Tragedy for families of Nepalis working abroad

There she is, her image shown on a GPJ reporter's mobile phone, playing a game with friends and helping her mother, B.K.'s wife, in their home in Nepal.

B.K.'s unblinking eyes fill with tears as he takes them in.

He cannot speak. He cannot move his limbs. His food comes through a feeding tube and no one knows how much he understands about his surroundings. He has been in a vegetative state for years. But, seeing photos of his family, he cries.

B.K., 33, is one of 15 injured Nepalese migrant workers stuck in hospitals in Qatar, where they moved, some illegally, to work. Their families can't afford to bring them home. In some cases, they're too fragile to make the trip, and doctors say they'd be unlikely to get the care they need in Nepal.

HOW MANY MIGRANT WORKERS DIE IN QATAR?

There are ongoing disputes over the number of migrant workers who die on the job in Qatar. Human Rights Watch noted in a 2012 report that Qatar's Ministry of Labor told its investigators that only six workers had died in the previous three years, and all of those deaths were caused by falls.

The Nepalese government tracks some details about Nepalese workers in Qatar, including the cause of death for those who die there.
Of the total 3,272 deaths of all Nepalese migrant workers abroad between roughly 2008 and 2014, 858 were due to heart failure, according to one Nepalese government report. "Other or unidentified cause" was the reason listed for 736 deaths; 444 workers died due to traffic accidents; 600 died of natural causes; 47 people were murdered, and 332 died via suicide. The remaining 255 deaths are formally blamed on workplace accidents.

Human rights advocates, however, note that a large number of migrant workers who die due to heart failure are within an age range for which heart problems aren't usually common.

B.K. was injured in 2011 when he was hit by a car. Others, about half the injured people on record, suffered workplace injuries, some under conditions that human rights advocates say are among the most dangerous in the world. B.K. had been in Qatar for four years when the accident happened, and he was just weeks from returning home.

He suffered multiple traumatic brain injuries and, after brain surgery, was transferred to long-term care, according to his medical records.

And like many others, he was working illegally in Qatar when he was injured, so he's not eligible for the Nepal government's compensation or insurance coverage, which legal workers hold, to cover his medical costs. In limbo, he remains in the long-term recovery ward on the first floor of the government-run Rumailah Hospital in Doha, Qatar's capital.

Neither B.K.'s wife, Krishna Kumari B.K., nor his family knows who paid for his medical costs. Poor and thousands of miles away, their demands for information have gone unheard. GPJ's requests to speak with officials at Hamad Medical Corporation, the main public healthcare provider in Qatar and the entity that runs the hospital, were not answered.

Kumari B.K., speaking at her home in rural Nepal while her husband languished in Qatar, told GPJ that the situation is painful, but better than the alternative.

"I am haunted by the fear that my husband will die for the lack of treatment if I bring him back," Kumari B.K. says. "It's better to treat him in the hospital in Qatar."

B.K. was one of an estimated 400,000 Nepalese migrant workers in Qatar. In total, about 2.1 million Nepalese - more than 7 percent of Nepal's total population of about 28.5 million - work abroad.

The number of migrant workers who have died in Qatar's building boom, which includes construction for the 2022 FIFA World Cup stadium and other related structures, is widely debated. Some human rights advocates say that number is as high as 1,000 people per year, but the Qatari government frequently disputes reports that unsafe conditions at work sites in the country are sending migrant workers home in coffins at an unusually high rate.

Meanwhile, little is said about the workers who are injured in Qatar. Many Nepalese migrant workers in Qatar come from poor, rural families and it's not unusual for them to be owed several months' pay. (See our story here.) When seriously injured, migrant workers fall into a limbo and stay there, in some cases, for years.

By late 2015, there were 11 Nepalese migrant workers, including B.K., in comas or vegetative states at Rumailah Hospital, according to an investigation led by Ramesh Prasad Khanal, chief of protocol at Nepal's Ministry of Foreign Affairs and who leads the task force into migrant workers issues.

Six of those 11 workers were involved in road accidents, while the others were injured on the job or became unconscious due to working in high daytime temperatures. Those findings were based on Khanal's in-person investigation. People with knowledge of Qatar's road safety conditions confirm that traffic accidents are common there.

By May of this year, four more workers were in comas or needed long-term care in Qatar, says Nitesh Sapkota, second secretary of the Embassy of Nepal in Qatar.

Giri Prasad B.K. was among more than a dozen Nepalese migrant workers who are in comas or vegetative states at Rumailah Hospital in Qatar.

Injuries are common among migrant workers, says one supervisor who works for a hospital in the Hamad Medical Corporation. The supervisor, who specifically recalls B.K.'s case, asked to remain anonymous because she fears losing her job.

The heat alone can cause health issues, she says.

Summertime temperatures in countries around the Persian Gulf can top 110 degrees.

"Nepalese workers are working hard in unsafe conditions here in Qatar," the hospital supervisor says. "Because of the workers' low energy and weakness in summer season they become unconscious during their work time."

An increasing number of Nepalese workers died in Qatar every year between roughly 2009 and 2014, for a total of 739 workers, according to a Nepalese government report. One tally, reported by The Guardian newspaper, estimated a death toll of as many as 188 Nepalese workers between January and mid-November 2014.

Solid data on the number of migrant workers who are injured is hard to come by. Information about gravely injured Nepalese workers was uncovered only when Khanal and his task force pursued their investigation.

The Nepalese government gives money to families when a loved one is injured or killed abroad. The Migrant Workers' Welfare Fund, to which migrants are required to contribute before they go abroad, pays 300,000 rupees (about $2,800) to families of workers who die, says Ashis Kumar Bhandari, an officer at Nepal's Foreign Employment Promotion Board.

Compensation paid to injured workers and their families varies.

Between 2011 and April 2016, 4,425 families of migrant workers who lost their lives or suffered injuries in Qatar have received compensation from the fund, Bhandari says. It's not clear how many of those recipients were migrant workers themselves or the families of workers who died.

Most of those cases stem from workplace injuries and traffic accidents, Bhandari says.

For gravely injured workers like B.K., compensation, if it can be accessed at all, wouldn't begin to cover the costs of long-term care. One Nepalese man, Khub Lal Thakur, has been in a vegetative state at Rumailah Hospital since December 2006, when he was injured in a road accident, according to Khanal's task force report.

B.K. first went to Qatar in 2003 to work at a construction site to help pull his family out of debt. He came home after three years, then went back to Qatar in March 2007. He switched companies to get better pay in 2008, but that move made him an illegal worker, without an identity card or valid work permit. As such, he's not eligible for compensation from the Migrant Workers- Welfare Fund.

Even legal workers, when injured, find themselves mired in disputes over who should pay for their care.

Insurance policies held by workers strictly note the conditions in which they'll cover medical care, says Ramesh Badal, secretary of the General Federation of Nepalese Trade Unions, which advocates for migrant workers.

"The life insurance is not 24 hours," he says. "And most of the accidents seem to have taken place outside the workspace."

In B.K.'s case, the construction company for which he worked legally before switching jobs offered him some compensation, says Mani Ratna Sharma, Charge d'Affaires and Nepal's acting ambassador to Qatar. But his family could only access that money if B.K. returned to Nepal, he says.

Even years after his injury, the prospect of caring for B.K. is overwhelming for his wife, Kumari B.K. She says she barely manages to survive.

She was five months pregnant with their daughter, Lozan, now 9, when B.K. left for Qatar the second time. Their son, Loveson, 15, lives in Kathmandu with relatives, but Kumari B.K. and Lozan eke out a living by growing rice and maize and rearing livestock in Nepal's rural Baglung district.

The family contacted Bir Hospital in Kathmandu, one of the city's largest government-run hospitals, to inquire about the long-term care options for their brother. But the hospital was not willing to accept him after reading the medical report sent by Rumailah Hospital.

"The hospital said there were no vacant beds to keep coma patients," he says.

Dr. Swayam Prakash Pandit, who until recently was director at Bir Hospital, denies any knowledge of receiving documents relating to B.K. or a request to provide care at the hospital for him. Even so, Pandit confirms that Bir Hospital doesn't have space for patients needing long-term care.

Dipak Adhikari, deputy spokesperson of the Ministry of Foreign Affairs, says Pandit's concerns are valid. Hospital officials worry that they would be blamed if patients died after receiving treatment in Nepal, he says.

Still, Adhikari argues, Nepal could bring some injured workers home.

"If two coma patients are brought to Nepal every year, it would be manageable in government hospitals," Adhikari says.

Sharma, the acting ambassador, says the embassy has been trying to return migrant workers needing long-term care to Nepal since Khub Lal Thakur was injured in 2006.

Lal Bahadur Subedi's son died in Nepal shortly after he was brought home to Nepal from Qatar, where he had been in a vegetative state since 2009, when he was injured in a road accident.

"It is a matter of shame for us to not be able to take back Nepali workers," he says in a phone interview from Doha. "Relatives of patients do not want to take them back."

Some families who have brought injured workers home say they now regret the decision.

Bishnu Bahadur Subedi, 41, went into a coma in September 2009 after he was involved in a road accident in Qatar. He was in long-term care at Rumailah Hospital.

Subedi's family brought him back to Nepal in 2015.

The cost of treating him for four days at the Intensive Care Unit of Green City Hospital in Kathmandu was 250,000 rupees ($2,334), says Narayan Bahadur Subedi, the patient's younger brother.

"This is impossible for a worker-s family to bear," he says.

The family admitted Subedi into a long-term care facility and he died there on June 6, 2015.

Narayan Subedi warns other families against bringing their loved ones home. Families that do so don't receive any support, he says.

"The government promises that it will provide support for treatment but the burden will come under the family if the government neglects the patient after bringing him back," he says.

A Nepalese friend of B.K.'s who lives in Qatar visited him frequently at the hospital there. He told GPJ reporters, during their visit to the hospital in Qatar, that he worried for B.K.-s long-term health.

"We cannot communicate in our language here," says the friend, who asked that his name not be used for fear of reprisals from the Qatari government.

B.K. hasn't improved at all since he was injured, he says.

"But he has become thinner than before," the friend says. "He has lost hair. His skin has whitened because he has not been in the sun for five years."
Giri Prasad B.K. returned to Nepal in late August. Doctors at Vayodha Hospital in Kathmandu say he is in a permanent vegetative state.

B.K.'s family felt they had no options until, one day in August, Kumari B.K. received a call from Nepal's embassy in Qatar. The Qatari government offered her a gift of 48,000 riyals ($13,184), she says, in exchange for bringing him home. She's not certain, but she believes Hamad Medical Corporation paid for his trip.

B.K. returned to Nepal on August 26, after a near-decade-long absence. He is now at Vayodha Hospital in Kathmandu. His care there costs 3,000 rupees (about $28) per day, and Kumari B.K. says she'd spent 120,000 rupees (about $1,119) toward a deposit, medicine and other costs.

B.K. is in a permanent vegetative state, P. Bista, Vayodha Hospital's head of neurosurgery told GPJ in a written response to questions about B.K. He's receiving basic nursing care at the hospital, but the family could care for him at home if he also receives intermittent medical supervision.

Kumari B.K. says she was warned about her husband's condition, but the sight of him still shocked her.

"Sometimes I feel this injured person could not be my husband," she says. "But when I look deep into his eyes, then I feel, 'This is my husband.'"

Sagar Ghimire, GPJ, translated this article from Nepali.

This series was produced with support from the Pulitzer Center on Crisis Reporting as part of the Persephone Miel Fellowship program.