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Toxic Air: Pollution and Health Consequences in Afghanistan

June 2011 Comprehensive Information on Complex Crises

Erin Foster Humanitarian Affairs & Socio-Cultural Development Knowledge Manager

erin.foster@cimicweb.org

As the population of Afghanistan grows and urban areas exceed their planning capacity, the health consequences for Afghans and others living in the country are likely to worsen. This paper takes a brief look at air pollution and some of the contributing factors, health risks and recommended environmental initiatives. Related information is available at www.cimicweb.org. Hyperlinks to source material are highlighted in blue and underlined in the text.

ir pollution is a problem that affects countries worldwide, with the World Health Organization (WHO) attributing more than two million deaths per year to this phenomenon. Estimates from Afghanistans Ministry of Public Health (MoPH) released in 2009 indicate that 3,000 Afghans die annually as a result of complications from air pollutants. Health officials further ranked Kabul as the most polluted province in the country due to rapid urbanisation. The capital city of Kabul was initially planned to hold a maximum of 500,000 residents, however, the actual figure is now close to five million.1 Further, the number of Afghan deaths attributed to pollution surpasses UN figures on the number of civilians killed as a result of conflict in Afghanistan in 2010 (2,777). It is against this backdrop that this report attempts to present information about air pollution in Afghanistan and its public health risks as well as efforts currently underway to assist the country in meeting national and international environmental standards.

Air pollution what is it and how is it caused?

Simply defined by the United States Environmental Protection Agency (US EPA), air pollution occurs when high concentrations of gasses and particles accumulate in the air. The US EPA provides a listing of the six most common air pollutants: (i) particulate pollution (particulate matter); (ii) ground level ozone; (iii) carbon monoxide; (iv) sulphur dioxides; (v) nitrogen oxides; and (vi) lead. According to the US EPA, particles less than 10 micrometers in diameter that are inhaled by humans2 pose the most severe health risks. Inhalable coarse particles measure between 2.5 and 10 micrometers and are often found near roads or from industry dust, while fine particles measure 2.5 micrometers in diameter and smaller and can be found in smoke and haze. Beyond heart and respiratory illnesses these particle pollutants also adversely impact the environment by reducing visibility and causing damaging acid rain. Ground level ozone is the result of a chemical reaction between oxides of nitrogen (Nx) and volatile organic compounds that produce smog. The majority of carbon monoxide (CO) emissions, which cause a reduction in oxygen flow in the body, are attributed by the US EPA to vehicle emissions. The presence of sulphur dioxide (SO2) is mostly attributed to the burning of fossil fuels (73%) and, to a lesser degree, industrial fumes (20%). Respiratory illness is the most common illness associated with SO2 exposure. Nitrogen dioxide (NO2) and Nitrogen oxides (NOx) are a by-product of vehicle and industrial emissions and, similar to SO2, can cause respiratory illnesses, particularly asthma. Lead (Pb) pollution is the result of both vehicular and industrial emissions. Lead is absorbed into the blood and bones in humans and causes reduced oxygen capacity, neurological disorders in children and heart disease in adults. WHO is currently the organisation tasked with setting the internationally-accepted environmental health standards. WHO first issued air quality guidelines in 1987, with subsequent revisions published in 1997 and
Population statistics for Kabul city vary, including planning figures with a report from Radio Free Europe/Radio Liberty citing a city planning figure of one million and a current population of four million. 2 According to the EPA, adults breathe more than 3,000 gallons of air per day.
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Monthly Report: Toxic Air Pollution and Health Consequences in Afghanistan

2005, to set targets for particulate matter, ozone, nitrogen dioxide and sulfur dioxide. According to WHO, the guidelines are intended to achieve air quality that protects public health in different contexts, thereby serving as a resource for governments when setting national standards. The full report provides the scientific rationale behind WHO target values for four key air pollutants (see Table 1). Values measured by public health officials in excess of recommended amounts are likely to pose public health risks for people living in exposed areas. Table 1. WHO Air Quality Guidelines3 Particulate Matter PM2.5 10 g/m3 annual mean 25 g/m3 24-hour mean 20 g/m3 annual mean Particulate Matter PM10 50 g/m3 24-hour mean 100 g/m3 8-hour mean Ozone O3 Nitrogen dioxide NO2 Sulfur dioxide SO2 40 g/m3 annual mean 200 g/m3 1-hour mean 20 g/m3 24-hour mean 500 g/m3 10-minute mean

Health risks and recommendations

Following the formation of the Afghanistan Interim Authority (AIA) in December 2001, a series of environmental studies took place to better understand the needs in the sector and to prioritise actions. A 2002 study conducted by the Asia Development Bank (ADB), entitled, Afghanistans Environment in Transition, identified pollution and environmental health among the most critical needs to address in Afghanistan. Causes of pollution were linked to the rapid growth of urban populations and the difficulty experienced by municipalities in coping with the increased demand by residents for services such as waste disposal and the regulation of dumping sites. Additionally, vehicular emissions were identified as the main cause of air pollution and the use of fuel burning stoves as the main source of indoor air pollution.4 The ADB report, which was issued nearly a decade ago, contained four key recommendations that remain relevant today: (i) focus on planning and zoning regulations; (ii) addressing refugee movements and resource needs; (iii) protection of green areas; and (iv) rethinking the location of industries to maximise recycling of waste by-products and regulating the storage of agrochemicals that contribute to air pollution. Similar to the ADB, the United Nations Environmental Programme (UNEP) undertook an assessment5 of Afghanistans environment in 2002-2003 in preparation for the establishment of national capacityDust kicked up from vehicles. UNAMA 2011

Extracted from WHO, Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide, World Health Organization, 2005. 4 For further information regarding indoor air pollution please see: WHO, Indoor Air Pollution: National Burden of Disease Estimates, World Health Organization, 2007. Also, WHO, WHO Guidelines for Indoor Air Quality selected pollutants, World Health Organization, 2010. 5 UNEP, Afghanistan Post Conflict Environment Assessment, United Nations Environment Programme, 2003.
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building measures that would follow, including the creation of the National Environmental Protection Agency (NEPA) in 2005, Afghanistans Environment Law (2007), and the Inter-Ministerial Committee for Environmental Coordination (CEC). The UNEP findings were similar to those of ADB and went into greater detail about some of the causes of air pollution, predominately found to be fine particulate matter and vehicle emissions. In 2003, Afghanistan had registered more than 500,000 vehicles, 30,000 buses and 50,000 trucks nationwide. It was not only the number of motor vehicles but the use of outdated engines, exhaust systems and dirty gasoline that the report cited as causing dangerous emissions. Power shortages also contribute to air pollution with residents using any materials available to burn as fuel, and at times releasing toxic fumes. Compounding the vehicle pollution were the fumes spread from industrial areas that were inspected by UNEP. These included toxic gases from plastic recycling plants, paraffin fumes from brick factories, lead dust from battery factories, cancer-causing Polynuclear Aromatic Hydrocarbons (PAHs). Air samples taken from the cities of Herat, Kabul, Kandahar and Mazar-e Sharif in 2003 showed the presence of PAHs in areas all four cities, with the pollutant Benzo-a-pyrene, linked to lung cancer, found in above average concentrations6 in Mazar-e Sharif (13.6 Ng/m3). The report warned that high levels of dust increased the risk of human inhalation of PAHs, as the dust binds to the hydrocarbons and prevents them from moving into the upper atmosphere. Moreover, the loss of vegetation in urban areas has elevated dust levels and is placing residents at further risk. Other sources of air pollution identified in the study were the lack of incineration facilities leaving waste exposed; the disposal of medical waste into regular dump sites spreading disease and polluting water; open sewers contaminating rivers and the lack of water treatment facilities causing emissions. A 2008 UNEP update on Afghanistan revealed that nearly 60% of residents in Kabul are exposed to elevated air pollution levels that include concentrations of particulate matter PM10 (fine anthropogenic dust), nitrous oxides (NOx) and sulphur dioxide (SO2). More recently in 2010, the Afghan MoPH released an assessment by Dr. Atiq Sediqi, listing 11 main causes for the deterioration of air quality in Kabul (see Table 2). Particulate matter, including PM2.5 and PM10, were found by the author in concentrations between two and five times the US EPA recommended levels. Particulate matter is especially harmful to humans because of its extremely small size, which allows it to pass into the lungs and has been found to cause ailments such as strokes, lung cancer, brain damage, respiratory, Table 2. Main Causes of Air Quality Deterioration cardiovascular, heart and circulatory diseases and 1. Dusty roads damage to unborn children. Nearly 80% of 2. Old and smoking vehicles random blood samples taken from Kabul residents by NEPA and MoPH tested positive for 3. Burning plastic, used motor oil and tires as a lead, a known fuel emission. Data tables source of fuel regarding air emissions from vehicles, burning 4. Urban sprawl tires, wood, coal, motor oil, generators, plastic 5. Geography - the valley that surrounds Kabul and styrofoam, as well as a table of common and traps air pollutants and promotes health effects from pollutants are also provided in atmospheric inversion the study. Although statistics vary regarding the 6. Leaded gasoline concentration levels of air pollutants in Afghanistan, Dr. Sediqi explained that [t]here is 7. 2-cycle electric generators no safe limit for cancer causing chemicals such as 8. Diesel generators benzene, PCBs, dioxin and others. He further 9. Coal and wood used for heating and cooking recommended improvements to transportation 10. Cutting down of trees, shrubs and bushes management, paved roadways, greening initiatives, bans on the burning of tires, motor oil 11. Lack of public awareness and plastic, and concerted public information campaigns. Beyond the studies reviewed above, additional information is available to the public from media sources that have occasionally reported on the public health dangers of air pollution in recent years in Afghanistan. An Integrated
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WHO averages used in the study showed rates of 1-10 Ng/m3

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Regional Information Networks (IRIN) article from 2008 cites officials from NEPA who link air pollution to nearly 70% of diseases occurring in Kabul, including increased cases of cancer, respiratory illnesses and eye and nasal problems. NEPA further noted challenges to controlling air pollution as Kabul has lost more than 70% of its vegetation during the past two decades and nearly 8,000 vehicles are registered in the city each month. Other media reports reference health risks for foreign military in Afghanistan, highlighting pollution concerns in the country. A recent article by USA Today suggests that dust particles may be one of the primary causes of illnesses facing soldiers who have deployed to Iraq and Afghanistan. New research being conducted by Navy Capt. Mark Lyles, Chair of Medical Sciences and Biotechnology at the Center for Naval Warfare Studies, suggests that fine particles of dust inhaled by soldiers in Iraq and Afghanistan contain more than 147 types of bacteria and 37 types of metal. According to Lyles team, 25% of [the bacteria] may cause diseases such as meningitis, cystic fibrosis, septic arthritis, gastroenteritis, staph infections, diarrhoea and food poisoning. The article further notes that heavy metals are linked with an increased likelihood of neurological diseases, cancer, respiratory ailments, depression and heart disease. However, further research is required as symptoms for the inhalation of heavy metals are often similar to post-traumatic stress disorder (PTSD). Additionally, US Department of Defense officials explained, we have closely examined our medical surveillance data for those personnel who have deployed some multiple times and we have not been able to identify any increased disease that could be associated with germs that were identified in the soil. Continued research into the health risks associated with air pollution is necessary to develop prevention strategies and treatment for all those exposed to toxic air, including both Afghans and foreigners in the country.

Initiatives to counter air pollution

Afghanistan ratified the UN Framework Convention on Environment crisis do not make a sound Climate Change (UNFCCC) in 2002. As a party to this like a suicide bombing, but air pollution is international agreement, Afghanistan pledged to reduce climate-changing greenhouse gases and develop a national no less a killer than a bomber. framework to reduce emissions. The most recent update on these efforts is provided in the February 2009 National Najibullah Yamin Capacity Needs Self-Assessment for Global Environmental Deputy Director General, NEPA Management (NCSA) and National Adaptation Programme of Action for Climate Change (NAPA): Final Joint Report. In February 2011, NEPA launched the start of its first ever Afghanistan country report on emissions and the removal of greenhouse gases in line with the UNFCCC. The initial meeting established six working groups dedicated to analysing information and writing the report anticipated to be completed by the end of 2011. From this Initial National Communication officials will develop a national strategy addressing the impact of climate change in Afghanistan. In March 2004, Afghanistan committed to achieving nine Millennium Development Goals (see CFC report, The Millennium Development Goals and Afghanistan), which included Ensuring Environmental Sustainability (Goal 7). One key target related to air pollution is the commitment to sustainable environmental policies as well as reversing the loss of environmental resources. MDG 7 specifically mentions deforestation, carbon dioxide emissions and the use of fossil fuels as three areas the Afghan government has committed to addressing. According to the last available MDG progress report (2008) published by the Afghanistan government and United Nations Development Programme (UNDP), this goal is achievable by 2015. Afghanistans Environment Law (Official Gazette No. 912) was published in January 2007 and sets the standard for government and citizen responsibility and actions to protect the environment. Chapter 4 of this gazette specifies requirements for integrated pollution control, prohibiting unlicensed release of pollutants and waste and license controls. UNEP provides a comprehensive guide to the 2007 environment law, which further describes the responsibilities for environmental protection as well as enforcement by NEPA.

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An emergency environmental protection commission was established by President Hamid Karzai in 2009 in support of the national environment law and NEPA initiatives to control air pollution, such as the enforcement of bans on old vehicles and poor quality fuel. Public health officials took further steps to reduce air pollution from vehicle emissions by declaring Thursdays a public holiday as of December 2010 to allow for a two-day weekend in Afghanistan. However, it is not yet known if this has had any effect on pollution levels. Kabul residents are now advised to wear protective masks to cover their mouth and nose during morning and evening traffic congestion. Recommendations to improve air quality and protect public health in Afghanistan continue to focus on the largest contributor of pollutants, vehicle emissions, while still other less commonly reported approaches may also merit mention. As reported by Radio Free Europe/Radio Liberty, unorganised waste collection and open landfills exacerbate air pollution, contaminate groundwater and may cause the spread of disease. The construction of landfills at the estimated cost of USD 8-10 million may assist in the reduction of harmful pollution affecting neighbouring communities. The United States Agency for International Development (USAID) currently funds Kabul city clean up Dust kicked up from vehicles. UNAMA 2011 campaigns that attempt to remove some of the nearly 3,500 tonnes of waste produced on a daily basis. Head of Kabuls municipal sanitation department, Nasir Ahmad Habibi, said such projects ease the burden of waste removal and public health concerns, but they do not solve the underlying need for sanitation infrastructure. In summary, air pollution in Afghanistan remains a serious public health concern, particularly in urban areas. Vehicle and industrial emissions are some of the largest contributors to pollution, while dust and indoor fuel consumption are other dangerous factors. Afghanistans commitment to achieving international air quality and environmental standards has resulted in the creation of government initiatives and studies that attempt to address the issue. However, concerted efforts are needed to ensure the enforcement of environmental regulations and to improve public participation through awareness campaigns.

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