Life in the Most Polluted Capital in the World

It’s 11 below (-24C) outside but the stove is burning and baby Almasbek Toltalkhan is warm in his family’s yurt. His mother, Nursaule, scoops him from a crib engraved with pictures of coconut palms and joggles him on her knee while the doctor readies his shot.

At 11 months old, Almasbek is just past the nebulous state of babyhood. He cannot say ‘mom’ or ‘dad’ but knows bainuu, the greeting with which Mongolians answer the phone, and he wears tartan felt pajamas. He also has a pug-like wheeze on every out-breath and has been hospitalized eight times since birth.

“Our youngest is sick very often,” says Nursaule, 25, who like many Mongolians goes by her first name. Almasbek was initially diagnosed with bronchitis in September. Pneumonia followed, and the family ended up spending most of November and December in hospital. “We would go to the hospital for ten days of treatment. Then after four or five days at home, we would have to go back again,” she says. “Last time they took him into intensive care.”

Pneumonia is now the second-leading cause of death for children under five in Mongolia. In Ulan Bator, the capital, respiratory infections have increased at a rate of 270% over the last 10 years and children living in the city have a 40% lower lung function than those living in rural areas, according to UNICEF.

In 2016, Ulan Bator overtook both New Delhi and Beijing as the capital with the highest air pollution levels in the world. The city’s topography is one factor: like Beijing, Ulan Bator was built in a river valley and surrounding mountains trap smog like soup in a pan. The extreme climate is another cause. In the world’s coldest capital, the average January low is 27.4 below (-33C) but temperatures can dip beneath -40, the point at which Fahrenheit and Celsius intersect.

Locals say winter air pollution was barely noticeable until the mid-2000s. Now, the city has among the world’s highest peaks of PM2.5—the ultrafine particles that can carry carcinogens such as arsenic and mercury and are small enough to permeate most of the body’s defensive filters. In late January, a government-installed sensor reported a PM2.5 per cubic meter rate of 3,320 in parts of Ulan Bator. That’s 133 times the level the World Health Organization (WHO) deems safe.

Mongolia is one of many urban centers, especially in developing countries, that are struggling with toxic levels of pollution as industrial emissions, automotive exhaust, and chemical releases rise. Pollution is responsible for an estimated 9 million premature deaths, or one in six of all deaths worldwide, according to an October 2017 study published in the medical journal The Lancet. More than 90% of those fatalities occurred in low or middle-income countries.

Pollution is a serious issue in cities in Africa and South America, but Asia is where the problem is most alarming. Delhi’s chief minister Arvind Kejriwal recently described his city as a “gas chamber” and pollution caused a staggering 2.5 million deaths across India in 2015. In China, the Lancet study estimates, pollution killed 1.8 million people the same year. In response to the health crisis, Beijing in 2017 canceled plans to build more than 100 new coal-fired power stations, improving air quality in the capital.

Ulan Bator’s air quality is less intensely polluted than Beijing, Karachi, Dhaka or Delhi when measured annually. But health officials say the extreme peaks in PM 2.5 levels during the winter are unlike those seen anywhere else—and that young children like Almasbek stand to suffer from it the worst. In February, with off-the-charts levels of pollution, UNICEF Mongolia warned of a looming “child health crisis.” The toxic air could be snuffing out lives in Mongolia even before they begin; preliminary data suggests a 3.5-fold increase in fetal mortality rates between summer and winter and a near-perfect correlation between stillbirths and air toxicity.

“People don’t really want to see what the potential impacts could be, they close their eyes,” UNICEF’s Mongolia Representative Alex Heikens tells TIME. “We really need to start talking about Mongolia — more than half the population is at risk.”

Learn more at TIME