KABUL – The street caretakers wafted around a portable stove on the sidewalk to give afternoon tea, sipping under masks that filter sharp smog.
The throat of Mohammed Sharif is burnt. His lungs hurt. But he can not afford a doctor about his wages, no more than he can afford to use gas or electricity to heat his home.
Sharif burns wood, animal fat and sometimes plastic to keep himself and his family warm, although he knows that this contributes to the toxins in the air that cover this city of 5 million.
"We have no other option," he said.
Afghanistan, which has long been in conflict, has focused on security and reconstruction in the last 18 years at the expense of environmental issues, according to current and former environmental officials. They say that the government is not well able to control the causes – such as the consumption of coal and vehicle exhaust fumes – from the thick mist of Kabul.
Approximately 4.2 million premature deaths worldwide were related to ambient air or air pollution in 2016, according to the World Health Organization, which brought the total of Afghanistan for that year to more than 17,000. Health officials in Afghanistan said they do not have data to measure mortality rates related to pollution.
Health and environmental experts measure PM2.5 pollutants in the environment, particles that are so small that they can nestle in human lungs and cause serious problems, including heart attacks, strokes and respiratory infections, and immature development in children. The recommended daily exposure level of the WHO is 25.
The population of Kabul has tripled over the last decade and the capital is buzzing with cars from the Soviet era that emit thick plumes of exhaust gas. Apartment buildings and factories send columns of coal smoke into the air, which in the winter become smogier as the temperatures drop and residents jack up their ovens.
At 11:10 am Friday the air quality of Kabul was the worst in the world with a score of 277, for Delhi and the Pakistani city of Lahore, according to a snapshot of the commercial website AirVisual, which captures the readings of the consumer operated sensors on the whole world.
These measurements are perhaps the only way in which Kabul residents can quantify the severity of air pollution on a daily basis.
Afghanistan's National Environmental Protection Agency, or NEPA, has its own air quality monitors, but does not publish the data publicly, said Mohammad Iqbal Hamdard, a spokesman for the agency, adding that NEPA is working on a format that is geared to social media.
NEPA officials follow the AirVisual score in Kabul, but the agency does not make any decisions on that basis, he said.
At the same time Friday, Salt Lake City ranked highest in the United States on AirVisual, with an air quality index of 93.
Residents were relieved here when two separate days of heavy snow drove the smog last week. Precipitation is typically the only thing that cuts the haze during the winter months.
NEPA has endeavored to warn the public about the health risks associated with air pollution, said Abdul-Hadi Zheman, a former chief of staff of the organization. Zheman resigned late December, citing frustration about maladministration and what he said was a lack of strategic vision on the agency.
He joined an exodus that last year included other senior officials and more than a dozen environmentalists, said Ghulam Mohammad Malikyar, a former technical deputy director who left the office months ago.
Although some Afghans are not aware of the dangers of air pollution, even those who know the risks have little choice but to continue the behavior that causes it, Zheman said. More than half of all Afghans live below the poverty line according to the World Bank and force many, like Sharif, to burn everything they cook and stay warm.
NEPA could find ways to reduce pollution, Zheman said, including subsidizing gas and electricity to make it more affordable and building more coal refineries capable of removing some of the harmful carbon and lead.
But Ezatullah Sediqi, the current technical deputy director of the agency, said that NEPA is neither financially nor technically capable of dealing with the crisis. One of the reasons, he said, is that since the Taliban rule ended in 2001, the government has given priority to development and security, leaving little money or political power to support environmental initiatives.
Yet, he said, government leaders have recently signaled that they will do more to reduce pollution. He called NEPA & # 39; s call for more inspections of new buildings, as well as an ongoing program to plant 1 million trees in Kabul in the coming years and a wave of crackdown on large polluters, alongside other initiatives.
Winter brings more reports of cardiovascular disease in adults and respiratory problems in children in large cities such as Kabul and Mazar-e Sharif, said Wahidullah Mayar, a spokesperson for the Ministry of Health.
In preparation for the season, the ministry trained doctors on new approaches to diagnosing and treating pollution-related diseases, Mayar said.
And yet the ministry has struggled to develop even rudimentary statistics for diseases related to pollution throughout Afghanistan, he said, while civil servants are not sure whether the rates are rising or falling, or whether the health policy has had an impact.
It is difficult to collect such data during an ongoing conflict in a developing country with infrastructure, said Mayar, speaking in a darkened conference room in Kabul after the ministry lost power.
For the time being, the inhabitants of Kabul see little progress, especially those who work outside.
Popal Ahmadi, a 16-year-old street vendor, sells crisps and sweets to students around the University of Kabul from early in the morning to the evening classes. He goes home with stinging eyes and painful lungs, he said, as the smog begins to choke the night.