Respiratory Infections are the Third Cause of Death in Damascus Automobiles are a main pollutant of the air, and 20 percent of them were manufactured over 17 years ago Concentration of “cancer causing gasoline” in the middle of the province is 2.3 times m

Mazen Al-Ulabi, 25 years old, spends most of his time at Madhat Pasha Souk/bazaar known for its heavily polluted air, high doses of antibiotics have become his steady companion, and as a result he suffers from chest infections and tonsillitis.

Simiarly to his case are the cases of his neighbors, Abdul-Razzaq Sabbagh, Yaseen Al-Ulabi, Anwar Al-Shami and other sufferers of recurrent respiratory tract infections. Registered pollutants in their neighborhood resulting from vehicle exhaust, a high population density, industrial and trade activities, are 11 times higher than the international levels allowed.

A mask of dust and charcoal smoke covers their faces at the end of their working day at the Souk, given the conditions of extreme pollution they are subjected to. A 1999 health study involving 120 people at Madhat Pasha showed 38 cases of chronic respiratory infection, 25 cases of allergic respiratory infections, 3 cases of pulmonary fibrosis, 13 cases of chronic coughing, 9 cases of upper respiratory infections, and 6 cases of sinus infections.

Many traders at Madhat Pasha Street who are infected with respiratory tract infections, wonder about the warnings given to them by their doctors against smoking. They assert that they do not smoke; but they work in a Souk known for its pollution.

That is the situation in merely one of Damascene markets. Hence, one cannot help but wonder how the situation in the capital might be, considering that one third of the country's population lives there. Additionally, given that “cars play a major role in increasing polluted gases in the air,” as stated in the strategy and work plan prepared by the Ministry of Local Government and Environment in 2003, with support of the United Nations Development Program and the World Bank, it is logical to assume that the level of pollution in the capital is unsafe.

According to the records of the Ministry of Transport, 20 percent of the cars in Damascus are over 17 years old. Furthermore, the fuel being utilized is below international standards, as explained by the local government and the ministries of oil.

A report by Tishreen newspaper revealed that respiratory tract diseases were the fourth cause of death in Damascus in the year 2000. In 2006, the dangers increased, making it the third cause of death amongst the Madhat Pahsa traders.
Measuring Pollution Records
The environment will not improve before “the standards of diesel and gasoline are improved and before using gas fuels as an alternative source in transport. Also, the development of traffic systems should be established, a new public transport system should also be built in order to replace the current individual systems. Furthermore, it is vital to establish specific environmental conditions for car imports,” as stated by the environmental strategy and work plan, and according to environmental experts and doctors interviewed by Tishreen.

The Public Organization for Environmental Affairs explains thar “pollution measurement processes are not permanent and take place far in between until permanent monitoring networks of air quality are operational. These processes are expected to take place in Damascus- the most severely polluted province, at the end of 2007. This will include four monitoring stations in the province.”The Ministry of Local Government and Environment is basing its action on a study conducted by the Center of Environmental Studies on Air Pollutants in Damascus in the years 2001, 2004 and 2005. The study determined a total average pollution in three locations in Damascus (Bab Touma, Al-Baramkeh Plaza and Al-Tijarah near Bassam Hamsho School).

This was preceded by some studies conducted by scientific and research institutions (the Scientific Studies and Research Center, the Environmental Studies and Research Center, the Nuclear Energy Agency, Ministry of State for Environmental Affairs and environmental researcher Muhammad Al-Oudat and others). More detailed measurements were conducted during intermittent periods in 1989 and 2001. The studies showed a declining quality of air in Damascus, where pollutants were found to be four times what is acceptable internationally. Concentrations of pollutants less than 10 micron (small, dangerous and that can be inhaled) was found to be 222 micrograms/square meter- three times the level internationally acceptable (70 micrograms per square meter). The concentration of pollutants smaller than 3 microns (tiny and extremely dangerous because they can penetrate breathing defenses and reach the lungs) 115 micrograms/square meter, which is 7.5 times more the internationally acceptable 15 micrograms/square meter.

Other measurements of air pollutants are as follows (1989-2001):
-         Increased hourly and daily average values of  SO2 are above acceptable levels by two times;
-         Double the acceptable levels of CO concentration in the air;
-         An increase in ozone level concentrations to 2.5 times internationally acceptable levels;
-         An increase in azote (nitrogen) oxides to 1.5 internationally acceptable levels.

All the above pollutants are known to the World Health Organization (WHO) as causes for respiratory tract diseases. Some are extremely dangerous on the lungs and lead to early death (such as pollutants smaller than 3.1 microns.)

High concentrations of cancer causing circular perfumed hydrocarbons stemming principally from the incomplete burning of fuels in vehicles were also registered. The concentration of the best known of these (betririne) is 2.3 above internationally allowed standards.
According to Al-Oudat, the Public Agency for Environmental Affairs and Dr. Nasr Al-Hayek, the smog which becomes a daily occurrence during the summer in Damascus due to high temperatures results from the reaction of primary pollutants, especially nitrogen oxides with oxygen in the presence of CO and CO2, under ultra-violet rays, parespiratory tract deathscularly in early morning hours. The result is a variation of dangerous pollutants to ones health-- especially the respiratory system, which Al-Oudat sees as “clear evidence of increased pollutants in Damascus.”

Traffic jams are a main cause of air pollution in Damascus, according to the Ministry of Local Government and Environment.According to  Ministry of Transport statistics, what is driven in the capital’s streets are not only the 278,000 registered cars, but an additional 50,000 vehicles that enter and exit Damascus from all other provinces.

The result of this great number of vehicles on the streets is a very slow vehicular motion leading to higher fuel consumption and the release of more pollutants, according to The Car and Environmental Pollution  reference written by Dr. Ali Mustafa Ala’a Eddin. According to the Public Agency for Environmental Affairs “Pollutants resulting from old cars are several times higher than newer cars, due to the fact that they constantly suffer from engine trouble”.

As pollutants accumulate on the noses and foreheads of citizens in what look like charcoal black smoke, which happens on a daily basis to residents living in old Damascus, the concern of citizens becomes good health in the middle of the traffic jams. So, what is the health status of residents?Pollution and Respiratory Tract Deaths
Respiratory tract diseases are the fourth cause of death in the country, according to Ministry of Health statistics (2006). In Damascus, it is the third leading cause of death. In 2006, over 57,000 deaths due to respiratory tract illnesses took place across Syria. Damascus experienced 13,287 deaths, 800 of which were due to such illnesses. In 2000, respiratory diseases constituted a 4.7 percent of all deaths in Damascus.

According to official data, the mortality rate in Damascus pertaining to respiratory tract infections, increased by a 1.3 percent within a period of six years. In other words, there were 400 new deaths resulting from respiratory tract infections in a time span of six years.

In 2006, 4,352 patients suffered from respiratory tract infections-- 800 of them died. Accordingly, deaths due to respiratory tract infections constitute more than 18 percent of the total number of deaths. in Syria This  illustrates how dangerous such infections are.

According to the WHO, there is a “close relation between respiratory tract illnesses and air pollution". The Ministry of Transport says that a connection can be made between such increases (between 2000-2006) and an average increase of 50,000 vehicles each year, an increase in traffic jams and fuel consumption. These indicators represent an increased level of pollution and illnesses in Damascus, according to Dr. Adeeb Dashshash, former Professor of Occupational and Environmental Medicine at Damascus University and the General Secretary of the Doctors Union presently. “In fact, 80 percent of respiratory tract illnesses are related to air pollution; so is the case of 80 percent of pulmonary cancers.”

The current five-year plan of the government states that “many indicators point to a regress in the health situation of areas suffering from pollution and high population concentrations.” Previous studies conducted by the Ministry of Health in 1995 state that respiratory tract deaths in polluted Syrian areas are three to four times that of cleaner areas. The Environmental Work Plan of 2003 considered pollution alone to be “the cause of 4,000 deaths annually in Syria.”

The Public Agency for Environmental Affairs considered air pollution “an environmental priority. Indicators are the increase of illnesses and early deaths due to respiratory infections.”

A study conducted in 2005 by Al-Oudat, from the Nuclear Energy Agency, and Dr. Adnan Gata, from Al-Ba’ath University, points to studies conducted in China (Anan and Pan 2004) showing that short exposures to an extra 10 microgram/square meter of respiratory pollutants lead to a mortality increase of 6 per 1,000 due to respiratory track deaths. Long exposure increases chest illnesses by 3.1 per cent for adults and 4.4 per cent for children. They also explored a study (Schneider, 2004) that explained that long exposure to micro pollutants decreases ones life expectancy by two to three years.

Thus, based on the above indicators, what are the consequences on the state budget tn order to provide a healthy, clean environment for its citizens?An Unknown Burden! The Ministry of Health has no estimates of the financial burden of respiratory tract deaths ,and resulting mortality rates in Damascus and other provinces, even though it has a directorate specialized in environmental and chronic diseases. According to Fadia Mi’mari, head of Tuberculosis and Respiratory Illnesses Department, such perceptions can be reached in the coming years. Dr. Atef Al-Taweel, Head of the Department of the Environment, said that knowing the financial burden requires a special program and experience in translating environmental issues into financial figures. He also stated that there is a request to establish a program for the cost of illnesses, but this needs basic assistance from the WHO.

Tishreen took the initiative of establishing indicators for some individual cases. For example, radiation and chemotherapy in the case of the respiratory system in one of the oncology hospitals in Damascus, costs around 200,000 Syrian pounds (US$ 4,000) per patient. This means that the 125 respiratory tract oncology patients in Damascus in 2005 (National Cancer Records) cost the government 25 million Syrian pounds for radiology and chemotherapy. This figure does not include other treatment costs, hospital stays and unemployment. According to the records of one lung cancer patient, the costs of treatment exceeded 2 million Syrian pounds.

A current patient of chemotherapy, a father of four children, talked about his year-long suffering because of lung cancer, saying that it cost him  300,000 Syrian pounds because he was out of work. He said he would have refused treatment because of his inability to cover costs, had it not been for the near free of cost treatment provided by the state. He estimated costs by the state to be  200,000 Syrian pounds.

Abu Ali, who has pulmonary infections, estimates that the cost of his treatments and other financial damage to be  500,000 Syrian pounds, considering the fact that he pays  500 Syrian pounds per visit to the doctor. His drugs cost at least  1,000 Syrian  pounds each time, and the hospital stay costs more than 30,000 Syrian pounds for a period of no more than five days.

Abu Nizar, who suffers from asthma, left his work in Damascus and went back to rural west Homs for clean air, “Asthma cost me more than  25,000 Syrian pounds I used to get from my work,” he said.

Until When?

Dr. Akram Khoury, director general of the Public Agency for Environmental Affairs, says that the Ministry of Local Government and Environment is working to provide solutions, and propose procedures that guarantee improving air quality which should be implemented before the end of 2015, as stipulated in the environmental strategy and work plan.

“The problem of air pollution is the mutual responsibility of several respiratory tract deaths,” he told Tishreen. “Its treatment is complex and needs the cooperation all agencies involved, especially the Ministry of Oil for improving fuel and the Ministry of Transport for developing traffic systems.”

While waiting for improving air quality in Damascus, the government acknowledges the increase in all causes of pollution, such as cars, traffic jams and fuel consumption. Research is scarce, and diseases are compounding, according to ministry of health statistics.

Clean air remains a demand by the population. So, when is it going to happen?

The question becomes more painful when you see the tears of Um Mohammed, whose young son is losing his struggle against a chronic lung disease that has nearly killed him. The mother says her son "has been dreaming of clean air in Damascus, which he has not yet found."

This report was supported by ARIJ network (Arab Reporters for Arab Investigative Journalism).

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Tishreen Zafer Ahmad

Mazen Al-Ulabi, 25 years old, spends most of his time at Madhat Pasha Souk/bazaar known for its heavily polluted air, high doses of antibiotics have become his steady companion, and as a result he suffers from chest infections and tonsillitis.

Simiarly to his case are the cases of his neighbors, Abdul-Razzaq Sabbagh, Yaseen Al-Ulabi, Anwar Al-Shami and other sufferers of recurrent respiratory tract infections. Registered pollutants in their neighborhood resulting from vehicle exhaust, a high population density, industrial and trade activities, are 11 times higher than the international levels allowed.

A mask of dust and charcoal smoke covers their faces at the end of their working day at the Souk, given the conditions of extreme pollution they are subjected to. A 1999 health study involving 120 people at Madhat Pasha showed 38 cases of chronic respiratory infection, 25 cases of allergic respiratory infections, 3 cases of pulmonary fibrosis, 13 cases of chronic coughing, 9 cases of upper respiratory infections, and 6 cases of sinus infections.

Many traders at Madhat Pasha Street who are infected with respiratory tract infections, wonder about the warnings given to them by their doctors against smoking. They assert that they do not smoke; but they work in a Souk known for its pollution.

That is the situation in merely one of Damascene markets. Hence, one cannot help but wonder how the situation in the capital might be, considering that one third of the country's population lives there. Additionally, given that “cars play a major role in increasing polluted gases in the air,” as stated in the strategy and work plan prepared by the Ministry of Local Government and Environment in 2003, with support of the United Nations Development Program and the World Bank, it is logical to assume that the level of pollution in the capital is unsafe.

According to the records of the Ministry of Transport, 20 percent of the cars in Damascus are over 17 years old. Furthermore, the fuel being utilized is below international standards, as explained by the local government and the ministries of oil.

A report by Tishreen newspaper revealed that respiratory tract diseases were the fourth cause of death in Damascus in the year 2000. In 2006, the dangers increased, making it the third cause of death amongst the Madhat Pahsa traders.
Measuring Pollution Records
The environment will not improve before “the standards of diesel and gasoline are improved and before using gas fuels as an alternative source in transport. Also, the development of traffic systems should be established, a new public transport system should also be built in order to replace the current individual systems. Furthermore, it is vital to establish specific environmental conditions for car imports,” as stated by the environmental strategy and work plan, and according to environmental experts and doctors interviewed by Tishreen.

The Public Organization for Environmental Affairs explains thar “pollution measurement processes are not permanent and take place far in between until permanent monitoring networks of air quality are operational. These processes are expected to take place in Damascus- the most severely polluted province, at the end of 2007. This will include four monitoring stations in the province.”The Ministry of Local Government and Environment is basing its action on a study conducted by the Center of Environmental Studies on Air Pollutants in Damascus in the years 2001, 2004 and 2005. The study determined a total average pollution in three locations in Damascus (Bab Touma, Al-Baramkeh Plaza and Al-Tijarah near Bassam Hamsho School).

This was preceded by some studies conducted by scientific and research institutions (the Scientific Studies and Research Center, the Environmental Studies and Research Center, the Nuclear Energy Agency, Ministry of State for Environmental Affairs and environmental researcher Muhammad Al-Oudat and others). More detailed measurements were conducted during intermittent periods in 1989 and 2001. The studies showed a declining quality of air in Damascus, where pollutants were found to be four times what is acceptable internationally. Concentrations of pollutants less than 10 micron (small, dangerous and that can be inhaled) was found to be 222 micrograms/square meter- three times the level internationally acceptable (70 micrograms per square meter). The concentration of pollutants smaller than 3 microns (tiny and extremely dangerous because they can penetrate breathing defenses and reach the lungs) 115 micrograms/square meter, which is 7.5 times more the internationally acceptable 15 micrograms/square meter.

Other measurements of air pollutants are as follows (1989-2001):
-         Increased hourly and daily average values of  SO2 are above acceptable levels by two times;
-         Double the acceptable levels of CO concentration in the air;
-         An increase in ozone level concentrations to 2.5 times internationally acceptable levels;
-         An increase in azote (nitrogen) oxides to 1.5 internationally acceptable levels.

All the above pollutants are known to the World Health Organization (WHO) as causes for respiratory tract diseases. Some are extremely dangerous on the lungs and lead to early death (such as pollutants smaller than 3.1 microns.)

High concentrations of cancer causing circular perfumed hydrocarbons stemming principally from the incomplete burning of fuels in vehicles were also registered. The concentration of the best known of these (betririne) is 2.3 above internationally allowed standards.
According to Al-Oudat, the Public Agency for Environmental Affairs and Dr. Nasr Al-Hayek, the smog which becomes a daily occurrence during the summer in Damascus due to high temperatures results from the reaction of primary pollutants, especially nitrogen oxides with oxygen in the presence of CO and CO2, under ultra-violet rays, parespiratory tract deathscularly in early morning hours. The result is a variation of dangerous pollutants to ones health-- especially the respiratory system, which Al-Oudat sees as “clear evidence of increased pollutants in Damascus.”

Traffic jams are a main cause of air pollution in Damascus, according to the Ministry of Local Government and Environment.According to  Ministry of Transport statistics, what is driven in the capital’s streets are not only the 278,000 registered cars, but an additional 50,000 vehicles that enter and exit Damascus from all other provinces.

The result of this great number of vehicles on the streets is a very slow vehicular motion leading to higher fuel consumption and the release of more pollutants, according to The Car and Environmental Pollution  reference written by Dr. Ali Mustafa Ala’a Eddin. According to the Public Agency for Environmental Affairs “Pollutants resulting from old cars are several times higher than newer cars, due to the fact that they constantly suffer from engine trouble”.

As pollutants accumulate on the noses and foreheads of citizens in what look like charcoal black smoke, which happens on a daily basis to residents living in old Damascus, the concern of citizens becomes good health in the middle of the traffic jams. So, what is the health status of residents?Pollution and Respiratory Tract Deaths
Respiratory tract diseases are the fourth cause of death in the country, according to Ministry of Health statistics (2006). In Damascus, it is the third leading cause of death. In 2006, over 57,000 deaths due to respiratory tract illnesses took place across Syria. Damascus experienced 13,287 deaths, 800 of which were due to such illnesses. In 2000, respiratory diseases constituted a 4.7 percent of all deaths in Damascus.

According to official data, the mortality rate in Damascus pertaining to respiratory tract infections, increased by a 1.3 percent within a period of six years. In other words, there were 400 new deaths resulting from respiratory tract infections in a time span of six years.

In 2006, 4,352 patients suffered from respiratory tract infections-- 800 of them died. Accordingly, deaths due to respiratory tract infections constitute more than 18 percent of the total number of deaths. in Syria This  illustrates how dangerous such infections are.

According to the WHO, there is a “close relation between respiratory tract illnesses and air pollution". The Ministry of Transport says that a connection can be made between such increases (between 2000-2006) and an average increase of 50,000 vehicles each year, an increase in traffic jams and fuel consumption. These indicators represent an increased level of pollution and illnesses in Damascus, according to Dr. Adeeb Dashshash, former Professor of Occupational and Environmental Medicine at Damascus University and the General Secretary of the Doctors Union presently. “In fact, 80 percent of respiratory tract illnesses are related to air pollution; so is the case of 80 percent of pulmonary cancers.”

The current five-year plan of the government states that “many indicators point to a regress in the health situation of areas suffering from pollution and high population concentrations.” Previous studies conducted by the Ministry of Health in 1995 state that respiratory tract deaths in polluted Syrian areas are three to four times that of cleaner areas. The Environmental Work Plan of 2003 considered pollution alone to be “the cause of 4,000 deaths annually in Syria.”

The Public Agency for Environmental Affairs considered air pollution “an environmental priority. Indicators are the increase of illnesses and early deaths due to respiratory infections.”

A study conducted in 2005 by Al-Oudat, from the Nuclear Energy Agency, and Dr. Adnan Gata, from Al-Ba’ath University, points to studies conducted in China (Anan and Pan 2004) showing that short exposures to an extra 10 microgram/square meter of respiratory pollutants lead to a mortality increase of 6 per 1,000 due to respiratory track deaths. Long exposure increases chest illnesses by 3.1 per cent for adults and 4.4 per cent for children. They also explored a study (Schneider, 2004) that explained that long exposure to micro pollutants decreases ones life expectancy by two to three years.

Thus, based on the above indicators, what are the consequences on the state budget tn order to provide a healthy, clean environment for its citizens?An Unknown Burden! The Ministry of Health has no estimates of the financial burden of respiratory tract deaths ,and resulting mortality rates in Damascus and other provinces, even though it has a directorate specialized in environmental and chronic diseases. According to Fadia Mi’mari, head of Tuberculosis and Respiratory Illnesses Department, such perceptions can be reached in the coming years. Dr. Atef Al-Taweel, Head of the Department of the Environment, said that knowing the financial burden requires a special program and experience in translating environmental issues into financial figures. He also stated that there is a request to establish a program for the cost of illnesses, but this needs basic assistance from the WHO.

Tishreen took the initiative of establishing indicators for some individual cases. For example, radiation and chemotherapy in the case of the respiratory system in one of the oncology hospitals in Damascus, costs around 200,000 Syrian pounds (US$ 4,000) per patient. This means that the 125 respiratory tract oncology patients in Damascus in 2005 (National Cancer Records) cost the government 25 million Syrian pounds for radiology and chemotherapy. This figure does not include other treatment costs, hospital stays and unemployment. According to the records of one lung cancer patient, the costs of treatment exceeded 2 million Syrian pounds.

A current patient of chemotherapy, a father of four children, talked about his year-long suffering because of lung cancer, saying that it cost him  300,000 Syrian pounds because he was out of work. He said he would have refused treatment because of his inability to cover costs, had it not been for the near free of cost treatment provided by the state. He estimated costs by the state to be  200,000 Syrian pounds.

Abu Ali, who has pulmonary infections, estimates that the cost of his treatments and other financial damage to be  500,000 Syrian pounds, considering the fact that he pays  500 Syrian pounds per visit to the doctor. His drugs cost at least  1,000 Syrian  pounds each time, and the hospital stay costs more than 30,000 Syrian pounds for a period of no more than five days.

Abu Nizar, who suffers from asthma, left his work in Damascus and went back to rural west Homs for clean air, “Asthma cost me more than  25,000 Syrian pounds I used to get from my work,” he said.

Until When?

Dr. Akram Khoury, director general of the Public Agency for Environmental Affairs, says that the Ministry of Local Government and Environment is working to provide solutions, and propose procedures that guarantee improving air quality which should be implemented before the end of 2015, as stipulated in the environmental strategy and work plan.

“The problem of air pollution is the mutual responsibility of several respiratory tract deaths,” he told Tishreen. “Its treatment is complex and needs the cooperation all agencies involved, especially the Ministry of Oil for improving fuel and the Ministry of Transport for developing traffic systems.”

While waiting for improving air quality in Damascus, the government acknowledges the increase in all causes of pollution, such as cars, traffic jams and fuel consumption. Research is scarce, and diseases are compounding, according to ministry of health statistics.

Clean air remains a demand by the population. So, when is it going to happen?

The question becomes more painful when you see the tears of Um Mohammed, whose young son is losing his struggle against a chronic lung disease that has nearly killed him. The mother says her son "has been dreaming of clean air in Damascus, which he has not yet found."

This report was supported by ARIJ network (Arab Reporters for Arab Investigative Journalism).