Over the nearly seven decades since the Dalai Lama led his flock of tens of thousands out of Tibet to escape Chinese persecution, he put himself to the grueling work of sustaining a nation in exile.

As both the spiritual and political leader of Tibetan Buddhists, he established a little democracy in the Indian Himalayas, complete with a parliament and all its routine bickering and beauty. He entrenched a bureaucracy that encouraged a culture of service among a scattered people. In refugee settlements across India, the Tibetan administration runs schools, clinics, monasteries, agricultural cooperatives and even old-age homes.

But as the Dalai Lama turns 90 next month, Tibetans in exile are anxious about the fate of their stateless nation.

The man who has been Tibetans’ binding force and most recognizable face is growing increasingly frail. His goal of returning his people to their homeland remains distant, with China working to finish the task of crushing the Tibetan movement for autonomy. And as Tibetans confront a future of continued exile, the United States and other global powers have become more unreliable in their support.