In Afghanistan, pollution-related illnesses are killing more people than the war

Afghanistan's air is far deadlier than its ongoing war, according to the State of Global Air, an initiative of two U.S.-based research institutes.

In 2017, 26,000 people died as a result of pollution-related respiratory illnesses. During the same time period, 3,500 civilians were killed by conflict according to the UN.

Those findings from the Health Effects Institute and the Institute for Health Metrics and Evaluation are shedding new light on the human costs of Afghanistan's poor air quality.

The diseases, which most affect children and seniors, ramp up during Kabul's harsh winter as citizens — particularly those displaced by war — light fires for warmth.

Though coal and wood are common, some burn anything they can get their hands on: food scraps, shoes and even rubber tires. Doctors attribute the increase in respiratory illness cases to the increased pollution.

Ivan Flores is a Kabul-based photojournalist. In February, he visited a hospital treating children for respiratory infections. He later wrote about the situation for Foreign Policy.

He spoke with Day 6 host Brent Bambury from New York about what he saw. Here's part of that conversation.

You went to the respiratory ward at the Children's Hospital in Kabul. Can you describe it for us?

It's a pretty dark space. The power situation in Kabul in the winter is pretty sporadic, so you'll get electricity for a few hours of the day. And they were running on a generator for the most part and you had a couple of lights hanging overhead and very dimly lit wards.

It's not how we would imagine a hospital in a Western context where everything's brightly lit and white and clean. You're kind of looking at this dark environment and the roof leaked a little bit and you could hear the children screaming and it would just echo off the walls in the ward.

Since it's predominantly children that are affected, it's filled with children, and they're pretty terrified.

For the most of them it's their first time away from home and then they're having these masks put on their faces so they can breathe in the nebulizer treatment that'll help cure their infections hopefully.

Are these kids going to get well?

I think so. Children are resilient. If they can access treatment, their chances of getting well are pretty high. It's mostly the elderly that have a lower chance of recovery from this.

Is there one family's story that that struck you most or stayed with you when you were talking to people at the hospital?

Yeah. I met one family, Abdul and Khalid. Abdul is the father and Khalid was the baby; I think he was about nine months old, and they're from Paktia province about 90 miles east of the capital.

Abdul said that his baby has been sick since he was born and it was always a respiratory ailment, and then once the winter hit, everyone in his village burns coal. So he said it was hard to breathe and his baby got even worse.

So he decided to make the journey to Kabul to take his baby in for treatment. We met him in the hospital, my translator and I, while the baby was being treated.

Once they get that mask over his [the baby's] face he started screaming, squirming and wiggling around, and his father was just there watching and waiting for the doctors to wrap up the treatment.

Is there any way for the Afghan government to address any of this as long as there's a war going on?

I think, yes, there is a way for the Afghan government to address it. I think NEPA — the National Environmental Protection Agency — could be given a little bit more agency over being able to shut down commercial polluters and regulate it.

There were some tariffs that were levied on vehicle imports so that way we would have checks on the exhaust and the fumes that were going to be used.

But I think overall there's not really much that I think can be done about the pollution situation, because even if you address the systemic issues that require having a national electrical grid that functions, it may still run on coal and natural gas which just shifts the pollution burden from the city out into the provinces.

But if the security situation improves in Kabul, or in Afghanistan, you're saying that realistically we can't expect air quality to improve to a point where, at least in winter, those kids don't end up back in those wards?

I think if the security situation improves in Kabul, government would be able to focus more resources and attention towards addressing those issues rather than being split between a conflict that hasn't ended in 40 years and the pollution sources that are happening.

And we wouldn't see as many [internally displaced persons] families that are gathered around living in pretty rough conditions because of the fighting and because of displacement.

This is an intensely seasonal problem. What are the doctors telling you that are treating these kids? Are they frustrated by the situation that's leading to these wards being overcrowded with kids that can't breathe?

I think they've come to expect it now.

There was one doctor that I was speaking to that says that he treats about 40 patients a day and it's all respiratory in the winter. And that's just how the seasons change.

Similar to how we deal with flu season here, and we just know that there will be a spike in cases around that time of year. They seem to treat it as, 'this is just what happens this season.'

This transcript has been edited for length and clarity. To hear the full interview with Ivan Flores, download our podcast or click 'Listen' above.