The new Balen Shah-led government recently unveiled its 100-point road map, which overlooked the ‘health and well-being’ of Nepali labour migrants. However, a press release from the Ministry of Labour and Social Security touched upon it. It includes initiatives on occupational health and safety, a minimum wage, as well as predeparture training. Still, there is a missed opportunity to make better use of existing data. Utilising data collected from aspiring migrant workers and initiating health screening for returnee migrants are vital to enable evidence-based policymaking and targeted educational interventions.

Each year, Nepal issues nearly half a million labour permits for foreign employment, with over 80 percent going to Gulf Cooperation Council (GCC) countries and Malaysia. The economic contribution of labour migration is undeniable. However, this comes at a high human cost. Many Nepali migrant workers in foreign employment face a wide range of risks to their safety and well-being. Over 13,000 migrant workers have died abroad since 2008. This figure likely underestimates the true scale, as it is based largely on compensation claims filed by families. Undocumented workers, arguably among the most vulnerable, remain invisible in official statistics.

Even less understood is the health status of those who return. Many come back with untreated injuries, chronic conditions such as diabetes and hypertension, kidney disease or mental health problems. Often, these issues are identified only after migrants are declared ‘medically unfit’ by host countries and sent home. In Malaysia and GCC countries, migrants must pass on arrival and periodic health screenings to retain their work permits. While these systems generate important health data about migrant workers, these findings are rarely shared with Nepal. Media reports suggest that thousands fail such screenings annually in Malaysia alone and are sent home to Nepal.

This lack of data-sharing by migrants’ host countries creates a major blind spot. Without comparing health data before departure and after return, it is difficult to determine whether illnesses are pre-existing, work-related or worsening abroad. Nepal lacks a systematic approach to capturing and analysing the health risks of its migrant population. This is not due to a lack of data. On the contrary, substantial information is collected through mandatory pre-departure screenings. More than 170 government-authorised medical centres conduct these tests, including screening for infectious diseases, kidney function, blood sugar levels and other key indicators. Yet these data remain largely underused.

With over 2,000 people leaving Nepal for foreign employment each day, pre-departure screenings offer a unique snapshot of the health profile of the country’s young workforce. Properly analysed, these data could reveal patterns of disease, identify at-risk populations and help improve pre-departure training content and health-promotion educational interventions for migrant workers, both abroad and upon their return. Nepal’s Foreign Employment Information Management System (FEIMS) was designed to track migrants across four stages: pre-recruitment, pre-departure, employment and on return. In practice, however, it falls short of its potential. Data are collected but rarely translated into actionable insights. There is limited understanding of how health conditions vary by age, gender, geography, occupation, or how they evolve.

The point of return presents another missed opportunity. In 2023-24, more than half a million migrant workers returned through Tribhuvan International Airport alone. Despite these numbers, there is no proper health screening system upon arrival. Reintegration programmes exist but are limited in scope and geography, covering only a fraction of local governments. More importantly, they tend to prioritise employment and livelihood over health and well-being.

Returnee migrants often carry a double burden: The physical toll of demanding work and the psychological stress of migration. Studies have documented rising rates of non-communicable diseases and mental health issues among returnees. Haemodialysis centres in Nepal, for instance, report a disproportionate number of kidney failure patients with a history of foreign employment.

Introducing health screening on return could enable early diagnosis and timely intervention. Basic medical examinations, mental health assessments and referrals to local health services could be integrated into existing systems. Even a pilot programme, sampling returnees across different days and arrival times, could generate valuable insights. Other countries, such as the Philippines, have adopted more comprehensive approaches to migrant reintegration, combining health services with psychosocial support and livelihood assistance. Thus, migration policy need not end at the airport.

Challenges, of course, remain. The new government has to consider both the shortage of trained personnel to manage and analyse health data, and weak collaboration between ministries themselves and academic institutions. A previous study has highlighted the absence of standardised indicators, fragmented record-keeping systems and insufficient investment in data infrastructure.

One immediate step would be to strengthen collaboration with academic institutions and researchers, many of whom are already engaged in migration and health studies. International organisations, including the World Health Organisation, International Labour Organisation, and International Organisation for Migration, could also provide technical support. More fundamentally, stronger coordination is needed between the Ministry of Labour, Employment and Social Security and the Ministry of Health and Population.

Political change is essential to shift Nepal’s migration policy from a focus on labour supply to a framework that prioritises the protection and well-being of migrant workers throughout the entire migration cycle.

Labour migration will continue to shape Nepal’s economy for years to come. Is the country willing to confront its hidden costs? By investing in data systems, institutional coordination and migrant-centred health policies, the newly elected forward-looking government should decide to turn good data into action and ensure that those who leave to work abroad do not return with preventable problems.

An integrated migrant health database, linked to the Foreign Employment Information Management System and accessible in anonymised format to researchers, would be a great way forward. By connecting pre-departure and post-return data, such a system could track health trends over time, identify high-risk groups and inform evidence-based policymaking.