Nepal villagers duped into selling kidneys and told organ would regrow – now country faces new health crisis
In the foothills of the Himalayas, two men lift their shirts to reveal wide scars on their bodies.
Both aged in their 40s, they appear self-conscious – even embarrassed – but they want to share their story.
The men – called Kanchha and Ram – sold their kidneys, driven by financial desperation. Kanchha is still in pain and unable to work because of the side effects from the surgery.
“It’s impossible to count how many have done it,” he says. “Everywhere, this village, that village, so many people have sold their kidneys.”
Ram and Kanchha show their scars
The tell-tale scar, evidence of kidney removal
The village of Hokse in Nepal has a unique and exceptionally troubled history. It’s known as Kidney Valley because someone from almost every household has sold a kidney.
Brokers have been visiting the area for years, persuading people to part with an organ, despite the fact it’s illegal.
Locals have desperately tried to shake that infamy in recent years – they feel duped, damaged by it. Some say they were exploited, some claim they were even told their kidneys would regrow. Some have died as a result of what was done to their bodies.
And now tragically, poverty is fuelling another health crisis in Nepal – with kidneys again at the heart of it.
The village of Hokse in Nepal is known as Kidney Valley
Increasing numbers of Nepalis have chosen to work overseas in the Gulf States and Malaysia to make more money for their families back home. But that’s come with its own jeopardy.
Young, once healthy men are returning to Nepal in desperate need of a kidney transplant. Some scientists say it is the result of exposure to extreme heat and severe dehydration.
Suman showed Sky News his scar
A few years ago, Suman, 31, was so broken financially and emotionally, he considered ending his life. He felt he had “no option” but to travel to India to sell his kidney to a woman pretending to be his sister.
It was a physically excoriating process that has scarred him. He was paid £3,000.
“I felt weak and I lost consciousness,” he says. “When I woke up, it was really hurting. Now I can’t work and I try to tell anyone I can, not to sell their kidney.”
Suman speaks to Sky News
Sky News visited the village of Hokse
Suman was not certain if the doctor knew what he was doing but Indian law is clear – donors must be related and they must present the relevant paperwork.
Organ trafficking remains a major concern in India. It is fuelled by a wide gap in demand and supply.
The lack of donors has given rise to a black market, with doctors and hospitals among those exposed in investigations into “cash for kidney” rackets.
But it is not unique to India. Estimates suggest that globally, one in 10 transplanted organs have been trafficked.
“The agents made fake documents in Kathmandu, including Indian ID cards,” says Kanchha, who also sold his kidney in India.
“My kidney was given to a fake sister. I think the doctor in India knew I’d sold it.”
In Hokse, locals insist no-one sells their kidneys any more – but some are still taking extreme risks to try to improve their lives.
Jit Bahadur Gurung has dialysis three times a week
Jit Bahadur Gurung spent three years working in Saudi Arabia. Aged just 29, he’s had four hours of dialysis – which he does three times a week – at the National Kidney Center in Kathmandu.
He looks fatigued and withdrawn.
“I had to work in extreme heat – around 50 degrees,” he says. “We didn’t have time to have lunch, go to the toilet or drink water.”
Describing the moment he realised something was wrong, he says: “I was overheating. Suddenly I felt my feet swelling and I couldn’t walk. Then I was told my kidney had failed.”
People have been left needing dialysis
On the dialysis ward
Symptoms of kidney failure can often go unnoticed and by the time migrant workers arrive back in Nepal, it’s often too late.
Jit is desperate for a donor. But the donor has to be a relative and there aren’t enough positive matches.
Ishwor is 34 and still searching for his lifeline. He says he worked 16-hour days for seven years in Dubai.
“I was working long hours in high heat without sleep,” he says. “My body started to swell up like I’d been beaten.”
Symptoms of kidney failure can go unnoticed
Dr Pukar Shresth, a pioneering and renowned surgeon at the Human Organ Transplant Center in Nepal, used to only perform transplants on the elderly, but has recently seen young people with scarred and shrunken kidneys.
He noticed a pattern – young men going to work in high heat, with little water and returning with “completely failed kidneys”.
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“It is very grave because about one third of all transplants are these labour migrant workers who have come from abroad,” he says.
“This has caused a huge burden to our health resources health facility because they account for more than 30% of the total transplant number in our country.”
It’s a disproportionate figure since overseas workers represent around 14% of the Nepali population.
Dr Shrestha believes education is key – informing young men going overseas about the importance of having water, taking breaks and a good diet.
Young men are returning with damaged kidneys
A young doctor working alongside him is collecting critical data about where the men have been and what conditions they faced. The men have to have medical tests before they can travel abroad for work, which is why it’s believed they were in good health previously.
The fact is they feel forced to work in some of the world’s hottest places and they have very little agency.
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While some countries like Qatar have reduced the hours people can work in the sun, Nepalis’ suffering hasn’t stopped.
Multiple studies have shown the risk of extreme heat in the Gulf States has only escalated in recent years due to climate change.
And a recent report by Human Rights Watch stated migrant workers are mistreated and viewed as “disposable”.
The hospitals of Nepal are a stark warning shot about the dangers of a warming world and the heavy price being paid by those at the coalface.
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK
Additional reporting by Rachael Thorn, Asia producer
Donkey karts loaded with wrapped parcels of unknown goods weave around the large puddles of water left in the dried riverbed.
Young men quickly hop over laid bricks to bridge the puddles followed by women treading carefully with babies on their backs.
The Limpopo River’s seasonal dryness is a natural pathway for those moving into South Africa from Zimbabwe illegally.
A sandy narrow beach undisturbed by border patrols with crossers chatting peacefully under trees on both banks as men furiously load and unload smuggled goods on the roadside.
Against the anti-immigration rage and xenophobia boiling over in South Africa’s urban centres, the tranquillity and ease of the border jumping is astonishingly calm.
People crossing the dried Limpopo River to get from Zimbabwe to South Africa
“You can’t stop someone who is suffering. They have to find any means to come find food,” one man tells us anonymously as he crosses illegally.
At 55 years old, he remembers the 3,500-volt electric fence called the “snake of fire” installed here by the Apartheid regime.
Hundreds of women and children escaping conflict in the late 1980s and early 1990s were electrocuted.
A woman near the border
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Today, people fleeing drought and economic strife are smuggled across or walking through border blindspots like this one.
“Now, it’s easy,” he says. “There is no border authority here.”
He crosses regularly and always illegally. While he laughs at the lack of border agents, he says he has been stopped by soldiers in the past.
“They send us back but then the next day you try to come back and it is fine.”
Part of the dilapidated border fence that separates South Africa with Zimbabwe
We find a few soldiers on our way back to the main road. They look confused by our presence but unphased. It is hard to believe they are unaware of the streams of people and goods moving across the dried riverbed just a few hundred metres away.
Border ‘fence’ trampled and full of holes
We drive along the border fence to get to the official border post into Zimbabwe, Beitbridge.
“Fence” is a generous term for the knee-height barbed wire laid across 25 miles of South Africa’s northern edges in 2020. Some sections are completely trampled, and others are gaping with holes.
The concrete fortress is a drastic change to the soft, sandy riverbed. Queues dismantle and reassemble as eager crowds rush from one building to another as instructions change.
Zimbabweans can live, work and study in South Africa on a Zimbabwean exemption permit, but many like Precious, a mother-of-three, cannot even afford a passport.
Precious, a mother-of-three, staying at a shelter in Musina, South Africa
Shelters for women and trafficked children in Musina
When we meet her at a women’s shelter in the border town of Musina, she says she only has $30 (£23.90) to find work in South Africa and that a passport costs $50 (£39.80).
“My husband is disabled and can’t work or do anything. I’m the only one doing everything – school, food, everything. I’m the one who has to take care of the kids and that situation makes me come here to find something,” she says tearfully before breaking down.
The shelter next door is home to trafficked children that were rescued. Other shelters are full of men looking for work.
Musina is a stagnant sanctuary for Zimbabweans searching for a better life who become paralysed here – a sign of the declining state of Zimbabwe and the growing hostility deeper in South Africa.
In Johannesburg, South Africa’s economic centre, illegal immigrants are facing raids and deportations organised by the Ministry of Home Affairs at the behest of popular discontent.
The heavy-handed escalation in the interior sits in stark contrast to the lax border control.
Derelict buildings in Johannesburg where migrants are living
“I wonder how serious our government is about dealing with immigration,” says Nomzamo Zondo, human rights attorney and executive director of the Socio-Economic Rights Institute of South Africa (SERI), as we walk through Johannesburg’s derelict inner city.
“I think part of it is that the South Africa we want to build is one that wants to welcome its neighbours and doesn’t forget the people that welcomed us when we didn’t have a home – and that is why I think they are so poor at maintaining the borders.”
She adds: “But then the call has to be one that says once you are here, how do we make sure you are regularised here, that you know who you are, and contribute to the economy at this point in time.”
More makeshift migrant accommodation in Johannesburg
Climate of anti-migrant hate
In 1994 as South Africa’s first democratically elected president, Nelson Mandela ordered that all electric fences be taken down.
His dream for South Africa to become a pan-African haven for civilians of neighbouring countries that provided sanctuary for fighters in the anti-Apartheid movement was criticised by local constituents back then.
Sky correspondent Yousra Elbagir speaks to migrants inside a government van
Now in a climate of increasing anti-migrant hate, that vision is rejected outright.
“I think that is the highest level of sell-out. When South Africans were in exile, they were in camps and they were restricted to go to other parts of those countries,” says Bungani Thusi, a member of anti-immigrant movement Operation Dudula, at a protest in Soweto.
Anti-immigrant protesters from the group Operation Dudula at a demonstration in Soweto
He is wearing faux military fatigues and has the upright position of an officer heading into battle.
“Why do you allow foreigners to go all over South Africa and run businesses and make girlfriends?” he adds, with all the seriousness of protest.
“South Africans can’t even have their own girlfriends because the foreigners have taken over the girlfriend space.”
Hamas has approved a list of 34 Israeli hostages to be returned as part of a possible Gaza ceasefire deal, an official from the Palestinian group has claimed.
But the office of Israeli Prime Minister Benjamin Netanyahu has put out a statement saying Hamas had not provided a hostage list “up to this moment”.
Israel and Hamas argued on Sunday over the details of an agreement to halt fighting in the war-ravaged territory and bring captives home.
A renewed push is under way to reach a ceasefire in the 15-month war before US president-elect Donald Trump takes office on 20 January.
Liri Albag’s family said her ‘severe psychological distress is evident’. Pic: PA
It comes as Hamas released a video of a 19-year-old Israeli hostage in Gaza.
In an undated recording, Liri Albag – one of five female soldiers kidnapped in Hamas’s 7 October attack – speaks under duress and shares her anguish at having been held for 450 days.
Speaking in Hebrew, she calls for the Israeli government to secure her release and says: “Today is the beginning of a new year; the whole world is celebrating. Only we are entering a dark year, a year of loneliness.”
Ms Albag – who has turned 19 while being held hostage – adds that a fellow, unnamed captive has been injured. “We are living in an extremely terrifying nightmare,” she says.
The teenager’s family said the video has “torn our hearts to pieces”.
“This is not the daughter and sister we know. Her severe psychological distress is evident,” they said in a statement shared by the Hostages and Missing Families Forum.
The family has not given permission for the video of Ms Albag to be shared publicly but they have authorised the release of two photos.
Ms Albag’s loved ones are calling on the Israeli government and world leaders to use the current ceasefire talks to bring all remaining hostages back alive.
“It’s time to make decisions as if your own children were there,” they said.
Mr Netanyahu’s office said he has spoken Ms Albag’s parents and told them efforts to bring hostages home are “ongoing, including at this very moment”.
“Anyone who dares to harm our hostages will bear full responsibility for their actions,” he said.
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Timeline of events since October 7 attack
Gaza’s health system ‘on brink of collapse’
Liri Albag was taken from Nahal Oz. Pic: Bring Them Home Now
Roughly 250 people were taken hostage by Hamas on 7 October 2023 and as of December last year, 96 remained in the group’s custody.
Israel’s subsequent military offensive in Gaza has killed at least 45,805 Palestinians, according to the territory’s Hamas-run health ministry.
It said 88 people have been killed in the past 24 hours. At least 17 were killed in airstrikes on homes in Gaza City on Saturday.
Several children were among those who died, medics said.
Palestinians gather at the site of an Israeli strike on a house in Gaza City. Pic: Reuters
Hamas’s video of Ms Albag, and Israel’s airstrikes, come amid a fresh push for an agreement to end the conflict in Gaza.
Israeli representatives arrived in Doha, Qatar, on Friday to resume indirect ceasefire talks brokered by Qatari and Egyptian mediators.
Hamas has said it is committed to reaching an agreement, but it is unclear how close the two sides are.
Joe Biden, whose US presidency comes to an end in just over a fortnight, has urged Hamas to agree a deal – while Mr Trump has said there will “be hell to pay” in Gaza if the hostages are not released before his inauguration in January.
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