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Invisible Battles: The Health Impact of Air Pollution on Nairobi’s Street Families

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  • Nyokabi has battled tuberculosis for the last 3 years. Our interview gets interrupted periodically as she turns to grab a glass of hot water from a thermos flask next to her to subdue a persistent heavy cough that keeps interrupting her speech.
  • “In June 2019, while picking waste at the dumpsite, I felt a sharp pain in my chest but ignored it. It persisted for two weeks until I fainted and was rushed to Dandora health center before being referred to Mama Lucy where I was diagnosed with TB and a lung infection’’ narrated Nyokabi who has also suffered two miscarriages in the past five years.
A mother and her children covered in heavy smoke as they pick waste at the Dandora dumpsite oblivious of the health risks facing them. Photo Credit/James Wakibia

As we force our way through the trash mounts towards a line of ramshackles edged on the west side of the Dandora dumpsite, an overwhelming and pungent scent lingers around with the smell of rot and decay that hung heavy in the polluted air, engulfing the already smoke-filled dark cloud above Kenya’s largest open public dumping site 5 kilometers East of the Capital City Nairobi

As heavy smoke billows from site, on a chilly, cold morning we meet Margaret Nyokabi, 30, ready to report to work in the vast land fill, a routine for 15 years. Notably, Nyobaki has an improvised nose mask, a precaution she says protects her from inhaling “bitter and suffocating air’’ dominating the dumpsite and its environs. Covered in choking smoke and seemingly undeterred by the strong stench, she joins a group of 10 other women who are busy turning the waste upside down as if looking for a lost treasure. Oblivious of the potential health risks, Nyokabi and her colleagues hold the Dandora dumpsite dear to their hearts.

“I have lived and worked here since I was 15. It is our home and employer’’ said Nyokabi who lives in a makeshift temporary structure made of polythene papers and cartons on the edges of the dumpsite.

For the majority of men and women living and working around the Dandora dumpsite, a backache, a recurring headache, an occasional nosebleed, a migraine, teary eyes, and a clogged chest are common occurrences Nyokabi told The Mt Kenya Times.

“When such conditions appear, we simply self-medicate by purchasing over the counter drugs. We rarely go to the hospital unless it’s serious. It gets worse when it rains because the whole place gets covered in smoke that emanates from the smoldering dumpsite. We struggle with breathing during the cold season and at night” said Nyokabi.

Opened in 1975, the 30-acre dumpsite which was declared full in 2001 swallows an estimated 2,000 tons of waste each day.

Bearing the Scourge

Nyokabi has battled tuberculosis for the last 3 years. Our interview gets interrupted periodically as she turns to grab a glass of hot water from a thermos flask next to her to subdue a persistent heavy cough that keeps interrupting her speech.

“In June 2019, while picking waste at the dumpsite, I felt a sharp pain in my chest but ignored it. It persisted for two weeks until I fainted and was rushed to Dandora health center before being referred to Mama Lucy where I was diagnosed with TB and a lung infection’’ narrated Nyokabi who has also suffered two miscarriages in the past five years.

Doctors told Nyokabi that her TB was at an advanced stage and was put on heavy medication. Dr. Arnold Bugah, an obstetrician-gynecologist based at the Mama Lucy hospital, explains that in Nyokabis’ case the developing fetus was exposed to highly toxic pollutants like carbon monoxide which is associated with higher risk for stillbirth and spontaneous abortion(miscarriages).

“For most women in street families, the perils of air pollution are magnified during pregnancy. Exposure to PM2.5 and carbon during pregnancy increases the risk of spontaneous abortion, and stillbirths especially during the third trimester,’’ explained Dr. Bugah.

“Most of these pregnant homeless mothers rarely have access to prenatal care and since they are always exposed and vulnerable they will in most cases have complicated pregnancies and births’’ he said.

Antony Munyiri, 28, was diagnosed with asthma in 2020. A waste picker for the past 10 years, Antony is currently grappling with the debilitating effects of a condition doctors said was exacerbated by his constant exposure to hazardous pollutants. “Struggling with breathing, a clogged chest and persistent coughing have become a routine,’’ says Antony who is also battling weakened lungs.

In 2022, Antony lost a seven-month-old son due to lung infection and in 2015 he lost his mother, also a waster picker at the dumpsite to chronic bronchitis and lung failure

Dr. Susan Kagwe, a pediatrician, said respiratory diseases, such as asthma and chronic bronchitis, are rampant among Nairobi’s street families, particularly the children. She observes that prolonged exposure to airborne pollutants irritates airways, leading to chronic respiratory conditions that are both debilitating and expensive to treat.

Dr. Kagwe, warns about the dire consequences: “These children are at high risk of lifelong health problems. Without intervention, we may see a generation with compromised lung function and stunted growth.”

Invisible Killers

Dr. Kagwe notes that “air pollution is not only about wheezing and coughing but can be a silent killer with long-term invisible health threats”.

For Anette Kasyoka, a waste picker at the Dandora dumpsite, prolonged exposure to the harmful fumes emanating from the site saw her diagnosed with chronic bronchitis, a condition she has lived with for the past three years.

“I knew I was sick when a local church organized a free medical camp for street families in Dandora. The doctor recommended further tests at Avenue hospital where I was diagnosed with bronchitis,’’ Kasyoka said.

Kasyoka says she is struggling with a weak body and that managing her illness is costly. She receives support from a local Catholic church. “Doctors warned me that continued exposure to the smoke and fumes from the site could make my condition worse.’’

Anne Wanjira, 37, battles with heavy and painful periods, a condition she says doctors told her was caused by inhaling toxic substances from the Dandora dumpsite where she has been living and working as a waste picker for the past 14 years.

“It is common to go for two or three months without my periods and when they eventually come, it’s hell on earth because of the pain and heavy bleeding’’ said Wanjira. At the Dandora health center, such cases are a common occurrence, said Grace Wamuyu, a clinical officer at the facility.

Street Families Status

Often referred to as the “Green City in the Sun,” Nairobi has a hidden struggle of street families, predominantly women and children, grappling with a relentless adversary of air pollution that remains largely invisible but profoundly impactful.

Nairobi has an estimated 15,337 street persons, majority aged between 10-34 according to the National census of street families report released in 2018. The report identified bronchitis as the leading infection among street children at 12%. Further the census established that many take time to seek medical attention with only 30% seeking help in government facilities and 8% in private hospitals.

According to Dr. Andrew Odhiambo, a Consultant Medical Oncologist at the Kenyatta National Hospital, populations around areas where air is concentrated with pollutants face an increased risk of being diagnosed with cancer due to high exposure to dioxins and furans, cancerous toxins released from burning of mixed waste.

“The toxic fumes being released by the dumpsite have a potential of causing different types of cancers especially if one is continually exposed to them for a longer period of time. There is likely to be a high rate of skin, lung and throat cancer cases among people operating and living within the said areas’’ said Dr. Odhiambo who since 2010, with support from the Catholic church, has dealt with 10 homeless cancer patients from Eastlands Nairobi  among them 2 children.

Nairobi Air Status

Nairobi’s air pollution stems from multiple sources, including vehicular emissions, industrial activities, and open burning of waste.

According to George Mwaniki, Head of Air Quality, Africa at World resources Institute, Air pollution in Nairobi is 2.4 times  HYPERLINK https://www.iqair.com/kenya/nairobi”higher than the level considered safe by the   HYPERLINK “https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health”World Health Organization. Mwaniki observes that poor air quality is responsible for more than 19,000 deaths in Kenya each year. Nairobi’s 16% of outdoor PM2.5 comes from fossil fuel combustion, residential at 27%, industry at 5%, energy at 8% while anthropogenic dust contributes  7%.

“At Least 30% of the entire health budget for the Nairobi County government goes towards treating and managing illnesses and infections caused by air pollution’’ said Mwaniki.

The Impact

There are an estimated 124 deaths per 100,000 people due to air pollution in Kenya which is higher than the global average of 86 deaths per 100,000. According to the State of the Global Air 2020 report, ambient air pollution was responsible for around 5,000 premature deaths in Kenya in 2019 alone. Air pollution was among the top 5 risk factors to death in 2019 accounting for nearly 9% of all deaths (more than 28 thousand) while ambient particulate matter (PM2.5) was ranked as the 6th leading risk factor for deaths with 14% of deaths due to air pollution being recorded among children while 14% were of adults over 70 years of age. 33% of the air pollution related deaths were due to stroke, with air pollution related diabetes accounting for 23%, ischemic heart disease 30%, cancer 29%, lower respiratory infections 39%, while neonatal deaths were at 22%.

Data from the United Nations Environment Programme(UNEP) estimates that in Africa alone, ambient air pollution caused close to 400,000 premature deaths in 2019, while indoor air pollution caused more than one million premature deaths in the same year.

According to the World Health Organization, globally, air pollution is the top environmental cause of disease and is estimated to cause at least 7 million premature deaths annually 

Remedy

In an effort to mitigate the effects of air pollution, the Nairobi County government developed the Nairobi Air Quality Action Plan designed to tackle air pollution by enhancing Air Quality (AQ) governance, setting out to lay the foundation for current and future AQ management and regulation through capacity building, public awareness, and legislation. The plan includes installing AQ monitors, analyzing future climate change trends, developing a more robust GHG inventory, creating a communications strategy and awareness materials.

In 2021, Nairobi also developed an air quality management policy, a legal framework under which air quality management in the city is anchored. Nairobi City County Minister in charge of environment Ibrahim Nyangoya says that the county has set aside a budget for quality air management to ensure the implementation of all air quality management policies.

Speaking during the celebrations to mark the fourth International Day of Clean Air for blue skies on September 7,2023, Nairobi Governor Johnson Sakaja decried the sharp rise in pollutants and the decline in air quality saying that children and women are the  most impacted.

“The County is constantly monitoring air quality in partnership with stakeholders because high quality information is needed to enforce air quality regulations. We also have a new Air Quality bill in the pipeline as well as new air quality regulations that will be presented before the county Assembly soon’’ Sakaja said.

Sakaja added that already Nairobi has an operational air quality data reference station and is investing in the installation of Air quality monitoring sensors across the City to collect data to help in formulating air quality control policies. “Nairobi is working towards becoming the first net zero city by 2050” said Sakaja.

But for Nyokabi and her colleagues, leaving Dandora is not an option despite the obvious health secrets they are exposed to. “I have no other place to go to. This dumpsite is my life and my home.’’ Nyokabi concluded.

This story was produced with support from Earth Journalism Network (EJN)

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