Since this week, there is again a thick layer of white smog over the Indian capital New Delhi. It is an annually recurring phenomenon. When it gets colder, the air quality of many North Indian cities plunges deep into the red. Residents increasingly suffer from respiratory complaints, irritated eyes, and migraines.
Pulmonologist Nikhil Modi sees many such complaints during his consultations, often even worse. The doctor shows a message on his mobile phone from a patient with pulmonary emphysema. A few days ago, he had come in for some standard tests that showed no major problems.
"His oxygen levels looked good, but a day after Diwali I received this message: that he had less than 90 percent oxygen in his blood." That is dangerously low.
Patients of 35 years
Last weekend Diwali was celebrated, one of the most popular Hindu festivals. Despite a court order that only less polluting fireworks were allowed, residents of the city noticed little difference compared to other years. Various air quality meters indicated that the air pollution during this Diwali was even higher than ever before.
In the 18 years that Modi has worked as a pulmonologist in New Delhi, he increasingly sees people with respiratory and lung complaints coming in, not only around Diwali but throughout the year. "Lung cancer used to be a disease for smokers around 60 years old, now we see patients around 35 years old who have never smoked a cigarette," says Modi.
Dirtiest city in the world
In 2014, the World Health Organization declared New Delhi for the first time the most polluted city in the world. Of the 1600 cities in 91 countries, New Delhi had the highest concentration of fine particulate matter according to the World Health Organization's database. This fine particulate matter is so small that it enters the bloodstream. It was the first time that air quality measurements made major news.
"Since 2014, knowledge and anger among Indians about air pollution have increased," says sociologist Vasundhara Bhojvaid. She researches the effects of air pollution on daily life.
Bhojvaid also sees problems with the measurements. "It is not as if the pollution suddenly appeared in 2014; we only saw it because it was measured clearly for the first time."
And where that measuring equipment is located matters, because in cities air quality is monitored better than in rural areas. Bhojvaid would like to see more attention paid to the countryside, where a large part of the pollution in New Delhi originates. However, much less is known about the health effects on Indian farm workers.
Fireworks temporary culprit
The fireworks during Diwali are mainly a temporary culprit. The rest of the year, a combination of factors causes the deteriorated air quality in Indian cities. In cold air, exhaust gases from cars linger longer. Also, dust from construction sites leads to more problems.
This year, local authorities have again set rules to prevent extra pollution. Older polluting cars are banned from the city center, construction work is partially halted, and civil servants are asked to work more from home or travel by public transport.
It is more complicated for farmers to do something about it. They have to prepare their land in a few weeks for a new sowing period. By burning the fields, they save time, but those smoke plumes drift toward the cities. Officially, burning fields is therefore prohibited, but on the day after Diwali alone, 200 new fires were reported.
Pollution refugees
A new trend is that Indians who have the means leave the city during the cold months, researcher Bhojvaid observes. "They are the wealthier residents who temporarily go to the Indian mountains or even move to Europe." Pollution refugees, Bhojvaid calls them.
It is a small group that is growing quickly. According to Modi, these are mainly people who do not have school-going children or a job in the city. It is not unthinkable for the doctor that he himself will become such a refugee: "I have a 14-year-old child myself, and children's lungs can still recover if we move to a place with healthier air."