The Winter We Don’t Prepare For

Every year, as the cold wind drifts down from the Himalayas and a blanket of fog settles over the plains, Nepal quietly transitions into winter. For many, this is a season of comfort—of woolen shawls, steaming cups of tea, and long evenings by the fire. But beneath the familiar rhythm of cold mornings and smoky kitchens lies a quiet public health challenge that few talk about. The arrival of winter does not only bring colder temperatures; it brings a rise in illness, a strain on families, and a reminder of how unprepared we remain for its health consequences.

Across the country, the health impact of winter is unmistakable. Hospitals in Kathmandu and other cities report a sharp rise in respiratory infections every cold season. According to the National Public Health Laboratory, more than 1,300 people tested positive for influenza in early 2024, and the rate of infection continued to increase through January. Pneumonia and bronchitis cases surged among children and older adults, while doctors warned of more co-infections involving influenza and other respiratory viruses. These numbers, though clinical, represent a deeper reality—the quiet suffering of families who mistake persistent coughs and breathing difficulties as inevitable parts of winter, rather than signs of preventable illness.

The problem is not only the cold itself but the conditions it creates. When temperatures fall, people stay indoors, often sealing windows to keep out the chill. In urban areas like the Kathmandu Valley, this habit traps pollution and smoke inside homes, while outside, a layer of cold air holds dust and vehicle emissions close to the ground. Studies have recorded winter particulate matter levels in Kathmandu reaching as high as 149 micrograms per cubic meter—many times higher than the World Health Organization’s safe limit. The result is a toxic atmosphere that worsens asthma, triggers respiratory distress, and weakens immunity just when people need it most.

In rural parts of the country, the challenges take a different form but lead to the same outcomes. In many hill and mountain communities, families still rely on firewood, crop residue, or animal dung to heat their homes and cook food. These fuels, burned in small unventilated kitchens, fill the air with dense smoke. Research in a Himalayan village recorded indoor pollution levels exceeding 1,900 micrograms per cubic meter of PM10, and nearly one in five adults in that community showed signs of chronic lung obstruction. Women and children, who spend the most time indoors, carry the heaviest burden of exposure. It is a silent crisis that repeats every year, out of sight and often out of concern.

Winter in Nepal is not uniform. It feels different in the icy Himalayas, the misty hills, and the fog-covered plains of the Terai. In high mountain districts like Mustang or Dolpa, temperatures drop well below freezing, and health posts struggle to remain open as roads close and supplies run out. In the mid-hills, valleys become bowls of trapped smog where smoke from fires and vehicles lingers for days. In the Terai, although temperatures are higher, thick winter fog mixes with pollution from factories and crop burning, forming a blanket of haze that makes breathing difficult. Each region faces a different version of the same challenge—cold, smoke, and limited access to clean air and healthcare.

The causes of these problems are interconnected. Nepal’s geography traps pollutants in valleys and plains, while the country’s dependence on solid fuels and outdated stoves worsens indoor air quality. Poor insulation forces people to burn more fuel, and limited awareness means few connect smoke or cold exposure with chronic illness. Many still believe that winter coughs, chest tightness, and fatigue are unavoidable parts of life. The result is a pattern of neglect that continues year after year, despite being preventable with simple changes in behavior and policy.

Evidence from national and international studies paints a worrying picture. Air pollution alone is estimated to cause over forty thousand deaths annually in Nepal, making it one of the country’s leading health risks. Hospital records show a clear seasonal spike in respiratory and cardiovascular admissions during the winter months. Exposure to extreme cold constricts blood vessels and raises blood pressure, increasing the risk of heart attacks and strokes. Malnutrition and limited physical activity further weaken immunity, while the lack of accessible healthcare in remote areas turns treatable illnesses into life-threatening conditions. Winter, in many ways, amplifies existing inequalities—it hurts the poorest the most.

Yet, much of this suffering is avoidable. Preparation does not require expensive interventions; it begins with awareness and small daily actions. Homes that burn solid fuels can be made safer by improving ventilation or switching to cleaner stoves. Opening windows for a few minutes each day, even in the cold, helps reduce indoor smoke. Covering cracks in walls, using thicker curtains, and ensuring proper bedding can conserve warmth without sealing in pollutants. Simple habits like eating fresh seasonal fruits and vegetables, staying hydrated, and seeking early treatment for coughs or fever can prevent serious illness. At the same time, local governments can play a stronger role by running winter health campaigns, supporting clean-cooking programs, and improving air quality monitoring in cities and towns.

Public health experts often say that prevention is cheaper and more effective than treatment, and nowhere is this truer than in winter. Hospitals across Nepal face an annual surge in patients with respiratory and heart problems once the cold sets in. But many of these cases could be reduced through better public awareness, targeted vaccination drives, and timely access to care. If winter preparedness were treated as seriously as monsoon preparedness, thousands of illnesses could be avoided every year.

Winter has always been part of Nepal’s identity. It brings beauty, stillness, and togetherness. But it also exposes the deep cracks in our health systems and habits. For too long, we have seen it as a season to endure rather than a challenge to prepare for. The truth is simple: the cold itself is not our enemy—our inaction is. The illnesses that accompany winter are not accidents of nature but results of choices, traditions, and a lack of awareness that can be changed.

“The Winter We Don’t Prepare For” should not remain just a phrase; it should become a reminder. Preparing for winter means more than finding warmth—it means protecting lungs from smoke, shielding hearts from strain, and ensuring that no child, elder, or worker suffers from something that could have been prevented. When we start seeing winter not only as a season of cold but as a season of care, Nepal can turn its most challenging months into a time of resilience and renewal. Because when the temperature drops, what truly keeps us warm is not just fire—it’s awareness, preparation, and compassion.