Thirty-year-old Kala Devi is a daily wage worker in Delhi and her earnings support her sick husband and five children. Devi lives in a slum called Andhera Gher near the posh locality of Vasant Kunj in the south west part of the city. Her husband Mangana has tuberculosis and has been ill for the past two years. Her 12-year-old daughter Aarti has been complaining of pains in her chest for the past two years. Devi finds her own health wavering.

“I become breathless when I am working,” she complained.

Devi and almost all the other residents of Andhera Gher use earthen stoves called chulhas, burning pieces of wood to cook, heat water and keep warm in the winter. The slum has no electricity. High rise buildings all around the settlement of about 18 houses ensure that the smoke generated from the chulhas get trapped in the air above the slum. By about 8 pm every evening, an hour after the chulhas have been lit, residents start feeling their eyes burning and watering.

Poonam, who also cooks on a chulha, falls sick with fever, a runny nose and cough at least two to three times a month – more so in the winter. She has a three-year-old daughter named Pinky, who she said was born underweight.

Household air pollution from solid fuels like wood is one the biggest sources of air pollution in India and the main cause of ill-health and death from air pollution as well. As smog heavy with dangerous levels of particulate pollution has settled over Delhi this winter, slum and street dwellers using wood to cook and keep warm, face double the risk of ill-health from pollution.

Almost everyone living in Andhera Gher complains of constant respiratory distress and burning eyes. The residents said that it is common for children to see a doctor for fever and respiratory illnesses twice or thrice a month during winter.

Dangerous fumes indoors

The smog over Delhi is largely caused by outdoor or ambient air pollution from sources like vehicle emissions, industry emissions and crop stubble burning. Household air pollution is the smoke generated within homes, which is also dangerous because of its proximity. Use of inefficient cooking fuels like wood and kerosene produces large amounts of small soot particles that can penetrate deep into the lungs.

A recently released study published in the journal Lancet showed that in 2015, air pollution contributed to 5.2 lakh premature deaths in India, next only to China. The single biggest cause was household air pollution, mostly from by solid cooking fuels, resulting in 1.2 lakh premature deaths.

An Andhera Gher resident using wood blocks to fuel her earthen stove to cook dinner. Photo credit: Menaka Rao.

The World Health Organisation accepts that there is strong evidence to show that exposure to household air pollution can cause acute and chronic respiratory conditions, lung cancer, heart disease, stroke and tuberculosis in children and adults. Household pollution is also linked to adverse pregnancy outcomes, like children being born with low weight, which is a key cause of death among infants.

For example, a study in 2012 found that women who used biomass, kerosene and coal as cooking fuels were at much higher risk of having low birth weight babies than those who used the far cleaner liquified petroleum gas. Another study in 2013 showed that the use of firewood, biomass – any kind of organic matter like crop residue, dried vegetation or even garbage – and kerosene was associated with higher occurrences of stillbirths.

The World Health Organisation states that over half of deaths among children younger than five from acute lower respiratory infections are due to particulate matter inhaled from indoor air pollution from household solid fuels.

At the same time, doctors in Delhi see the impacts of the use of dirty fuels first hand. Dr Arvind Kumar, chest surgeon at the Sir Ganga Ram Hospital, said that he has seen many women who use chulhas to cook develop lung cancer, even though they are not smokers.

Dr Raj Kumar, from the department of respiratory allergy and applied immunology at the Vallabhbhai Patel Chest Institute, led a major study on indoor air pollution and its effects on more than 6000 households between 2004 to 2009 in eight areas of Delhi. “We found that the use of wood fire and cow dung as cooking fuel causes chronic obstructive pulmonary disease in women and girls (they also cook), and other respiratory problems in men and boys,” he said. “We observed that the health effects were seen more in people living in lower class as compared to people living in middle class and upper middle class areas.”

Burning garbage in Andhera Gher slum in Delhi. Photo credit: Menaka Rao.

In Andhera Gher, a two-month-old baby girl lay in her cradle, while her mother, 21-year-old Mamta, cooked on the earthen stove in the next room. The windowless room slowly filled with smoke.

In poorly ventilated dwellings, like those in Andhera Gher, indoor smoke can carry 100 times more fine particulate matter than accepted standards. This is also much more than the particulate matter in Delhi air that is categorised as severe or dangerous.

A study in a village on the outskirts of Delhi with 92 households showed that women and girls who cooked in houses without separate properly ventilates kitchens had significantly higher respiratory symptoms such as shortness of breath, wheezing and cough.

The dangers of household air pollution have been well established for at least two decades and successive governments have made efforts to help people switch to cleaner fuel sources. In May 2016, Prime Minister Narendra Modi launched the Pradhan Mantri Ujjwala Scheme to provide free LPG connections to families below the poverty line. In one year, the programme had provided LPG connections to 2.2 crore households and the government wants to reach five crore more families by 2019.

However, the programme has not been able to ensure that beneficiaries continue to use LPG after they have exhausted the the free gas cylinder. Many families cannot afford a refill gas at market rates. The high price of LPG, the difficulty in getting LPG connections for lack of documentation in migrant families and other factors have led women to stack stoves, using multiple types of heating devices and fuels for different purposes such as boiling water or cooking dal. Poonam in Andhera Gher cooks on a earthen stove fueled by pieces of wood. Her family is one of two in the area that has an LPG connection. Both families use the LPG sparingly, making do with firewood when they can.

Kalpana, who works as domestic help in Vasant Kunj apartments, does not use wood as fuel and buys LPG from the black market. But living in the Andhera Gher makes her family vulnerable to the pollution. Her two year old was hospitalised last month, after she got breathless in the night. “She suffered from pneumonia and she needed a nebuliser.”

The ill-health of residents on Andhera Gher may have many different causes and triggers. Even their respiratory distress cannot be pinned down to the smoke from chulhas alone. Yet, the household air pollution makes them far more vulnerable.

“Any lung exposed to pollutants makes it weak,” explained chest surgeon Kumar. “A weak lung is prone to catch every kind of infection, be it viral, or fungal or bacterial, such as pneumonia or tuberculosis. It does not show up overnight but over a period of time.”

But, the Andhera Gher residents, while in great discomfort due to the smoke, are little aware of the extent to which it can compromise their health. Most believe that their colds and coughs are part of the normal winter illnesses.

Sixteen-year-old Rahul simply steps out of the slum to the main road for the one-and-a-half hours in the evening when the chulhas are all lit.

“My eyes hurt a lot when I sit before the fire,” he said. “I prefer roaming outside.”

Andhera Gher slum residents keeping themselves warm by a wood-fueled fire on a cold November night. Photo credit: Menaka Rao.