At 9 on a cold January morning, Sami Iqbal got ready for work at his home in Lahore’s old quarter, a stone’s throw from the historic Badshahi Mosque. It was 6 degrees Celsius and the city was beginning to come alive — chai stalls in the vicinity pushed open their shutters and the doughy smell of flatbreads puffing up in iron skillets filled the air. Iqbal wrapped a muffler around his face before revving up his Honda motorbike to begin his day as a bike-taxi rider. 

Iqbal is a self-employed gig worker who works across multiple ride-hailing apps, including Careem, Bykea, and inDrive. As he set off for his first job that day, the city was covered in a thick, poisonous smog. He drove through visible specks of reddish dust and other particulate matter, breathing through his muffler and trying to ignore the metallic, almost sulfurous stench permeating his nostrils.

“I’ve been ill for a week,” Iqbal told Rest of World, his voice hoarse. “It’s probably because of the smog. I’m on the road for so long.”

Lahore is the most polluted city in the world, according to Swiss air quality monitoring platform IQAir. In November, the air was so poisonous that authorities issued a citywide lockdown, closing schools, markets, and parks for four days, and advising people to stay indoors.

Other cities in South Asia have similarly alarming levels of air quality: Eight out of the top 10 most polluted cities globally are in the region. Causes include rapid urbanization, construction, vehicular pollution, coal-fueled power plants, crop burning, and the operation of brick kilns. Air quality in the region is at its worst from October to February due to atmospheric conditions which cause pollutants to be trapped closer to the ground.

Exposure to this pollution can have serious health impacts — from headaches and breathing difficulties to heart and lung disease, stroke, and cancer. For gig workers, who often have no choice but to work in the smog, the effects are clear. By the end of a day’s work, Iqbal said, his whole body feels lifeless. “I also experience exhaustion, I get a lot of headaches. I get body aches,” he said.

Rest of World spoke to 25 gig workers in Lahore, New Delhi, and Dhaka, all of whom reported symptoms that health experts believe are the consequence of routine exposure to carcinogenic pollutants, including eye and throat irritation, persistent coughs, dizziness, and nausea. “I can’t even stand because of how tired I get, and most days I just cough and cough the entire shift,” Sachin Gupta, a 29-year-old Swiggy and Zomato delivery worker in New Delhi, told Rest of World.

“Outdoor workers are particularly vulnerable because of the number of pollutants they’re inhaling,” Muhammad Irfan Malik, a pulmonologist in Lahore, told Rest of World. “Pollution [has become] an invisible killer that we are seeing all year long.”

To better understand air quality exposure among gig workers in South Asia, Rest of World gave three gig workers — one each in Lahore, New Delhi, and Dhaka — air quality monitors to wear throughout a regular shift in January. The Atmotube Pro monitors continually tracked their exposure to carcinogenic pollutants — specifically PM1, PM2.5, and PM10 (different sizes of particulate matter), and volatile organic compounds such as benzene and formaldehyde.

The data revealed that all three workers were routinely exposed to hazardous levels of pollutants. For PM2.5, referring to particulates that are 2.5 micrometers in diameter or less — which have been linked to health risks including heart attacks and strokes — all riders were consistently logging exposure levels more than 10 times the World Health Organization’s recommended daily average of 15 micrograms per cubic meter. Manu Sharma, in New Delhi, recorded the highest PM2.5 level of the three riders, hitting 468.3 micrograms per cubic meter around 6 p.m. Lahore was a close second, with Iqbal recording 464.2 micrograms per cubic meter around the same time.

A line chart showing the PM levels during a set amount of time recorded in Lahore.

Alongside tracking specific pollutants, the Atmotube Pro gives an overall real-time air quality score (AQS) from 0–100, with zero being the most severely polluted, and 100 being the cleanest. According to Atmo, the company that makes the Atmotube monitors, a reading of 0–20 should be considered a health alert, under which conditions “everyone should avoid all outdoor exertion.” But the three gig workers found their monitors consistently displayed the lowest possible score. 

As Iqbal went about his work picking up and dropping off customers, his pollution monitor barely budged from a score of zero. “Is this device even working?” he asked.

He only briefly achieved a score over 40 — considered simply “polluted” — when he went indoors to eat lunch and pray.

An evening street scene in Dhaka.

Rest of World followed gig workers during their shifts in three of the world’s most polluted cities.

A portrait of RedX delivery rider MD. Nur Afsar taken indoors.

In Dhaka, we met with 30-year-old Mohammad Noor Afsar, who is all too familiar with the city’s pollution — first as a battery salesman and now as a delivery person.

A bicycle with a delivery box attached to the rear.

Afsar rides a bicycle for RedX, a logistics company with a vast delivery network across Bangladesh.

A RedX delivery rider sips tea on a break at a road side tea stall.

“School traffic clogs the roads twice daily, with private car fumes choking the air,” Afsar said. “It’s a nightmare on a bike.”

Danger to health

When Manu Sharma, a 35-year-old rider for Indian food delivery platform Swiggy, set out for his shift on his electric bike around 2:45 p.m. that day, he couldn’t see through the smoke in the air. “There is so much pollution and smog that I can’t even see the next building,” he told Rest of World

Intrigued by Rest of World’s experiment, Sharma initially doubted there was anything left to learn about New Delhi’s polluted air. “You can just have a look around, and with decreasing visibility it’s obvious,” he said. He hadn’t noticed any health issues until he started gig work, and now has constant headaches and fever, Sharma said. He often feels as if he cannot breathe. When he heads out to work, he wears a cloth mask over his face. “In a few days, I think we will have to carry oxygen cylinders with us,” he joked. 

But as Sharma’s shift came to an end around 7:45 p.m., he was concerned about what the pollution monitor showed he had been inhaling through the day. Similar to Iqbal, the device’s AQS reading had been stuck on zero for the majority of the day, with PM2.5 levels mostly oscillating between 100–200 micrograms per cubic meter. Sharma, who moved to New Delhi from the eastern state of Bihar in July, said he is now contemplating moving back out of the city.

A line chart showing the PM levels during a set amount of time recorded in New Delhi.

Mohammad Noor Afsar, the 30-year-old RedX delivery rider who carried the Atmo device for Rest of World on a foggy January morning in Dhaka, has been battling the fumes from the city’s traffic for years. Before joining the courier service, he worked as a battery salesman. Though it has been a welcome change, he said, he continues to struggle with the pollution.

As traffic intensified around him toward the evening, so did the air’s heaviness. The metallic tang of exhaust, the grit of dust — Afsar felt the grim cocktail filling his lungs. “You can just feel the pollution,” he said. “But thankfully, my shift ends soon.”

Just as for Iqbal and Sharma, the air quality monitor showed Afsar was routinely breathing in much higher levels of PM2.5 and PM10 than are considered healthy. A single notable moment of respite — visible in the data — occurred around 7 p.m., when Afsar retreated to his office for a while. Even then, PM levels were well above the WHO’s guidelines.

Among health experts, PM2.5 is a particular concern. According to the United States Environmental Protection Agency, particles of this size can get deep into the lungs, and some particles may even get into the bloodstream. Health effects attributable to long-term exposure to PM2.5 include “ischemic heart disease, lung cancer, chronic obstructive pulmonary disease (COPD), lower-respiratory infections (such as pneumonia), stroke, type 2 diabetes, and adverse birth outcomes,” according to the State of Global Air initiative, a collaborative project which analyzes trends in air quality around the world.

“There is so much pollution and smog that I can’t even see the next building.”

As South Asia’s megacities top global air pollution rankings, hospitals are piling up with patients suffering from pollution-related illnesses. In November, a pulmonologist at New Delhi’s Manipal Hospital noted that up to 50% of the beds in their intensive care unit had filled up with patients who had respiratory illnesses such as pneumonia and asthma, despite having no history of these conditions. 

Physicians Rest of World spoke with sounded alarm bells. “We’ve found people who don’t have a family history of asthma coming to us with severe lung disease,” Malik, the Lahore-based pulmonologist, said. “This is called chemical-induced lung injury because of exposure to particulate matter, such as PM2.5.”

A line chart showing the PM levels during a set amount of time recorded in Dhaka.

Malik and his colleagues have now begun to associate cases of respiratory distress with a new subclassification of chronic obstructive pulmonary disease called COPD-P — in which P stands for pollution. 

Neetu Jain, a New Delhi-based pulmonologist, has also been witnessing a rise in patients reporting coughs, shortness of breath, and wheezing. “There is a definite increase in viral and bacterial lung infections,” she told Rest of World

Pollution-related conditions can have long-term health impacts. The 2023 Air Quality Life Index, carried out by the Energy Policy Institute at the University of Chicago, found that air pollution shortens lives by an average of 11.9 years in New Delhi, 8.1 years in Dhaka, and 7.5 years in Lahore. A nonprofit called Fair Finance Pakistan has estimated that air pollution leads to at least 128,000 deaths every year in the country. In India, pollution has led to more than 1.6 million premature deaths, according to a 2019 study by The Lancet. And in Bangladesh, the World Bank projects that air pollution will be responsible for 186,000 premature deaths by 2030. 

Although pollution can affect anyone exposed to it, delivery riders are particularly vulnerable owing to the nature of their work: They are outside for extended periods of time, often on congested streets, with little shelter from the smog.

In September 2020, environmental scientist Ahmad Kamruzzaman Majumder from the Center for Atmospheric Pollution Studies in Dhaka and three other researchers published a case study on the impact of air pollution on rickshaw pullers in Dhaka. Majumder and his team spoke with 35 rickshaw pullers — all non-smokers with no history of respiratory issues — and measured their lung function. 

“The majority of the respondents had various seasonal and environmental disorders since coming to Dhaka,” Majumder told Rest of World. “Forty-six percent of the respondents mostly had eye irritation, fever, and cough during winter, which decreased their ability to pull their rickshaws.”

A study on gig workers in Ghaziabad, a city adjoining New Delhi, found that they were exposed to levels of particulate matter and carcinogenic compounds such as benzene that were much higher than the safe levels set by local authorities and the WHO. 

Mannu Kumar, Zomato’s delivery partner speaks on his phone while parked on a busy street.

Manu Sharma, 35, works as a delivery rider for Indian online food delivery giant Swiggy in New Delhi.

A closeup of a car exhaust with fumes next to a motorbike.

Sharma did not have health issues until he moved to New Delhi from Bihar, a state in eastern India, eight months ago.

Zomato’s Delivery partner Mannu Kumar, on his way to pickup an order from Khan Market.

After experiencing frequent headaches and bouts of fever, Sharma said he is considering moving back to his village.

Zomato's delivery partner, Mannu Kumar, checks his phone while parked on his bike by a street.

“I haven’t seen the sun rise in this city for almost two weeks,” Sharma said. “This job and this city are not for me.”

Broken solutions

Part of the reason air quality is so poor in these South Asian cities is due to what environmental author Siddharth Singh calls a “meteorological misfortune.” In his book The Great Smog of India, he explains that the landlocked parts of the country are geographically positioned such that the winds from the coastal regions collect pollutants on their way inland, which then get “trapped” before the Himalayas. “The air pressure pushes from one direction, and with the inability to escape quickly in the other, the particulate matter accumulates over the northern plains,” he writes. “This accumulation and entrapment affect not only Delhi, but the entire expanse between Punjab in the west to West Bengal in the east.”

Abid Omar, founder of the Pakistan Air Quality Initiative, a think tank focused on air pollution research, told Rest of World this affects other South Asian cities too, especially in winter. “That misfortune is what results in temperature inversion, which keeps the pollution trapped close to the lower atmosphere, where it builds up,” he said. Temperature inversion occurs as warmer air rises, trapping pollutants in a blanket of cooler air close to the Earth’s surface, such that they can’t escape. It is also why pollution isn’t such a visible problem in the summer months, even if the number of harmful emissions does not change. 

Iqbal, the Lahore-based bike-taxi rider, noted that he experienced more symptoms in the winter months. “I’ve ridden my bike in the summer months, too. The effects aren’t as adverse,” he said. “I don’t experience eye irritation in the summer. But I do in the winter.”

On the day Rest of World followed Iqbal, he could not stop coughing through his muffler by the time he finished work. “I’ve been ill for a week, have had fever, chills, and a bad cough,” he said. “You could say that my cough is due to air pollution, because I’m out on the road for up to 10–12 hours a day.”

Measures of air quality

PM1

Particulate matter (PM) refers to microscopic particles in the air that are small enough to be inhaled. These can include dust, dirt, or soot. PM1 are particles equal to or less than a single micrometer in diameter.

PM2.5

PM2.5 — any particulate matter that is 2.5 micrometers or less in diameter — is particularly harmful to human health, causing conditions including heart disease and lung cancer.

PM10

All particulate matter under 10 micrometers in diameter is of concern, as these particles are small enough to get into the lungs and may even enter the bloodstream.

VOCs

Volatile organic compounds (VOCs) are gasses that can harm human health, and include benzene and formaldehyde. Most come from manmade sources such as solvents and industrial emissions.

AQI

Air Quality Index (AQI) is an overall measurement of air quality, based on the density of pollutants in the air. The best score is 0; the worst is 500.

AQS

AQS is Atmo’s own overall air quality score, intended to give a real-time idea of general air quality. For AQS, 100 represents the cleanest air; 0 is the most polluted.

Temperature

Temperature can impact air quality in different ways. One phenomenon is temperature inversion, which occurs when a layer of warm air traps cooler air — and the pollutants in it — closer to the Earth’s surface.

As pollution climbs to worrying levels in the subcontinent, local governments are scrambling for solutions. In Lahore, some officials are washing roads in an attempt to reduce dust and other pollutants, while others are trying out a technology called cloud seeding to create artificial rain in 10 locations around the city using a small Cessna plane. Indian scientists, too, are mulling the use of cloud seeding to trigger heavy rain in some parts of New Delhi.

In Bangladesh, officials have brought in carbon taxes in an attempt to reduce the number of vehicles on the road — a measure they claim will help decrease both the emissions and traffic congestion. But experts say these attempts aren’t tackling the biggest source of Dhaka’s pollution: the at least 1,252 brick kilns operating in the suburbs, which account for more than 58% of the pollutants circulating in the city’s air. 

Similarly, Omar, of the Pakistan Air Quality Initiative, said cosmetic technical fixes like road washing do not solve air pollution. Instead, he said, the country’s environmental laws should be improved and enforced. “You have to measure factory emissions, make sure they stay within certain limits. And there are different standards that apply to a cement plant versus a power plant. All of these rules and regulations exist, but they’re not enforced.”

In some cases, gig workers told Rest of World the attempts to reduce the effects of pollution had had negative impacts for them. Iqbal, the bike-taxi rider in Lahore, said he spent more time on the road when Lahore locked down some institutions due to pollution. “Because people were out and about, there was actually more traffic on the streets,” he said.

“[Lockdowns to reduce pollution] don’t help in a city like Lahore where there aren’t alternatives for transport,” Hassan Aftab Sheikh, a climate scientist from Lahore based in Oxford, told Rest of World. “You need to have alternatives for mobility if you’re restricting mobility.” 

Gig platforms operating in these cities are aware of the pollution their workers face. In a November social post, Indian food delivery giant Zomato even joked about the conditions, telling customers that their chat support “can’t help if your chicken gets delivered as smoked chicken.” 

In November 2020, Pakistan’s leading ride-hailing platform, Careem, distributed “smog kits” — consisting of masks, paracetamol, and nasal spray — to its riders in Islamabad and Lahore. Careem’s parent company, Uber, had launched a similar initiative in Lahore in 2017.

Rest of World asked Careem if these kits are still being distributed among riders, but received no response. Rest of World also reached out to Pathao, Bykea, inDrive, Zomato, and Swiggy to ask if they had introduced smog-combating initiatives — such as mask mandates or smog kits — for riders, or offered any other accommodations. Most did not reply; Zomato and Swiggy declined to comment.

Delivery rider Sami Iqbal checks his phone by the side of street covered in smog.

Thirty-two-year-old Sami Iqbal has been a gig worker in Lahore since 2019.

A road beneath an overpass in Lahore, Pakistan with heavy smog.

He spends 10 hours a day riding a motorbike-taxi, and earns about 90,000 rupees ($322) a month.

A closeup of people riding a bike near a street market in Lahore.

Scientists say Lahore’s residents may lose up to seven years of life expectancy from breathing toxic air.

A phone showing the air quality through the Atmotube app in Lahore.

“My whole body feels lifeless by the time I get home,” Iqbal said.

Inequity in breathing

Gig workers told Rest of World they were left with no choice but to continue working on the streets, breathing toxic air day in and day out. 

Gupta, the New Delhi-based delivery worker, said he was “well aware” that his health symptoms were a direct fallout of the severe pollution, but that he couldn’t quit the work — even though his family had asked him to. “We can’t quit the job just because of pollution and risk our livelihood, can we? We aren’t that privileged,” he said.

Malik, the pulmonologist from Lahore, has been telling his patients with COPD and asthma to consider moving away from the city. “But when I suggest this to them, they look at me, and they cry,” he said. “They say, ‘Where will we go? We don’t have money to resettle. Where will we work?’”

Though the air has changed for everyone in the region, there remains an “inequity in exposure to air pollution,” Pallavi Pant, an air quality scientist from New Delhi, told Rest of World. “Who among us has the means to reduce exposure? Many people are getting exposed to high levels of air pollution as a result of their job or their occupation. How can we best protect people knowing that some cannot afford to sit at home, or purchase air purifiers?” 

Many workers told Rest of World they were also concerned about the impact of pollution on their families. Lahore-based Foodpanda delivery rider Rizwan Khan said he had considered sending his children away for short stretches to their grandfather’s village, just so they could breathe fresh air. “You know kids, they want to run around outside and want fresh air, but the air is so poisonous. I can’t keep them shut inside the house,” he said. Khan’s youngest, a 2-year-old boy, has a wheezing cough. “You can hear a whistling sound.”

Iyaz Kamran, 30, who works with inDrive in Lahore, migrated to the city with his wife and two children in 2019. Now, his 6-year-old daughter has been diagnosed with asthma, and he takes her to Sir Ganga Ram Hospital every few days so she can get nebulized — a treatment for the condition. “I can’t afford to buy a nebulizer because it costs 60,000 rupees [$215] and that’s how much I make in a month,” he told Rest of World. But Kamran said he can’t go back home to Hafizabad, where the air is cleaner and there are fields where his children can run and play. 

“What will I do there? Sit at home? Over here, my wife has started working … We are able to feed our children, send them to English-medium schools, [and] secure their futures,” he said. “I will stay in Lahore, and maybe my children will have a better life than me.”



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