Ghaszaszh Nyirh is one of the Old Ones who ruled Earth over 1,000,000 years ago before being banished from the reality through unknown circumstances. After Doctor Strange was forced to destroy his magical artifacts to protect his friends from the alien sorcerer Urthona, thus breaking the magical barriers keeping away the Old Ones, Ghaszaszh Nyirh was able to return to Earth once again and command human sacrifice.
Ghaszaszh Nyirh is seen on Doctor Strange's globe in his Sanctum Sanctorum as being one of the sources of evil that had returned to Earth. Along with his new mentor in black magic Kaluu, Strange goes to an impoverished part of Africa where Ghaszaszh Nyirh's temple is located. They see that large crowds of starving people are entering the temple and decide to have Strange transfer his essence into the body of a small child being carried inside by his mother. As the mother walks deeper into the temple, Strange sees from the perspective of the child that Ghaszaszh Nyirh is providing the starving people sweet rice cakes that greatly distorts their bodies in exchange for their souls and constant supply of human sacrifices. Once the mother reaches Ghaszaszh Nyirh on his throne, Kaluu commands Strange to create an explosion with his magic, which kills the people inside and destroys much of the temple.
The explosion fails to destroy the temple or kill Ghaszaszh Nyirh, who uses voice projection over the temple grounds to beckon the sorcerers to him. Kaluu places a protective shield over Strange and is able to use his mystical expertise to guide them through the maze-like temple until they reach Ghaszaszh Nyirh. The Old One attempts to drive a psychological wedge between them by turning into both Strange and Kaluu. When this does not succeed, he morphs into Strange's love interest, Clea. Strange stops Ghaszaszh Nyirh from morphing again by trapping him in it with a containment spell. The Old One retaliates by creating illusions of Shuma-Gorath's servants that Strange had previously fought, such as Erlik Khan and the Water Elemental.
Ghaszaszh Nyirh grabs Kaluu and appears to rip his heart from his chest, causing Strange to forget Kaluu's commands and leave his protective shield. Seeing that Strange is vulnerable, he shoots a green ray of energy from his eyes and destroys Strange's left eye, leaving it a bloody socket. Kaluu orders Strange to flee the temple, who unleashes a powerful spell of black magic from outside that completely destroys Ghaszaszh Nyirh's dwelling. Kaluu appears beside Strange, having used an illusion to guide him inside the temple, and tells him that his hesitation to use black magic cost him his eye. However, the threat of Ghaszaszh Nyirh was eliminated by destroying his temple, which was was his gateway into Earth.
Ghaszaszh Nyirh was later invoked for power along with Shuma-Gorath in an incantation meant to bring the master of the Old Ones back to Earth. 
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