When Dr Sohail Raja selected pulmonology (respiratory and lung department) for his specialisation in 2012, he believed the climate in Kashmir was clean. During his training, he discovered that respiratory diseases are highly prevalent in this region. Following an in-depth study, it was unveiled that there is a significant amount of particulate matter in the atmosphere.

Invisible chemical components of air pollution and dust particles infiltrate the body through inhalation and enter the bloodstream through the lungs. These are measured as particulate matter (PM) and are classified as PM 1.0, 2.5, and 10.

Sohail Raja is associated with the Abbas Institute of Medical Sciences (AIMS), a prominent hospital in Azad Kashmir in Muzaffarabad. He notes that the outpatient department (OPD) at AIMS sees approximately 40 people daily, all presenting complaints related to lung diseases. The 24-bed ward under his care consistently remains occupied with patients.

A 2017 study published in the journal Aerosol and Air Quality reveals a concerning escalation in air pollution levels in Muzaffarabad city. The research, conducted by two educators from the University of Azad Jammu and Kashmir, includes Dr Wajid Aziz from the Department of Computer Science.

Dr Wajid Aziz says there is an overabundance of three types of particulate matter (PM) in Muzaffarabad’s atmosphere, including PM 10, PM 2.5, and PM 1.0. The study collected data from six locations: Chehla Bandi, CMH Chowk, Muslim Book Land, Old Secretariat, Chattar, and Qadri Travels.

“The average PM 1.0 level at these locations measured approximately 400 micrograms per cubic meter, and PM 2.5 recorded around 500 micrograms per cubic meter. In comparison, the World Health Organisation (WHO) defines safe limits as 25 micrograms per cubic meter for PM 2.5, 10 micrograms per cubic meter for PM 1.0, and 50 micrograms per cubic meter for PM 10.”

Dr Wajid Aziz says that PM 1.0 and PM 2.5 pose greater harm as these minuscule particles infiltrate the brain, blood vessels, and lungs through inhalation, leading to respiratory diseases and potential cancer risks. He highlights the health risks for all Muzaffarabad residents due to air pollution and urges the government to implement preventive measures.

Experts attribute the rise in air pollution levels in Muzaffarabad to various factors, including extensive reconstruction after the 2005 earthquake, heightened traffic, and increased mining activities.

Shafiq Abbasi, the Director of the Environment Protection Department, points out that the post-2005 earthquake migration of people from rural areas to poorly managed cities has contributed to environmental challenges.

The 2018 environmental report highlights a 153 per cent increase in Muzaffarabad’s built-up area from 2000 to 2017. Due to migration, the rise in urban population has led to construction along canals and rivers. Despite the presence of regulatory authorities, their impact in addressing these concerns remains minimal.

Muzaffarabad’s rivers and canals have been transformed into construction, roads, and commercial centres, contributing to resource consumption and waste generation as the population expands.

Despite significant road expansion projects, such as the Nalochi Bypass, undertaken after the earthquake in Muzaffarabad, traffic congestion remains a challenge due to the substantial increase in population, leading to environmental issues in densely populated areas.

Dr Sohail Raja says that the rise in respiratory and lung diseases is evident throughout the year, including summer, as the hospital wards consistently witness a high influx of patients from these areas.

“The primary cause behind this surge is the emission of fine particles into the air from fuel combustion and domestic fires, as people lack alternative energy sources. During summer and for a significant portion of winter, individuals burn firewood for cooking and heating their homes, releasing fine particles that elevate the risk of respiratory illnesses like lung cancer, asthma, and tuberculosis, particularly affecting non-smoking women and children.”

According to a study published in the Pakistan Journal of Public Health earlier this year, 270 out of every 100,000 people in Azad Kashmir are currently suffering from tuberculosis (TB).

Dr Waleed, a cardiologist at AIMS, says that about 40 to 50 people arrive at his hospital daily with heart-related complaints, leading to daily admissions in the wards. While some receive treatment at the hospital, others are referred to Rawalpindi due to a lack of modern technology.

Dr Waleed says that complaints of narrowed arteries, once prevalent in individuals over 40, are now evident in those aged 20 to 40. Contributing factors include insufficient physical activity, diabetes, and blood pressure issues.

Additionally, excessive consumption of junk food and drugs is on the rise, exacerbating heart diseases, which are further compounded by air pollution.

WHO Director Tedros Adhanom Ghebreyesus has likened polluted air with chemical components to “the new tobacco,” emphasising the global impact on people regardless of race, caste, or economic status. In drawing parallels to the discourse on the harmful health effects of tobacco, he underscores the need for worldwide awareness of this new form of pollution.

Azad Kashmir’s Environment Department acknowledges the severe air pollution caused by harmful particles. Secretary Muhammad Naeem Bismal says that 2021 data from Muzaffarabad indicates particulate matter levels significantly surpassing safe limits. He identifies crushing machines and rising traffic in Chehlla, on the city’s outskirts, as primary contributors.

Naeem Bismal highlights an ‘Ambient Air Quality Monitoring System,’ alongside experts, to monitor air pollution. Annual State of the Environment reports and mining regulations aid in managing the situation. A vehicle inspection system has also been implemented to assess vehicle conditions and smoke emissions.

Shafiq Abbasi notes that two or four crush machines in Shuwai operate under stringent environmental and social safeguards. Housed within concrete structures, these machines avoid crushing dry material directly. Instead, they follow a process of washing before crushing, contributing to a reduction in pollution levels.

The police department issued 426 challans with fines of one lakh 77 thousand rupees in 2021 for vehicles emitting smoke. In 2022, 721 challans were issued, resulting in a two lakh 67 thousand rupees fine. As of 2023, 395 challans have been issued, with a total fine of 98 thousand 850 rupees imposed.

Despite implemented measures, air pollution in Muzaffarabad has reached dangerous levels, threatening human lives. Dr Wajid Aziz suggests addressing the lack of awareness by introducing environmental education in educational institutions.