KABUL — The street cleaners huddled around a portable stove on the sidewalk to pour midday tea, taking sips underneath masks that filter acrid smog.
Mohammad Sharif’s throat burned. His lungs ached. But he can’t afford a doctor on his wages, any 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 adds to the airborne toxins blanketing this city of 5 million.
“We don’t have any other option,” he said.
Afghanistan, long embroiled in conflict, has focused for the past 18 years on security and reconstruction at the expense of issues affecting the environment, according to current and former environmental officials. They say the government remains ill-equipped to curb the causes — such as coal consumption and vehicle exhaust — of Kabul’s thick haze.
About 4.2 million premature deaths worldwide were linked to ambient, or outdoor, air pollution in 2016, according to the World Health Organization, which put Afghanistan’s total for that year at more than 17,000. Health officials in Afghanistan said they do not have data to measure death rates related to pollution.
Health and environmental experts measure ambient PM2.5 pollutants, particulate matter so small it can embed in human lungs, causing severe problems including heart attacks, strokes and respiratory infections, along with stunted development in children. The WHO’s recommended daily exposure level is 25.
Kabul’s population has tripled over the past decade, and the capital buzzes with Soviet-era cars emitting thick plumes of exhaust. Apartment buildings and factories send columns of coal smoke into the air, which grows even smoggier in winter as temperatures plummet and residents crank up their furnaces.
At 11:10 a.m. Friday, Kabul’s air quality ranked worst in the world with a score of 277, ahead of Delhi and the Pakistani city of Lahore, according to a snapshot from the commercial air-quality website AirVisual, which logs readings from consumer-operated sensors around the globe.
Those readings are perhaps the only way Kabul residents can quantify the severity of air pollution day-to-day.
Afghanistan’s National Environmental Protection Agency, or NEPA, has its own air-quality monitors but does not publicly release the data, said Mohammad Iqbal Hamdard, a spokesman for the agency, adding that NEPA is working toward a format geared for social media.
NEPA officials monitor the AirVisual score in Kabul, but the agency does not make decisions based on it, he said.
At the same moment Friday, Salt Lake City ranked highest in the United States on AirVisual, with an air quality index of 93.
Residents here were relieved when two separate days of heavy snow this past week drove away the smog. Precipitation is typically the only thing that cuts the haze during the winter months.
NEPA has made an effort to warn the public of the health risks associated with air pollution, said Abdul-Hadi Zheman, a former chief of staff for the organization. Zheman resigned in late December, citing frustration over mismanagement and what he said was a lack of strategic vision at the agency.
He joined an exodus that has included other senior officials and more than a dozen environmental experts within the past year, said Ghulam Mohammad Malikyar, a former technical deputy director who left the agency months ago.
While some Afghans are unaware 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, forcing many, like Sharif, to burn whatever they have to 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 agency’s current technical deputy director, said NEPA is in no position either financially or technically to deal with the crisis. Among the reasons, he said, is that since Taliban rule ended in 2001, the government has prioritized development and security, leaving little money or political clout to support environmental initiatives.
Still, he said, government leaders have recently signaled a deeper commitment to reducing pollution. He cited NEPA’s call for more inspections of new buildings, as well as an ongoing program to plant 1 million trees in Kabul over the next few years and a wave of crackdowns on big polluters, among other initiatives.
Winter brings more reports of cardiovascular disease among adults and respiratory problems in children in big cities such as Kabul and Mazar-e Sharif, said Wahidullah Mayar, a spokesman for the Public Health Ministry.
To prepare for the season, the ministry has been training doctors on new approaches to diagnosing and treating pollution-related illnesses, Mayar said.
And yet, the ministry has struggled to develop even rudimentary statistics for pollution-related illnesses across Afghanistan, he said, leaving officials unsure whether rates are up or down, or whether health policies have made an impact.
It is difficult to collect such data during an ongoing conflict in a nation with developing infrastructure, Mayar said, speaking in a darkened conference room in Kabul after the ministry lost power.
For now, Kabul residents see little progress, especially those who work outside.
Popal Ahmadi, a 16-year-old street vendor, sells chips and candy to students around Kabul University from morning until evening classes end. He goes home with stinging eyes and sore lungs, he said, as the smog begins to choke the night.