On the worst day of the smoke, Madhumitha Janagaraja remembers watching four ambulances speed through the centre of Canberra in a single hour.

“My only thought was: how many people are going to die?” she says.

It was early January. The Australian capital had endured days of poisonous air quality. Thick smoke from fires burning in New South Wales and Victoria had rendered the city’s landmarks invisible.

On New Year’s Day in Canberra the air quality reading was the worst on the planet: 26 times levels considered hazardous to human health.

Janagaraja, a psychology student at the Australian National University, has rheumatoid arthritis. “I think for even ordinary people it makes it really hard to breathe,” she says. “But for me, when [the air pollution] increases, my levels of inflammation, my joint pain, increases massively. It gets worse every time I take a deep breath.”

By the time she asked a friend for help she had spent two days indoors, skipping meals, barely able to breathe, such was the effect of the smoke on the already inflamed joints around her rib cage.

“It’s been quite a huge loss of bodily autonomy because I’m not someone that’s very good at asking for help.”