Three times each week, for four hours at a stretch, Sujan Thami is hooked up to a jumble of tubes in a hospital ward in Kathmandu, while his blood is drawn out to be cleaned. Thami has chronic kidney disease and the treatment now dictates his life. It is not what he envisaged when he set out to work overseas, a journey that took him first to Malaysia and then Qatar. “I had to go abroad to make a living, but it’s cost me my health,” says Thami, 39. “It’s not the life I hoped for.” Four years ago, Thami was labouring under the searing sun on a construction site in Doha. Minutes into his 12-hour shift, his clothes were already drenched. “If I squeezed them, the sweat would drip out,” he says. “It was so difficult to work in that extreme heat.” At one site, at least 100 workers were forced to share one water cooler, and so during their lunchbreak Thami and his co-workers would go down to the sea to cool off. “We used to drink the water. It was salty, but cool, so we felt refreshed,” he says. Nine months after arriving in Qatar, Thami began to get blurred vision, he would vomit in the morning and feel weak all day. The doctor’s diagnosis was swift. Thami’s kidneys were failing and he needed immediate dialysis. Every day, about 1,500 young Nepalis leave the country to take up work abroad, mostly in the Gulf and Malaysia. When they leave they are generally healthy, but medical professionals say growing numbers are returning with chronic kidney disease (CKD), an irreversible condition, and they point to one likely cause. “One factor highlighted again and again is heat. Prolonged exposure to heat and repeated dehydration,” says Rishi Kumar Kafle, the director of the National Kidney Center. Kafle added that eating too much meat, working long hours, taking large amounts of painkillers and drinking soft drinks instead of water – all common habits among migrant workers – may also be contributory factors. A forthcoming paper by researchers from Johns Hopkins University in the US, La Isla Network and the Nepal Development Society has found that 31% of patients receiving treatment at two kidney dialysis centres in Nepal were returnee migrant workers, the vast majority from the Gulf, Malaysia and India. Unlike the usual cases of CKD, which tends to affect older people, half were under 40. Over a third said they had experienced extreme workloads and two-thirds suffered from exhaustion. Jason Glaser, the director of La Isla Network, an occupational health research organisation, says: “When you see such a high prevalence of young labourers and with such a high risk associated with working abroad, it strongly suggests that the same heat stress-driven CKD we see in Mexico and Central America is affecting migrants working in the Gulf and south-east Asia.” The risks of working in the Gulf are increasing, according to new analysis of climate data, commissioned for a report released this week by the human rights group FairSquare. The analysis found that if global temperatures breach 1.5C above pre-industrial levels, which scientists have warned is likely in the next five years, most parts of the Gulf could experience about 160 days a year when the maximum daily temperature exceeds 40C (104F). With a global rise of 3C, the number of days would increase to 180. Barrak Alahmad, a research fellow at Harvard T H Chan School of Public Health, who analysed the data, says he is “deeply concerned and alarmed” by the findings. “Inevitably, this will translate into excess deaths. Those who are differentially exposed to extreme heat, like migrant workers, will bear a larger burden,” he says. The main strategy governments in the Gulf have adopted to minimise exposure to heat stress is to prohibit outdoor work during the hottest parts of the day in the summer months. The regulations vary between countries, with the most stringent measures imposed in Qatar, where outdoor work is banned between 10.30am to 3.30pm from June to mid-September. However, experts such as Alahmad say summer bans on midday work are simplistic. He advises a “more refined, risk-based approach”, taking into account environmental, workplace and personal factors. Furthermore, the bans effectively extend the working day for many workers, who must complete a morning shift, go back to their labour camp during the hottest part of the day, and then return to work for another shift in the late afternoon. Qatar’s regulations allow workers to stop working if they feel heat stress is a threat to their safety or health. However, FairSquare questions how realistic this is in practice, “given the unequal power relations between employees and employers in Qatar”. Sujan Thami’s experience bears that out. “We got a 15-minute break in the morning and an hour at lunch. I never got any breaks other than this because supervisors did not allow it,” he says. La Isla Network conducted research with farm workers in Central America, which indicates that the risks of working in intense heat could be significantly reduced by regular short, mandated breaks in the shade, to keep the body’s core temperature down, and easy access to drinking water. Rigorous enforcement of this routine by management would be necessary, the researchers advised. Where these measures were implemented among sugarcane cutters in Nicaragua, there was a 94% reduction in hospitalised acute kidney injury from heatstroke. In addition, Glaser says: “Productivity went up enormously because workers were getting the chance to rest and recharge.” For Raj Kumar Rai, 36, these findings have come too late. Like many, he had no idea of the risks of CKD while working for four years as a scaffolder in Qatar, Saudi Arabia and Dubai. Medical professionals in Nepal say this lack of awareness must be addressed. Rai has now lost his health and his livelihood. “This disease weakened me and my financial status,” he says. “I regret migrating but I went because I needed the money. I was hoping to improve my situation, but I ended up like this.” Although dialysis is free in Nepal, he must find about 20,000 rupees a month (£120) to pay for medicines. Kidney transplants are allowed only between family members but none are a match for Rai. Unable to work, he now relies on financial support from his brother – who is working in Qatar. “I’m worried,” says Rai. “Sometimes I wonder what will happen if he ends up like me.” This article was amended on 26 June 2023 to remove an embedded image that contained some personal information.