This month's area report on the Indian subcontinent is a photo-essay by Marco Sacco, looking at air quality in Nepal's capital, Kathmandu

According to the World Health Organization, 24 per cent of diseases and 23 per cent of all deaths – about 12.6 million a year – are linked to environmental risks such as polluted air, water and soil, chemical exposure, climate change and radiation.

Nepal is no exception, with troubling levels of air pollution. Because it is a gateway to the pure peaks of the Himalayas, it can be difficult to imagine that Kathmandu is among the world’s most polluted cities. But a recent investigation by Nepal Academy of Science and Technology (NAST) links 35,000 deaths a year there to air pollution.

Photojournalist Marco Sacco decided to explore the links between Nepal’s environmental pollution and health problems, especially in urban areas that suffer from both infected water and air pollution.

Kathmandu’s unchecked air pollution is caused by under-regulated urbanisation, traffic and haphazard use of chemicals, especially by construction workers, exposing residents to dust.

Nepal’s indoor and outdoor air pollution is compounded by waste being burned or deposited in landfills, by using furnaces to fire bricks and using biomass and kerosene for heating and cooking, often with poor ventilation.

The Kathmandu valley lies at an altitude of 1,400m, surrounded by sub-Himalayan mountains. This location restricts the city’s air flows, suspending pollution in a grey cloud that hangs over the city, that rarely disperses.

Exposure to unhealthy air indoors and outdoors has led to a dramatic increase in people suffering cardiovascular disorders, including allergic rhinitis, bronchial asthma, cough, dyspnoea and wheezing, lung cancer, chronic obstructive pulmonary disease (COPD) and strokes. Elderly people and children are often the worst affected.

Air pollution is also linked to pneumococcal disease, caused by bacteria that can lead to pneumonia and meningitis.

Long before the coronavirus outbreak, Nepalese doctors were warning about an upturn in respiratory illnesses in Nepal and urging local people to wear face masks. NAST researcher Madan Lal Shrestha has linked air pollution to 26 per cent of lung cancers, 34 per cent of heart attacks and 27 per cent of other cardiac diseases.

“The Kathmandu valley is not a good place for people who are allergic to dust; the number of patients with respiratory problems has increased by 20 per cent,” says chest specialist Dirgha Singh Bam.

And Tribhuvan University respiratory specialist Kabir Nath Yogi warns people sensitive to dust pollution to avoid areas of new road construction.

“No place in the Kathmandu Valley is free from pollution, but those who live in houses by the roadside should be more cautious about their health,” he says. “Dust particles suspended in the air from construction and vehicle emissions are the main causes increasing cases of respiratory problems and other health problems related to air pollution in Kathmandu.”

Sacco studied engineering before taking up photography. He chose to shoot in Nepal because its religion – in sharp contrast to the environmental problems the country now faces – has traditionally venerated nature, because air pollution is a national public-health emergency, and because high birth rates are likely to make the problem worse.

“The air is objectively unbreathable,” he says. “This series of factors constitutes a vicious circle of difficult solutions that make Kathmandu a potential epidemiological bomb.”

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