A bizarre arithmetic is working for the Nepalese workers, who are going abroad. Their number has more than doubled but so has the number of those returning home dead. Since the country began promoting foreign labor in recent years, the number of Nepalese workers went up from about 220,000 in 2008 to about 500,000 in 2015. Yet the number of deaths among those workers has risen much faster in the same period.
One out of every 2,500 workers died in 2008 while last year, one out of every 500 died, according to data released by Nepal’s ministry of labor and employment. In total, over 5,000 workers from this small country have died working abroad since 2008— more than the number of US troops killed in the Iraq War. The causes, in many cases, have been mysterious. Natural death, heart attack or cardiac arrest are listed for nearly half the deaths. Most families are notified that their loved ones simply went to bed and never woke up. But now medical researchers say these deaths fit a familiar pattern. Every decade or so, dozens, or even hundreds, of seemingly healthy Asian men working abroad in poor conditions start dying in their sleep. It happened in the US in the late 1970s, in Singapore about a decade later and more recently in China. The suspected killer even has a name: Sudden Unexplained Nocturnal Death Syndrome.
Conditions vary by country and employer, but it is not uncommon for workers to find themselves living a dozen or more to a room, sleeping stacked on three-tiered bunks, working 10 to 15 hours a day, seven days a week, for years. If they are lucky — and some are — they can send home wads of cash, about USD300 a month. Often, however, they are tricked or cheated out of their earnings. About 10 percent of Nepal’s 28 million residents are working abroad. They send back more than USD6 billion a year, amounting to about 30 percent of the country’s annual revenues. Only Tajikistan and Kyrgyzstan are more dependent on foreign earnings.
Nepal is one of the poorest and least developed countries in the world. Authorities in Nepal say their citizens seem to die abroad more frequently than their equally vulnerable Sri Lankan, Bangladeshi and Indonesian co-workers, but the explanation for the increased mortality has been unclear. “It is usually sleeping disease,” said Kumud Khanal, vice president of the Nepal association of foreign employment agencies, which represents more than 400 registered agents. The deaths are reported as a hypertension problem, he said, like a heart attack or cardiac arrest. But medical experts say there have been waves of deaths before among young, rural southeast Asian men working abroad in physically stressful conditions.
“I see some familiar patterns here with Nepalese workers,” said Patrick Clarkin at the University of Massachusetts, Boston, who has written about the biology and epidemiology of Sudden Unexplained Nocturnal Death Syndrome (SUNDS). “I suspect that there would be little harm in improving the diets and living conditions of these young men. Something as simple as a multivitamin could go a long way and with little risk.” In rural Nepal, people eat rice, lentils and seasonal greens around 10 in the morning, and a second meal of rice and vegetables in the evening. Milk and eggs are almost always available as well. Abroad, Nepalese workers also eat twice a day, but the mainstay is whole meal flour flatbread with some pickle or a vegetable, and once a day they have chicken. Some in the Middle East say they drink less water at their desert worksites than they do in mountainous Nepal because, as Hindus, they are not allowed to use Muslim bathrooms and are forced to wait for hours.
No one has identified a single cause of SUNDS fatalities — medical journal discussions include genetics, infection and nutritional deficiencies. And in Nepal, the syndrome is not being considered at this point. Instead, Nepali authorities say it could be stress, even homesickness, brought on by physically demanding jobs in extremely hot climates. Utah State University professor Ron Munger studied heart scans of migrant workers in Thailand after hundreds died in their sleep in Singapore, where they had gone for jobs. He said the Nepalese deaths “sound like exactly the same thing.” While the causes of the previous strings of deaths have never been pinpointed, the number of fatalities dropped in each case when workplace safety, housing and diet were improved.