The Sunday Times November 14, 2021 19
NEWS
Dying for the World Cup
Louise Callaghan Kathmandu, Nepal Bangladesh and Sri Lanka have died in
Qatar, which claims that the mortality rate
is within the expected range for the size
and demographics of the population.
Yet among the young men who sur-
vived and built the stadiums where
England hope to play chronic kidney dis-
ease has taken a terrible toll.
“They go abroad seeking some job, and
when they return they know they have
acquired the disease,” said Dr Niraj
Dhakal, a doctor at the department of
nephrology and transplant medicine at
Tribhuvan University teaching hospital in
Kathmandu, who treated Magar.
He was the lead author of a study that
found an increased incidence of chronic
kidney disease (CKD) among migrant
workers in Nepal.
In a separate survey of 38 nephrologists
in Nepal by a team of researchers at
Bournemouth University led by Dr Nirmal
Aryal, the vast majority of respondents
thought that returnee migrant workers
were at higher risk of kidney-related prob-
lems than the general Nepali population.
Working long hours in hot weather
with little water, no rest and few bathroom
breaks, as well as a lack of medical check-
ups, can create a high risk environment
for its development, doctors said.
If enough time passes without medical
intervention, the damage can become
irreversible — and CKD is diagnosed. At
this stage, dialysis or transplant are the
only options.
Dr Prateek Singh, an internal medicine
resident at the Institute of Medicine in
Kathmandu, who wrote his doctoral the-
sis on the subject, said: “Most of the
migrants were working 12, 14, 15 hours a
day and not consuming much water —
hardly one or two litres per day — and, in
such adverse working conditions, I think
that was the leading factor.”
Dr Rishi Kumar, chief consultant neph-
rologist at the Nepal Kidney Centre, said
that he had seen the issue of kidney dis-
ease grow over the past three to five years.
During a visit to Nepal last month, we
spoke to more than a dozen men who had
been diagnosed with CKD after returning
from Qatar. Almost all were under 40
years old, below the usual age bracket
where the disease develops. Like all
migrant workers travelling abroad from
Nepal, they had passed health checks,
including urine tests that analyse kidney
function, before leaving the country.
These men left healthy, and returned
with a life-threatening disease — their lives
destroyed, unable to work.
Til Bahadur, 38, developed CKD after
four years working as a truck driver in
Qatar for around $450 (£335) a month. At
times he was forced to work 18-hour shifts
without water or lavatory breaks. Since
he had to ask to use the lavatory, he
heavily restricted the amount of water
he consumed.
After he came back to Nepal in 2017, he
had a kidney transplant.
“The temperature was very hot, and we
don’t have time to take rest, drink water,
and sometimes go to the restroom also,”
he said. “Private companies in Qatar don’t
follow the Qatar government rules.”
Sanjay Kumar Yadav, 34, worked
12-hour days as a security guard in Qatar,
became sick and returned to Nepal for
treatment, where his doctor told him that
his kidney failure was most likely caused
by his work. His kidney function was nor-
mal in tests he had before leaving Nepal,
he said. “My kidney failed in Qatar.”
Professor Vivekanand Jha, chair of
global kidney health at Imperial College
London, said that there were strong links
between working in extreme heat and
chronic kidney disease. Migrants from
India, Bangladesh, Pakistan and Nepal
who travelled to work in the Gulf have all
been affected in a similar way, he said.
“They went with the hope that they
would improve the lot of their families.
But found themselves in an even more
hopeless situation, where they now face
this large healthcare burden,” he said.
Magar was only 22 when he left his
home village in eastern Nepal for Qatar,
hoping to make some desperately needed
money for his family. While still in college,
he had eloped with his girlfriend Rozina,
whose parents opposed their marriage
because she was from a higher caste.
They were madly in love, and soon had a
son, Arav.
“I felt like he was a good man,” Rozina
said. “He was respectful not just to me but
to all women.”
But Magar found that he couldn’t make
enough money to support his family.When he found the job in Qatar, it seemed
like a godsend.
It wasn’t long after arriving that he real-
ised he had instead landed in a nightmare.
Stuffed into a room with six others, with
one semi-functional fan, he was shuttled
back and forth to the stadium with barely
any time to eat or sleep. The heat was con-
stant and pounding. Sometimes, his nose
would start bleeding and he would vomit.
“If there was some shade in the stadium
we used to try to hide in there but we’d
have to come back, we couldn’t stay in
there,” Magar said.
Complaints about conditions to his
supervisor brought only threats.
“Sometimes I would work until the
next morning, and if I said I didn’t want to
work, they’d say I would be cut off from
my payments,” he said. “The manager
used to threaten me if I wouldn’t work
long hours, he’d say, ‘I’ll cut your over-
time work’, but he never paid me over-
time anyway.”
After a year and a half, Magar managed
to get home, though he was paid a fraction
of the amount written in his contract. But
he had lost weight and started vomiting
and running fevers regularly.
His family took him to hospital. Tests
showed irreparable damage to his kid-
neys. Dhakal, his doctor, told him he
would have to go on dialysis three times a
week for the rest of his life. At 23, he was
the first member of his family known to
have had kidney problems.Dr Dibya Singh Shah, a nephrologist
and dean of the Institute of Medicine at
Tribhuvan University, said large-scale
studies were urgently needed to assess the
cause of the high rate of CKD among
migrants who had worked in the Gulf.
Though his health has been destroyed,
Magar bears no anger or ill-feeling
towards the fans who will go to watch
World Cup matches, or the footballers
who are participating. Rather, he said, he
will be proud to tell his friends that he had
worked on one of the stadiums.
“The great players will be playing
there, so I’ll be proud to say that this is the
stadium I helped construct,” he said.
His wife, though, has a different view.
“Workers should be treated like human
beings and not as slaves,” Rozina said. “If
the conditions had been different, he
wouldn’t have suffered so much.”We confronted several prominent play-
ers and former players, including Beck-
ham, with evidence about the prevalence
of kidney damage among workers in
Qatar. None of them chose to comment.
The Football Association said: “We
believe that there is evidence of substan-
tial progress being made by Qatar in rela-
tion to workers’ rights. However, we rec-
ognise there is still more to be done. Our
view remains that change is best achieved
by working collaboratively with others so
that we can continue to ask the right ques-
tions, while always being mindful that we
have our own challenges in this country.”
The Supreme Committee for Delivery
and Legacy (SC) in Qatar, which oversees
the construction and infrastructure for
the tournament, said: “The committee
has no record of any worker on al-Thu-
mama stadium suffering from CKD or any
other kidney diseases. To date, 39,
medical exams have been provided to
those engaged on SC projects since 2017.
“The SC mandates a stringent and con-
tractually binding heat mitigation strat-
egy across its projects to ensure workers
are protected in Qatar’s summer months.
“The SC is dedicated to ensuring the
health, dignity, safety and security of
every worker on SC projects, and our
record on this matter is acknowledged in
Qatar and the international community.”
@LouiseElisabet
Additional reporting: Maham Javaid,
Yogesh Nepal, Bishal KarkiExtreme heat and ‘torturous’ conditions have left migrant workers building football stadiums in Qatar with chronic kidney disease
I
n the strip-lit glare of the hospital
ward in Kathmandu, Amit Ali Magar
winced in pain as a nurse eased a
needle into his arm. It was his sec-
ond kidney dialysis session of the
week, and afterwards he’d be so
exhausted that he’d barely be able to
stand. He had a high risk of having a
heart attack or stroke, and an aver-
age life expectancy of between five
and ten years. He is 24.
Magar did not envisage this future for
himself when he left home for the Gulf
three years ago. He was promised £220 a
month and reasonable working condi-
tions to work as a carpenter at the al-Thu-
mama football stadium, one of the eight
new and refurbished arenas being built
for the World Cup in Qatar next year.
Like the former England captain David
Beckham, who recently agreed a deal
worth a reported £150 million to be a
global ambassador for the tournament,
he saw in the absolute monarchy’s ambi-
tious plans an opportunity to improve
his circumstances.
But the reality proved very different for
Magar, a talented footballer who used to
play every day with his friends and who
worshipped Neymar and Lionel Messi.
“It was really torture to work there,” he
told me late last month in the hospital
ward where he was waiting to be hooked
up to a dialysis machine.
Tens of thousands of migrant labourers
have built the venues, hotels and infra-
structure for next year’s tournament over
a decade. Today, a silent plague of suffer-
ing among them can be revealed — in the
plight of people like Magar, whose lives
will be cut short by life-changing kidney
damage that doctors say is likely to be
linked to working conditions in Qatar.
In interviews, more than a dozen doc-
tors and public health experts — most of
them in Nepal — said that, based on their
interactions with patients, significant
numbers of healthy young men were leav-
ing home to work in the Gulf and return-
ing with kidney diseases so severe that
they required either transplants or dialy-
sis. Each doctor said that they saw new
cases every month — some as many as ten
a week — and many said they believed that
the problem was becoming increasingly
acute. Three estimated that about one
fifth of dialysis patients in Nepal were
workers who had returned from the Gulf.
The evidence will lead to extra scrutiny
of the England team ahead of the World
Cup. During qualifiers for the tourna-
ment, the Norwegian, Dutch and German
national teams held on-pitch protests
against Qatar’s human rights record. But
in England criticism from within the game
has so far been more muted.
In Qatar, Magar was forced to work out-
side all day in temperatures of up to 50C. It
was so hot, he said, that the workers used
to pour water into their shoes so that their
feet didn’t burn.
This unbearable heat persuaded the
organisers to move the tournament from
July 2022 to the end of November. Players,
it was felt, wouldn’t be able to compete for
90 minutes in such temperatures, and
fans would be uncomfortable.
For the migrant workers, however, it
was apparently acceptable.
Qatar has trumpeted reforms to its
labour laws, including the abolition last
year of the slave-like kafala system, which
effectively prevents migrants from chang-
ing jobs, yet the absolute monarchy’s reg-
ulations are often not being implemented
on the ground.
Magar said he worked all summer in
direct sunlight with insufficient water, a
clear contravention of Qatari labour regu-
lations, which stipulate that no one
should work outside between 10am and
and 3.30pm from the beginning of June to
the middle of September. Three other
men who worked in stadium construction
in Qatar gave similar accounts.
Some days Magar worked 12-hour
shifts, and on others his supervisor would
push his team to keep going for more than
20 hours, with only a few short breaks.
In the heat, drinking water quickly ran
out, and the workers would sometimes
have to wait for it to be replenished. They
had to ask to use the lavatory, and permis-
sion was at times denied if there was a lot
of work to do. There were few days off.
Food came twice a day, mixed together in
a small plastic bag.
Since the World Cup was awarded to
the state in 2010 more than 6,500 migrant
workers from Nepal, India, Pakistan,If there was shade
in the stadium, we
used to try and
hide in there
w w b b y w wyfyyMany returning workers require
dialysis three times a week; David
Beckham has signed a £150 million
deal to be a World Cup ambassadorThe manager used
to threaten me
if I wouldn’t
work long hours
19
Amit Magar and his mother. He worked
on the al-Thumama stadium, leftEURASIA SPORT IMAGES/GETTY IMAGES; TRIPTY TAMANG PAKHRIN FOR THE SUNDAY TIMES