Kathmandu’s skyline often disappears beneath a dense layer of haze, particularly during winter. For most adults, this has become a common sight—a regrettable but accepted part of their daily life. But for children, whose lungs and immune systems are still developing, this polluted air is a silent and relentless threat.
Air pollution is not only an environmental issue; it is a public health crisis that is taking the breath away from our children. Children are more at risk because their lungs are still growing, their airways are smaller, and they breathe faster than adults. Pollutants penetrate deeper into their respiratory tracts, which can cause pneumonia, asthma, meningitis and allergies. Weakened lungs provide an ideal environment for respiratory viruses such as influenza and coronaviruses. The situation in the Kathmandu Valley deteriorates annually due to the accumulation of pollutants during winter inversions, which are further exacerbated during the cold months of November to February.
The immediate symptoms are clear: watery eyes, chronic coughing, skin allergies and frequent hospital visits. But the long-term effects are even worse, including reduced lung function, a higher risk of heart disease, chronic obstructive pulmonary disease (COPD), and even cancer later in life. According to the Health Effects Institute, in 2021 air pollution caused more than 8.1 million premature deaths globally, including over 700,000 children under five. A significant portion of this burden falls on Nepal, where average pollution levels are frequently almost five times higher than WHO recommendations.
Hospital data underscore this crisis. An analysis of inpatient records from 13 major hospitals in 2014/15 showed that COPD accounted for nearly 40% of respiratory admissions, pneumonia for 29%, and acute respiratory infections for 15%. Children under 10 and the elderly were the most vulnerable, with children making up over a quarter of cases. Behind each statistic are missed school days, mounting medical expenses and futures compromised before they begin.
Time to introduce alerts for toxic air
Although everyone is affected by air pollution, it disproportionately harms children from marginalised and low-income families who cannot afford quality healthcare, nutritious food or even proper masks. This inequity makes them more vulnerable and exacerbates health and social disparities.
Nepal has not been passive in addressing this challenge. Government regulations phasing out old vehicles, promoting electric mobility and expanding green spaces are positive steps. Media and civil society initiatives promoting public awareness, school programmes and community-based air quality monitoring are equally important. Yet scaling up these initiatives and closing enforcement gaps remain significant challenges. Protective measures such as mask-wearing are implemented inconsistently. While KN95 masks can filter up to 70% of harmful particles, the majority of children neither wear them nor know how to use them correctly.
I have seen parents bring children to hospitals unaware of the long-term risks of air pollution. Sometimes, even children with respiratory illnesses arrive without masks, or wearing them inappropriately. Many mothers have told me they were unaware that polluted air could cause lifelong damage to a child's lungs or even increase the risk of heart disease. Small steps can make a big difference, such as keeping children indoors on high-pollution days, ensuring masks are worn correctly and seeking appropriate healthcare for respiratory issues.
But hospitals alone cannot solve this crisis. Pollutants must be reduced at the source through stricter emission regulations for vehicles, brick kilns, construction sites and open waste burning. If our cities invested more in electric buses and safe, reliable public transport, families would not have to depend on old motorcycles that emit harmful smoke into the air we all breathe. Schools in high-risk areas need clean indoor air systems, and children’s health must be safeguarded through specialised screening programmes.
It is also important to address indoor air pollution, which remains a major problem in rural homes that rely on biomass for cooking. Additionally, creating green spaces, public parks, gardens and tree-lined areas would provide children with safe, clean places to play instead of the enclosed, poorly ventilated indoor play areas that are becoming increasingly common in Kathmandu.
We also need a stronger healthcare system that includes measures for managing airborne diseases in major hospitals in highly polluted areas, along with better air-quality monitoring and dedicated child-care support. Imagine if parents visiting a clinic were alerted to dangerous air quality, or if schools provided regular updates to protect their students.
Every time I see a child struggling to breathe, I am reminded that clean air is not a luxury; it is a constitutional right, enshrined as the right to live in a clean environment. Protecting this right requires coordinated action from policymakers, health professionals, communities and international partners. As a mother of two children under 12 growing up in Kathmandu, I feel the urgency of this crisis personally. Clean air is not just a scientific or policy goal; it is a child’s right to grow, learn and dream without the invisible burden of polluted air.
Air pollution in our country is both a public health crisis and a moral test. The choices we make today—about transport, energy and policy enforcement—will shape the lungs and futures of an entire generation. Ensuring that every child can breathe freely must be a national priority.
(The author is a Matron at Kathmandu ENT Hospital and a graduate in Nursing with a specialisation in community health and child care.)
