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very day Noreen, a 25-year-old school teacher in Peshawar, Pakistan, drives along polluted streets on her way to school, breathing in fine dust that makes her sick.
“The dust during my daily commute triggers cold-like symptoms, worsens my condition, and even affects my eyes, hindering my ability to work,” she says, adding that her doctor attributes all these problems, and her persistent ear pain, to air pollution.
About 1,700 kms away, in Begusarai, Bihar, India, 80-year-old poet and writer Mukulal Iltiza has had to leave her decades-old family home and transfer residence to the city’s outskirts in a bid to be relieved of severe breathing problems and chest ailments. According to the latest report by the Swiss tech company IQAir, Begusarai in 2023 claimed the unenviable title of the world’s most polluted city, boasting an average annual PM2.5 concentration of 118.9 – 23 times higher than the tolerable limits set by the World Health Organization (WHO). (PM2.5 refers to fine particles or droplets in the air that are 2.5 microns or less in diameter.)
Over the last two decades, air pollution has evolved into a global crisis, WHO says. The impact is stark. It’s the top environmental factor contributing to poor public health, experts say, leading to as much as nine million deaths worldwide annually, and to millions more people falling ill due to respiratory and cardiovascular problems, as well as cancer, among others.
For many countries, transboundary pollution is a reality, with a neighboring nation’s toxic fumes carried by the winds across borders. This the case with the world’s top three most polluted countries in the world – Bangladesh, Pakistan, and India – which are next to each other and where, aside from the usual industrial and vehicle emissions, crop residue burning, brick kilns, and cultural practices such as cooking stoves and human cremation have been noted as primary contributors to the gray-brownish haze that often hangs over their cities and towns.
Cultural practices and norms as well have made women in South Asia among those most affected by air pollution, with gender inequality leaving many women and girls in the region less educated and less nourished compared to men and boys, yet more exposed to indoor and outdoor pollution.
It takes two – or more
Transboundary pollution and its profound impact on the most vulnerable, including women and girls, have prompted scientists and health experts to call for crossborder cooperation to find solutions. In its 2023 study on air pollution and public health in South Asia, the World Bank said, “Without coordination, regions cannot reliably predict their future air quality. The long-range transport of pollution makes actual air quality improvements in a region dependent not only on local measures but also on measures taken in other areas.”
But so far governments across the region have not made any concrete move toward such an initiative, although they have individually crafted and implemented some air-pollution mitigation policies and programs for their own countries. This is despite the decades-old Malé Declaration on the Control and Prevention of Air Pollution and Its Likely Transboundary Effects in South Asia, which has as participants not only Bangladesh, India, and Pakistan, but also Nepal, Maldives, Sri Lanka and Iran. In 2022, there was even a supposed “revival” of the declaration, but the effort has yet to lead to anything significant on the ground.
Interestingly, the greatest push has been toward getting constantly bickering Pakistan and India – where IQAir says the world’s top 10 most polluted cities from 2017-2023 were – to join hands and search for ways to control and prevent air pollution.
Just last year, the Indo-Pakistan Climate Collective (IPCC), composed of scientists and members of civil society, issued its inaugural annual report that highlighted the need for enhanced cooperation and information sharing between the two countries to address crossborder air pollution.
Maryam Shabir Abbasi, a visiting senior researcher at the Sustainable Development Policy Institute in Islamabad and a participant in the IPCC’s “Air We Share” report, also underscores the critical need for foundational research to catalyze collaborative attitudes and policy innovation between countries.
For sure, the two countries have had instances of cooperation before. For instance, Indian environmentalist Bhavreen Kandhari points to India and Pakistan’s successful collaboration in the Indus Waters Treaty, which effectively regulates the sharing of water resources from the Indus River system.
Kandhari, co-founder of the NGO Warrior Moms, remarks, “This collaboration serves as a positive example for addressing future environmental challenges affecting both nations.”
For the most vulnerable, bilateral cooperation to mitigate air pollution cannot come any sooner. Abbasi tells ADC that low-income groups as well as women and girls in both countries specifically face heightened health risks from air pollution due to “limited healthcare access and pervasive exposure.”
Dr. Muhammad Shahzad of the Aman General Hospital in Peshawar meanwhile says that the women’s high vulnerability to the effects of air pollution is due mainly to their sheer physiology, caregiving responsibilities, poor nutrition, and financial constraints. Across the region, too, many women are exposed to indoor air pollution caused by cooking with cow dung and wood, compromising their health and exacerbating the negative impact of outdoor pollution.
“Women are more exposed to biomass gas,” Shahzad says. “Additionally, according to various studies, they are more prone to asthma due to their hormonal problems. These factors contribute to why women are more affected by air pollution compared to men.”
Recent research also linked air pollution to a higher incidence of breast cancer in women, while Shahzad adds that inhaling traffic fumes that carry toxic metals such as mercury and lead can harm not just the lungs, but also the kidneys. Not surprisingly, air pollution has adverse effects on women’s reproductive health as well, and puts pregnant women at risk of suffering from high blood pressure, still births, and miscarriages, among others.
Better together
Citing the experience of Warrior Moms, which collaborates closely with healthcare workers to raise awareness about air pollution and debunk misconceptions about supposed solutions such as air purifiers and smog towers, Khandari says that collaboration between Indian and Pakistani healthcare professionals, as well those from other nations, can lead to campaigns to educate women, promote cleaner fuels, ensure healthcare access, and advocate for stricter emissions regulations. She says healthcare professionals can also address poverty and infrastructure issues driving pollution, fostering sustainable growth.
Climate Forward Pakistan founding director Durlab Ashok, for his part, says that public awareness campaigns and addressing the gendered impacts of air pollution, where women often bear a disproportionate burden, are crucial strategies in any collaborative effort between India and Pakistan to combat the problem. Sharing knowledge and data, developing a joint policy framework, and exchanging clean-energy solutions, can be among the main parts of such collaboration, he also says.
2Particulate pollution, also called particle matter (PM), is a mixture of tiny solid and liquid droplets suspended in the air, exposure to which has been known to lead to cardiovascular and respiratory diseases. The tolerable annual limit set by the World Health Organization is 5 µg/m3.
“By pooling their strengths and expertise,” Ashok stresses, “(there is greater) opportunity for both nations to effectively address this transboundary issue.”
Cooperation, however, seem to be farthest from the minds of the respective leaders of India and Pakistan. As political analysts Annutama Bannerji (Indian) and Muhammad Sharez Qazi (Pakistani) put it in a 2023 piece on the related issue of climate change, India and Pakistan have been choosing to “prioritize their rivalry” instead.
The two analysts observed as well: “The reluctance of both governments to engage with each other on bilateral or multilateral issues in recent years is evidence of how they perceive any chance of mutual consensus.”
At the very least, though, both countries have taken steps to mitigate air pollution within their respective borders. In March last year, Pakistan approved the National Clean Air Policy (NCAP), which aims to improve air quality by focusing on transportation, industry, agriculture, waste management, and residential sectors, with five key actions for each sector.
According to the policy’s proponents and supporters, the NCAP’s implementation could reduce mortality rates and transboundary pollution, benefiting Pakistani citizens and boosting economic activity. Yet while climate-change expert Mohammad Akmal Khan praises the policy’s comprehensive framework, he notes Pakistan’s weak infrastructure for climate-change challenges.
On the other side of the border, India’s somewhat similarly named National Clean Air Programme (also abbreviated as NCAP) aims to address pollution in 131 cities but faces challenges with fund utilization and varying pollution-reduction impacts. Originally targeting a 20- to 30-percent reduction in key pollutants by 2024, the goal was revised to 40 percent by 2026. Progress has been mixed, with some cities showing improvement but many others still falling short of pollution reduction goals.
India also has City Action Plans (CAPs) that target specific sources of pollution like dust, vehicles, and industries in each city, aiming to improve air quality. These plans and programs, needless to say, have no gender component. Yet even if they did have one, the chances of them fully meeting expectations are slim so long as coordination and collaboration with neighboring countries remain absent.
In its 2023 study, the World Bank even pointed out that “it is impossible to improve air quality to healthy levels using the city-by-city approach prevalent across South Asia today.” It said that “even if Delhi, the most polluted capital city in the world, were to fully implement all technically feasible air pollution control measures by 2030, the city would still not meet the WHO Air Quality Interim Target 1 if neighboring states and countries continue to follow their current policies.”
“This is because the inflow of pollution from these states and bordering countries accounts for more than 50 percent of air particulate matter in Delhi,” the World Bank explained. “The same is true in many other cities, and in their surrounding rural areas as well. Only through cooperation at the province, state, and regional levels can South Asia hope to beat air pollution.” ◉
With additional reporting by Meenakshi J and Amit Baijnath Garg. This story was part of a cross-border reporting workshop organized by the U.S-based East-West Center.
