Atovaquone-Proguanil (Malarone) — Preferred

One tablet daily starting 1–2 days before entering Terai risk areas, throughout stay, and 7 days after leaving. Recommended for travelers visiting Chitwan, Bardia, and other Terai destinations. Discuss with your travel physician.

Chloroquine

Some areas of Nepal still have chloroquine-sensitive malaria (P. vivax dominant in some Terai areas). However, P. falciparum with chloroquine resistance is also present — discuss with your travel physician which prophylaxis is most appropriate for your specific Terai itinerary.

No Prophylaxis for Treks Above 1,200m

Everest Base Camp trek, Annapurna Circuit, Langtang, Mustang, and all major trekking routes above 1,200m have no malaria risk. No prophylaxis is needed for these itineraries. Altitude sickness is the dominant health concern for high-altitude trekkers — not malaria.

Kathmandu

CIWEC Hospital Travel Medicine Center is the leading clinic for travelers and expatriates — English-speaking, well-equipped for travel-related illness, and experienced in altitude sickness. Patan Hospital offers the best general care. B&B Hospital and various private clinics cater to international patients. Serious conditions may require evacuation to Bangkok or India.

On Trekking Routes

Namche Bazaar (3,440m) has a clinic with basic altitude facilities. Pheriche and Manang have Himalayan Rescue Association (HRA) aid posts staffed by physicians during trekking season. Beyond these points, medical care is essentially non-existent. For any serious medical emergency on trek — especially altitude illness — immediate helicopter evacuation is the only option.

Helicopter Rescue

Nepal has an established helicopter rescue infrastructure operating in the Everest and Annapurna regions. Operators including Simrik Air, Dynasty, and others respond to medical emergencies. Rescue requires confirmed payment or insurance authorization before departure. Without pre-authorized insurance, you may need to pay a deposit of $4,000–$10,000 USD before rescue is dispatched. Always carry insurance company contact information on your person.

US Embassy Kathmandu

Maharajgunj, Kathmandu 44600
Phone: +977 1 423-4000
After-hours emergencies: +977 1 423-4000
np.usembassy.gov

US State Dept 24/7 Hotline

From US/Canada: +1-888-407-4747
From abroad: +1-202-501-4444
Available 24 hours a day, 7 days a week.

STEP & HRA

Register at step.state.gov. Save HRA Kathmandu: +977 1 444-4664. For all treks, register your route with your trekking agency and inform someone of your itinerary and expected return dates.

Altitude Sickness — Critical Risk

Acute Mountain Sickness (AMS) affects many trekkers above 2,500m. More severe forms — High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE) — can kill within hours. The golden rule: if symptoms worsen, descend immediately. Acclimatize properly (no more than 300–500m gain per day above 3,000m), rest days every 3 days, stay hydrated, and avoid alcohol. Never ascend with AMS symptoms.

Hypothermia & Frostbite

High Himalayan terrain brings severe cold — temperatures at Everest Base Camp (5,364m) can drop to -30°C (-22°F) at night. Even at lower elevations, hypothermia risk is real when caught in rain or unexpected weather. Wear proper technical layering systems — moisture-wicking base, insulating mid-layer, and waterproof/windproof outer shell. Never underestimate mountain weather changes.

Avalanches & Landslides

Avalanches are a significant hazard on Nepal's high-altitude routes — particularly post-monsoon and in spring. The 2014 Khumbu Icefall avalanche killed 16 Sherpas. Landslides during monsoon kill dozens annually on trekking paths. Research current conditions before departure, heed all guide and local advice, and avoid known avalanche chutes. Never walk through icefall zones unnecessarily.

Earthquakes

Nepal is seismically highly active — the devastating 2015 Gorkha earthquake (7.8M) killed nearly 9,000 people and triggered avalanches on Everest. Earthquakes occur regularly. In a city, take cover under sturdy furniture and move to open ground after shaking. In the mountains, move away from slopes and cliff faces. Familiarize yourself with emergency evacuation points in your lodge.

Small Aircraft Safety

Nepal has one of the world's most dangerous aviation environments. Mountain airstrips (Lukla/Tenzing-Hillary Airport — consistently ranked world's most dangerous), mountain weather, and aging aircraft create significant risk. Lukla flights are frequently delayed or cancelled by weather. Fatal small aircraft accidents occur in Nepal regularly — be aware of this risk when booking scenic mountain flights.

Road Safety

Nepal's roads are among the most dangerous in Asia. Mountain roads are narrow, unpaved, and wind along precipitous drops with no barriers. Bus and vehicle accidents killing dozens occur regularly, particularly in monsoon season when landslides cover roads. Avoid night travel. Use reputable private vehicles rather than overcrowded local buses for long mountain road journeys.

Political Demonstrations

Politically motivated strikes (bandhs) and demonstrations occur in Nepal and can disrupt transport, close businesses, and occasionally turn violent. Monitor local news and STEP alerts. During a bandh, remain at your accommodation — do not try to travel during active strikes. Most demonstrations are peaceful but exercise caution near government buildings.

Trekking Scams & Fraudulent Agencies

Fraudulent trekking agencies, fake guides, and permit scams are common in Kathmandu's tourist district (Thamel). Only use government-registered trekking agencies. Verify guide credentials. Book through established operators or your accommodation's recommendation. Do not hand over large cash payments without proper receipts and contracts.

Petty Theft

Pickpocketing and bag snatching occur in Kathmandu's Thamel district, at Pashupatinath temple, and on crowded buses. Use hotel safes for passports and valuables. Be alert in crowds. Keep bags in front. On treks, secure your gear at teahouses — theft from shared dormitories does occur occasionally.

Air Pollution — Kathmandu

Kathmandu Valley traps vehicle and brick kiln emissions in its bowl topography. PM2.5 levels frequently reach hazardous levels, especially November–February. Those with asthma or respiratory conditions should carry adequate medication and consider wearing an N95 mask outdoors during high-pollution periods. Air quality improves dramatically once you begin trekking at elevation.

Altitude Sickness (AMS/HACE/HAPE)

The most critical health risk for trekkers. AMS: headache, nausea, fatigue — treat with rest and acetazolamide, do not ascend. HACE (brain swelling): confusion, ataxia, loss of consciousness — descend immediately and give dexamethasone. HAPE (lung fluid): shortness of breath at rest, cough — descend immediately, use supplemental O2 if available, give nifedipine. Both HACE and HAPE are medical emergencies requiring helicopter evacuation.

Traveler's Diarrhea & Enteric Disease

Very common throughout Nepal including on popular trekking routes. Giardia is particularly prevalent on trekking routes — causing chronic diarrhea, bloating, and fatigue that can persist for weeks. Use water purification religiously. Avoid raw foods. Carry ORS and a standby antibiotic (azithromycin recommended for Nepal). Tinidazole is the treatment for confirmed Giardia.

Dengue Fever

Increasingly common in Nepal, including the Kathmandu Valley. Aedes mosquitoes bite during daylight hours. Use DEET repellent in Kathmandu and Pokhara. Dengue risk diminishes above 2,000m. Any fever in or after returning from Nepal should be evaluated and travel history disclosed.

Tuberculosis (TB)

Nepal has a high TB burden including drug-resistant strains. Risk for short-term tourists is low. Long-term travelers, healthcare workers, and those living in crowded conditions (teahouse trekking in dormitories) face higher risk. Consider pre-travel TB testing for extended stays and post-travel follow-up after significant exposure.