Health

Dying to Breathe in Mongolia – Namuun Enkhbat Clifford

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Image credit: UNICEF

Air pollution is the greatest environmental risk factor for premature death and disability worldwide. The World Health Organization (WHO) estimates that 9 out of 10 people in the world breathe polluted air, resulting in 7 million deaths in 2016 due to outdoor and household air pollution.

Although air pollution affects everyone, the burden of disease and death is not equal and disproportionately affects the low to middle income countries. 94% of the total 7 million deaths due to air pollution occurred in Asia and Africa.

Countries with the highest air pollution levels are in orange and red. Source: 2018 World Air Quality Report

My hometown of Ulaanbaatar, Mongolia is an extreme example. Once known as the “Land of the Eternal Blue Sky”, it is now covered by a dense cloud of grey smog choking its inhabitants half the year. Mongolia is the world’s most sparsely populated country in the world with just over 3 million people. Today almost half the population, 1.4 million, live in the capital city of Ulaanbaatar (UB).

Mongolia, Land of the Eternal Blue Sky. Image credit: Tom O’Malley, Lonely Planet

During the long, frigid winter season which can range from September to April, UB ranks as the city with the worst air pollution in the world, surpassing highly polluted cities in India and China. A 2018 report by UNICEF, Mongolia’s Air Pollution Crisis: A Call to Action to Protect Children’s Health described air pollution levels on January 23, 2018 measured 3,320 μg/m3, an astounding 133 times higher the 25 μg/m3 daily average recommended by WHO. Air pollution is often referred to as an “invisible killer” but in UB it is far from invisible. The grey smog can get so dense it often obstructs people’s view making it difficult to see even a few steps ahead.

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Air pollution covers Ulaanbaatar in a hazy fog. Image credit: AKIpress

This is not a new issue. UB has been experiencing increasing levels of air pollution since the 1990s, reaching dangerously high levels over the past two decades. PM2.5, the tiniest pollutant particles in the air is one of the key measurements in assessing air quality and its impact to health. One of the problems in Mongolia has been access to reliable and accurate air quality monitoring data. According to a WHO policy brief, of the total 15 air quality monitoring stations in UB, only 8 measure PM2.5 levels. A post by a data scientist living in UB remarks that air quality monitoring stations often do not work, especially when temperatures get extremely low down to -40°C. This is also likely the reason that you get some variance in the air quality data depending on where you look. Regardless, the data that we do have demonstrate that air quality levels in UB have been at alarmingly high levels for decades and continues to be today.

Source: The World Bank

Just a few months ago, data from Agaar.mn the air quality site run by the government shows that average PM2.5 levels in January 2019 was 195 μg/m3, which is 8 times higher than the WHO recommended daily average of 25 μg/m3.

January 2019 average PM2.5 level is in purple at 195 μg/m3. Source: Agaar.mn

Mongolia is a beautiful country with a rich history and a culture deeply rooted in nomadic pastoralism. In 1950 only 20% of Mongolians lived in urban areas. The majority lived as nomadic herders on the vast grasslands, packing up their “gers” and relocating with their livestock each season in pursuit of prime pasture.

Tradition Mongol ger dwelling. Image credit: Nomadic Expeditions

After the fall of the Soviet Union in the 1990s, Mongolia underwent a profound social and economic transition to a democratic, market-based society. A new constitution was adopted in 1992 which provided unrestricted movement domestically and internationally (Article 16.18) and lifted the restriction on urban migration. Prior to this, although herders could move and relocate seasonally, their movement was monitored and restricted to certain geographical locations.

Climate change and global warming have also led to an increase in frequency of severe weather patterns and harsh winters in Mongolia. During the freezing winters, herders lost thousands of livestock. The combination of loss of their livelihoods, new freedom of unrestricted movement, and the search for better educational and employment opportunities have led to a rapid and poorly planned urban migration into UB within the past three decades.

Today, around 73% of Mongolia’s total population live in urban areas, with UB being the most populated city. Based on a 2010 report by The World Bank, UB’s population has more than doubled since 1990. The former herders moving into the city from the countryside brought their gers and settled into outskirts of UB in traditional nomadic fashion. At that time there was no city planning or regulations to prevent the nomads from moving in. Today, the “ger districts” make up more than half (60%) of UB’s population. They are also home to the poorest communities and either have extremely limited or nonexistent basic services such as water, sewage, and central heating.

Ger districts, home to 60% of UB population are highlighted in dark green, surrounding the urban center. Image credit: The Guardian

In the coldest capital in the world, when temperatures can drop to -40°C residents burn raw coal inside their gers, one of the cheapest available fuels for heat to prevent from literally freezing to death. Mongolians have been living in gers for thousands of years, burning biomass such as cow dung for energy. Historically, when most of the population lived scattered throughout the vast steppe, the pollution from the stoves was not as big of a threat to human health as gers were separated by hundreds of miles of distance.

Image credit: UNICEF

However today in a city located in a valley surrounded by mountains, emissions from over 200,000 chimneys combined with the cold air gets trapped near the ground by an inversion by a layer of warmer air above, preventing the pollutants from escaping and exacerbating the situation. It has been estimated that 80% of air pollution in UB is caused by the burning of raw coal in ger districts during the winter season, followed by emissions from cars (10%), power plants (6%), and soil pollution (4%).

Sources of air pollution in Ulaanbaatar. Image credit: Mongolian Observer

This is also the reason for the seasonal variation of air pollution in Mongolia. During the summer months when the weather gets warmer, residents do not need to burn as much coal for heating and air pollution levels drop significantly.

Graph demonstrating seasonal spikes in air pollution levels in Ulaanbaatar from 2008 to 2011. Image credit: Urban Emissions

Air pollution is killing people in Mongolia. A study led by UC Berkeley researchers estimated that exposure to air pollution in Ulaanbaatar in 2014 was responsible for 27% of all heart attack deaths, 24% of all lung cancer deaths, and 42% of all stroke deaths. This is concerning as heart attack and stroke are the top two leading causes of death in Mongolia and lung cancer is now the top tenth leading cause of death.

It’s also causing serious short and long term illnesses, affecting the health and well being of the most vulnerable in our population, young children. 2018 UNICEF report states that incidence of respiratory diseases in Mongolia has had a 2.7 fold increase per 10,000 population in the past 10 years. Pneumonia is now the second leading cause of under-five child mortality.

If you were living in UB this past January 2019, just breathing in the air was equivalent to the harm of smoking almost 9 cigarettes per day. (This is based on the air pollution cigarette equivalence calculator developed by Berkeley researchers using the average PM2.5 level of 195 μg/m3 in UB in January 2019). That is 9 cigarettes per day for every man, woman, and child. But unlike cigarettes, people living in UB have no choice but to breathe the polluted air.

Image credit: UNICEF

Despite the severity of seasonal air pollution levels in UB (ranking #1 polluted city in the world during wintertime), globally Mongolia has often been overlooked. The fact that our air pollution is seasonal also leads to Mongolia’s average annual air pollution levels to drop when compared to other polluted cities (although we still rank in the top 10 despite it). The past couple years, Mongolia’s air pollution crisis has been garnering more attention from the media with news sites such as the National Geographic, Time and the The New York Times covering the story, and international organizations such as UNICEF calling action to the crisis.

Mongolia ranks #5 as city with worst air pollution levels in the world in 2018 based on average annual pollution levels. Source: 2018 World Air Quality Report

The impact of air pollution in Mongolia, especially on the health of our citizens is evident. Young children are getting sick, parents and grandparents are dying prematurely from heart attack and stroke. In the winter months, kids frequently get sick with pneumonia and have to be hospitalized. Hospitals are so overburdened that they often run out of beds, resulting in sick kids being treated in the hallways.

It is clear that air pollution is a public health crisis in Mongolia. As a healthcare provider, I am deeply concerned about what air pollution is doing to the health and well being of Mongolians, especially our young children. I believe we all have a responsibility to do everything we can to protect the health and future of our youngest and most vulnerable citizens. This starts with protecting our own children, but it cannot stop there. We know that the poorest in our communities, those living directly in the ger districts are the ones who are the most exposed to the harmful pollutants. They are also the ones who face the biggest barriers in protecting themselves from pollution due to lack of evidence-based information and financial implications.

I am working with Breathe Mongolia, a clean air coalition, to raise awareness of this public health crisis and provide accurate, evidence-based information on the steps that individual citizens can take on a daily basis to protect their health. If you want to get involved, please join us! We need healthcare professionals, translators, journalists, social media managers, web designers, content creators, students, teachers, parents…anyone who is passionate about this problem and wants to contribute in any way you can.

One day, every child in Mongolia will be able to breathe clean air year round. Let’s work together to reach that day as soon as possible.

Image credit: Video Blocks

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