Abstract
Nepal’s government banned social media in early September 2025 as it was exposing nepotism and the excessive and luxurious lifestyles of families of influential political leaders. The ban enraged Nepali youth particularly those aged 14–29 known as Generation Z (Gen Z) who accordingly gathered to protest peacefully and lawfully as allowed by Article 17, Nepal Constitution 2015. However, the police opened fire on them using live ammunition causing 77 deaths. We present a case of a 22-year-old man who had been protesting and died from gunshot injuries inflicted by the police during these demonstrations against a social media ban. The wound trajectory was inconsistent with Nepal’s legal requirement to aim below the knee. Indeed, the upward posterior-to-anterior trajectory of this lethal injury suggests the victim was retreating, rather than posing a threat to his attacker and points towards human rights violation during the protest in Nepal.
Introduction
A recent trend on social media networks exposed the excessive and ultra lavish lifestyle enjoyed by the children of Nepali political leaders in this poverty-stricken country. In response, the government of Nepal banned 26 social media platforms on 4 September 2025. 1 Generation Z (Gen Z) were furious; they have grown up using these digital platforms and all that flows from them. Nepali youth organised through the Discord platform and called for protests on 8 September.1,2 The protesters were predominantly Gen Z Nepali citizens, born between the late 1990s and early 2010s.1,2 In an attempt to suppress the demonstrations, police used excessive lethal force and fired live ammunition, that killed 19 protesters in school uniform.1,2 The killing of youths further escalated unrest and generated mob frenzy on 9 September who vandalised and set ablaze government buildings and houses belonging to political leaders.
Under the Constitution of Nepal 2015, the right to protest is a fundamental right guaranteed by Article 17 (Right to Freedom). This provision protects freedom of opinion and expression, peaceful assembly without arms and the formation of unions and associations. Citizens may therefore organise demonstrations, rallies and protests, provided they remain peaceful and unarmed. The Constitution allows the government to impose reasonable restrictions on these freedoms on grounds such as sovereignty and territorial integrity, public order and security, public health and morality and the maintenance of communal harmony. Authorities may regulate the time, place and manner of protests to maintain public order. Accordingly, thousands of unarmed Gen Z protesters, many in school uniform, were in the streets on 8 September 2025, exercising a constitutionally recognised right.
Protest movements worldwide have often been met with force by law enforcement agencies, sometimes with fatal consequences. Human rights monitors report dozens of deaths from crowd control methods, for example, a global review found that at least 53 people died from projectiles fired by the police between 1990 and 2017. 3 A study of the 2023 Bangladesh protests found that 78.7% of the deaths were caused by gunshot wounds to the chest, neck and head. 4 These injury patterns underline the life-threatening consequences of gunfire in crowd settings. International standards regulate the use of firearms in crowd control situations. Lethal force is allowed only as a last resort when there is an imminent threat to life that cannot be contained by lesser means.5,6
The 2-day protest resulted in 77 deaths and a change of government. 1 An interim administration led by a former chief justice on 12 September was mandated to oversee national elections. 1 A judicial inquiry commission was formed to investigate the killings during the protest led by a former judge. Their report of 8 March 2026 concluded that the killings were avoidable and recommended criminal prosecution of the former Prime Minister, the former Home Minister, the Inspector General of Police and the Kathmandu Chief District Officer. 7
Case presentation
A 22-year-old male was among the many wounded when Nepal’s law enforcement agents opened fire on a group of peaceful protesters near the national parliament building. He was immediately taken to hospital but died later that day. According to the police inquest report, the deceased had sustained a firearm injury while security personnel were attempting crowd control.
External examination
The body measured 68 inches in length, was of average build, clothed in a blood-stained white and black hooded garment and grey trousers. A circular defect corresponding to a projectile perforation was identified in the upper posterior region of the hood, with a surrounding blackened margin suggestive of close passage of a high-velocity projectile through the fabric. Post-mortem changes were consistent with refrigeration; no decomposition was noted.
An oval to circular penetrating wound measuring 0.4 × 0.5 cm was present over the left scapular region between the third and fourth intercostal spaces, located 6.5 cm lateral to the posterior midline. The margins were inverted and well-defined, surrounded by an abrasion collar, suggestive of an entry wound (Figure 1(a)). There was no blackening, tattooing, or burning of the adjacent skin. A corresponding irregular perforation wound measuring 4.5 × 4.0 cm was present over the left anterior lower neck, just above the clavicle and lateral to the anterior midline. The margins were everted, ragged and undermined with protrusion of lacerated soft tissues which was suggestive of an exit wound (Figure 1(b)). No abrasion collar or soot deposition observed.
Gunshot wounds in a 22-year-old male. (a) Entry wound over the left scapular region showing a circular defect with inverted margins and abrasion collar. (b) Exit wound over the left anterior lower neck showing an irregular perforation with everted and ragged margins.
Multiple abrasions over the right temporal region, right eyebrow, back, shoulder, elbow and knee were present. There were brush-abrasions with underlying laceration over the left toes with exposed bone, consistent with contact with a rough surface.
Internal examination
Layer-by-layer dissection of the anterior neck along the wound track demonstrated extensive soft tissue laceration and haemorrhagic infiltration. The platysma and sternocleidomastoid muscles on the left were disrupted. There was a complete transection of the left common carotid artery near its base, with extensive surrounding haemorrhage. The left internal jugular vein was also transected. The trachea, oesophagus and cervical vertebrae were intact.
Dissection of the posterior wound track revealed penetration through skin, subcutaneous tissue, trapezius muscle and intercostal muscles entering the thoracic cavity between the third and fourth ribs. The lower margin of the third rib showed chipping consistent with projectile impact.
The left pleural cavity contained approximately 500 mL of blood clots. The upper margin of the lower lobe of the left lung was lacerated, and a perforating wound was present at the lower pole of the upper lobe. Both lungs were collapsed and pale. Rest of the findings were unremarkable.
The projectile entered posteriorly through the left scapular region, traversed the thoracic cavity that caused laceration of the left lung and rib clipping, and exited anteriorly through the lower neck, transecting the left common carotid artery and the internal jugular vein before emerging above the left clavicle. The trajectory was consistent with a posterior-to-anterior, slightly upward course, that resulted in a vascular injury and rapid exsanguination.
Discussion
The autopsy findings demonstrated a penetrating thoracic–cervical trajectory resulting in catastrophic vascular injury. Combined cervical vascular disruption and pulmonary injury would result in rapid haemorrhagic shock.8,9 Penetrating gunshot wounds involving major cervical vessels have mortality rates exceeding 80% without immediate surgical intervention. 10
The morphology of the wounds is consistent with injuries produced by a high-velocity projectile, such as those fired from military or police rifles. Entry wounds from rifles are usually narrow with clean, inverted edges, and often surrounded by an abrasion collar, whereas exit wounds are usually larger and asymmetrical with everted edges. 11 The absence of soot or tattooing indicates that the shot was distant (>1 m), 12 although the exact range cannot be determined. High-velocity projectiles create both a permanent wound track and a temporary cavity caused by radial tissue displacement, which may produce tissue damage beyond the direct bullet path.12,13 In this case, the pressure wave likely contributed to the lung laceration and contusion of the surrounding musculature beyond the direct path, causing extensive soft-tissue disruption in the thorax.
International standards on policing and crowd control emphasise that lethal force must only be used as a last resort. The United Nations’ Basic Principles on the Use of Force and Firearms require that the law enforcement officials apply non-violent means before resorting to the use of force and firearms, using firearms only to the extent strictly necessary to protect life. 14 Likewise, Amnesty International’s guidelines stipulate that any use of force must be proportionate, necessary and minimised, with priority on peaceful settlement and de-escalation. 15 The Organisation for Security and Co-operation in Europe (OSCE) Human Rights Handbook on Policing Assemblies similarly instructs that force should always be an exception that is, police should first seek dialogue and negotiation, give clear warnings and only escalate through a calibrated continuum of measures. 16 Firearms are to be used at the extreme end of this continuum and only against individuals posing an imminent threat to life.14,15
Nepal’s own laws echo this approach. The Local Administration Act of 2028, obligates the authorities to attempt control through negotiation, baton charge or tear gas first (Ministry of Home Affairs 2021, accessed 25 February 2026). Only if the crowd remains violent after a clear warning may live fire be permitted by the written authorisation of the Chief District Officer (CDO). 17 Most importantly, the act mandates that any shooting must target below the knee. 17
In the present case, the wound trajectory indicates that the projectile struck the upper torso, which is inconsistent with recommended aiming guidelines that suggest targeting the lower limbs when live fire is authorised. Public reporting in the aftermath of the incident indicated uncertainty regarding the chain of authorisation for the use of live ammunition, with senior administrative officials and law-enforcement officials attributing responsibility to different levels of command.1,2 There is no evidence that non-lethal methods or adequate warnings were used before the critical shot was fired.
Thus, the mechanism of death in this case was determined as acute haemorrhagic shock due to combined major cervical disruption and intrathoracic bleeding with the mode of death classified as traumatic hypovolemic shock. The trajectory suggests a posterior-to-anterior upward path, but the relative positions of the shooter and victim cannot be determined with certainty from autopsy findings alone. Upward trajectories in thoracic gunshot wounds may occur when the shooter is positioned at a lower level or when the victim is leaning forward or running. This is a sign of retreat by the victim rather than posing threats to anyone’s life which would have lawfully prompted the officials to shoot lethally. The publicly documented inter-personal and inter-institutional blame, therefore, matters not only politically but also medico-legally because effective oversight, clear adherence with authorisation protocols and rapid medical response are a part of safeguards intended to prevent the fatal outcome that was recorded here.
Notably, the inquiry commission formed by the interim government in the aftermath of these protests, found that the deaths were avoidable and attributed responsibility to the highest levels of political, police and administrative command.7,18 The national elections on 5 March 2026 resulted in a landmark victory for young leaders and a new government was sworn in on 27 March 2026. 18 The first cabinet meeting implemented the decision of the committee of inquiry and led to the subsequent arrest of the former Prime Minister and Home Minister on 28 March 2026, and the Chief District Officer on 31 March 2026.7,18,19 These outcomes directly underscore the medico-legal importance of rigorous, objective forensic documentation in cases where accountability at the senior command level is contested and legally pursued.
Conclusion
This case illustrates the consequences of a firearm injury sustained during the Gen Z protest and highlights the role of medico-legal autopsy in establishing the cause and mechanism of death. The documented trajectory of the projectile and the associated internal injuries were consistent with a high-energy gunshot wound resulting in catastrophic organ damage and rapid physiological decline due to haemorrhage. Beyond determining the cause of death, forensic examination provides objective documentation that contributes to the broader public health and legal discourse surrounding the use of firearms in crowd-control situations. In contexts where the circumstances and authorisation may be contested, careful medico-legal analysis becomes essential for reconstructing events and informing evidence-based discussions on proportional use of force, accountability and prevention of similar fatalities in the future.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
