378: India: Life Inside Delhi's 'Airpocalypse'

[15:15] Dia Mirza

So he was born extremely premature, which means his airwaves are narrow at birth. And it takes them much longer to get stronger. And therefore, they are a lot more susceptible to getting unwell. And their frequency of illness is higher than, say, a child who's had a full term. And in Avayan's case, I remember he coughed nonstop for six hours. And no matter what we did, it just wouldn't stop. And it was excruciating. It was just unbearable. And we're parents who have seen him through some pretty terrifying experiences right from birth, I mean, including his birth. He was born in the sixth month. He was 820 grams. He was in the NICU for over two months. He went through life-saving surgery twice. So we'd been through all of that. And we thought that, you know, it was all behind us. Until the pollution got to him and he was almost two. And we had to, you know, rush him to the hospital. And we discovered that he was unable to breathe. And the coughing was basically his body's way of trying to cope.

[16:38] Tom Rivett-Carnac

That was when he was still very young. A few years on, the same boy is old enough for a school sports day.

[16:44] Dia Mirza

And so he wore his mask and he got to the playground and he watched his friends from a distance. He refused to go and meet his friends or his teachers because he was wearing a mask. And he felt uncomfortable about it. This is not a small thing, Tom. Clean hair should never be a privilege. I think I'm extremely conscious about the fact that we come from a place of privilege. We're able to protect our children at some level. But there are so many children in our country and in the world that live in street situations that are exposed to all of this all of the time with no protection.

[17:24] Tom Rivett-Carnac

So let's zoom out from one home, from one sports day, to this whole vast country. Air pollution is having a devastating impact on GDP across India and the resultant impact on people's lives. But not only that, PM 2.5 has been linked to around 1.9 million deaths in India in just one year. Air pollution is always present, but it is cyclical and it gets worse at certain times of the year. Every November, the capital tips into what many people simply call the airpocalypse.

[18:00] Dia Mirza

The fact of the matter is that no one can escape it, right? Air is everywhere. It's going into our lungs every day. And no matter who you are or how well placed you are, or how much money you have, you can't avoid it entirely.

[18:18] Tom Rivett-Carnac

Now, we're probably all familiar with facing challenges that seem so big that we've got no idea where to start and it can feel futile. But if you look at this challenge, look at what has actually been achieved. Bhavreen and the Warrior Moms have gone from a handful of frightened mothers trying to affect a problem that seemed way bigger than themselves to now a national network running campaigns, going to court and pushing their way into rooms where key decisions get made.

[18:46] Bhavreen Kandhari

The Delhi government invited the mothers and citizens to the table and many conversations began after that. But we know that, of course, a lot of things are said and we know how it is and we are still critical. We don't feel happy that we are called, so we'll be nice to them.

[19:03] Tom Rivett-Carnac

You'll keep pushing.

[19:04] Bhavreen Kandhari

Exactly. But we got a chance and we appreciate that.

[19:11] Tom Rivett-Carnac

So this is a good moment to introduce you to another remarkable person that I met on that first day in Delhi, and someone who has dedicated decades of his life to trying to address the challenges of air pollution, bring the solutions and support individuals. That person is Dr. Arvind Kumar. We went to visit him at the Medanta Medi-City Hospital in Southern Delhi. Now that hospital is genuinely world class, and Arvind Kumar is a world leading pulmonary surgeon. His room is lined wall to wall with awards and honors, and the office next door is the same.

[19:44] Arvind Kumar

I was told that my entry is to be in a filmy style.

[19:47] Tom Rivett-Carnac

I believe so. So we look forward to the performance. We're ready. Are you ready? Yeah. He pioneered keyhole lung surgery in India and chairs an Institute of Chest Surgery and Lung Transplantation and holds the BC Roy Award, the country's highest medical honor. I would like to just start by asking you, you are a pulmonary surgeon, you understand very well what's happening to the lungs of Indian people. You've been doing this for many decades. What has changed in the time you've been doing this work?

[20:16] Arvind Kumar

So, I started operating on lungs in late 80s. So it's about 36 or 37 years now and I've been looking at people's lungs. And very sadly, and I say it with a very heavy heart, that I have noticed a change in the color of the lungs of people. So lungs are pink, pristine pink when we are born. But the toxins that we inhale during the course of breathing 25,000 times a day, from the first breath of our life till the last breath of our life, those toxins are bringing about a change in the color of the lungs of my countrymen. And nowadays, when I look at the lungs, I hardly ever find a pink lung. Earlier, I used to find pink lungs in non-smokers and black deposits in smokers. But that difference has gone. And now, whether you are a smoker or a non-smoker, whether you are a city dweller or you come from rural areas, it's the same color, black, black, black deposits all over the lung. And most sadly, I now also see deposits on the lungs of teenagers. Which means that the air we are breathing is carrying toxins inside. And those toxins are getting to be deposited right from the first breath that a child takes after coming out into this world. And this is a very provoking statement. But I make this statement with full conviction that in a polluted city, a child becomes a smoker from the first breath of his or her life. Now don't get upset with that statement. Why do I say that? Now there is an equation from the University of Buckley which says that in terms of damage to lungs, 22.5 microgram of PM25 is equal to one cigarette. In October, November, December, it goes to 500, 600, 700. Sometimes the meter stops. So is there anything wrong if I say that this child has become a smoker from the first breath of his or her life? And that explains another very significant finding which I have observed in the course of the last 30 years of my practice and that is a change in the demography of lung cancer in India. Back in 1988, 95% of the patients were smokers. Today my recent data which I looked at yesterday only, there is a 50-50 distribution between smokers and non-smokers. Number one. Number two, most of the patients were men back then. Today 40% of the patients are women, non-smokers from non-smoking families. The peak age back then was 50s and 60s. Today the peak age is 40s and 50s. It's down by a decade and a half. 10% of the patients are in 30s. Youngest patient I have operated is 26-year-old boy. So it's no more a smoker's disease, now it's a breather's disease.

[23:48] Tom Rivett-Carnac

Given this is so fundamental, it's affecting our children, it's affecting our lives of millions of people. Our understanding is, that has not yet really led to the kind of outrage from people. On the streets, calling for change. Why not?

[24:03] Arvind Kumar

Visibility. Visibility. So, people react to what is visible to them. When COVID came, COVID impacted people and they died. Three days, five days, seven days, 14 days later, they died. Cause of death? COVID. The whole world came to a grinding halt, because it was a direct cause and effect. When air pollution affects you, first of all, it is not an immediate effect. It will have long-term effects on my system. Not immediate. So pollution leads to whole lot of diseases from brain to toe. In the lungs, it causes bronchial asthma, it causes COPD, it causes lung cancer, it causes higher incidence of tuberculosis and whole lot of ILD and other problems. They are all related. But they all occur slowly. So the exposure starts at birth. You get lung cancer when you are 35. And what do you get? Lung cancer. When you die of lung cancer, what is the cause of death? Lung cancer. Nowhere is it written lung cancer due to exposure to polluted air. So the problem is with the medical profession, which has not worked hard to get air pollution included in our cause of death as a contributing factor. There is only one case in the world. There was a girl named Ella in London. The cause of death was written aggravation of asthma, leading to respiratory failure. Her mother didn't accept it, went to the court, fought the battle for six, seven years, finally managed to convince the court to order the hospital to remake her death summary and write asthma aggravated by exposure to air pollution leading to respiratory failure.

[26:04] Tom Rivett-Carnac

That's Ella Adoo-Kissi-Debrah, nine years old from South London, who died in 2013. Now tragically, her story isn't unusual. Children die of dirty air all the time around the world. But what was unusual is that as a result of a sustained and dedicated campaign by her mother, a coroner did something in 2020 that no one had ever done before. He wrote air pollution onto her death certificate. That recognition that the polluted air in London was leading to premature deaths of children was a significant part of what led to London's ultra low emission zone. And this month we have seen stunning scientific evidence of how positive that policy has been for the development of lungs in children and for the health of populations of all ages in the city. Now Dr. Kumar understands the power of demonstrating human impacts and how that can lead to policy change which is why he is not only continuing his work as a surgeon but also taking further steps to show Indians just what is happening inside their bodies.

[27:14] Arvind Kumar

If I just continue my job as a surgeon, there is a finite number that I can help because I can do two or three cases in a day in my OR, so the rest of my life, 10, 15 years, I'll be only able to do X number of cases. But if I go out into the public with these images and share these images with people and with the help of these images I'm able to impress the people that pollution is a major issue, I might have prevented millions of people from getting diseased.

[27:48] Tom Rivett-Carnac

On the way back, I sit in the car with our producer Ben, with pictures of blackened lungs still in our heads. Dr. Kumar explained when we were off camera that everything exists in India from the best hospitals in the world to the worst in the world and people will do their best to get to the place on that spectrum that will provide them with health care. But there are many people who have so little, they have to take what they can get. This was an experience of a hospital at the top end of that spectrum and the provision they provide is clearly world-class. Nevertheless, any amount of provision does not protect you from the air in this city. It's heartbreaking when you think about the scale of human impact. When you have 12, 14-year-olds both pre-cancerous black spots on their lungs. I'm obviously a father of children. That's not the only reflection here. But thinking about the scale of the human impact of those parents of those kids, city of 35 million people, and he made the point that being in a rural area is not necessarily protection. It was a sobering experience to realize that in a world that is so dependent on fossil fuels, you can get to a place where there is literally no escape from air that is making you sick. And that is heartbreaking for individuals. It's heartbreaking for parents, which I think is largely why we see that it is often parents who form these activist groups to try to create change here. But it's going to be hard to achieve. But despite this, there is good news as well. Just this year, in 2026, Delhi recorded its best January to May air quality in eight years, excluding the pandemic. There are some early signs of progress, but there's a long way to go. For DIA, all of this is linked. The pollution, the poverty, the climate crisis, it all shares a common history and one that we can't ignore.

[29:51] Dia Mirza

Unfortunately, human beings think that they're separate from nature. And until and unless we start to see every problem and every solution through the human lens, it will not compel us to act differently or respond differently. What are we doing? What has industrialization that has led to our current temperature rise and the madness that it has unleashed on humanity and the crisis that it is unleashing on humanity, who caused it? It is a few who decided to colonize the earth without really considering the impacts of that on people. There is pain, there is anger, there is hopelessness, there is helplessness, and at some level, there is also just acceptance. For me, the most terrifying part is the acceptance, because if we are not going to continually and persistently reject what doesn't work for our children and our health and our lives, we're not going to see change. And I find that when we are consistent in our protest and we kind of continually reach out to the authorities, to the civic body, to government, and engage regularly with policy makers, and also with community, and see how and where and in what ways we can contribute to reducing pollution. It can be transformative. It can make a big difference. We've currently experienced over two weeks of pretty clean air. Okay. And I'm amazed that it's happening. But I think maybe just so many of us speaking about it so regularly, has at least put certain checks and balances in place. And therefore, we are able to breathe.

[31:57] Tom Rivett-Carnac

Across town, in the heart of Old Delhi, tuk-tuks everywhere, horns, traders spilling out around the Red Fort. In among the throng, our cameraman and journalist Adnan, picks out a man driving one. It looks a little different and it sounds a lot quieter.

[32:12] Adnan Bhat

The auto is for three people, five people, five seats.

[32:16] Tom Rivett-Carnac

This man switched to an electric tuk-tuk, he tells us, because it was cheaper and because he could carry more passengers, not out of any climate conviction. That's a more honest version of what transition actually looks like than anything we might hear elsewhere. For decades, Delhi's rickshaws have run on CNG, compressed natural gas, after a court order in 2002 forced the whole fleet off even dirtier diesel and petrol. And now, the government is subsidising and incentivising a move to electric vehicles. As we wave off our first driver, our eyes are caught by another electric, lavender coloured and driven by a woman.

[32:56] Adnan Bhat

Very rare to have a female auto driver in India. So it's also a bit gendered.

[33:02] Tom Rivett-Carnac

I jump on for a short ride, the production team trying to keep up from behind.

[33:07] Adnan Bhat

She also believes that women are much more safer drivers than men because men are egoistic and they keep fighting with other people around them. So she's saying that women are the way forward.

[33:17] Tom Rivett-Carnac

Her name is Bilkis, she's 38, she has three children and this rickshaw is how she supports them. Thank you for having us in your rickshaw. It's wonderful to meet you. How long have you been driving an electric rickshaw?

[33:29] Bilkis

It's been four to five years, sir.

[33:31] Tom Rivett-Carnac

Five years. How do you think that there is a difference in driving an electric rickshaw to driving a regular rickshaw? Easier to drive, yeah. And it's catching on faster here than almost anywhere. India is now the world's biggest market for electric three-wheelers. Since 2021, more than half of all new three-wheelers sold in the country have been electric. And soon, in Delhi, no new petrol or CNG auto will even be able to get a permit. They all have to be electric.

[34:04] Unidentified (Rickshaw Driver)

It doesn't cost as much when it takes time to charge this thing.

[34:07] Unidentified (Rickshaw Driver)

But yeah, it's better than the petrol or CNG.

[34:10] Unidentified

OK.

[34:11] Tom Rivett-Carnac

This shift to electric three-wheelers represents an enormous transformation in India. But it's just one small part of a much broader change which is going on across the economy. That innovation, that entrepreneurial spirit that is so evident in India is what we need to take us through these difficult years to create the opportunities in the future. What I learned from the people I spoke to in India is that these opportunities are there to be grasped. To take the three-wheeler example, yes, we need to build out charging infrastructure. Yes, there still remain problems in the transition to electric transportation. But those challenges are being met as opportunities in the economic interests of people. When you bring together global issues, government intent and personal interest, then you can deliver real breakthroughs. In the coming years, we are going to need to work our way through this fulcrum, from a dirty history to a regenerative future. India is showing us how we can do that. It's showing us the possibility of changing some of the most challenging experiences of air pollution and health impacts, and using that to create a brighter future. None of this is yet guaranteed, but actually, what we can see is that when it relates to individuals, the seeds of transformation really are present.

[35:33] Shyla Raghav

Taking action on air pollution is not a sacrifice, because it's benefiting you and your community directly. So I think a lot of it has come down to inviting and opening up conversations through these more constructive frames. And in India, because it's so stark and it's so present, that has become a daily reality, and one that most Indians are quite open to and receptive to as a result.

[35:58] Tom Rivett-Carnac

Dia keeps returning to one image, the Ganges, the river millions worship as a living mother.

[36:04] Dia Mirza

You know, I traveled from the source of the Ganga to see, and she's a river that's worshiped and revered by millions of people across the country. And when I traveled her length, I think it just became, that paradox became so evident, because I said, here she is, this river that supports millions of lives, the biodiversity, the culture, the ethnicity, the language, the food, the texture, the textile. The way we breathe, the way we think, the way we interact with the river, she supports it all. She's in our mythology, she's in our history. And yet we pollute her.

[36:45] Tom Rivett-Carnac

This isn't a story about India being unlike the rest of us. Delhi isn't different in kind, it's different in scale. And it's dealing with that problem today. But sitting next to that toll is the other thing I kept seeing. A chance to take on health and work and climate as one problem, in a way that is unmistakably India's own. Shyla puts that better than I can.

[37:10] Shyla Raghav

The climate transition for India will become inevitable, will become profitable and will become an opportunity. So India's climate leadership will not be a result of the West forcing India to embrace or adopt clean energy. It will come out of homegrown solutions, out of the innovation, out of the creativity and out of the ambition of the Indian people.

[37:33] Tom Rivett-Carnac

Which leaves the question we'll explore through the rest of this series. What does it really take for a country of one and a half billion people to change everything at a pace we've never seen before while sharing the benefits among a vast and diverse population?

[37:51] Shyla Raghav

If we can see a future, then we can be that future. And if we can imagine that things can be different, we can imagine that the impossible can be a reality, then there's no reason why it can't be true.

[38:06] Tom Rivett-Carnac

If you want to hear more from any of the people you've been listening to here today, please go to our YouTube page. I'll be back next week with more from India.

[38:14] Sarika Chakravarty

This is a concept which will only work in Europe.

[38:17] Sarika Chakravarty

You know, this is quote unquote, this is what we heard from them. This will never work in India.

[38:20] Adnan Bhat

But look at us, we've been fighting for 50 years and nothing has changed. Just tell the world what is the reality of being here in Delhi.

[38:27] Prachi Shevgaonkar

A nine-year-old girl emailed me and asked, what change can I make in my life to fight climate? And she said I'm going to a school on a cycle recorded saving 60 kilograms of carbon emissions by doing this, which was three times our weight.

[38:39] Mahendra Singhi

I have committed to my grandchildren that I will do my best so that at least I feel that I have secured their future.