Md Armaan Sheikh is one among the many parents waiting to get his two-year-old son Hassan nebulised inside the crowded emergency ward of Delhi’s Kalawati Saran Children's Hospital. Being a daily wage labourer, it’s the second time in a week that he has to leave his work to get his child's check-up done.

Sheikh first took the baby to Mahavir Hospital located in the city’s Pitampura area four days ago but was turned away. “My son has been facing difficulty in breathing. He is also vomiting. The problem has persisted for the last 3 days. It's a repeat of what we witnessed last winter,” he says. His fear is that, while Hassan is not asthmatic, he may develop the disease.

As Delhi gasps for breath with Air Quality Index (AQI) numbers breaching the 1000 mark in several areas of the city, the Supreme Court has ordered suspension of in-person classes for all school students for the time being. Children are the worst-affected victims of the acute air pollution that has gripped the national capital. All three central universities in Delhi namely University of Delhi, Jawaharlal Nehru University and Jamia Millia Islamia have also shifted to online mode of teaching.  

Six-year-old Sarthak Shakya, who has been diagnosed with pneumonia since he turned one, has been visiting Kalawati Saran Hospital every year during winters.  

His mother, Suman, says pollution doubles his pneumonia problem. “He was admitted for several days two years ago during winters as he couldn’t breathe owing to air pollution. I bring him here every winter to get him nebulised and for further treatment,” she elaborated. Sarthak has been missing his classes as well as his treatment is underway.   

Unaware of the multiple factors that lead to pollution, Suman is not sure as to when her child will breathe a sigh of relief. What turns winters in Delhi deadly is the fact that there is little rain or wind to disperse toxins. Farmers in neighbouring states like Punjab, Haryana and Western Uttar Pradesh burn their crop residue (parali), sending black smoke wafting into the city. Stubble burning this season has contributed as much as 40 per cent of Delhi's pollution, as per SAFAR, a weather forecasting agency under the ministry of earth sciences. There are industrial emissions which contribute heavily to the worsening of air quality. And then comes Diwali, when people burst firecrackers which release harmful chemicals into the atmosphere along with noxious gases.  

This is alarming for parents like her as World Health Organisation (WHO) data suggests that 17 per cent of deaths from acute lower respiratory infections (i.e., pneumonia) are attributable to ambient air pollution. 

Dr Mayank Saxena, Additional Director in the Department of Pulmonology at Noida’s Fortis Hospital says the hazardous levels of pollution has led to influx of patients in his own hospital resulting in even ICU admissions particularly of patients who have asthma and Chronic Obstructive Pulmonary Disease (COPD). “Avoid stepping out of home if not needed. Do not visit areas with the worst AQI levels. Use a face mask all the time when stepping out. If one’s having a respiratory medical history, consider using an air purifier at home. Pollution can eventually have long term effects on our organs and hence precaution is necessary,” he says.

At Chacha Nehru Bal Chikitsalaya, another hospital dedicated to children in the national capital, the scene is no different. The reception as well as the waiting area is packed with anxious parents carrying toddlers with breathing issues. On top of that, children were being administered nebulisers in the diarrhoea ward.  

Md Hassan, a resident of Delhi’s Geeta Colony and a professor of Persian, is carrying his two-year-son Ruhan inside the ward after getting him nebulised. “Pollution has made things worse for my family. My child is facing cough and chest congestion along with breathlessness and has been vomiting all night. All my family members are experiencing irritation in their eyes and throat,” he says.

Hassan further details out the issues in his locality where he lives. “We stay on the fourth floor of our apartment. Roads are swept without water being sprinkled. There’s a cloud of dust that has formed. Adding to this is the surge in pollution after Diwali as firecrackers went on all night despite a ban. We still have the privilege to stay indoors in our homes but what about those who live on footpaths?” he asks.

Dr Trupti Gilada, Infectious Disease Physician, says that children are particularly vulnerable to air pollution due to their developing respiratory systems and higher breathing rates relative to body size. “Exposure to high levels of PM (particulate matter) 2.5 and PM 10 can lead to compromised lung functions among children, along with the risk of increased respiratory ailments including bronchial inflammations and infections, and potential long-term impacts on cognitive development,” she says.

“It's a worrying trend. This generation will probably grow up to have higher rates of respiratory diseases, cardiovascular diseases and more cognitive decline. It’s sad because we are letting an entire generation grow up breathing toxic air like this,” she added.

Sameena’s problems are two-folded. Her nine-year-old son Md Ahad has been suffering from asthma for the last 2 years. The pollution season makes breathing almost impossible for her son. Her husband is handicapped and therefore, she has to finish her household chores first and then carry Ahad from Badarpur to reach the hospital for checkup.  

Ahad has been facing issues like irritation in the throat and coughing for sleepless nights. Experts suggest that people with asthma are at greater risk from breathing in small particles and toxic air. They can irritate the airways and make asthma worse. Anyone can feel the effects of air pollution, but people with asthma are at a greater risk all the time.

A study by Lung Care Foundation and Pulmocare Research and Education Foundation found that a total of 31.5 per cent of children in Delhi reported shortness of breath. The prevalence of asthma was also found to be higher among children in Delhi. The spirometry test detected asthma in 29.4 per cent of children surveyed.

Sharing a bed with 3 other child patients, Lalita is anxious while administering nebuliser to her 10-month-old son Uttam who developed breathing issues for the first time since birth. The child is also facing nose block, running nose and sneezing. She attributes the development to the quality of air Delhi residents are breathing. Hers is the youngest child seen in the hospital who has developed respiratory issues owing to bad air. “I don’t know how and why it’s happening but the air quality around us has depleted post Diwali and here we are,” she says.

Delhi which anyway remains unliveable in summer owing to heat waves, in the rainy season due to floods and severe waterlogging, turns out to be a nightmare in winters. However, for most times of the year, Delhi keeps topping the charts for worst air quality. Come the onset of winter, the pollution problem surges, and a public health emergency like situation is triggered. But the irony however is even then it’s not officially announced by the government as a public health emergency.

Delhi is currently under GRAP 4 restrictions imposed by the Commission for Air Quality Management (CAQM). It’s the most extreme stage of the Graded Response Action Plan (GRAP) which encompasses an 8-point action plan designed to mitigate pollution. Among other measures, the entry of trucks into Delhi has been banned except for those carrying essential commodities or providing essential services. The ban on construction and demolition activities have also been extended.  

Dr Nikhil Modi, Pulmonology Respiratory Medicine Specialist at Apollo Hospitals Indraprastha, says that the number of cases have started to rise for the last two weeks itself, but the numbers dramatically surged this week in particular. “Patients with respiratory problems, particularly children, are visiting us with increased difficulty in breathing in OPD. Along with that, they are also considering emergency visits now as they face a drop in their oxygen levels owing to pollution,” he said.

Dr Modi says that people from all age groups are affected right now, but children definitely manifest symptoms much severe as compared to adults. He called for a curtailment on outdoor activities for children and said they should not be allowed to play outside right now because the pollution levels are hazardous and it can leave a lasting impact on their health.

“We are seeing asthma cases mostly in children and young adults, and Chronic Obstructive Pulmonary Disease (COPD) in the elderly,” Dr. Modi further said. “Patients who have COPD, which was once a disease mainly seen in smokers, has now become common. It’s safer to attribute the deaths of patients to air pollution along with smoking, whose cause of death is COPD.” According to aqi.in, Delhiites are effectively smoking the equivalent of 49.02 cigarettes daily.  

Air pollution shortens the lives of Delhi residents by around 11.9 years, according to the Air Quality Life Index report for 2023 by the University of Chicago’s Energy Policy Institute. “So our life expectancy- with all the advancement in medical science, was bound to go up, but now with this pollution crisis, it has started to come down,” he added.  

There is also a socio-economic dimension of the pollution crisis. A World Bank study (2022) shows that children from low-income families face heightened risks, often residing in high-density areas where pollution levels are 1.5 to 2 times higher than in less congested neighbourhoods. They also have limited access to healthcare. It’s also not affordable for their parents to buy air purifiers, which are seen as protective measures. Therefore even the inaccessibility of machines like these exacerbate their vulnerability, creating a cycle where air pollution perpetuates existing social inequalities. 

As children feel asphyxiated in the national capital, the political blame game continues between the Centre’s BJP government and Delhi's AAP government. No politician talks about climate in election agenda. No party promises to guarantee right to breathe clean air to the residents of Delhi. With the absence of a concrete action plan in place to curb pollution, it remains to be seen for how long the future of this country, the children, are left to die breathing polluted air.