Environmental health inequalities in cities of the Global South are hardly studied up to now, though they are expected to increase due to rapid urbanization and motorization taking place in many of these cities. In this study, environmental inequalities in the city of Kathmandu, Nepal for the years 2013 and 2021 are analyzed. The goal of the study is to determine the degree of environmental inequalities and their changes over time. The study examines horizontal and vertical inequalities in access to drinking water sources, air and noise pollution exposure, and health effects based on self-reported household data. Results show statistically significant environmental inequalities between neighborhoods in Kathmandu regarding access to basic water infrastructure, air and noise pollution exposure, and resulting health effects. Inequalities between socio-economic groups are not significant. Over time, the perceived exposure to air pollution has increased, mainly due to increased motorized traffic, whereas vertical inequalities persisted. While inequalities between socio-economic groups have not increased, the high socioeconomic group reveals more concerns and awareness about environmental burdens than the low socioeconomic group. In conclusion, given the intertwined horizontal and vertical inequalities, any planning response action needs to consider the population's vulnerability to target interventions to the most affected areas.