On some winter days Skopje residents say the city looks like it has been attacked by chemical weapons. The smell of the air is terrible, leaving those who breathe it with a bitter taste in their mouth and watering eyes, and forcing some of them to wear protective masks.

Heavy smog is not very frequent in the Macedonian capital but it’s hard to shift once it envelops the city, which is surrounded by mountains on all sides. This allows the pollution from heavy traffic – mostly old cars – and smoke from wood-burning fires to accumulate when there is no wind or rain to disperse it. 

Many residents of Skopje and other towns in Macedonia – Tetovo has the unenviable status of having the worst air pollution of any city in Europe – suffer from respiratory problems, as well as being at higher risk of heart disease, strokes and lung cancer. The local health authorities say 30%-35% of deaths during the winter in Skopje in the last few years were linked to air pollution. 

World Health Organisation (WHO) data on PM10 and the smaller and more harmful PM2.5 particles shows that cities in the Western Balkans have the worst air pollution in the continent. Tetovo, the home of the Jugohrom Ferroalloys plant, is in first place, and Skopje in third. Cities from Bosnia & Herzegovina, Bulgaria and Macedonia are close to the top of the list (if Turkey is excluded), alongside three Polish cities. 

Admittedly, air pollution is less severe in Europe than in other parts of the world. The WHO’s study of over 3,000 cities in 103 countries, analysed by the Guardian, finds that worldwide air pollution is worst in Zabol, Iran, while other cities from the Middle East, China, the Indian subcontinent and Africa are also among the most polluted. 

Overall the study finds that more than 80% of people living in urban areas that monitor air pollution are exposed to air quality levels that exceed WHO limits, with populations in low-income cities the most impacted. 98% of cities in low- and middle income countries with more than 100,000 inhabitants do not meet the body’s air quality guidelines, while in high-income countries the percentage is a still worrying 56%.

“Urban air pollution continues to rise at an alarming rate, wreaking havoc on human health,” said Dr Maria Neira, WHO director, Department of Public Health, Environmental and Social Determinants of Health, in a 2016 statement. 

On a more positive note, she added, “At the same time, awareness is rising and more cities are monitoring their air quality. When air quality improves, global respiratory and cardiovascular-related illnesses decrease”.

Very few cities from Russia, Central Asia and the Caucasus are included in the study, although the Mongolian capital Ulaanbaatar, whose population has soared to 1.6mn, is shown to be severely affected by air pollution, with most of it caused by coal and other solid fuels burnt in the shantytowns of gers (traditional Mongolian felt tents) that now surround the city. The problem has become so great that enterprising locals are opening “clean air cafes” where customers can inhale fresh oxygen along with their cappuccinos. 

Driving up air pollution

The root causes of air pollution in cities across Eastern Europe and Eurasia show some similarities. 

Car ownership is booming, adding to emissions especially in cities not built for large numbers of cars and that therefore suffer from high levels of congestion. As incomes remain relatively low, many of the cars are old, often second hand models imported from Western Europe or Japan. Auto markets are dominated by second hand car sales from Southeast Europe to Central Asia to Iran, where one MP claimed in March that there were more than 1.25mn clunkers on the roads. 

“Many of our cities are at a stage in their development were everybody wants to buy a car,” says Lin O’Grady, deputy director for municipal and environmental infrastructure at the EBRD, whose Green Cities Programme is intended to encourage systematic planning at the city level to address environmental challenges. Giving the example of an investment into compressed natural gas buses in the Georgian capital Tbilisi, she explains that “this investment is to try to stop that modal shift to cars, to provide high quality public transport that people are incentivised to use”. 

Other issues faced by cities across the EBRD’s region of operations include low energy efficiency, and the lack of well functioning waste collection and disposal systems and waste water facilities. However, Lin’s colleague Nigel Jollands, senior manager for policy and climate finance, points out that air quality is often the most pressing and visible problem. 

“Air quality would be one of the first drivers for a city incentivising them to work with us. It has an immediate impact on people’s health and wellbeing,” he says. In addition to cars, “We know for sure that many of the cities in our countries of operation don’t use energy efficiently, and they also in many case use fuel types that are detrimental to health like burning coal and wood for heating in an urban environment.” 

Air pollution from coal-fired power stations, especially those located close to major cities, is another problem in the Western Balkans, as well as countries like Poland that rely to a large extent on coal power. While the EU has set the target of boosting renewable generation to 20% of total generation by 2020, investments into solar and wind power have been held back in the eastern part of the bloc by issues such as powerful hydrocarbon lobbies and confusing and ever-changing legislation. 

A study from Brussels-based NGO the Health and Environment Alliance (Heal) found that air pollution from coal-fired power stations could result in public health costs of up to €8.5bn for governments in the Western Balkans. 

The figure is made up of costs directly related to air pollution including premature deaths, respiratory and cardiovascular hospital admissions, new cases of chronic bronchitis and respiratory problems, medication and days of restricted activity due to ill-health, including lost working days. 

“Patients with asthma and other respiratory problems suffer greatly during smog episodes. Children with breathing conditions cannot play outside and may not be able to go to school. Some adults may be prevented from going to work because of the air pollution and older people are more likely to need hospitalisation,” pneumologist Professor Dr. Zehra Dizdarević told Heal’s March 2016 press conference to present the report in Sarajevo. 

Ad hoc measures

Air pollution is a global problem, and cities around the world have experimented with various solutions from car-free days to congestion charging to investing into better public transport. However, efforts to address the root causes of air pollution and mitigate its impact on cities have been mixed. 

People in Skopje and other polluted cities in Macedonia, for example, say they are mostly left alone to cope. When the level of PM particles in the atmosphere is extremely elevated they stay at home as far as possible or put on masks, a cheap but inconvenient solution to the problem. Many complain of claustrophobia as they are unable to open the windows in the evenings or at night, when the pollution is particularly acute. 

Some official steps have been taken. When air pollution hit record high levels in Skopje in February, free public transport was offered to reduce the use of cars. Other measures taken included more intense street cleaning, the use of calcium magnesium acetate to reduce particle pollutants emissions, and increased controls on construction sites. Back in 2015, Skopje-based steel mill Makstil was forced to install air filters. However, these steps were not enough to solve the problem. 

Planning for the future

The Western Balkans is one of the areas initially targeted by the EBRD’s Green Cities Programme, along with the Caucasus, Belarus and Moldova. 

In 2015, the bank approved a new green economy transition approach, with the goal of 40% of its investment volume – which totals around €10bn a year – being in the green space by 2020, a target Jollands describes as “pretty ambitious”. He and O’Grady came up with the idea as the EBRD municipal team’s response to the green agenda; it involves taking the bank’s existing business in this area and packaging ad hoc investments into something more systematic. 

Under the Green Cities Programme, which has a lifetime of five years and a budget envelope of €250mn, the bank works with cities to draw up a Green City Action Plan (GCAP), which identifies investment priorities. The bank is working with cities with a population of over 100,000 that are willing to undertake a GCAP and where there is a “trigger project” – an investment project that clearly tackles environmental issues. 

It has already signed two investment projects – the green buses in Tbilisi and a programme for energy saving in public buildings in Chisinau – and has GCAPs up and running in Tbilisi, Tirana and Yerevan. More GCAPs will be implemented in 2017. “The idea is that once we have a track record we will start to expand to the other countries of operation, and at the moment we are looking seriously at SEMED [the Southern and Eastern Mediterranean region] and Mongolia,” says O’Grady.