Though the city's air quality index is crossing alarming levels, comparable with cities like Delhi, and harming public health like never before, the issue remains buried under the usual war talk.
KABUL — When 2019 arrived in Kabul, it did so under a haze of dirt, smoke and fog.
As with so many winter nights, the city’s six million residents were struggling to keep warm by burning everything from wood — usually reserved for the financially comfortable — sawdust, coal, plastic, car tyres and anything else at their disposal.
Whether it was one of the newly constructed high rises, where rents can top out at $1,000 a month, or the dozens of informal settlements and internally displaced person (IDP) camps that dot the Afghan capital, streams of smoke were constantly rising into the air, and will continue to do so nearly all winter.
This, combined with the exhaust fumes from millions of vehicles — many of them rickety, gas guzzling relics that pump out black smoke from their tail pipes — and a lack of precipitation, has left a massive physical and emotional toll on the Afghan capital’s nearly six million residents.
Violence and viruses
Across the city, tens of thousands of people are trying to deal with the country’s 40 percent unemployment rate by turning to the informal economy, which often requires them to work on the streets as kebab sellers, money exchangers, shoe cobblers, street-side barbers and day labourers.
Jalil, one of a dozen shoe cobblers who spend 10 hours a day on the street outside the city’s iconic Haji Yaqoub Mosque, knows that working in the open leaves him susceptible not only to attacks by groups like the Taliban and so-called Daesh forces, but also to the various health effects of spending hours breathing in fumes.
“Look at us, we sit out on the side of the street all day,” Jalil says as a middle-aged man waits for his black knock-off Gucci loafers to be polished. The traffic of the the world’s fifth fastest growing city whirs past while Jalil tends to the layers of dirt and mud that have caked the man’s faux-leather shoes.
“We feel the cold and breathe the dirty air that mixes with the fumes from the cars that pass by,” Jalil says.
For more than a week he’s suffered from a cough, sore throat and a sense of dizziness, all of which his doctor attributes to the dirty air Jalil breathes in seven days a week. Like millions of other Afghans, Jalil has been prescribed an antibiotic, Amoxicillin, and a cough syrup for his symptoms.
The proliferation of antibiotics among the Afghan people only adds to the worries of doctors in the country.
Najmusama Shefajo, an OB-GYN doctor who spends her days shuffling between three clinics in the city, is especially worried by the low quality of antibiotics being sold in the country.
“People’s immune systems are already weak due to the lack of nutrition and the poor air quality, when you add poor quality antibiotics to that, it only compounds everything,” she says.
The spread of antibiotics
Shefajo says the over-reliance on low-grade antibiotics means too many patients are prescribed high dosages or extremely powerful antibiotics for even colds and flu.
“We can cure them once with these really heavy drugs, but what do we do the next time they get sick?” she asks.
As a gynaecologist, Shefajo is especially worried of the impact the winter air, heavy with smoke and pollution, has on pregnant women and their children. She says so far this year, at least 10 percent of her patients have complained of weather and pollution-related illnesses.
“So many of my patients tell me they don’t even want to step out in the dark, black air, because they feel suffocated just walking around in the open,” she explains.
Aware of the chemistry and biology behind their illnesses, Shefajo recommends that pregnant women, the elderly and children avoid venturing outside as much as possible during the winter.
“Cold weather is breeding ground for bacteria, they love it,” says Shefajo. She explains that each winter the city’s already polluted air is filled with hundreds of strains of bacteria floating around and multiplying.
In an effort to combat the proliferation of antibiotics in the country, Shefajo recommends that her patients alter their diets to include more fruit, vegetables and dairy products, rather than medication.
However, with more than half of all Afghans living on less than a dollar a day, economics can be a major impediment to healthier eating in the country.
Even Jalil, the shoe cobbler, who makes up to $12 a day, complains of the 85 Afghani ($1.12) cost of the antibiotics prescribed to him. Given his other monthly costs — rent, car fare to and from his post outside the mosque and other basic expenses — upping the quantity of fruit and vegetables he brings home to his family of five is a near impossibility, he says.
Shefajo says one of her patients reacted similarly to her suggestion.
“This woman in her 20s came up to me requesting five or six different medications, I told her she doesn’t need all of those drugs, that she should instead put that money towards fruits and vegetables,” Shefajo remembers.
The patient responded by reminding Shefajo that she lived with her in-laws and that her husband couldn’t possibly afford to spend more on nutritious foods for more than a dozen people. It was simply cheaper to rely on pharmaceuticals.
The Kabul residents that TRT World spoke to said they are used to the cold air that comes with living in the Central Asian steppe, but the increasing amounts of pollution each year is too much to deal with.
In April, Schahzaman Maiwandi, director of the National Environmental Protection Agency, warned that air pollution had become ‘a silent killer’ in the country. Currently, Kabul rates third in global pollution rates. That puts it higher than than Cairo (8), Delhi (13) and Beijing (24), all significantly more developed cities with much larger populations.
Khalid came to Kabul from his native Takhar province two weeks ago. Like so many other people who come to the capital for improved employment prospects, the 33-year-old works in the open grilling kebabs at a small restaurant near the city’s 10th police district.
“I’m not fazed by the cold here, Takhar is much colder, but I can’t deal with the air, it’s so filthy,” he says, wearing a second-hand 200 Afghani fleece, a beanie, gloves with holes in them, a sweater and a jacket over his traditional piran tomban.
Lawmakers agree with Khalid.
Shortly before the New Year, members of the health and environment protection commission of the lower house of parliament summoned officials from the National Environmental Protection Agency (NEPA) and the Ministry of Public Health to explain exactly how they are tackling the problem.
Ezatullah Sediqi, Deputy Head of the NEPA, said that when they do try and address the issue by ordering companies burning non-standard fuel to cease the practice or face closure, but government officials, including MPs, often interfere in favour of the offending company.
Sediqi told MPs that in place of support, the agency receives mixed messages from officials, who often side with their business and personal interests over the good of the general public.
“Some of them say you should close [the offending companies] and others say not to close and allow them to stay open,” Sediqi said during the December 30, 2018, hearing.
Concerns about air quality in Kabul date back at least a decade. In 2009, the Asian Development Bank warned that poor air quality in the city posed “a negative impact on public health and welfare” that will have significant economic and social costs.
Khalid and Jalil, who both work on the streets of Kabul, said the problems are compounded by the lack of precipitation in the country over the last year-and-a-half. According to the United Nations, a precipitation deficit of 70 percent between the autumn of 2017 and the spring of 2018 has led to a drought which has taken a devastating toll on 20 of the nation’s 34 provinces.
In urban centres like Kabul, the lack of rain and snow mixed with pollution and overcrowding is affecting the health of millions. In fact, Ministry of Public Health officials say that air pollution is responsible for at least 26 percent of all deaths in a country that has been involved in one conflict or another for the last four decades.
Jalil, the shoe cobbler, sums it up, with a single phrase: “No one is healthy in Kabul in the winter.”