Shut out of India

A

t 83, Harka Jung Subba suffers from severe knee pain and other age-related ailments, making it difficult for him to walk without support. For the last several years, he and his wife – who suffers from back pains – have been receiving treatment at a private multi-specialty hospital in Siliguri, an Indian city near the India-Nepal border in West Bengal.

But last December, the Shashtra Seema Bal (SSB), India’s Central Armed Police Force responsible for securing the borders with Nepal and Bhutan, stopped them from crossing into India from Nepal. According to the guards, the couple’s refugee cards issued by the Nepalese government were no longer enough for them to gain entry into India. 

After an hour or so of trying to convince the SSB to let them through, the octogenarian husband and wife, along with the relative who had accompanied them, finally gave up and began to plan the more than 50-km trip back to the Beldangi Refugee Camp in eastern Nepal.

Months later, the strict border regulations remain in place. Just last June, Kamala Khadka, who is from the same refugee camp as the Subba couple, was also denied entry by SSB personnel at the Mechi border.

“I suffer from gland tuberculosis, a rare form of the disease that affects the lymph nodes,” says the 54-year-old widow, who lives with her son at the Beldangi camp for refugees from Bhutan. “I wanted to seek treatment in Assam, India. However, I was stopped at the border because my refugee ID card was deemed invalid for entry into India.” 

For sure, these incidents show the lack of confidence in Nepal’s healthcare system even among refugees, as well as the challenges they face whenever policies shift.  At the same time, however, they are reminders of the plight of the remaining Bhutanese refugees in Nepal, a significant number of whom are now elderly or suffer serious medical afflictions that need specialized treatment, or both.

Tens of thousands of Bhutanese of Nepali descent had either fled or were forced out of Bhutan in the late 1980s and early 1990s as a result of a series of revamps in citizenship rules there. Called “Lhotshampas (people of the south)” in Bhutan, the refugees first landed in neighboring India before they were transported en masse to Nepal.

At the peak of the crisis, there were more than 100,000 Bhutanese who registered as refugees in Nepal, and who were distributed across seven camps set up by the U.N. Refugee Agency (UNHCR) and the Nepalese government. 

Most of these refugees have since been resettled in other countries, among them the United States, Australia, New Zealand, Canada, and Norway. Only two of the original camps for the Bhutanese refugees remain open in Nepal. Of the 7,000 or so Lhotshampas still in Nepal, though, about 30 percent are over the age of 60. 

A recent report by the U.S.-based Global Press Journal meanwhile offers another estimate of 6,300 people living in the two camps, and quotes Bhutan Refugee Resettlement Management Committee Secretary Sanchahang Subba as saying that 1,000 of that number are “disabled, infirm, or elderly.”

In search of reliable medical care

Refugees at the camps say that before the border rules changed, several of the camp residents had been heading to India for treatment of serious medical conditions, especially those involving the heart, brain, spine, and kidneys. But most of the refugees have relied on the health services of their host country.

“Not everyone goes to India for treatment,” says Beldangi camp resident Krishnabir Tamang, recalling how he rushed his wife to a local hospital in Damak, the Nepali city nearest to them, after she suffered a stroke during the pandemic. “For sudden ailments or first aid, we mostly visit local hospitals, where we are covered under the Nepal’s National Health Insurance Program (NHIP) provided by the UNHCR meant for Nepali citizens.” 

While UNHCR closed its local office catering to the Lhotshampas in Nepal in 2020, it worked with the Nepalese government for the refugees to continue having health insurance. Under the program, every refugee family must pay an annual insurance premium of NPR 3,500 (approximately US$26) for a family of up to five members.

This covers up to NPR 100,000 (approximately US$750) per year for in-patient treatments, surgeries, and hospitalizations. Tamang adds that UNHCR covers the entire premium for camp residents over 65 years old, as well as for individuals with mental and physical disabilities.

Yet while the insurance covers essential healthcare services, the annual limit of NPR 100,000 may be inadequate for serious conditions. Treatment for these may not be immediately available in Nepal as well. In cases where they are, the refugees themselves may not be confident enough in their efficacy to put down substantial amounts, which in all likelihood they received from relatives living overseas.

“My son is young and doesn’t have a job,” Khadka says. “With me unwell most of the time, we can barely make ends meet. I had to rely on financial help from my brothers, who were resettled in America through the UNHCR’s third-country resettlement program.”

Her apparent wariness toward the Nepali healthcare system is common not only to refugees like her. Many Nepalis themselves would rather not be treated in their public health institutions if they can help it, despite what observers say have been vast improvements in the country’s health services. 

One 2023 study, for instance, noted that Nepali rural dwellers would rather avail themselves of the outreach services offered by a private health institution than those in public health centers. A June 2024 report published by Republica has also pointed out that many of Nepal’s public officials seek medical treatment overseas even for common ailments even though “there is no need to go abroad for medical treatment anymore.”

“The leaders do not have faith in the healthcare system that they have established themselves,” Dr. Jageshwar Gautam, former spokesperson of the Ministry of Health and Population, said in the report.

But he also told Republika that quality infrastructure and adequate equipment remain missing in many of the country’s health institutions. Said Gautam: “The hospitals which have competent doctors lack in equipment and quick medical services.”

But he also told Republica that quality infrastructure and adequate equipment remain missing in many of the country’s health institutions. Said Gautam: “The hospitals which have competent doctors lack in equipment and quick medical services.”

Sources: World Health Organization, U.N. Refugee Agency, National Library of Medicine, Migration Data Portal

South Asia’s medical go-to

The popular perception in Nepal seems to be that India’s healthcare system does not have similar problems. Part of that perception may be due to India’s successful campaign to project itself as a medical tourism hotspot, which in turn has benefited from New Delhi’s support of neighboring countries through various medical initiatives.

These have included medical diplomacy, which has India providing healthcare services and supplies during emergencies, as well as bilateral agreements that enhance cooperation in medical training and technology exchange. 

Moreover, India has invested in quality specialized healthcare facilities for critical care. It is particularly recognized for its expertise in specialized fields such as organ transplants, cardiology, and oncology among its South Asian neighbors.

Official Indian government data show that between 2018 and 2021, Nepal ranked 19th among India’s top 20 source countries of medical tourists; in 2018 alone, India hosted more than 11,400 Nepalis who were seeking medical treatment. Nepal’s Bhutanese refugees who visited India for medical care during that period were most probably excluded from that count.

But now they are certain not to appear in any such tally as they can no longer officially access the services of India’s health institutions. This is even though in over three decades, they had few problems using just their refugee identity cards to visit relatives in India’s North Bengal and Sikkim. Some Lhotshampas have also married Indian citizens and maintain strong cultural and familial ties with India.

Former Beldangi camp secretary D.B. Subba remarks, “It’s shocking that … we refugees are no longer allowed to enter India, especially when we were once transported from Jaigaon – an Indian border town near Bhutan – to Nepal by Indian buses in the early 1990s.”

It’s not really clear why there has been a sudden tightening of India-Nepal border rules when it comes to the Bhutanese refugees. One Beldangi camp resident thinks it may be due to last year’s fake refugee scandal, in which some of Nepal’s top political leaders were among the scammers.

In exchange for huge sums, hundreds of Nepali citizens were supposed to be passed off as Bhutanese refugees so that they could take relocation slots meant for the Lhotshampas in the United States. 

SSB officials in Siliguri, however, say that border patrols have intensified since a Pakistani woman illegally entered India through Nepal to be with her partner, an Indian national, in May last year. 

The woman had crossed into India from Nepal via the Rupaidha border in Uttar Pradesh. The SSB faced flak over the incident, which led to the suspension of a head constable who had inspected the bus the woman had been on. SSB Deputy Commandant Ravi Bhushan says that thereafter, “only individuals with valid visas or, in the case of Nepali citizens, national identity cards, are permitted to enter India through the Nepalese borders.”

But the Bhutanese refugees have only their refugee cards, which remain valid for just five years and have to be renewed each time these expire. Complicating matters is the fact that India is not a signatory to the 1951 United Nations Convention Relating to the Status of Refugees or its 1967 Protocol, meaning it does not recognize refugee status granted by the UNHCR.

Consequently, India lacks a specific legal framework for refugee protection, resulting in varying approaches based on nationality and circumstances. In a recent case involving a Rohingya refugee, the Indian government stated that UNHCR-granted refugee status is irrelevant if the individual does not possess valid travel documents.

Back at the Beldangi camp, Kamala Khadka looks upset, now fully aware that the new border rules may be in place for much longer than she had hoped. She realizes that she needs to quickly find an alternative treatment option in Nepal. 

Weeks after she was turned away by the SSB last June, Khadka had tried to enter India via a different route. She decided to cross the Mechi River by bike, in an area where there is no police patrol. 

“It was a desperate moment that led me to cross the river,” she confesses. Yet while she was successful, she is no longer willing to take any more risk. ◉