”

Meanwhile, doctors say that Nepal’s weak health infrastructure means there have been preventable deaths due to lack of timely access to healthcare. “The quality of the available health service is very poor, and in remote areas it is almost non-existent,” said Dr. Deuba. “We are not able to manage cases and prevent deaths.” In 2021, a major outbreak of Covid-19 stretched Nepal’s health service beyond breaking point.

In the capital, Kathmandu, where most dengue cases this year are concentrated, Nepal’s sole hospital specializing in tropical diseases has struggled with very high patient numbers.

Nepal’s Constitution guarantees the “right to seek basic health care services from the state” and that no one should “be deprived of emergency health care.” The government has an international legal obligationto respect, protect and fulfil the right to health. In 2021, in cases related to the Covid-19 pandemic, the Supreme Court issued several judgments requiring the government to uphold these rights, although the rulings appear to have had little impact.

Nepal held federal and provincial elections on November 20. The new federal, provincial, and local governments should work together to strengthen and coordinate systems to control and treat outbreaks.

“Without effective measures to remove breeding grounds, reduce transmission, and improve treatment, Nepal is likely to suffer much worse outbreaks of dengue and other mosquito-borne diseases as temperatures rise in the coming years,” Ganguly said. “If the government fails to act to protect people’s right to health, the health of millions of Nepalis may be placed in jeopardy.”