Ramesh Yadav had never experienced extreme heat until he arrived in Saudi Arabia. He struggles to breathe, he says, while working under the scorching sun in the Jua’ymah gas processing plant in Ras Tanura. At work, he drinks a lot of water to keep hydrated.

Fear looms over him when he sees his coworkers collapsing due to heat exhaustion on the staggeringly hot and unstirring summer days. “Workers faint. Frequently. I get scared. But what can I do? I must continue work unless the company closes the site.”

He moved from Nepal to escape the vagaries of climate change, but now faces even more challenges due to the extreme heat in the Kingdom. Back home, his family could no longer solely rely on agriculture to make a living. Ramesh recalls, “I tilled the land. I planted paddy. I sprayed fertilizers and added compost. I spent a lot of money. But when it was time to flower, there was no rain. It all went dry. I went to the field and cried: ‘Hey God, what happened!’”

Studies on the relationship between climate change and migration are still in a preliminary phase. While poverty, political factors, and unemployment are recognized as primary drivers of labour migration among Nepalis, the International Organization for Migration (IOM) highlights “complex” and “subtle” connections between climate change and migration in South Asia. IOM  research says that extreme weather has contributed to rising migration “by increasing food insecurity and destroying arable and usable land” in the region.

The growing role of climate change in migrants’ decision-making process is evident in the experiences of workers MR interviewed. Ramesh recalled how the 2019 dry spell turned his arable fields arid, proliferated pests in the crops, and diminished rice production. In the succeeding years, torrential monsoon rains flooded a nearby river, sweeping away his mango trees and burying the fields with sands and pebbles. With the weather becoming more unpredictable in recent years, he says it was difficult for him to feed his small children and ageing parents. He felt compelled to find an alternative livelihood. In 2022, Ramesh headed to Saudi to work for one of the most profitable companies on earth: Aramco.

Ramesh is one of a rising number of Nepalis forced to seek work overseas after climate-change-induced disaster undercut their livelihood. He says, “in my hometown, we rely on rainwater to farm. But these days, it’s not certain when it will rain. When there is drought or too much rain, we cannot grow crops. And to survive, we have to go abroad.”

Across Nepal, agricultural lands are suffering widespread degradation. A 2021 report by Climate Action Network South Asia (CANSA) found that found that unpredictable weather patterns, including heavy rains, droughts, and fluctuating cold seasons, are crippling agricultural production in the southern plains and eastern mountains, and forcing people to migrate for survival. Decreased income due to lower crop yields or destroyed fields was the primary reason for migration in the areas studied.

Like other Nepali labour migrants driven by unemployment and poverty, these climate-driven migrant workers are vulnerable to exploitation and abuse at every stage of migration, from recruitment to employment.  Ironically, while climate change may be one factor in their decision to go abroad, many find themselves once again subject to the vagaries of extreme weather conditions in the Gulf.

Employed by the world’s largest oil exporter with over 2 trillion dollars market cap, Ramesh expected better working conditions. He works outside, both as a carpenter and an assistant surveyor, even in over 50°C temperature, with little chance to rest. Rivulets of sweat run down his body, he says, drenching clothing and filling safety boots in minutes. “The summer days are the worst to work. When I squeeze my vest, a mug of sweat comes out,” Ramesh says.

Approximately 3.5 million Nepalis are working abroad today. The GCC states and Malaysia are the major destination, hosting more than 80% of the total labour force. In the Gulf, where temperatures are projected to be increased by 5°C by the end of the century, 50% of the Nepali workers work in construction, agriculture, and food delivery.

And these outdoor workers in particular face grave risks.

Saudi laws prohibit outdoor work between 12 pm and 3 pm in the summer months. But workers say the three-hour ban is not fully in place, and even its full implementation wouldn’t be enough to ensure their safety. Ramesh works at Aramco’s gas plant through L&T Hydrocarbon, an India-headquartered contractor company. He says the company generally stops work when the temperature exceeds 55°C, but “it’s completely a company’s choice” and workers have no say in it. Workers fall to the ground even before temperatures hit 55°C or before and after summer ban hours, he says. When they collapse, they’re given a brief break and water, he says, then they need to get back to work.

Consultant cardiologist Professor Dr. Ratna Mani Gajurel says working in the temperature above 40°C is dangerous for the workers. “Even healthy people suffer from heat stress, heat stroke and heat exhaustion in such temperatures because our body’s normal mechanisms start to disintegrate” he says.

Ramesh has been lucky so far. He hasn’t collapsed, but he has often teetered on the brink of fainting. Working six days a week in blistering heat by the side of hazardous gasses, Ramesh worries about his own safety and future health. “Anything can happen anytime here, but I’m here to earn money.”

In Nepal, his family, who used to make a living from agriculture, now waits for Ramesh’s wages to keep up. In Ras Tanura, Ramesh works 11 hours a day, despite feeling exhausted and dizzy, to earn more than his basic SAR1200 monthly income. “It’s an unfair salary for the hard work I do” he says.

From mountains to desert

Sanjay Chhetri, another worker, who came to Saudi when his patch of land was washed away by the landslide in the mountains of midwestern Nepal, says he was cheated from the very beginning of his recruitment.

In Nepal, Sanjay says, he was told by the recruitment firm that he would be directly employed as an indoor electrician at Aramco facilities, earning SAR1700 monthly. But when he arrived in the Kingdom, he ended up with a labour supplier called Al-Rashid Trading & Contracting Company (RTCC) that assigned him to work outdoors, at a gas pipeline project being built from scratch. He works 10 hours a day, six days a week to earn 1000 riyals.

Sanjay’s job doesn’t have one specific task, instead he has to do whatever his senior workers ask him to do, including cleaning debris, lifting and passing equipment, and operating grinding machines. The demanding supervisors, Sanjay says, yell and scold him when he makes a mistake.

Taking a brief break on hot summer days is rare. “I go to the shade of [an] umbrella to feel better, but they immediately call me back to work,” says Sanjay. “Workers go inside the shuttle bus during one-hour lunch. That’s when we get rest in the whole shift.”

Work at 50°C is considered a “normal thing” in Saudi, Sanjay says, “I came here because I was compelled to do so. So, I can’t say no. I must be ready for everything. I feel like I’m a prisoner. Helpless.” Because of the heat and hard work, Sanjay says, he doesn’t like to eat the way he used to. His hair has been falling out rapidly ever since he started work.

Sanjay’s family in Nepal has no source of income other than his meagre salary. The family’s subsistence has shifted from agriculture to the remittance money he sends. But as a large chunk of his paltry salary goes toward paying the loan, the family is struggling to survive.

“We have been a farming family for generations. But now, my family depends on me to survive,” Sanjay says. “I had big hopes when I came. But everything happened the opposite. I couldn’t earn money as I expected and needed. My situation is like from the frying pan to the fire.”

Deadly delivery

Bishal Mandal delivers Hunger Station food on a motorcycle in Al Qassim to people’s doorsteps. In a single shift that might stretch to 15 hours, he says he rides roughly 300 kilometres.

He bleeds from his nose, and the skin of his hands is peeling. But, he says, “No matter how hot it is, or too cold, or it’s raining, I have to drive. I drove even in 48 degrees. Imagine how difficult it was for me.”

Bishal’s village in Nepal’s southeast is a flood-prone area  in the Madhesh province, the largest migrant-sending region in the country.  where the largest number of people have gone for foreign jobs. With hundreds of rivers down the mountains, intense rain causes flooding almost every year. As a consequence, many people from the national “granary” have left agriculture and sought foreign jobs.

In 2022, when the floods swept away his scrap of land, Bishal says, his family asked him to go to Saudi. They took a loan from the lenders and sent him to Saudi, paying over $1,500 to the recruitment firm.

In Saudi, first, he was kept in a room for a month without a job, hungry, he says, then he was sent for a delivery driver’s job for which he had to meet targets to secure monthly wages. Delivering 420 orders to people’s homes means 1800 riyals (US$480) in a month, he says, but he never met this target. Delivery below the targets resulted in an extremely low take-home pay.

Because of the difficult job and unbearable weather, he has fallen sick many times. In the past seven months, the 23-year-old had headaches almost every week, a cold a few times, and toothache and tonsillitis once. “I never fell sick back home; I never took painkillers,” Bishal says. “Here, now, I always keep medicine with me. I take medicine; otherwise, I cannot work.”

Muscle cramps, leg pains, and itchy eyes have become common for him. Rashes and profuse sweating are routine in summer. “I don’t want to work here, but I can’t quit either,” he says.“I have loans to pay; my family wants me to earn money.

Bishal had a motorcycle accident on the very first day of his work, but says his employer, Al Saeed General Contracting, refused to pay for medicine. He kept bleeding from his leg, and his friends gave him first aid. “The company doesn’t listen to us. They threaten us to send home if we make any complaints,” Bishal says. “We’re helpless.”

Lax response to work place injuries

For some workers, the grueling work in searing heat has had clear deleterious effects on their health.

Sanjiv Kumar Mandal worked as a construction labourer in the UAE and then in Qatar. In 2022, while working at the under-construction army camp in Abu Nakhla in Qatar he started to have difficulty urinating. For several weeks, he had to push hard to urinate. But after that, it became worse, he says, when he lost bladder control and struggled with incontinence. “I would cover it with a plastic bag to prevent urine falling down from the bed,” recalls Sanjiv, who used to sleep on the upper deck of a bunk bed in a workers’ camp.

The 23-year-old was not given days off from work. His company, Red Links Construction, forced him to work 12 hours a day outdoors, all while leaking urine in the plastic. “It used to be extremely hot, my body would be drenched in sweat,” says Sanjiv. “But the supervisors and foremen wouldn’t let me sit in the shade. They would say, ‘You came here to work, you must work.’”

Except for the one-hour lunch break, Sanjiv says, he would carry 300-400 sacks of 50-kg cement daily, mix them with concrete, making it ready for the masons. He would get thirsty, but he couldn’t drink cold water as the cooler was not functioning.

With no money in his pocket, he pleaded with his bosses to take him to the hospital, he says, but the company refused to pay for his medical care. He borrowed money from coworkers and did a medical check, where he was diagnosed with enlarged kidneys and grossly inflamed bladders. Then, instead of offering him treatment, Sanjiv says, the company asked him to go home but denied him a flight ticket. His friends intervened and put him on a flight home.

Now back in Nepal’s southern plains, Sanjiv is with his family, wandering through various clinics to find medical treatment. But already deep in debt of around US$6,000, he is not able to afford advanced medical care in the hospital. Sanjiv, who has heard the stories of workers’ kidney failure, fears he has met the same fate.

Nepali migrant workers’ kidney failure has been documented in dozens of news reports and research. Doctors have also seen the close connection of difficult work in extreme heat to chronic kidney diseases (CKD).

Dr Rishi Kumar Kafle, chief nephrologist at the National Kidney Center in Kathmandu, says, “working in extreme heat without drinking water certainly contributes to kidney-related problems, including its failure. I have found many such workers here.”

A few kilometres away from Sanjiv’s home in Nepal’s south, another returnee from Qatar is in even worse physical condition. While working on road construction, Upendra Pasman, 42, sustained a head injury, when he fell into a deep ditch in Qatar in February 2019. (While it is a relatively cooler season, health issues related to extreme dust persist.) Unnoticed by coworkers, he was trapped alone for more than 10 hours, says brother Ranjit Pasman; when coworkers found him, he was unconscious.

Wife Ram Sunair Devi says her husband journeyed to Qatar with a hope of earning money for their daughters’ wedding. “But see, what he ended up?” she says, sobbing. “We’re ruined”.

Upendra met his misfortune within four months of starting work for Al Wakeel Trading and Contracting, as he was struggling to pay off the loans that he took to go there. He used to dig ditches for 12 hours a day on a new highway to pocket 1000 riyals.

Upendra spent two years at the Rumailah Hospital, struggling to survive. In 2021, he was sent home on a stretcher. Now, he spends days in a wheelchair and nights lying in a bed, unable to speak and identify people.

(Un)natural death

Studies have shown the myriad consequences for health after exposure to extreme heat, ranging from heat rash and cramps to kidney failures. It can impair people’s judgment, leading to the risk of occupational injuries.

The link between extreme heat and long work hours and heart diseases, heart attacks, and strokes has also been documented. However, due to the lack of proper investigation, migrant workers’ deaths in the Gulf have remained a mystery for their families.

In the summer of 2021, Sabir Husen Ansari died after being admitted to the King Fahad Specialist Hospital in Buraidah, Saudi Arabia. His medical report states that he was provided care at the catheter lab but unresponsive to resuscitation. He was diagnosed with myocardial infarction (a type of heart attack).

Myocardial infarction, which is a common “cause of death” among Nepali migrant workers, can be triggered by exposure to extreme heat, according to studies and doctors. In 2017, a study published by the Journal of Exposure Science and Environmental Epidemiology found that exposure to extreme heat during summer months is associated with an increased risk of acute myocardial infarction.

Cardiologist Dr. Ratna Mani Gajurel says that outdoor workers in the Gulf are likely to have such attacks as they do strenuous work in the extreme heat and become easily dehydrated, which creates pressure on their heart and increases the risk of a heart attack.

The circumstances of Sabir’s death made the family suspect that the overwork and extreme temperature contributed to his death.

Sabir’s wife, Sakina Khatun, a mother of seven, says, “He had no medical issues. It was hard to believe that he had a heart attack.” But a few hours before complaining of chest pain, the 41-year-old was loading and unloading gypsum boards and plywood from the trucks under the sun, says Sakina, recalling what the co-workers told her on the phone. She says that he would work 10 hours, both in the non-air-conditioned store and outside.

Sabir’s employer, Arabian Decoration Est., didn’t explain his cause of death to the family, Sakina says. According to his colleagues, he was completely fine and as-usual on that day. Saudi’s Ministry of Interior says his death was natural.

Nearly 4,300 deaths of Nepali migrant workers have been reported as “natural” or due to heart attack and cardiac arrest in the past 14 years. The majority of these occurred in the Gulf, a region where temperatures have been rising twice as fast as the global average rate.

Concerned after hearing horror stories of workers’ deaths and treating ailing migrant workers in the hospital, Dr Ratna Mani says, “Workers need to be better protected in the warming climate.”

While better protections for migrant workers in GCC states are without doubt the need of the hour, the worsening weather conditions in Asia and the lack of commitment to prevent deterioration and to manage the impact is also a matter of concern. With limited employment opportunities in a majority agrarian economy such as Nepal, citizens will look outward for survival. The 2021 CANSA report estimated that, “Nepal will see about 1.3 million people being forced to migrate from their homes by 2050 due to climate disasters, i.e. over three times more than the figures for 2006-2020.”

Meanwhile, the GCC states’ response to intolerable summer heat are midday work breaks that fall woefully short of even minimal protection. As MR has previously reported, the bans are based on arbitrary calendar dates rather than on real daytime temperatures, leaving workers exposed to dangerous levels of heat stress. Moreover, heat stress is just one of the several environmental risks migrant workers are exposed to in the Gulf.

The region has some of the worst air quality in the world, with annual PM2.5 and PM10 concentration levels significantly exceeding the World Health Organization (WHO) air quality standard. These conditions increase migrant workers’ risk of illness and mortality, on days with poor air quality.

*The names of workers currently working in the GCC states have been changed to protect their identity.