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Doctors Advising Kids, Vulnerable Populations To Leave Delhi-NCR Due to Toxic Air

Doctors Advising Kids, Vulnerable Populations To Leave Delhi-NCR Due to Toxic Air

Delhi engulfed by smog on November 2, 2023. Photo: Shekhar Tiwari/The Wire

Humans of Air Pollution: India’s Growing Tribe of Environmental Refugees

This is the third and final part of a three-part series on India’s small but growing tribe of environmental migrants. Currently, these “pollution refugees” come from the privileged class of the educated aware. But as awareness grows and people connect the dots around the health harm pollutants trigger – in this case, the human cost of air pollution – the country will see a greater migration from extremely high to relatively low pollution areas, says Jyoti Pande Lavakare, who has been tracking this space since 2014. Read part 1 here and part 2 here.

It isn’t as if leaving for a few days during episodic peaks can save us from the long-term impact of breathing toxic air. Many suffering folk leave Delhi during Diwali and around Christmas, the two highest peak pollution times, some under the express advice of their doctors and when fortunately, school holidays allow them to flee. Pulmonologist Dr Randeep Guleria is just one among the several doctors who have told me they have begun advising patients, especially the elderly to get out of the city that its own chief minister calls a “gas chamber.” (It’s a separate matter that his rival party, the right-wing Bharatiya Janata Party, instead of trying to improve pollution, politicised the matter by calling him Hitler.)

It’s also a separate matter that even though people can escape episodic peaks, which cause the maximum and most intensive damage, there are enough reports that show that lower levels of air pollution still trigger disease and disability. Experts speak in one voice when they say, “There are no safe levels of air pollution,” whether it is the World Health Organisation, the National Institutes of Health, the American Journal of Respiratory and Critical Care Medicine or others. Very simply put, it is the difference between smoking 2 cigarettes or 20. Both harm our health, but smoking two will harm relatively less than smoking 20 cigarettes. Dr Naresh Trehan was probably among the earliest Indian doctors to call attention to how exactly harmful Delhi air was through pictures of healthy pink and sooty black lungs of two similar aged non-smoking men, one living in Himachal Pradesh and the other in Delhi. Many more doctors have joined these ranks and there is now a network of “passionate and informed” doctors called Doctors for Clean Air who are fighting against air pollution.

As far back as 25 years ago, a study by doctors had shown that high episodic air pollution increased cardiovascular and respiratory events, leading to higher emergency room visits at AIIMS, with increased morbidity and mortality from acute asthma, acute exacerbation of chronic obstructive airway disease and acute coronary events. 

Have you ever noticed, even anecdotally, how many more heart attacks and lung failures happen just after Diwali and in the polluted north Indian winter? Dilshad Master-Kumar’s father-in-law Narendra “Bull” Kumar passed away in polluted December. Another example is Ratan Lal, film-maker and clean air evangelist Nutan Manmohan’s father. “Post-Diwali pollution created a complex set of medical problems for my father,” she says with conviction. Escaping Delhi’s post-Diwali air in 2018, Manmohan was jolted out of her sleep early one polluted morning with a phone call that informed her that her father, who she says was “a robust man,” had fainted. Since he had past cardiac history, he was rushed to Delhi’s Escorts Heart hospital. But what he was diagnosed to have was severe lung infection. Fortunately, her father pulled through, but doctors advised him to stay strictly indoors to protect himself from the high pollution levels. But when he finally resumed work in February, “tests showed that the winter had certainly left its impact,” says Nutan. Basically, “pollution triggered a lung infection. With his lungs compromised, his heart had to work harder, which affected the already weak heart valves. He was absolutely fine before Diwali. By the end of winter, he had a massive heart attack and we lost him.”

Studies correlating high episodic air pollution with ER visits, morbidity and mortality hide several stories similar to this.

As recently as 2021, a study correlating high pollution levels to emergency room visits from acute respiratory symptoms  in two Delhi hospitals showed that children were even more severely affected

Children are the most vulnerable because their airways and lungs are smaller and still developing, They also absorb greater amounts of pollution as they breathe more rapidly. In fact, children born and raised (and breathing) in Delhi have been found to have smaller lung size, said Dr S.K. Chhabra, former director-professor at Vallabhbhai Patel Chest Institute in the Journal of Indian Paediatrics.  They also have lower lung function compared to children who grow up in areas of lower pollution. A study by the Chittaranjan National Cancer Institute showed that 53% of children in polluted cities have impaired lung function, liver and brain ailments with boys five times more prone than girls We are setting up our young for failure from an early age – and this, in a country where we talk proudly of our young demographic. 

Ishita Mohindra, a highly educated first-time mother in her early 30s belongs to this young demographic. Mohindra moved back to Delhi from London where she and her husband were working in order to be close to parents, family and homeland. She sent me a desperate text Thursday morning even as I was wrapping up writing this story. “I’m just so distraught about the quality of air. The helplessness and lack of effort from multiple agencies is starting to affect me so much that I want to start having conversations about moving again. How did you deal with it? The stress of it all is getting to me and affecting my mental health!” 

I met Mohindra three years ago through our dog playgroup, when she was considering starting a family. I sense the panic of a young, new mother in her text. She knows what I went through with my young children when we moved back to India. She just wants to protect her two-month old, enjoy and bond with her daughter while on maternity leave from the multinational she works for. “What to do though? Just sit inside with the purifiers on? I was looking forward to taking my girl out on a stroller but I can’t even imagine it at this point for the next few weeks (possibly months),” she texts. Today’s AQI in Delhi is 343 according to SAFAR’s monitor and is predicted to rise to 349 tomorrow. Independent weather agencies show much higher levels, with Delhi’s Anand Vihar levels going off the charts at 999. If people flout the cracker ban again this year, this number could go up beyond 3200, which is unreal, but was measured by my friend Barun with his trusty DustTrak in Diwali 2013. Young, educated Indians like Mohindra, who are in their prime productive stage of life still have the agency to migrate away from their homeland. And they will, if nothing strong and significant is done to bring levels down urgently, becoming pollution migrants despite wanting to stay in their home country, close to their parents and extended family.

The AQI levels in Anand Vihar, where PM 2.5 levels shot up to 999 on Thursday. Photo: Screengrab via

Transparency precedes accountability; need data, science but also year-round action

After the sharp peak in north India’s air pollution in October-November, often the wind and rain end up cleaning up the air by early December. However, the dip in temperature towards the end of December leads to another cluster of fires – that of the urban and rural poor, who burn biomass for heating in addition to cooking. 

All this information on fires is usually publicly and transparently available on government websites, from where air pollution experts and atmospheric scientists scrape it to analyse data and devise mitigation strategies that policy makers can execute. But this year, in an unexpected move mid-October, as soon as AQI started worsening, the government walled this data without any explanation. Real-time data adds to the science behind air pollution. And since the most precise measuring machines – large, expensive, reference grade instruments – are owned by the government and paid for by tax money, there is no reason why this data shouldn’t remain public.

In a similar oblique move aimed at discrediting data by low-cost sensors, the CPCB on March 25 released a circular stating that it would not be using measurements from low-cost sensors for regulatory purposes as ‘its accuracy, linearity, reliability, and long-term performance are not yet fully established.’ Low cost sensors bridge the critical gap between ‘no monitoring’ and ‘very precise monitoring’ by expensive machines and these have been accepted by the government’s own National Clean Air Programme. India needs 4,000 continuous air monitoring stations, but has less than 20% of that number. Additionally, these are skewed towards urban metros, with Delhi-NCR hogging the lion’s share.

Transparency precedes accountability, and without data to make the invisible visible, like my friend’s DustTrak did for me, it is easy to sidestep this “wicked” problem that kills more people in India than Covid ever did. What the eye cannot see, the mind doesn’t know. But more than all of this is the need for serious, urgent, proactive and long-term action in reducing emissions.

In fact, during the COVID-19 pandemic, air pollution continued to play its stealthy role as a hidden killer. Research showed that more people got COVID and more severely in areas that were more polluted. Simple logic suggests that had India’s pollution levels been lower, fewer people could have suffered and died from COVID. When the rest of the world was going through a pandemic, India was going through a twindemic.

If COVID-19 was a visible, viciously virulent, insanely infectious pandemic, killing swiftly and mercilessly, air pollution is its invisible, non-communicable evil twin, killing unhurriedly, under the radar, but equally ruthlessly. It is a non-communicable disease pandemic in slow-motion, matching – if not surpassing – the cataclysmic fury of SARS-CoV-2. Air pollution in India kills nearly 1.7 million each year. COVID-19 killed less than one-third of that number in one year.

In this context, it may sound dramatic when people like Jaidhar Gupta, a long-time Delhi resident, call this “mass genocide,” but air pollution is definitely a violation of human rights, according to David Boyd, the United Nations Special Rapporteur on Human Rights and Environment, when the involuntary act of just breathing can slowly and silently kill you.

“I have bronchial asthma. My child has bronchial asthma.” We have no option but to leave north India during its extreme pollution peaks, Gupta says bluntly. “I’m a pollution refugee.”   

Band-aid measures normalise high levels of pollution

Despite these winter pollution peaks, all that the government does is announce short-term band aid measures, some under a reactive, knee-jerk emergency plan called the “Graded Response Action Plan“, a misnomer which has neither action, nor any real planning embedded in it.  

This plan gets activated only when pollution levels get to “very poor” (above 300) and severe (above 400) levels, when activities such as banning construction and entry of commercial diesel vehicles, or closing schools, staggering work timings or even worse, red herrings like anti-smog guns (imagine a diesel truck going around the city spraying scarce water to wash down particulate matter like fake rain) are implemented, even as company and government-sponsored marathons like the annual “Run for Unity” continue to exhort people to come and exercise in these hazardous levels of pollution, without sharing any health warnings. Every year, telecom giant Airtel’s well-known half-marathon takes place in the most polluted time of the year. This year’s Vedanta half-marathon on October 15 took place on the first day the AQI slipped to the “poor” category.  These events, more than anything else, normalise high levels of air pollution. 

That may finally be changing. For the first time in history an Indian cricket team captain has expressed concern over poor air quality publicly. The issue of air quality had been raised earlier during the World Cup by Joe Root following England’s defeat to South Africa in Mumbai.

“I’ve not played in anything like that before,” Root had said. “I’ve obviously played in hotter conditions, and probably more humid conditions. But it just felt like you couldn’t get your breath. It was like you were eating the air. It was unique.” These public statements have nudged the Board of Cricket Control of India to issue a statement saying they won’t add to the pollution by bursting firecrackers at the end of the matches.

This is an improvement from December 2017, when a Sri Lankan player vomited on the field, was escorted off the ground as heavily polluted air continued to plague an international cricket test match in Delhi and yet many, including some BCCI officials, dismissed this saying that if the Indian team and viewers on the stands had no problems, why were the Sri Lankans making such a big deal about it. But just not bursting crackers just isn’t enough. 

Fortunately, the Supreme Court, forced to step in in 2016, in response to a petition by three toddlers for their fundamental right to breathe clean air, has already banned crackers. First, it banned the distribution and sale of fireworks, followed the next year by a ban on their manufacture, an excellent ruling because in addition to PM 2.5, firecrackers add toxic metals to the air, making post-Diwali air even more poisonous.  But more needs to be done proactively and urgently through the year instead of just not “adding” to the pollution. 

With Mumbai air becoming as bad or worse than Delhi air, my worst fear is that the Maharashtra government may also succumb to the kind of  pseudo-science and wasteful use of public funds in building giant outdoor air purifiers that atmospheric scientists have declared ineffective and inefficient. 

Three years ago, for instance, despite the science, the courts directed the Delhi government to build two anti-smog towers, which cost the public exchequer around Rs 44 crore. After these were commissioned with great fanfare, the government admitted in parliament that the towers were ineffective.

There is only one way to reduce pollution: bring down emissions at source. Nothing else works. This isn’t rocket science – and don’t forget, India has the capability of getting to the moon. Let us contextualise this debate in the words of Chandra Bhushan, the chief executive officer at International Forum for Environment, Sustainability & Technology (iFOREST) who put it very simply on NDTV last evening. “Air pollution is nothing but what we burn. India burns 2 billion tonnes of solid material… Of this 1.1 billion tonnes is coal.” Another 600 million tonnes is crop residue burnt by farmers and biomass for cooking. “There is no action on solid fuel. No country in the world has been able to address pollution without addressing the issue of pollution from solid fuels,” he says. It’s that simple, really. We need to strictly ban open waste burning, (even our public landfills are constantly catching fire) crop stubble burning (which is another story of growing the wrong crop in the wrong state at the wrong time) and have a solid waste burning policy in addition to clean energy and renewable energy fuelling public mobility. So far, the focus has been on liquids (petrol, diesel) and gases (CNG, LPG). As for useless burning like crackers, that shouldn’t even cross our minds.

So it isn’t as if the solutions to this problem, this twindemic, this public health emergency aren’t known. They are, and countries like Mexico and China have demonstrated they can clean the air, and quickly. The COVID-19 lockdown also showed us blue skies in Delhi, demonstrating that the problem is solvable and is reversible.  

The real reason why my tribe of pollution migrants is growing is different. It is because we are losing hope, because we know we are running out of time. And that is because some of us have begun to realise that, as founder and former president of the World Resources Institute, co-founder of the Natural Resources Defense Council and adviser to two former US Presidents, Gus Speth articulated very succintly:

“I used to think the top environmental problems were biodiversity loss, ecosystems collapse and climate change. I thought that with 30 years of good science we could address those problems. But I was wrong. The top environmental problems are selfishness, greed and apathy… and to deal with those we need a spiritual and cultural transformation and we, (lawyers) and scientists, don’t know how to do that.” 

And selfishness, greed and apathy is harder to get rid of than pollution. 

Read part 1 here and part 2 here.

Jyoti Pande Lavakare is the author of Breathing Here is Injurious to Your Health: The Human Cost of Air Pollution, published by Hachette in November 2020. 

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