Invisible killer: how one girl's tragic death could change the air pollution story

In a far-reaching human rights case, Ella Kissi-Debrah could become the first person to have toxic air given as their cause of death – and finally make this silent killer visible

From a tiny office on the top floor of the old town hall in Catford, south-east London, Rosamund Kissi-Debrah is leading a campaign to push air pollution on to the political agenda as never before. It has been claimed for years that pollution caused by motor vehicles, especially diesel cars, buses and lorries, is a killer, with talk of tens of thousands of premature deaths. But the number was always abstract, the identities of the dead unknown. Now, for the first time, campaigners have the name of a young victim they say died as a direct result of air pollution: Ella Roberta Kissi-Debrah, Rosamund’s daughter, and if they can prove it they believe an invisible killer will become all too real.

Ella, who suffered from severe asthma, died in 2013 at the age of nine. She had been suffering asthma-related seizures like the one which killed her for three years. Kissi-Debrah says her daughter, who grew up and went to school close to the busy South Circular Road in Lewisham, had cough syncope – a condition usually associated with long-distance lorry drivers who’d been driving for decades. “I couldn’t work out why a nine-year-old child should have that,” she tells me.

Ella Kissi-Debrah.
Ella Kissi-Debrah. Photograph: Family photo

While Ella was alive, Kissi-Debrah sought a medical explanation for the condition. Now she is convinced it was related to air pollution, arguing that her daughter’s lungs had been weakened over the course of her short life, with pollution spikes then triggering the attacks that repeatedly hospitalised her in the final three years. “When she first became ill, I just went to the GP and got normal antibiotics and thought ‘a few days and that will be it’,” recalls Kissi-Debrah. “But she developed this cough and it was really strange-sounding, like a whooping cough.”

The cough persisted. On the third visit to the surgery the doctor referred her to a specialist, and eventually Great Ormond Street took over Ella’s treatment. “By New Year’s Eve 2010 she was in intensive care,” says Kissi-Debrah. “It now turns out that all we were doing for the next two years was maintaining her. She would have times when the cough disappeared, but it was never long enough.” Kissi-Debrah contends that the damage her daughter suffered to her lungs in the early years of her life condemned her to death.

Supported by the human rights lawyer Jocelyn Cockburn, Kissi-Debrah is pressing for a new inquest into her daughter’s death that for the first time would make it explicit that pollution was the cause. To get a second inquest, they will need to show there is new evidence that was not taken into account at the original investigation in 2014. Step forward Stephen Holgate, professor of immunopharmacology at the University of Southampton, who has taken a fresh look at Ella’s medical records and concluded there is a “real prospect that without illegal levels of air pollution Ella would not have died”.

On the basis of his findings, Cockburn – a partner at Hodge Jones & Allen who represented Neville Lawrence in his fight to get the director of public prosecutions to reopen the investigation into his son Stephen’s murder – has written to the attorney general, Geoffrey Cox, to ask for a new inquest. Sadiq Khan, the mayor of London, has given public backing to the call, and a response is expected from Cox in the next month. Even if he turns it down, Cockburn, who is herself asthmatic and took an interest in the issue of air pollution long before she started acting for Kissi-Debrah, says she will press ahead with a judicial review of the case, believing it to have far-reaching human rights implications.

Jocelyn Cockburn.
Jocelyn Cockburn. Photograph: Linda Nylind/The Guardian

“We have met a lot of hurdles along the way,” Cockburn tells me, “because although there has been evidence that air pollution kills, which is acknowledged by experts and even the government, we’ve found a reluctance to consider it on an individual, personal basis.”

Cockburn wants the terms of the new inquest to be as broad as possible: “We think it should be a human rights inquest – one of the wider type of inquests based on article 2 of the European Convention on Human Rights, which is the right to life. It’s important to identify whether state activity was relevant to the death and what lessons can be learned to prevent future fatalities.”

At that point, the personal becomes deeply political. London and many other towns and cities in the UK routinely breach EU guidelines on safety limits for nitrogen dioxide (NO2), which comes mainly from diesel vehicle exhausts. They are similarly lax in observing World Health Organization-recommended levels on fine-particle pollution. Particulate matter, to use the academic term, comes mainly from diesel and petrol vehicle engines, brakes and the contact between tyres and the road.

The particles, called PM 2.5 and PM 10 according to size, are impossible to see with the naked eye but can be deadly. They penetrate the lungs and cardiovascular system and have been linked to strokes, heart disease, lung cancer and respiratory infections. If the government’s failure to meet pollution limits could be tied to specific deaths, it would potentially be liable to claims for compensation. Hence, no doubt, the reluctance to move from acceptance of tens of thousands of abstract deaths to the identification of any concrete, named ones.

“This is a health crisis,” says Sarah MacFadyen, head of policy at the British Lung Foundation. “People don’t always think of it in that way because it is invisible. If it was unhealthy food or dirty water coming out of the taps we would see it. The kind of air pollution that we had in the past and that everybody remembers – the great smogs – again we could see it; we could see the air that we were breathing.

“But we had a Clean Air Act; we cleaned up factories, we cleaned up our industry, so you don’t get that pollution any more. Instead the pollution in our air, which in town and city centres is largely from vehicle exhausts, is invisible.”

A girl blows into a spirometer, a device that measures the volume of air inhaled and exhaled by the lungs.
A girl blows into a spirometer, a device that measures the volume of air inhaled and exhaled by the lungs. Photograph: Justin Tallis/AFP/Getty Images

Kissi-Debrah stood for the Green party in the byelection in Lewisham East in June, coming fourth. Reducing air pollution is a central policy for the party, which sees Ella’s case as a potential game-changer. “If air pollution is put on the death certificate of a child who has died, that – in political and policy terms – has huge ramifications,” says London assembly member Caroline Russell, Green party national spokesperson for transport. “It would be absolutely unprecedented.”

Russell says the move from purely “statistical” deaths to real deaths would encourage the revolution in thinking needed to combat air pollution. “One of the problems with getting the government to take air pollution seriously, getting the mayor [of London] to take air pollution seriously, is that the action that needs to be taken so that everyone can trust the air they breathe is pretty radical,” she says.

“It is about rethinking our transport system so that everyone has access to affordable, regular and efficient public transport and are not car-dependent. That kind of transport change is difficult to bring about: we have a car-dependent culture, politicians who are frightened of the motorist, and a press that is very motor-centric.”

Linking the mayor’s approach to air pollution with the government’s is perhaps unfair. Khan, who is himself asthmatic and has children who suffer from asthma, has made reducing air pollution a key policy – hence his support for Kissi-Debrah’s campaign for a new inquest.

“London’s lethal air is one of the biggest health challenges of this generation,” he said last November when announcing a new central London clean air zone to be launched next year that will levy charges on high-polluting diesel vehicles. “We can’t continue breathing in air so toxic it harms children’s lung development and causes chronic illness and premature death.”

Russell accepts the mayor is making progress but thinks he could do more. “He could consider taking the ultra-low emission zone to the M25, so that every Londoner is covered,” she says. “He’s also stuck with the old-fashioned system of a cordon around an area where you pay a fixed, chunky fee to drive a non-compliant car into that area. Road pricing would be a much better and more flexible option.”

Emissions zone map

“Sadiq made air pollution a key plank of his manifesto,” counters Shirley Rodrigues, London’s deputy mayor for environment and energy, “and as soon as he came in, one of his first actions was to support [environmental pressure group] ClientEarth’s legal action against the government on air quality. It’s about the impact on people’s daily lives. Most poorer communities are living on main roads, so the mayor sees this as a social justice and a health issue, not just as an environmental issue.”

This summer’s slew of stories about the harmful effects of air pollution has hit home. New research has linked it with reduced intelligence, with changes in the structure of the heart consistent with the early stages of heart failure, and now with damage to the placentas of pregnant women and the onset of dementia. The charity Living Streets says the issue is rapidly rising up the list of public concerns. “People are definitely becoming more aware of it,” says spokeswoman Kathryn Shaw, “and parents are thinking about it when choosing schools for their children.”

“The invisible is finally becoming more visible, because there has been concerted action to bring it to the attention of both the public and the politicians,” says Frank Kelly, professor of environmental health at King’s College London and chairman of the Committee on the Medical Effects of Air Pollutants. “The evidence base regarding the impact of these different pollutants on health has been pretty robust for at least a decade, but the challenge has been getting it into people’s perception that this is an issue which affects them and their children’s health. But it’s also an issue that they are intimately involved in because they are part of the problem. They contribute to the pollution we have in our cities.”

London, partly obscured by morning fog.
London, partly obscured by morning fog. Photograph: Hannah Mckay/Reuters

He suggests three reasons for rising awareness of air pollution over the past couple of years: the BBC starting to include air quality information in its weather forecasts, ClientEarth’s court victories against the government over its failure to meet EU pollution limits, and the Volkswagen “dieselgate” scandal, when it 2015 it was revealed that the carmaker was doctoring the results of laboratory tests to make its diesel vehicles appear less polluting than they were. Dieselgate was a disaster for Volkswagen and for diesel cars generally, sales of which have since fallen dramatically.

Before the Volkswagen scandal the government had been actively encouraging drivers to switch to diesel cars, believing them to be more fuel-efficient and less harmful to the environment because they produce less carbon dioxide (CO2). Governments offered incentives to motorists to buy diesels and sales increased considerably. Those motorists were literally taken for a ride. Now the damaging effects of diesel cars on health and the foolishness of using them in cities are understood, sales are plummeting.

It’s an unpleasant choice – more NO2 using diesel or more C02 using petrol. There is already evidence that the switch back to petrol cars is increasing CO2 emissions, a problem highlighted by Mike Hawes, chief executive of the Society of Motor Manufacturers and Traders. “CO2 and climate change appears to be an issue forgotten by some,” says Hawes. “Because diesel cars typically consume less fuel than petrol equivalents, they emit on average 15-20% less CO2. Without modern diesels on the roads, coupled with a slow uptake of alternatively fuelled vehicles, it will be increasingly difficult to meet tough EU targets and deliver shared ambitions on climate change.”

Rod Dennis at motoring organisation the RAC reckons motorists are now thoroughly confused about what they should be buying. “Most drivers have little awareness of how polluting their present car, or one they are thinking of leasing or purchasing, really is,” he says. “There is a large job to do in educating drivers about the best type of vehicle for them, in terms of the type of driving they do, their budget and what is best for the environment.

“Today, there is no single source of information that allows a driver to look up to what emissions standard their vehicle conforms. Without these basic tools, it will be very difficult to persuade motorists to take more ownership of the emissions for which they are responsible, and therefore more difficult to persuade them to move to a lower emissions vehicle.”

Prof Kelly says the government is still dragging its feet on introducing policies that would make dramatic improvements to air quality, and points out that successive reports by the parliamentary environment committee have condemned government inaction. “Despite mounting evidence of the costly health and environmental impacts of air pollution,” said one report in 2016, “we see little evidence of a cohesive cross-government plan to tackle emissions.”

Air pollution warnings on the busy South Circular Road where it crosses Clapham Common.
Air pollution warnings on the busy South Circular Road where it crosses Clapham Common. Photograph: Guy Bell/Alamy

A spokeswoman for the Department for Environment, Food and Rural Affairs (Defra) defends the government’s record. “Air quality has improved significantly in recent years,” she says. “Nitrogen oxide emissions have fallen by 27%. But we recognise there is more to do. That is why we are taking comprehensive action through our ambitious new clean air strategy. By ending the sale of conventional new diesel and petrol cars and vans by 2040, we are also acting faster to tackle air pollution than almost every other major developed economy.” But 2040, as critics like to point out, is a long way off, and by then none of the present generation of politicians will be around to be held accountable for meeting – or missing – the target.

After Brexit the UK government, rather than the EU commission, will be responsible for legal standards on air pollution in the UK. Could this, as some fear, be an opportunity to relax safeguards and lower safety limits? Defra insists this will not be the case. “The EU (Withdrawal) Act ensures that existing EU environmental law continues to have effect in UK law after exit,” says the spokeswoman, “and the forthcoming environment bill will include provisions to improve air quality.”

As that legislation passes through parliament next year, Rosamund Kissi-Debrah hopes to be back in a coroner’s court trying to prove that air pollution killed her daughter. If she does, it would be a crucial milestone for clean air campaigners, and the government’s 20-year timescale for ending the sale of diesel and petrol vehicles might have to be speeded up.

Kelly’s committee estimates that nitrogen dioxide and particulate matter are responsible for between 28,000 and 36,000 premature deaths a year in the UK. If correct, that would make it the number two public health killer after smoking, and a bigger cause of premature death than alcohol and obesity. But these are just numbers, lifeless statistics; Ella, until asthma immobilised her, was a vibrant, sporty, life-loving little girl, which is why a new inquest could change everything. “No one gets ‘Died from air pollution’ on their death certificate,” says Kelly, “and if her death can be solidly linked, it would be a big step forward.”


The view from the street

I recently took a walk along two of London’s most polluted streets – Marylebone Road in central London, which according to one recent report has the highest concentration of nitrogen dioxide in Britain, and Brixton Road in south London, another hotspot, notorious for breaching its annual pollution limits within days of the start of each new year. The responses I received when I asked people about the UK’s “invisible killer” demonstrated that the dangers of air pollution are now clearly understood.

“It bothers me hugely that I have to breathe this,” says Peter, who has run a stall selling coffee next to Marylebone Road for six years, “but I’m not in an economic position to be able to do anything about it. This is my own business and I’ve put a lot of money into it. I just have to live with it.” Why not wear a mask? “I’d look like a Millwall fan from the 1980s,” he replies. “It’s not really going to encourage people to buy any coffee.”

Environmental activists from Stop Killing Londoners and Mums for Lungs block Brixton Road at rush hour.
Environmental activists from Stop Killing Londoners and Mums for Lungs block Brixton Road in front of Brixton station at rush hour as part of a protest demanding urgent attention to prevent premature deaths from air pollution.
Photograph: Mark Kerrison/Alamy

Chloe, who lives in a street close to the Marylebone flyover, where the vehicles are backed up and you really can smell the fumes, does intend to do something about it. “I’m living with a friend but I’m going to move away because of the pollution,” she says. “I’m very aware things get dirty quickly around here.” David, a lawyer who is having a cigarette outside Westminster magistrates court, also dislikes the road. “The pollution bothers me enormously,” he says. “It’s bad in much of London. The idea that there is no escape from polluted air is the thing I like least about living in this city.”


On Brixton Road, Antina, who is wearing a mask (though mainly to ward off germs, she says), says her teenage daughter has educated her about the dangers of air pollution. She is with her friend Joe, who works in Brixton. Joe, who is asthmatic and says he sometimes suffers badly from its effects, suggests cheaper tube tickets and pro-bike initiatives to combat the problem. “Air pollution harms everybody,” he says. “We have to look at the long-term effects.”

“I went down to Somerset on holiday recently,” says a young woman called Sydney who lives locally. “I found I could breathe a lot better in the country air, and coming back was like being choked.”

“I don’t think there’s enough public pressure on politicians,” says her friend Luka. “We don’t push enough to show this is how much damage we’re doing. It needs to get talked about 24/7.”



Stephen Moss

The GuardianTramp

Related Content

Article image
'Invisible killer': UK government urged to tackle air pollution
British Heart Foundation says 15m Britons are exposed to toxic levels of pollution

Matthew Taylor

04, Feb, 2020 @6:00 AM

Article image
UK is endangering people's health by denying their right to clean air, says UN
World body urges Conservative government to ‘step up and show leadership’ on the air pollution crisis

Matthew Taylor

19, Oct, 2018 @2:17 PM

Article image
Air pollution plan cannot be delayed, high court tells government
Court rules that immediate publication is essential and rejects Defra’s plea to delay until after the general election

Sandra Laville

27, Apr, 2017 @6:06 PM

Article image
Tories 'on very dodgy ground' over delay of air pollution plan, say experts
Constitutional experts say government is on ‘very dodgy ground’ claiming election purdah forces it to postpone publishing pollution strategy

Matthew Taylor

25, Apr, 2017 @4:02 PM

Article image
Cumulative pollution from London traffic may have led to girl's death
Ella Kissi-Debrah’s fatal asthma attack coincided with a high air pollution episode

Sandra Laville

08, Dec, 2020 @3:52 PM

Article image
'In the days around Ella's death, there were big spikes in air pollution'
Rosamund Kissi-Debrah believes poor air quality in London contributed to her daughter’s death

Sandra Laville

07, Jul, 2018 @6:00 AM

Article image
UK's new air pollution plan dismissed as 'weak' and 'woefully inadequate'
Lawyers who forced ministers to deliver new proposals to tackle toxic air crisis say government is not taking responsibility for public health emergency

Damian Carrington Environment editor

05, May, 2017 @2:46 PM

Article image
Air pollution linked to more severe mental illness – study
Exclusive: research finds small rise in exposure to air pollution leads to higher risk of needing treatment

Damian Carrington Environment editor

27, Aug, 2021 @11:26 AM

Article image
Mother wins right to seek new inquest into girl's death linked to air pollution
Attorney general allows move to quash Ella Kissi-Debrah verdict, paving way for fresh hearing

Sandra Laville

11, Jan, 2019 @11:56 AM

Article image
The government's air pollution plan is a beautiful smokescreen
A ban on new petrol and diesel vehicles from 2040 is a great vision for the future but does nothing to address a public health emergency happening right now

Damian Carrington Environment editor

26, Jul, 2017 @2:29 PM