The combined effects of environmental air pollution and household air pollution led to 6.7 million deaths in 2019.Reference Fuller, Landrigan and Balakrishnan ¹ Approximately 90% of these deaths occur in low- and middle-income countries, with Afghanistan having the highest age-adjusted mortality rate reported in 2016.Reference Fuller, Landrigan and Balakrishnan ¹ Contributing factors include smoke from burning wood and plastics, as well as leaded emissions from vehicles in congested roads.Reference Taylor and Ross ² Furthermore, the issue is exacerbated in rural areas, similar to the capital, where many people use solid fuels for cooking and heating.Reference Taylor and Ross ²

The issue of air pollution can exacerbate health risks for residents and responders during large-scale disasters such as earthquakes, as earthquakes can release particulate pollutants and chemicals into the atmosphere and worsen indoor air quality issues.Reference Chandrappa and Chandra Kulshrestha ³ These conditions can lead to serious health harms, including infectious diseases, inhalation injuries, interstitial diseases, and chronic pulmonary effects such as cancer.Reference Chandrappa and Chandra Kulshrestha ³ In the western province of Herat, Afghanistan, it was reported that in October 2023, earthquakes with magnitudes of around 5 to 6 occurred consecutively three times, resulting in more than 2000 fatalities and over 9000 injuries. Approximately 2000 homes were reported to have collapsed in these earthquakes, raising concerns over significant health impacts due to air pollution from asbestos and other pollutants.

Particularly in Afghanistan, the current political factors make it challenging for foreign NGOs and other organizations to assist during disasters directly. Taking into account the frequent occurrences of earthquakes (such as in January and June of 2022, and March of 2023), it is considered essential for the general population to engage in prior training in mutual assistance among residents through emergency response training (ERT).Reference Sugano ⁴ Without standardized practice and education in ERT, survivors in disaster-affected areas might participate in support activities without adequate knowledge about health and protection. This lack of preparedness could lead to potential long-term respiratory damage, such as pulmonary fibrosis and malignant mesothelioma, due to exposure to pollutants dispersed during disasters, similar to the aftermath of the 2011 Great East Japan Earthquake.Reference Yamanda, Hanagama, Kobayashi, Satou, Tokuda, Niu and Yanai ⁵

In conclusion, in Afghanistan, where air pollution poses a severe threat, raising awareness about the proper use of respiratory protective equipment before disasters occur is essential for protecting all individuals, including victims and responders, from respiratory diseases. Even if unable to enter the country, international support organizations are required to effectively disseminate risk communication to the local population using online technologies and other appropriate means.