On Monday, the Word Health Organization released a report on air quality around the world, which estimated that more than 2 million people die globally each year from the effects of air pollution.
The report included air quality data from almost every one of Cambodia’s neighbors—Thailand, Indonesia, Malaysia, the Philippines and even Burma, but there was no information for Cambodia —particularly the amount of PM10 and PM2.5, the most dangerous airborne pollutants, that might be in the air.
“[I] can confirm that we made every effort to locate such data from Cambodia, but could not find any,” said Dr Annette Pruss-Ustun, a public health and environment scientist for the WHO.
The reason the WHO could not find Cambodia’s data on PM10 and PM2.5 levels—tiny particles that come from the burning of fossil fuels and cause serious health effects—is because the data does not exist, officials said.
Medical and scientific research has linked respiratory diseases with pollutants found in the air for years. But in Cambodia, air quality monitoring is still at a very basic stage, meaning that no one really knows what’s in the air, particularly in Phnom Penh, the country’s largest and most congested city.
Data from the Ministry of Environment shows monthly monitoring of three out of six core pollutants since 2000: carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide (SO2). The other three key pollutants— lead, ozone and PM10—have not been monitored. Moreover, government data for the three pollutants monitored, CO, NO2, SO2, is almost nonexistent for 2011 because of a delay in the delivery of replacement air quality monitoring equipment from Japan.
While the Ministry of Environment waited for the equipment to arrive—it eventually arrived in August—sampling of the air at three locations around Phnom Penh had been limited only to CO.
But even the equipment being used now to monitor CO is “not the most accurate” and “not used by other countries,” said Thiv Sophearith, chief of the Air Quality, Noise and Vibration Office of the Ministry of Environment.
Monitoring for the far more dangerous PM10 is nonexistent, Mr Sophearith said.
“We don’t have the equipment to monitor for PM10,” he said. And since PM2.5 monitoring is a subset of PM10 data, those concentrations are also going unmonitored.
PM10 literally means “particle matter less than or equal to 10 microns,” said Stephen Vermette, an environmental science professor at the State University of New York,who conducted air monitoring in Phnom Penh in 2007. The bigger particles are usually made of dust, he said, while the smaller ones, known as PM2.5, are the real threat. “The smaller particles are of a greater concern, as they can enter your lungs,” Mr Vermette said.
In 2000, Kyoto’s Kanazawa University Professor Masami Furuuchi conducted air quality monitoring in Phnom Penh. Prof Furuuchi found maximum levels of CO, a pollutant that comes from burning carbon, at 7.12 mg/m3 (milligrams per cubic meter), which is well below the US Environmental Protection Agency standard of 10 mg/m3.
Subsequent Ministry of Environment data shows that number has grown exponentially since 2000. In 2008, maximum CO levels rose to 8.33 mg/m3; in 2009, the figure was at 12.50 mg/m3; and in 2010, the figure was at a whopping 16.67 mg/m3.
In a separate 2006 air quality study, Prof Furuuchi found that traditionally polluted Bangkok has scored higher than Phnom Penh when it came to PAH’s (polycyclic aromatic hydrocarbons), which can cause cancer. The PAH count in Phnom Penh’s air was at levels six times that in Bangkok. He also found TSP, or the total number of particles in the city’s air, at 240 micrograms per cubic meter, or ug/m3, compared with Bangkok’s 144 ug/m3.
Prof Furuuchi declined to be interviewed for this article as he required permission from the Apsara Authority, which is entrusted with the safeguarding of the Angkor Archaeological Park and for whom the professor is currently working.
The Clean Air Initiative-Asia, an Asia Development Bank-funded clean air organization, stated in a 2006 Country Synthesis Report on Urban Air Quality Management that “respiratory diseases are among the leading causes of morbidity in Cambodia and PM has been tagged as a potential cause.”
It went on to state that while air pollution is a “significant” concern because respiratory diseases are a leading cause of death in Cambodia, “ambient air quality monitoring results are not yet being correlated with health surveillance programs.”
Despite several independent studies gently nudging that air pollution could be associated to respiratory disease in Cambodia, all reports stop short of making a direct link.
In 2008, respiratory diseases were the number one identifiable killer of people in Cambodia, according to national health statistics. The figures from that year showed lung disease killed 1,188 people. Children, even more than the elderly, are most vulnerable to respiratory ailments, said Doctor Khol Khemrary, chief of the Ministry of Health’s Health Information Bureau. Dr Khemrary provided ministry statistics showing that in 2008, 926,344 children aged 4 years and younger were seen at health centers around the country for respiratory diseases. Out of those, 40,943 had to be hospitalized, and 697 died.
“Children are most susceptible to upper and lower ARI’s [acute respiratory infections like the flu, viruses and bacteria],” Dr Khemrary said. While asthma, bronchitis, and other bacterial infections of the lungs may be hereditary, they are affected by many external factors—including air pollution.
“In polluted air, the proportion of oxygen is less than normal, and there may be pollutants or specific particles in the air that affect people suffering from asthma or chronic respiratory illnesses,” said the WHO’s country representative Pieter Van Maaren. “People, and particularly children, suffering from asthma are more vulnerable to pollution than anyone else.” Dr Van Maaren, however, said pollution was not yet “a real issue for this country.”
But some are concerned that not enough air quality monitoring is being conducted and by the lack of data.
“It’s a sensitive issue,” said Dr Tek Chheng Eap, the chief of respiratory medicine at Phnom Penh’s Pediatric Hospital.
“I don’t want to accuse, either, but people should worry about this problem of pollution,” Dr Eap said as he held up a lung X-ray of a child, Pasda, who had been admitted to the hospital because of asthma two days prior.
Doctors admitted 3-year-old Pasda after his mother, Prey Chant Sara, 36, brought him in with an unrelenting cough and shortness of breath. It was an asthma attack, Dr Eap said.
Sitting cross-legged on a bed at the Pediatric Hospital, her eyes fixed on her sleeping son, whose heartbeat lifted his chest like a pump while an IV tube rushed medicine into his tiny wrist, Ms Sara recounted how her child’s illness had terrified her.
“I was very worried; he wouldn’t stop coughing,” Ms Sara said. Pasda was lucky though. Treated by Dr Eap, he was well enough to leave the hospital with his mother the next day. It had been his second time at the hospital; he was brought in two months before for pneumonia. Dr Eap said the medication he had prescribed should lessen Pasda’s chances of suffering another attack.
“As a practitioner, I see these patients every day,” Dr Eap said. “We don’t have an assessment of air quality, so we can’t say there is a direct link, but there is evidence that we should be afraid of air pollution,” he said.
Though the Ministry of Environment’s Mr Sophearith maintained that air quality in Cambodia “is still good,” he admitted that it is bound to get worse “as the country develops.”
He said the only reason his department was not monitoring for PM10 was because of a lack of resources and lamented his department not being able to conduct meaningful checks—enshrined in a 2000 sub-decree on air pollution—particularly of pollution emission standards at the city’s garment factories.
And what is little known to many people is that the majority of Phnom Penh’s garment factories actually burn wood to heat up large boilers used when dyeing clothes. If he had the capability, Mr Sophearith said he would start monitoring those factories first.
“We just conduct visible monitoring because we don’t have enough equipment to sample the smokestack,” he said.