Mohamed, who lives near a dump in Bar Elias in the Bekaa Valley, where trash has been burned for over 20 years, told HRW that he suffers from “coughing, pulmonary infections, inability to breathe and, more recently, coughing blood.” According to the report, “Open burning solid waste can release a range of pollutants into the air. PM 10 particles, which are particles of 10 micrometers or less, can penetrate the lungs or enter the bloodstream, and can lead to heart disease, lung cancer, asthma, and acute lower respiratory infections.”

“The garbage crisis gained prominence in 2015, but open burning has been ongoing for decades in more than 150 dumps across the country, and it poses a health risk to people living nearby,” said Bassam Khawaja, a Lebanon and Kuwait researcher at HRW, during a press conference presenting the report on Dec. 1 in Beirut. According to the World Health Organization, the air pollution in Beirut is three times over “ the safe level ,” and there are nearly 1,500 deaths by air pollution every year in Lebanon.

Mousa is one of the 53 residents that Human Rights Watch (HRW) interviewed while preparing a report published Dec. 1 on the health risks caused by trash burning in Lebanon, titled “ As If You’re Inhaling Your Death .”

Mousa, a 35-year-old gardener, lives close to a dump in Chehabiyeh in south Lebanon. “They burn at least three truckloads of trash a day: nylon, plastic, household waste, everything,” he told Al-Monitor. “My 4-year-old daughter has [allergic reactions] all over her body, but we can’t relocate. We have no money and no support from the government.”

The Lebanese government may have adopted a waste management plan in March 2016 that put an end to the most visible aspects of the 2015 garbage crisis, but decades of waste mismanagement have dangerous and long-term implications for public health.

According to the report, the government does not communicate about the health consequences of open burning of waste “due to a lack of resources and expertise.” As a result, anxiety among people who experience trash burning is common. “They do it during the night, like criminals. You wake up, you don’t know what to do, there’s no place to go,” Amal Ephrem, a resident of Furn El Chebbak, a suburb of Beirut, told Al-Monitor. She remembers that garbage was burned several times in her neighborhood in 2015. “It was very painful, I suffered for days in a row. My lungs were hurting, and my heartbeat went up during the night.”

It’s not clear who is actually behind the burning of garbage, according to HRW. “Some say it’s the municipalities, but the municipalities say it’s other people. Whoever is burning the trash, we have come to the conclusion that it’s the government’s responsibility to prevent these health violations,” Khawaja told Al-Monitor.

Burning only increased in Beirut and Mount Lebanon after the closure of the Naameh landfill in 2015. The frequency of burning garbage diminished after the government adopted an emergency plan in March 2016, which included the opening of two temporary landfills — in Bourj Hammoud and Costa Brava. According to Khawaja, nine of the 150 dumps where trash is still burned on a weekly basis are located in Beirut and Mount Lebanon.

But the rest of the country — especially the most marginalized areas — has been suffering from burning for decades. “The problem is there has been two systems in Lebanon after the end of the civil war [1975-1990]: one for Beirut and Mount Lebanon, and one for the rest of Lebanon. The 2015 garbage crisis affected Beirut and Mount Lebanon, and the new emergency plan only includes that region. There needs to be a solid waste management plan for the entire country,” argued Khawaja. As a result, burning outside the capital and the country’s most wealthy suburbs continues today as it did in the 1990s.

According to HRW, “Doctors and other public health experts strongly suggest a causal relationship between air pollution from the open burning of waste and poor community health.” For Zeina Aoun, a pulmonologist at Hotel Dieu Hospital in Beirut, “A proper study would have to be conducted to prove [this].”

However, Aoun told Al-Monitor that she has noticed an increase in respiratory problems in her clients in the last few years, such as asthma, bronchiolitis and pulmonary fibrosis. Some of these illnesses affect her patient’s life expectancy, and the strong immunosuppressive treatments they must go through can lead to further complications. These treatments are often costly and out of price for the majority of locals. The Global Wealth report, published by Credit Suisse in November, estimated that the net wealth per capita was under $10,000 for 69% of the Lebanese population.

Finding a solution for Lebanon’s trash problem is getting urgent once again as the two temporary landfills of Bourj Hammoud and Costa Brava are due to reach capacity in 2018, according to information that HRW gathered from the Ministry of Environment. “Will garbage burning in Mount Lebanon increase by 330% again, like it did in 2015?” asked Khawaja during the Dec. 1 press conference. “This is still a live issue.”

In late October, the Cabinet ordered a study regarding the possibility of expanding the Costa Brava and Bourj Hammoud landfills. Activists condemned the move and criticized it as a maneuver to avoid a new garbage crisis right before parliamentary elections, which are scheduled for May 2018.