In 2022, Pakistan was the third most polluted country and now Lahore’s winter season comes with almost certain respiratory issues.

In late October, my grandmother who was in Karachi, Pakistan for some medical checkups was meant to travel back home to Lahore. But her trip was unexpectedly delayed a week as the smog crisis in Lahore continued to worsen.

With an already existing lung condition, exposing herself to the polluted air would only mean much worse for her health, and her children insisted she try and stay away from it.

"More recently in late November, the AQI in Lahore, Pakistan measured a terrifying 345"

A week later than intended, she only went back when a rain spell seemed to clear the air for a few days. That clean spell didn’t last all that long, and a few days after she went back, Lahore's air quality depleted again. 

More recently in late November, the AQI in Lahore, Pakistan measured a terrifying 345. According to the Swiss company IQAir anything above 301 is hazardous for breathing.

The smog that has been choking Lahore for the last two months is not a sudden or unique phenomenon.

In 2022, Pakistan was the third most polluted country, and for pretty much the last half-decade, Lahore’s winter season, which citizens used to look forward to, now comes with almost certain respiratory issues.

Citizens of the city have taken to social media to share the impact the environment has been having on them, from headaches to throat infections and even lung issues and asthma. “

"The most impacted group includes small children. There were reports of increased admission of children in hospitals because of respiratory complaints," Dr Aamer Iqbal, a doctor in Lahore with a main focus on Asthma and COPD tells The New Arab.

"The elderly are also at risk but mostly individuals with respiratory or heart disease are at particular risk. People whose work requires them to be outdoors, cyclists, pedestrians, and commuters on motorcycles are also at risk,” Dr Aamer Iqbal added. 

In response to the unrelenting smog, the city government initiated a drive to clean the streets, which has garnered severe criticism from online users.

Experts like environmentalist Rafi Alam also called the government’s approach to restricting restaurant timings, and putting city-wide holidays in place for schools and offices as policies “made in haste.” 

While it has become very common to see Lahore’s AQI being discussed on social media and in everyday conversations, there’s far less understanding of the long-term contributors to the problem and even less conversation on how disproportionately the crisis impacts those most vulnerable. 

Last week, 16-year-old Aisha visited a clinic near Chungi Amar Sidhu, run by Dr Alia Haider and her team, which caters to low-income communities. Dr Haider, who works on the intersection of climate and health also ran medical camps to track and treat lead poisoning in Chungi Amar Sidhu and Harpansura last year.

She shares how Aisha came in complaining of severe cough and headache, which are symptoms she says are increasing in her patients due to the smog issue. The 16-year-old was taken in for an x-ray, and despite never having smoked a cigarette in her young life, Dr Haider shares that her results showed lung damage that was equivalent to decades worth of smoking.

"Low-income communities are at higher risk of respiratory and smog-related health issues, which is made worse by the fact that they don’t often have access to decent health care either"

For Aisha, the severe cough and lung damage have also led to anaemia, as the young girl shares she’s not able to lie down because it restricts her breathing, and that her cough is so severe it often leads to vomiting. 

Aisha isn’t the only one who’s been suffering from these issues. Dr Haider says that low-income communities in particular are at higher risk of respiratory and smog-related health issues, which is made worse by the fact that they don’t often have access to decent health care either.

“When we talk about a specific group, working-class people, usually domestic workers or labourers, health and education is a luxury for these people," Dr Haider adds. 

These are also the same people who need to take public transport, who often work as labourers in already polluted conditions, and who come back to even more risky environments in their homes as they often only have access to contaminated water and live in high-smog areas due to their proximity to the industrial areas where they work. 

Urban development specialist Momin Sheikh compares this to when the water lines started getting contaminated years ago, leading people to start buying bottled water and dispensers where water companies like Nestle would provide households with a certain number of water containers and refill them weekly.

“When we first started buying that bottled water for regular use, people found that odd. There was a joke that started going around that soon we’ll have to buy air as well. We used to think that was impossible, but in a way, that’s what air purifiers are now,” Momin says.

He also believes that temporary fixes like purifiers only benefit the privileged class, adding “It is the people on cycles and bikes, and those walking that are constantly exposed to the smog. And we’ve removed sidewalks and put them even more at risk by making them walk near cars and inhale those fumes.” 

Both the lack of health care and consistent exposure to the pollutants put marginalised groups at a much higher risk.

“Patients with known respiratory and heart disease are at particular risk. COPD, asthma, and lung fibrosis of a moderately severe degree predispose to respiratory failure," explains Dr Iqbal. 

"Poor air quality means they have to breathe noxious gases and particulate matter instead of clean air. The same is true for heart disease. Smokers with smokers coughs are also at higher risk. Smokers cough means that half of the small airways inside the lungs are destroyed,” Dr Iqbal adds. 

Both Momin and Dr Haider also point out that car-centric constant construction and development is to blame for the crisis. They also believe that the development the government should be focusing on should be much more focused on accommodating public transport, cyclists and pedestrians. 

Rarely is there any lens on Lahore’s smog crisis looking at it from a human lens, where a city should change to accommodate its residents, instead of the other way around.

If anything, Lahore’s increasing smog crisis is just making obvious what’s been there all along — no solution works if it’s not for every citizen. 

Anmol Irfan is a freelance journalist with bylines in VICE, HUCK, and The Guardian among others. She has experience writing on minority politics, activism, and gender issues. She is also the founder of the Pakistani community platform, Perspectives Magazine

Follow her on Twitter @anmolirfan22

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