“Mama, why do I have to wear this again? It hurts my mouth,” says Norik, 5, to his mother, Igballe, before she puts a small, child-size air pollution mask over his face.

Igballe Ferati, a finance specialist, makes the usual walk to a local kindergarten every weekday with Norik along the streets of central Skopje, a city which often experiences dangerous levels of air pollution.

“I am really scared about the health of my child and I always check the pollution levels on my phone via the MojVozduh [MyAir] app before going outside. Especially in winter when the air pollution gets worse, I can’t let Norik go out, and I know some parents who don’t even allow their children to go to school on certain days, so they are not exposed to the air pollution. We are locked in our houses with air purifiers hoping that this will not affect the health of our children in the years to come,” says Igballe.

“We are forced to tell the children that they are superheroes to put on the masks. It is too difficult and sad to explain this situation to a child.”

Skopje, a city of more than half a million people, located in the centre of the Balkan peninsula in southern Europe has been listed by the World Health Organization (WHO) amongst the cities in Europe with the highest concentration of harmful fine particulate matter (PM) 2.5 in the air.

Particulate matter 2.5 includes a variety of components such as nitrates, sulphates, organic chemicals, metals, dust and black carbon, which pose a risk to human health. Due to their small size, they penetrate the lungs and are known to cause heart, lung and other diseases.

The latest data released by the World Health Organization in 2018 shows a PM 2.5 annual mean level of 40 micrograms per cubic metre in Skopje—four times the recommended levels of 10µg/m³.

In terms of mean concentrations of both PM 10 and PM 2.5, the World Health Organization Ambient Pollution Database for 2018 ranks Skopje as Europe’s most polluted capital city.

Moreover, Skopje suffers spikes in air pollution. To take one day as an example, on 13 November 2018, the European Environment Agency rated the Skopje municipality of Karpos as having “very poor” air quality. It registered 104.6µg/m3 of PM 2.5 – more than 10 times the levels recommended by the World Health Organization.

The organization estimates that 2,574 people die prematurely in the country annually because of air pollution.

Skopje in December 2017. Photo by Reuters

Causes of the Skopje air pollution

The city’s pollution has been blamed on a mix of coal burning, fuel oil and wood burning stoves in households, open waste burning, emissions from aging industry and old, highly-polluting vehicles.

In particular, the city has been reliant on lignite coal for heat during winters - a leftover from the Yugoslav era.

Many Skopje residents cannot afford to move to cleaner, more sustainable forms of heating and thus rely on cheaper, more polluting ones, such as wood.

The geography of Skopje, surrounded by mountains, means that the polluted air is effectively trapped. Skopje is particularly affected by pollution in the winter season which has contributed several times to the closure of the city’s airport.

“You can feel a sour, metallic taste in your mouth when the air pollution levels get high,” says Hristijan Gjorgievski, a Skopje office worker.

Vehicles and pedestrians are seen during evening fog and air pollution covering Skopje. Photo by Reuters

The unanswered call for solutions

Numerous public protests have taken place in Skopje and in a city in the north of the country, Tetovo, calling for state action against air pollution in those areas.

“While there has been much talk of the damage that climate change is doing in the long term, we need to look at the damage that air pollution is doing now, to Skopje and to the people who live there,” says Ana Čolović Lesoska, from Eko-svest (Eco-sense), a non-profit organization that advocates for environmental protection. “A lot of people have had enough of inaction on air pollution and civil society across the country is rising up to force change.”

On days with high air pollution in the city, Skopje authorities deploy emergency measures such as days off from work for pregnant women, those over 60 years of age, and people suffering from chronic asthma and related conditions. The city has previously offered free public transport and cancelled sporting events.

However, the root causes of pollution still need to be addressed. The city encourages people to move away from polluting heating systems such as wood-burning stoves to pellets and is considering car scrappage schemes for older, more polluting cars. If households burned cured wood instead of young, wet wood, that would also reduce smoky emissions.

“An integrated approach is really necessary and there is not going to be a ‘silver bullet’ for cities like Skopje,” says Rob de Jong, Head of UN Environment's Air Quality and Mobility Unit. “UN Environment’s Share the Road Programme is centered around designing cities for pedestrians, to make it easier for those who walk and cycle while trying to reduce people’s reliance on polluting vehicles.”

The European Bank for Reconstruction and Development approved a US$13.5 million project to upgrade Skopje’s older diesel buses to low-emission, compressed natural gas buses. The government itself approved a US$1.8 million programme in November 2018 to tackle air pollution.

Given that household heating accounts for 32 per cent of the city’s air pollution, the United Nations Development Programme’s office in Skopje works with national partners to design cost-effective solutions to reduce air pollution caused by polluting heating systems.

“I am really scared of what the long-term health effects on children growing up in Skopje might be,” says Igballe. “My family and I have to get away from the city on the weekends in search of clean air. This affects our lives and budgets heavily.”

“What is clear is that if the authorities don’t react timely with a structured and serious approach towards the reduction of air pollution in the city, then the consequences for families living in cities such as Skopje are going to be severe.”

UN Environment and the Government of the Republic of Serbia, with the support from the Italian Ministry of Environment, Land and Sea, are convening a Ministerial conference on “Innovative Solutions to Pollution in South East and Southern Europe” which will take place on 4-5 December 2018 in Belgrade, Serbia.