nce known as the City of Gardens, Lahore now suffocates due to smog, which is having a devastating impact on children’s health.

Anoosha Ghazi, an 8th-grader in Lahore, recently experienced coughing and breathing difficulties due to the city’s worsening smog. Her condition, requiring medical attention, underscores the grave impact of Lahore’s hazardous Air Quality Index (AQI) on children. As a young climate activist, Anoosha is urging authorities to address the crisis, emphasising that clean air is a constitutional right that must be upheld for the health and safety of all citizens.

Staggering statistics
According to data sourced from the Health Department as of 13th November, the Lahore region has seen a substantial rise in smog-related diseases in November 2024. On November 13th, the city recorded 5,538 new cases of respiratory diseases, 291 cases of asthma, 3 cases of ischemic heart disease, 14 stroke cases and 206 cases of conjunctivitis. Looking at the prior week from that, the numbers were to 33,524 respiratory cases, 1,857 asthma cases, 188 ischemic heart disease cases, 212 strokes and 663 cases of conjunctivitis.

The data also shows that in October-November, Lahore had 131,368 respiratory disease cases, 5,129 asthma cases, 5,254 ischemic heart disease cases, 464 strokes, and 1,379 cases of conjunctivitis.

Worsening trends

Analysing the data for the Punjab and Lahore region during October 2024 compared to July-September 2024 for the Punjab, we observed that the total daily disease incidence rose from 4.99 to 5.30 per 10,000 people, with noticeable increases in the rates of acute upper respiratory infections (AURI), ischemic heart disease (IHD) and stroke. Conjunctivitis showed a slight decline.

Similarly, Lahore experienced an increase in total daily disease incidence from 2.71 to 3.12 per 10,000 people, alongside rising rates for AURI, IHD and stroke, while the incidence of conjunctivitis remained unchanged. These trends underscore the intensified health impacts of smog during October, with most disease categories showing significant upticks in incidence.

UNICEF warning

The UNICEF has issued a stark warning regarding the health risks faced by children in the Punjab, emphasising that over 11 million children under the age of five are exposed to toxic air. Abdullah Fadil, UNICEF’s Representative in Pakistan, highlighted the urgent need for comprehensive action to combat air pollution and safeguard the health of vulnerable children. He stated, “The air pollution crisis is a silent killer that threatens the lives and future of our children. We must prioritise their health by addressing the sources of pollution and implementing effective policies.”

According to IQAir.com, smog levels in Lahore and Multan reached alarming heights, surpassing an Air Quality Index of 1,900 on November 10. The extreme pollution level is considerably above the World Health Organisation’s recommended limits of 35 µg/m³ for a 24-hour average of PM2.5 and 50 µg/m³ for PM10, which are established to protect public health.

Prior to these extreme conditions, approximately 12 per cent of deaths among children under five in Pakistan were attributed to air pollution. The current crisis has disrupted the education of nearly 16 million children due to school closures aimed at reducing exposure to smog. The UNICEF warns that the long-term effects of such pollution could severely impair cognitive development and overall health in affected children.

The healthcare system

Dr Zaheer Akhtar, a physician at a government hospital in Lahore, says that smog exposure is particularly harmful to vulnerable groups such as children, women and the elderly. According to him, “One day of exposure to dense smog is equivalent to smoking 30 to 50 cigarettes.” Patients with no prior conditions are now presenting with conjunctivitis, throat irritation and bronchitis. Those with pre-existing ailments like the COPD and asthma are experiencing a sharp decline in their health, requiring extended hospital stays and increased oxygen support.

To tackle the growing number of cases, public hospitals have ramped up their capacity, adding more oxygen-equipped beds and expanding nebulisation facilities. “We’ve also increased the use of antibiotics to manage chest infections that commonly accompany smog-related illnesses,” Dr Akhtar says. Despite these efforts, the burden on healthcare facilities continues to grow as smog remains a persistent threat.

“Several hundred children in the Punjab died of pneumonia last January,” says lawyer Rafay Alam. “Tens of thousands were hospitalised in the Punjab during the brown haze event we experienced in early November. The consequence of air pollution is death and loss of life expectancy in both humans and animals.”

The culprit is a deadly cocktail of industrial emissions, vehicle fumes and agricultural burning that has made the air toxic. “It is not just a Lahore issue and not seasonal,” Alam says, “it is a regional issue, from Kabul to Calcutta, and a year-round public health emergency.”

Remedial efforts

Sajid Bashir, the communication head at Punjab’s Environmental Protection Agency, acknowledges the crisis. He also highlights the recent government efforts. “The EPA has taken concrete measures to improve the air quality in the Punjab through ensuring installation of emission control systems (ECS) in industrial units, converting brick kilns to zigzag technology and prohibiting sub-standard fuels to name a few,” he says.

Bashir points to several initiatives, including the Climate Resilient Punjab Vision Action Plan 2024, the Punjab Clean Air Policy (with Phased Action Plan) 2023, and the Smog (Prevention and Control) Rules 2023. “With the efforts of EPA-Punjab, the concentration of particulate matter (PM2.5) has been reduced to 41.25 per cent of the previous year. This has been made possible by elimination of sub-standard fuel, installation of ECS in industries, zigzag brick kilns and control of fugitive dust.”

The way ahead

However, Alam says meaningful progress will require long-term, multi-pronged solutions. “Fixing air pollution will take time, money and political will underpinned by a civil society vision of a clean-air future that’s more sustainable than the five-year election cycle,” he says.

Alam outlines a comprehensive agenda for reforms: “We need to upgrade our (oil) refineries so that they produce Euro 6 fuels; fulfill our commitments under the Paris Agreement to transition to 60 per cent renewable energy production by 2030; bring industrial emissions under control by introducing and promoting cleaner production measures; invest in public transport and expand an electric vehicle fleet (especially 2- and 3-wheelers and public transport).”

Alam also emphasises the need to curb stubble burning, improve emissions from brick kilns and change the way cities are designed to reduce reliance on automobiles. “We need to increase the use of natural gas for domestic use so that people don’t burn wood or plastic in their stoves. All this has to be done at the same time, over years. Then, maybe in a decade, we can see a 40-50 per cent improvement in air quality.”

Apportioning blame

Smog is driven by several factors. According to a report released in 2018 by Food and Agriculture Organisation of the United Nations in collaboration with Punjab Agriculture Department
(R-SMOG-Report), crop residue burning, practiced by 44 per cent of farmers, particularly in non-Basmati rice cultivation, has increased significantly over the last 16-30 years, with 23 per cent of farmers reporting a rise in this practice. Industrial and vehicular emissions are major contributors, with the transport sector accounting for 43 perent and the industrial sector 25 per cent of total air pollutant emissions in the Punjab. Agriculture, particularly crop residue burning, adds 20 per cent to these emissions.

Additionally, meteorological conditions play a significant role, with 65 per cent of aerosol sources originating within Pakistan, compounded by weather patterns that trap pollutants. Transboundary pollution, especially from crop burning in Indian Punjab, exacerbates the smog intensity in the region.

What role can common citizens play? Alam says, “frankly, very little. You can, you know, do something on an individual level to protect yourself. So like wear masks, limit outdoor activities, and run an air purifier indoors if you have one.”

Zara Aqib, a housewife in Lahore, describes her experience. “My husband and father-in-law have field jobs. They suffer from respiratory issues and their skin is getting dry. They also experience eye irritation.”

She mentions the precautions she is taking at her house. “Wearing masks is mandatory in my house. I make sure that we stay at home and curtail our exposure to smog. We keep our doors and windows closed and ensure that we stay hydrated.”

Syeda Zainab, a pre-9th grade student at a private school in Lahore, has firsthand experience of the smog’s impact. She says, “Smog has affected my daily routine. I cannot go outside. We have to close all the windows, and our daily outdoor tasks are delayed due to smog.”

Zainab also mentions the toll on her studies. “There is a major impact on studies caused by smog. I have missed several classes during the restrictions imposed by the government. The online classes are not as effective. Going to the school during the days of high smog levels, visibility was significantly reduced and many of my classmates got sick.”

Lahore has frequently been reported as the most polluted city globally, highlighting the urgent need for effective air quality management and public health interventions.

As the smog shows no signs of lifting, children in the Punjab remain vulnerable to this public health hazard.

The writer is a tech enthusiast and climate justice advocate. He can be reached at muhammadtalaljokhio@gmail.com or on X: @muhammadtalalj