KATHMANDU: On the morning of August 11, the back gate of Paropkar Maternity and Women’s Hospital in Thapathali was filled with the usual chaos of honking rickshaws, hurried footsteps, and shouts over traffic. At 7:40 am, the rhythm broke. Rephatbi Ansari, 29 and was six months pregnant at that time of reporting, stood face-to-face with two men whose cigarettes released slow spirals of smoke into the air.

It was not the sort of scene most passersby stopped to watch, though the argument carried the stubbornness of men convinced their right to smoke outweighed someone else’s right to breathe.

The Ansari family owns a junkyard in Buddhanagar under the Bagmati corridor, which also serves as their home. Ansari was not in the mood to remain silent.

“I have never liked the smell of cigarettes,” she told Nepal News. “But since my pregnancy, I cannot tolerate it at all. Even the smell from my husband’s junkyard does not bother me as much. This smoke makes me lash out.”

Her frustration was not about one morning’s encounter. Weeks earlier, she had watched video reports about the government’s renewed push to enforce its long-standing ban on smoking in and around hospitals, schools, and public spaces.

The law, introduced in 2011, often feels more like a suggestion than a rule in Kathmandu. Before learning of it, she endured cigarette smoke quietly at bus stops, parks, and alleys. Now she felt armed with the knowledge that she was in the right, even if no one else seemed willing to act.

“Even if there is a law, I cannot understand why people still smoke in public places,” she said. “It is about respect for other people’s health and rights.”

Tobacco in Nepal is not only a health crisis but also an economic powerhouse. Surya Nepal, the country’s largest manufacturer, produces more than 3 billion cigarettes annually.

The Ministry of Finance had projected Rs 35 billion in tobacco excise revenue for fiscal year 2024/25. By mid-year, however, tobacco products had generated Rs 13.79 billion in six months, up from Rs 12.92 billion in the same period of the previous fiscal year, showing that even a habit as steady as smoking is not immune to the quirks of tax collection.

The Tobacco Product (Control and Regulatory) Act of 2011 prohibits sales within 100 meters of schools, hospitals, and childcare centers. It also bans sales to anyone under 18, sales of single sticks, and sales to pregnant women. Yet in Kathmandu’s dense neighborhoods, the 100-meter buffer exists only in theory.

A short walk around major hospitals such as Paropkar Maternity, Civil Service, Bir Hospital, and TU Teaching shows cigarette shops almost at the doorstep, along with eateries where indoor smoking passes without comment. Security staff at these institutions admit the rule is violated every day.

Dr. Shree Acharya, director of Paropkar Maternity and Women’s Hospital, has long tried to keep the hospital surroundings clean and smoke-free.

“There is no safe level of exposure to tobacco smoke for a pregnant woman,” he said. “Secondhand smoke increases the risk of premature birth, low birth weight, birth defects, and Sudden Infant Death Syndrome (SIDS). We have worked with local authorities to reduce public smoking, but without regular monitoring, we cannot stop it completely.”

The World Health Organization, the Nepal Health Research Council, and the Nepal Development Research Institute all agree on the scale of the problem. Tobacco use kills more than 27,100 Nepalis annually, making it one of the leading causes of preventable death.

The 2019 WHO-STEPS Survey found 28.9 percent of adults were current tobacco users. A 2024 NDRI survey shows the figure has risen to 34.1 percent, while WHO’s 2022 data suggest a lower prevalence of 14.5 percent. The conflicting statistics underline the need for updated national data.

Passive smoking is equally dangerous. The 2019 WHO-STEPS survey reported 33.5 percent of adults were exposed to secondhand smoke at home and 22.5 percent at work. For women and children, the risks are even higher—weakening the immune and pulmonary systems, worsening cardiovascular disease, and possibly aiding viral transmission through exhaled smoke.

Not all smokers are the same. Jay Kumar Sah, a teacher at Campion School in Lagankhel, smokes daily but only in designated zones.

“I have never smoked in a public place,” he said. “I criticize others who do. People who do not smoke have rights too, and they should not be made to suffer because of our choices.”

Sah supports Kathmandu Metropolitan City’s decision to fine public smokers but notes that cigarettes are not the city’s only air quality villain.

“Vehicles and construction dust cause far more pollution than cigarette smoke,” he said.

Baburam Ghimire, spokesperson for the Ministry of Forest and Environment, echoed the point.

“Burning cigarettes obviously causes pollution, but in Nepal it is still at a micro level. We have not conducted studies to measure its share in overall air pollution.”

For others, smoking is a lifelong habit they see no reason to quit. Amar Bahadur Pulami, a 56-year-old construction worker from Gorkha, has smoked since his teens.

“I do not think smoking has affected my health, except for heavy breathing, and I have never had it checked,” he said. “But it is cruel for us smokers to harm others. We should smoke only in designated places.”

His words reflect a contradiction common among long-time smokers: unwilling to quit, yet unwilling to be the villain in someone else’s health story.

For younger generations, public smoking shapes how they experience city life. Bhawani Bhusal, now 17, recalls her school days at Shree Guhyeshwori Bal Shiksha Secondary School. One of her routes home always passed through an alley where at least one smoker stood.

“Vehicles and construction dust cause far more pollution than cigarette smoke,” Sah said.

“After getting COVID-19, I cannot stand cigarette smoke,” she said. “Authorities should monitor alleys near schools so students have a smoke-free way home.”

Her suggestion highlights a gap in the law. It focuses on broad zones like hospital grounds but ignores everyday spaces such as alleyways, bus stops, and side streets, where smokers gather and passersby have no choice but to inhale.

The Ministry of Health and Population is not unaware. Dr. Bhakta Bahadur KC, the ministry’s focal person for tobacco control, said they are working with all 753 local units and 77 district offices to strengthen enforcement. Administrative officers in municipalities and assistant chief district officers are being tapped to lead local tobacco control units. Still, progress is slow.

“Despite knowing it is dangerous and causes cancer, people smoke in public regardless of how it affects others,” Dr. KC said.

The health burden is severe. The NHRC’s 2024 study found that 35.3 percent of all cancers in men and 17.3 percent in women are linked to tobacco use, with lung, mouth, and esophageal cancers most common.

Globally, WHO cites at least 16 types of cancer caused by smoking due to the 70-plus carcinogens in cigarette smoke. In Nepal, the odds are stark: one in 36 men and one in 65 women will develop tobacco-related cancer before age 75.

Research on public smoking is still limited. “Some studies have been completed, and we are collecting more data now,” said NHRC’s Chandra Bhushan Yadav. “Public smoking has been a challenge in Nepal, and in recent years, media and awareness campaigns have encouraged more people to speak out against it.”

Meanwhile, Ansari’s confrontation in Thapathali ended without intervention from police or hospital staff. The men stubbed out their cigarettes only after finishing them. By the time the smoke cleared, the street had moved on, and so had she. Another day, another fight in a city where law often loses to habit.

“Burning cigarettes obviously causes pollution, but in Nepal it is still at a micro level. We have not conducted studies to measure its share in overall air pollution,” said Spokesperson Ghimire. 

Kathmandu may have rules against smoking in public, but rules here are like the breeze: visible only when they stir the dust, gone again in an instant.

Dr. KC of the ministry told Nepal News that public smoking has continued ever since the formulation of the constitutional law meant to stop it, and it is now slowly becoming a threat to non-smokers.

Schoolteacher Sah said his school is in an alley connected to Patan Hospital, where he regularly encounters two or three people smoking. “I think people do not quit public smoking despite the strict law because of a lack of visible awareness campaigns and programs at sensitive locations. The current situation of public smoking is threatening due to a lack of civic sense,” Sah added.

Similarly, grade 11 student Bhusal said that her college ends at 1:00 pm, and during her daily commute to and from the institution, she regularly observes at least four or five individuals smoking on the streets. “I also think people openly smoke on the streets due to lack of civic sense and disregard for others’ health,” she said.

In an interview with this scribe, Dr. Khem Karki, a public health specialist, offered insight into the nature of smoking addiction and why it persists. He described quitting as a “battle fought on two fronts: the body’s addiction to nicotine and the mind’s reliance on the ritual. It is a struggle where every craving is a chemical command and every habit is a psychological trap.”

Dr. Karki further explained that a smoker’s compulsion can override civic sense and public health concerns. “A person addicted to smoking might not care about public health when the urge strikes,” he stated. “It is futile to expect a chain smoker to hesitate when they see even a single hint suggesting they can get away with it.”

This behavior exists in direct conflict with Nepal’s legal framework. The Tobacco Products (Control and Regulation) Act, 2011, explicitly bans smoking in all public places, broadly defining them to include government offices, hospitals, schools, and restaurants. The law prescribes a fine of Rs 100 for individuals and up to Rs 5,000 for establishment managers who fail to enforce the ban. However, Dr. Karki stressed that without proper monitoring, the law “simply does not seem to exist.” A clear sign of this failure is the ease with which one can buy a single cigarette in Kathmandu.

“A person addicted to smoking might not care about public health when the urge strikes,” he stated. “It is futile to expect a chain smoker to hesitate when they see even a single hint suggesting they can get away with it,” said Dr. Karki.

The human cost of this regulatory gap is evident in individual experiences. Prabhawati Devi Tharuni, a 43-year-old woman who underwent a hysterectomy and frequently visits Kathmandu Medical College for follow-ups, expressed her distress. “I have never liked smoking, but since recovering from COVID-19, it has become even harder to tolerate the smell of cigarettes,” she said. “Every time I visit the hospital, I am forced to cover my nose to avoid the smoke from people casually smoking in the parking lot and surrounding streets.”

Similarly, Ratan Bahadur Budha, a 26-year-old Jumla resident caring for his uncle at Civil Service Hospital, described the pervasive presence of smokers near the hospital gate, a public bus stop, and the adjacent alleyway. “I do not smoke and do not appreciate the smell at all,” he said. “Nobody from the authorities is there to stop them, even with a college, hospital, and bus stop nearby.” When Budha confronted a group of smokers and a street vendor, he was met with ridicule and disrespect.

Dr. Karki cited Japan as an example, where public smoking was controlled over two decades through a shift from a “manners-based” approach to a legally enforced “rules-based” system. He suggested Nepal adopt a similar strategy with designated smoking zones and swift action against violators.

“The lives of passive smoking victims will always suffer in silence unless authorities intervene with a solid plan,” Dr. Karki concluded, urging immediate action to protect public health.