How Kenya’s air quality was affected by anti-government protests

As the Healthy Nation team treads down the alleys of Mathare’s number 10 area in search of Florah Okumba’s home, everyone in the neighbourhood seems to mind their business.

Women are seated by the doorstep outside their tin-houses facing their neighbours’ houses. They are mostly shooting the breeze as they work on their daily chores.

Children are playing at an earshot distance from their mothers. Some are whimpering, others are laughing their bellies out and the rest are engrossed in their little games.

Most men are not in the vicinity of their houses. We learn that some have left for work and others have left their homes to look for work –a quest that is usually not guaranteed.

Moving closer to Florah’s home, which is located near a Seventh Day Adventist Church in the city slum, angelic voices from choristers probably practising for the Sabbath, fill the air.

There is a sense of communal tranquillity. While some residents could be going through life challenges inside their houses, the neighbourhood seems tension-free.

However, a month ago, walking along those alleys was akin to deliberately extracting one’s teeth with no form of anaesthesia.

It was at a time when the anti-government protests were on steroids.

When the day breaks and its light illuminates the earth, Florah, 71,  tells us that she always sees it as an opportunity to fend for her family.

She lives with her grandchildren, most of whom are orphaned. Her only source of income is water vending, thanks to her ward representative’s philanthropy who donated a water tank to her.

In one of the protest days, the light that comes with day-break seemed like a figment of imagination in her world. A dark world overtook the daylight. At some point, she could not breathe. 

“I was seated on my couch with my youngest grandchild who is just a few months old. I could hear the police colliding with the youth outside and I dared not to step outside. The loud sound resulting from firing of the teargas canisters drew near. I was not worried. I was in my house, I was safe, or so I thought,” she narrates.

Outside, her water tank had been shot at and the stored water was already flowing towards her house. A few minutes later, she heard a loud commotion from her door and a police officer stormed in.

“He fired a teargas canister inside my house. I had a small baby with me. I was helpless and could not breathe properly. My grandchild wept, his eyes bulged out. We all needed help as I could not breathe properly, I had no strength,” she tells Healthy Nation.

Florah screamed, alerting her neighbours that she was in danger. One of her eldest grandsons was the first to throng into her house.

“My grandson came into the house with his eyes closed. I could hear him ask where I was. He held me and took me out. It was risky, but he took me far away from where we stay, a safer place,” she says.

“One of my neighbours rescued my grandchild, he went outside with him,” she adds.

Before the turn of events that painted the daylight dark, Florah had never had any breathing complications. Her grandchild's health was good.

“I went to a nearby clinic and was told that I would be okay, they said that teargas had caused my chest pains, but the pain would subside in a few days,” she recalls.

The first round of the protests affected my daughter, who was pregnant with my grandchild. We thought we would lose her because she developed breathing complications.

“Now we are surprised that the same fate has befallen the newborn,” she says.

Anna Nafuna, who lives in Mukuru kwa Njenga slums, woke up on the protest day to go out and do manual jobs that she always does. Her husband died last year so she cannot afford to stay in the house even when protests rock. She is asthmatic.

“I went to Donholm area hoping to get clients that would want me to do their laundry. As I strolled along the road in the estate’s outskirts, I met a group of young men who were burning tyres and pelting stones towards the police,” she says.

“I couldn’t be at that place for long. Everyone seemed to be in a hurry, I hurt my leg and could not run. In no time the police fired teargas towards the direction that I was. That destabalised me,” she adds. Anna fainted and well-wishers took her to hospital. She was put on oxygen for some time and only released when she stabilised.

“I know that I have always had lung complications because of my asthmatic condition. It was not my wish to step out and go to a place that would risk my health. I went out because of my children. I did not have any food in the house and they needed something to eat,” says Anna

When she regained consciousness, the doctors told her that a combination of pollutants from teargas and burning of tyres had blocked her airways.

“Since then, my voice has remained croaky and I am at risk of another attack,’ she adds.

Anna tells Healthy Nation that even before the anti-government protests, her life had always been at risk. She constantly needs an inhaler especially when she gets an asthmatic attack.

“I use two types of inhalers, all of which are quite expensive. When I fainted during the demonstrations, I did not have one of my key inhalers since I needed a replacement. I don’t have money to buy it,” she says.

She got an unexpected hospital bill of about Sh8, 000 that she had not planned for. “I did not have money to pay that bill at Equity Afya in Fedha where the well-wishers took me. I called one of my friends who came to see me in hospital with the Member of County Assembly who cleared the bill,” Anna recounts.

Analysis

Anna, Florah and her grandchild are just a few people who were affected by a sharp rise of air pollutants during the anti-government protests.

Using air quality data from Code for Africa’s sensors. Africa, Healthy Nation found out that there was a spike in polluted air in some of the areas in Nairobi.

The analysis focused on particulate matter as one of the air pollutants that the World Health Organization (WHO) says causes negative health impacts. It is abbreviated as PM.

According to the WHO, the main components of PM are sulfates, nitrates, ammonia, sodium chloride, black carbon, mineral dust and water.

The data analysed PM 2.5 and PM 10, whose particles vary depending on their sizes. Particulate matter 2.5 or (PM2.5)) is the tiniest. It has a diameter that is equal to or less than 2.5 micrograms. It is the riskiest air pollutant that one can be exposed to.

WHO says that in a day, people should not be exposed to PM2.5 of more than 15 micrograms per cubic metre.

Apart from particulate matter, other air pollutants available include ozone, carbon monoxide, nitrogen dioxide and sulfur dioxide.

An analysis by Rose Kwamboka, a data scientist at Code for Africa in four areas in Nairobi where air quality sensors have been mounted, shows that during the demonstrations, all the areas were above the World Health Organization recommended guidelines.

In Mathare where Florah stays, for instance, data shows that PM2.5 levels between July 21 and 23 had shot up to about 60 micrograms per cubic metre. This, according to WHO, is unhealthy especially for sensitive groups.

In other areas like Redcliffe Gardens in Nairobi’s Kilimani Estate, data before and after protest days shows that PM 2.5 in that area was below recommended guidelines, denoting that they have safer air quality on most days.

On July 19, however, PM2.5 shot up to more than 40 micrograms per cubic metre. The other area that we analysed was Ngotho road, whose sensors are near Dagoretti, and it shows that it had higher PM2.5 levels than Redcliffe Gardens; shooting to about 50 micrograms per cubic metre.

In areas where there was little to no protest like Haile Selassie Avenue in Nairobi, PM 2.5 levels were about 25 micrograms per cubic metres on most days. This however, is also above WHO’s recommended guidelines.

What do studies say about teargas exposure? 

While tear gas is not composed of particulate matter, its exposure can predispose one to lung complications.

Its impact varies from indoor exposure to outdoor, with the former having dire consequences.
The Centres for Disease Control and Preventions says that exposure to teargas can lead to chest tightness, coughing, choking sensation, noisy breathing (wheezing) and shortness of breath.

Florah and her grandchild experienced some of these symptoms.

In the long run, researchers explain that it may lead to respiratory failure that can cause death.

An epidemiological study published this year by the scientific journal BMJ shows that the massive use of tear gas increases the likelihood of getting respiratory emergencies and particularly bronchial diseases in the vulnerable population. 

"Acute and chronic respiratory injuries due to tear gas exposure have been described in the adult population with acute and intense exposure to tear gas. During weeks of political unrest between October and December of 2019 in Chile, the police extensively used tear gas in residential areas to disperse multitudes in demonstrations against social injustice," shows the study.

"Our study supports an increase in short-term respiratory emergencies due to tear gas use in residential areas. The long-term impact is yet unknown. We recommend modifying public policy to severely restrict or ban the use of tear gas to protect vulnerable populations." 

Experts

Dr George Mwaniki, head of Air Quality for the World Resource Institute’s in the African region, tells Healthy Nation that air pollution is a slow killer, and its impact is likely to come later in life.

“Assuming you have an axe and there is a tree outside your house. If you cut it with the axe every day, it may not fall down immediately. One time it will become weak and when the wind blows, it will fall. That is how air pollution's effect on health works,” he explains.

During the protests, one of the pollutants that Dr Mwaniki points out is that which comes from burning of tyres.

“When we burn tyres, some black smoke comes out as a result of combustion. The black smoke is scientifically called black carbon,” says Dr Mwaniki.

WHO points out that black carbon is one of the components of particulate matter.

The Climate and Clean Air Coalition in a report explains that black carbon lasts only days to weeks in the atmosphere but has significant direct and indirect impacts on the climate, snow and ice, agriculture and human health.

Sammy Simiyu, a public health specialist who works with Vital Strategies, explains to Healthy Nation that burning of tyres has both PM2.5 and PM 10. He says that PM2.5 has damning impacts to one's health because of the depth in which it travels inside our bodies.

 “PM 10 may not have devastating impacts on one’s health because it has bigger particles that can be blocked from entering our bodies. But PM2.5 is a bit dangerous since it goes deep down to people’s blood streams and can either end up in the heart or lungs causing other diseases that may not be related to respiratory infections,” says Simiyu.

“People need to understand that some actions like burning of tyres leads to air pollution. It is important to avoid it because of the long-term health risks,” he adds

Dr Jeremiah Chakaya, pulmonogist and former president of the International Union against Tuberculosis and Lung Disease, tells Healthy Nation that short term exposure to air pollution may not have immediate severe impacts to those exposed.

However, he says that people with chronic respiratory illnesses may have dire impacts when exposed to high levels of pollutants even briefly.

“Short term exposure can make people with no underlying conditions to feel choked and lose their breath, but they bounce back when they get to safer air. Chronic exposure to air pollution, which happens to most of us, is a ticking time bomb for diseases such as cancers, tuberculosis and even chronic obstructive pulmonary disease,” Dr Chakaya explains.

“Air pollution can exacerbate the situation of people with underlying respiratory illnesses such as asthma, bronchitis or chronic lung disease,” he adds.

He explains that when people are exposed to air pollution, air pipes respond to irritants that find their way in the body. When this happens, there is a high level of inflammatory processes which now causes an air pollution related injury.

“When PM2.5 enters one’s body, it can go very deep into the lungs. PM 10 on the other hand has larger particles that may be trapped by the hair in our nostrils. Once the tiniest particles go deep, they may find their way into the bloodstream; creating a war between the particles and the defense system,” he says.

Dr Chakaya says doctors cannot directly pin-point some diseases to be as a result of air pollution unless there is an epidemiological link to it.

“It cannot just be one person. We have to analyse a population so that we can make an inference. If the patterns in a population point to a certain thing, then scientists may know the risk factor to a certain disease and then model it and scientifically link it to air pollution,” he explains.

He advises people to stay away from solid fuels, if they can, because using those predisposes them to risks associated with air pollution. 

“I know some people still use charcoal to cook, but I’d rather they use other sources of energy that are cleaner,” he says.

Outside people’s homes, people are exposed to air pollution when on traffic, when they burn waste and tyres and when they live near dumpsites. 

Dr Chakaya says the bigger responsibility lies on the government, which should come up with policies that reduce the risk of people exposed to polluted air.

According to the World Health Organization, air pollution leads to about 7 million premature deaths every year.

“It is the greatest environmental threat to health and a leading cause of non-communicable diseases such as heart attacks or stroke,” they say.

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