Mahwish Nawaz is worried. Her son has had a cough that refuses to go away. With accompanying breathing issues, her concerns have multiplied. Her worst fears were realised when a pulmonologist she consulted in her native Lahore about her son's recurring cough diagnosed her son with a pulmonary infection. The doctor informed her that her son is particularly sensitive to dust and the acrid smog which continues to hang around Lahore. Unless the environment in which her child is raised changes, he could eventually develop respiratory problems or even asthma.
Over a decade, Lahore has undergone many changes. It has become the largest city by population in the country, has a metro, Orange Line, several underpasses and flyovers, new housing societies, increased traffic, a large industry and even Tim Hortons. At the same time, the air in the city has become increasingly unbreathable while its crown as the 'City of Gardens' is visibly under threat as it completes its transformation into the most polluted city in Pakistan.
According to the World Air Quality Index 2021, Pakistan holds the unwanted distinction of being ranked as the third most polluted country globally. Various factors contribute to air pollution, including fuel consumption - particularly coal, urbanisation and transportation. Industries are also responsible for emitting copious amounts of carbon dioxide, while agricultural residue and waste burning contribute to the issue at a secondary level.
As Lahore has learnt this past decade, poor air quality does not only mean a haze on the skyline. Rather, it can lead to thick, acrid smog suffocating an entire city. The problem has become so severe that it has sparked an annual smog crisis in the city. Residents, however, have had little option but to gradually become more aware of environmental and health considerations and tackle the smog. The rapid increase in health-related problems caused by smog raises concerns about the long-term impacts it can have on public health.
The Sectoral Emission Inventory of Lahore report shows an annual increase in cases of acute (upper) respiratory infections (AUR), hypertension, asthma, pneumonia, depression, and chronic obstructive pulmonary diseases (characterised by coughing and shortness of breath). Additionally, there is a rise in complaints of discomfort in the eyes, including cataracts and seasonal influenza.
The incidences of seasonal influenza, pneumonia (in five-year-olds and above), Acute Upper Respiratory Infections (AURI), and cataract reported during smog season was 40%, 37%, 35%, 33%, and 32% of the whole year (October 2021 – October 2022) respectively.
Dr Muhammad Irfan Malik, a professor of Pulmonology and Focal Person for the novel coronavirus (COVID-19) at the Lahore General Hospital, shared: "I have over ten years of experience in both the public and the private sector. I examine 30 to 35 patients daily in my private clinic and several patients in a government hospital daily. According to my observations, the number of patients suffering from COPD-p (Chronic Obstructive Pulmonary Disease due to pollution) has increased by 30% so far this year. Additionally, the COPD-p symptoms are also on the rise in children, which is a matter of great concern."
He conceded that they lack comprehensive data on the subject, and there is a need for medical professionals and policymakers to think about it.
Dr Malik continued that in COPD, "once the airways are narrowed, the symptoms increase and become irreversible, whereas asthma is reversible. He explained that COPD is most commonly found in smokers.
But given the air quality situation in Pakistan, a specific term was specially coined this year to describe the situation, labelled as 'COPD-P' (COPD Pakistan). The term has been reserved for those Pakistani patients who exhibit symptoms similar to asthma but are unresponsive to medication, Dr Malik explained.
In 2018, the World Health Organization (WHO) acknowledged in its report that approximately seven million deaths per year are attributed to the hazardous quality of air worldwide. The annual Global Air reports showed that some 128,000 people die in Pakistan annually due to air-pollution-related illnesses. Between 2016 and 2018, the WHO reported that some 543,000 children under five years of age had died globally and another 52,000 deaths among children aged 5 to 15.
The composition of smog produces substances which damage our lungs, he said.
"If we examine the air quality index on a rainy day, like it was a few days ago, the count for particulate matters remained at 2.5 despite the rain. This situation, he explained, is hazardous, as it showed that rain was unable to wash away particulate matter, which is nine times the normal size.
Dr Malik said that particulate matter enters our lungs, causing inflammation. Although the body initially recovers from this, the recovery process gradually slows down over time. Children have a less robust immune system than adults, making them more susceptible to these effects. Additionally, smog impairs the growth of their lungs.
Smog doesn't solely affect the respiratory system but also has implications for the skin, eyes, and nervous system and can even lead to skin cancer. Prolonged exposure to smog during pregnancy can lead to increased chances of birth problems in newborns, and it may also impact the growth of their organs."
The Global Air report stated that exposure to smog reduces life expectancy by 2.7 years, and there were 235,000 premature deaths worldwide due to air pollution alone in 2019. Another report from the Urban Unit revealed that 80% of air pollution in Lahore is caused by vehicular traffic. One estimate puts the number of registered motorbikes in Lahore at approximately 7.7 million. These bikes use a 2-stroke system. Moreover, the petrol used in two-wheelers and diesel in four-wheelers in Pakistan does not meet Euro-II standards. This deadly combination has been filling up the skies with smoke anytime someone takes a car trip to the grocery store.
While sharing his recommendations for a solution, Dr. Malik stated, "We need a multisectoral reform policy for comprehensive solutions. We can transition all fossil fuel-powered vehicles to electric with proper planning and government commitment. The government could also implement policies or offer subsidies for hybrid cars, facilitating an easy shift from the existing system to hybrid vehicles.
With private schools charging substantial sums, Dr Malik suggested the government should mandate schools operate buses to ferry students to reduce the number of cars on the roads. Additionally, he called for encouraging a culture of cycling.
"If someone needs to travel within a kilometre to buy something or meet someone, the use of a bicycle should be promoted."
He said there is a need to develop both short- and long-term plans to comprehensively tackle air pollution and smog issues.
"Just as we learned to wear masks and practice hand hygiene during the COVID-19 pandemic, we should similarly raise awareness about air pollution," he shared.
"The Parks and Horticulture Authority should conduct awareness campaigns about natural air-purifying plants such as the money and rubber plants, and promote their free or low-cost distribution. He suggested that the government could condition approvals for new housing societies to allocate specific areas for tree plantation.
Dr Malik said that the government needs to become more proactive about tackling the issue of crop stubble burning, suggesting that the Motorway Police can play a role in promptly notifying local administrations about instances spotted along the motorway.
He stressed that the government, institutions, civil society, and media all have their parts to play, adding that a continuous dialogue on the topic will help increase public awareness about the seriousness of this problem and its potential solutions.
Naseem ur Rehman, who heads a government-run environment agency (EPA), shared that Pakistan has devised a National Clean Air Policy (NCAP). Punjab's Caretaker Chief Minister Mohsin Naqvi ratified the policy at the provincial level on April 6, 2023.
Regarding his agency, Rehmand said that currently, EPA has approximately 17 air pollution monitors spread throughout the city. He added that the smog issue typically surfaces in October and November and that, at the moment, air pollution levels are within the normal range.
"During the pre-smog period, EPA is conducting meetings and running awareness campaigns to inform the public about the emission control system in the industrial zones of Lahore (where steel factories and industries emit hazardous fumes), Gujranwala, and Sheikhupura," he said.
He added that the Punjab government had allocated Rs2 billion to the Small and Cottage Industries Corporation to provide loans for installing this system to benefit small industrialists. Furthermore, 70% of brick kilns in Punjab have transitioned to the zig-zag emissions reduction technology, and the remaining will be converted soon. Similarly, the Agriculture Department has undertaken responsibility for educating farmers about alternative methods, such as using the happy seeder machine instead of burning crop stubble.
Rehman said that they are collaborating with the traffic police to address the issue of vehicles which exhaust copious amounts of smoke. Further, traffic police have been tasked with checking the engine fitness of larger vehicles. During the smog season, he said they plan to ban the entry of heavy smoke-emitting vehicles into the city. Further, anyone violating the clean air policy by setting garbage, tires, or plastic on fire will be fined per the policy.
"To combat dust, the Parks and Horticulture Authority, along with the local government and Lahore Development Authority (LDA), have adopted measures such as sprinkling water on roads," the EPA chief said.
Moreover, he said that the Planning and Development Department has been requested to pave unconstructed roads.
He said that the government will be putting up banners in the industrial areas apart from running public service announcements on television to get the word out. He pointed out how similar efforts last year helped reduce the AQI level by 15% in Lahore.
"This year, our goal is to achieve even further reduction."
Sadia Khalid, a climate activist who runs a Facebook page on climate issues, urged the government to declare a climate emergency to help people comprehend the severity of the situation and encourage them to play their roles as responsible citizens.
Fatima Ali, the mother of a 10-year-old boy, stressed educating children about protecting the environment.
"I believe we should educate our children about the importance of not littering, using bicycles instead of cars, and planting a tree on their birthdays. It's essential to replace unhealthy habits with positive ones to preserve the environment for the next generation."
Dr Umar Saeed, a professor of Biochemistry, highlighted how, over the past 10-15 years, Lahore has lost a significant amount of its green cover due to rapid and unplanned construction of numerous housing societies, apart from the construction of highways, underpasses, and flyovers. The surge in automobile sales within the city in recent years has led to a substantial increase in toxic vehicular emissions. Corrupt emission testing procedures, inadequate vehicular inspections, and widespread fuel adulteration compound this issue.
He explained that our air is polluted with toxic chemicals such as carbon monoxide, nitrogen dioxide, sulfur dioxide, and methane. Dr Saeed suggested greater public education efforts through electronic and print media to encourage minimal waste burning and to motivate the public to have their vehicles inspected to reduce tail-pipe emissions. Further, he suggested the gradual relocation of industrial estates to the outskirts of the city in phases; stringent enforcement of regulations for industries to transition to cleaner technologies, promoting smoke-free emissions and proper toxic waste management in accordance with regulations; the increased use of low-emission fuels and renewable, combustion-free power sources (such as solar, wind, or hydropower) for power generation; adoption of effective strategies for waste reduction, recycling, and improved methods of biological waste management, including alternatives to open incineration; and strict emission control measures.
Environmental lawyer Ahmed Rafay Alam said that not only does air pollution lead to respiratory diseases among children, but it also contributes to heart and brain strokes in adults. There isn't a single organ that remains unaffected by air pollution.
Referring to the use of quality fuel and other energy sources, he said there is a need to upgrade our fuel refineries and produce petrol that matches Euro-6 standards. He said that Pakistan has been importing Euro-4 quality petrol since 2019, but most of it is consumed in Karachi and Sindh and very little makes it to other parts of the country that have to mix poor quality fuel.
Elsewhere, he said there is a need to look at how coal is used for power generation and certain industries burn tires and plastics for energy.
Alam suggested that industries should be shifted to renewable energy sources such as solar and wind power and improve the vehicle certification system. Additionally, upgrading the engine testing system for the 40-year-old diesel trucks still on the road is essential.