Nepal: Waste Collectors at Risk

For thirty years, Doctors of the World has been working in Nepal, providing emergency assistance to populations frequently affected by violent earthquakes. Today, our focus has shifted to supporting a community whose work poses a direct threat to their health: waste collectors.

The noise is deafening, and the stench is unbearable. By early morning, the sun already scorches Kathmandu Valley, casting shadows of hundreds of figures scrambling over towering heaps of rubbish at the landfill. Amid the constant activity of bulldozers and trucks unloading waste from the capital, waste collectors work relentlessly, risking everything to sort through the refuse swiftly. Along the way, they salvage items for resale, ensuring some semblance of an income.

“Everyone here fears accidents, but there are other dangers too—exposure to toxic or sharp materials,” says Jano Dangol, a representative of the Sasaja waste collectors’ association.

The Dangers of Waste Management in Nepal

In Nepal, waste management is a complicated and undervalued system. It relies on the labour of some of the most vulnerable people, including Indian migrants and members of lower castes—often referred to as Dalits or “Untouchables.” These individuals face societal neglect, stigma, and even violence, as the lowest rungs of the social ladder.

“People don’t want to speak to us or touch us,” explains Madan Pandit, a door-to-door waste collector. Only a small minority are formally employed by municipalities and provided with basic equipment. “All others are informal workers in extremely precarious conditions, with no safety assurances or stable income,” raises Abdul Saboor Khan, Doctors of the World’s country coordinator.

The dangers are numerous: cuts, infections, burns, poisoning, exposure to tetanus and transmissible diseases, as well as musculoskeletal trauma. Yet, access to healthcare is severely limited. “Nepal’s health insurance scheme is effective in covering basic health needs,” Abdul Saboor explains, “but it is way too expensive for the vast majority of informal collectors.” This challenge is compounded by a lack of healthcare support and, in some cases, reluctance from healthcare providers to treat them.

A New Healthcare Model in Nepal

In 2015, Nepal launched Urban Health Promotion Centres (UHPCs), designed to provide accessible care for the most vulnerable and remove some of the pressure on the country’s seven hospitals. Doctors of the World saw this as an opportunity to promote inclusive healthcare. However, due to a lack of political will or resources, progress stalled. In 2019, we opened the first UHPC in Kathmandu.

“Our aim was to demonstrate the effectiveness of this model and provide a blueprint for the government to replicate it across the country,” recalls Abdul Saboor. “But we insisted on one condition: these centres must include healthcare in response to the specific needs of waste collectors.“

Today, this centre serves approximately 15,000 residents in the neighbourhood and has become essential to informal collectors, offering free, specific care. Aastha Lamichhane, a nurse at the UHPC, notes, “People understand the immediate risks of their work but are less aware of indirect consequences. Because survival is their priority, we often see delayed treatment, which worsens their health conditions. We take a proactive approach to their care, including free vaccinations for diphtheria and tetanus.“

Thanks to partnerships with local associations like Sasaja, the centre maintains trusted relationships with the community, organising field awareness activities. The success of this model has prompted Kathmandu’s municipality to take over the centre’s management, with plans to replicate it in 32 districts of the capital. Doctors of the World continues to support the growth of UHPCs and provides direct aid to five of these centres, as well as other paramedical facilities in Kathmandu and Nepalganj.

The Fight for People’s Right to Healthcare in Nepalganj, Nepal

In Nepalganj, a border city where another UHPC has been established, the Balmiki caste has managed waste for over 500 years. “Originally, we were forbidden from taking any other job. Even now, we cannot eat or worship with people from other castes,” shares Jagdish Balmiki, a community member.

To combat this deeply rooted stigma, Doctors of the World helps these communities organise and advocate for their rights. “Since uniting our voices, we feel more respected, which has greatly helped negotiations to improve our working conditions,” says Jagdish. In Kathmandu, the organisation Sofai Yoddha pledged to represent Nepalese recyclers on international platforms.

Abdul Saboor believes working hand in hand with affected communities offers hope. “Nepal’s healthcare system is evolving slowly but surely. Challenges remain, but we will face them together.“

2,100 waste collectors supported
427 families enrolled in health insurance

Safer working conditions in Nepalganj, Nepal

Tarka Bahadur Thapa, Doctors of the World’s programme manager in Nepalganj, talks of another vulnerable group—farmers exposed to pesticides.

“In Nepalganj, where the use of pesticides is widespread, farmers are also endangered by their work.

Respiratory and dermatological problems, tetanus and diphtheria, as well as musculoskeletal issues are common. We were struck by their acute lack of access to healthcare, as their income is too low to afford health insurance.

We have therefore developed a comprehensive health response in collaboration with our local partner, Bee Group. This began with the distribution of protective equipment and awareness campaigns on reducing risks associated with pesticide use. We also support the transition of farmers to organic farming. And we provide assistance to three health centres to ensure free and specific care, including vaccinations and registration to health insurance schemes.

Today, a significant portion of the supported farmers has embraced organic farming. By improving their health, we are safeguarding the wellbeing of the entire population of Nepalganj.“

Photos © Christophe Da Silva