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Air pollution and the death of Ella Kissi-Debrah: key questions answered

Emily Beament, PA Environment Correspondent
·5-min read

The coroner in the inquest for nine-year-old Ella Kissi-Debrah, who suffered a fatal asthma attack in 2013, has said tougher legal limits for dangerous air pollution known as particulate matter would prevent future deaths.

– What happened to Ella?

The schoolgirl, who lived 25m from the busy South Circular road in Lewisham, south-east London, was an active and healthy baby, according to her mother, but in the three years before her death she suffered multiple seizures and was in hospital 27 times.

She was seen by consultants at six hospitals in the years before her death and had tests for epilepsy, but doctors eventually concluded her condition was purely respiratory.

In February 2013 Ella was rushed to hospital but died from a fatal asthma attack. She was nine years old.

Ella Kissi-Debrah inquest
Ella Kissi-Debrah (Family handout/Rosamund Kissi-Debrah/PA)

– What did the inquest say about her death?

The first inquest in September 2014 was heard at Southwark Coroner’s Court by assistant coroner Philip Barlow, who recorded the cause of death as acute respiratory failure caused by severe asthma.

After air pollution came to greater prominence as an issue, Ella’s mother, Rosamund Kissi-Debrah, launched a legal fight, with the help of Hodge Jones & Allen Solicitors, over concerns that her daughter’s health may have been affected by pollutants, and the impact they might be having on other children.

In 2019, the first inquest was quashed by the High Court following new evidence about the dangerous levels of air pollution close to her home.

Ruling in a second landmark inquest in December 2020, Mr Barlow gave the medical cause of death as follows: “I intend to record 1a) acute respiratory failure, 1b) severe asthma, 1c) air pollution exposure.”

He said the principal source of the pollution she was exposed to was traffic emissions.

He also said there had been recognised failures to cut a key pollutant to legal limits during the time Ella was ill, and that her mother was not given information on pollution that could have led her to take steps that might have saved her daughter’s life.

Ella Kissi-Debrah inquest
Rosamund Kissi-Debrah, outside the High Court after judges ruled that a fresh inquest would be held into the death of her nine-year-old daughter Ella (Sam Tobin/PA)

– What happened next?

The coroner asked interested parties in the inquest, which included the Department for Environment, Food & Rural Affairs (Defra), the Department of Health, the Department for Transport, Transport for London, the Mayor of London’s Office and Lewisham Council, to contribute further submissions for a prevention of future deaths report.

He has now published his report, raising a series of concerns and calling for action by Government departments, local authorities and professional organisations to act on his recommendations.

– What does the prevention of future deaths report say?

The report highlights that national limits for particulate matter (PMs) are set at a far higher level than World Health Organisation (WHO) guidelines.

Legally binding targets for particulate matter based on the WHO guidelines would reduce the number of deaths from air pollution in the UK and the Government should take action to address the issue, Mr Barlow said.

He also said there is low public awareness of the sources of information about national and local pollution levels, and that greater awareness would help individuals reduce their personal exposure to air pollution.

In addition, the adverse effects of air pollution on health are not being sufficiently communicated to patients and their carers by medical and nursing professionals, he said.

Ella Kissi-Debrah inquest
Ella Kissi-Debrah lived just 25m from the busy A205 South Circular road in Lewisham, south-east London (Dominic Lipinski/PA)

– What is the problem with air pollution levels?

Key pollutants are nitrogen dioxide, which comes from sources such as traffic fumes, and particulate matter, or PMs, which come from a range of sources including vehicles. Levels of the pollutants have fallen in recent years.

But levels of PMs are above the guideline limits recommended by the WHO.

Legal limits for nitrogen dioxide are in line with the WHO guidelines, but the UK has been in breach of them for years.

Analysis by environmental lawyers ClientEarth found that 33 out of 43 air quality zones across the UK still have levels of nitrogen dioxide that are above legal limits that should have been met by 2010,

– What can be done to curb pollution?

With traffic a key cause of pollution in towns and cities, campaigners want to see more encouragement of active travel such as walking and cycling, including e-bikes, and the introduction of clean air zones, which charge motorists for driving more polluting vehicles in certain areas.

Longer term the switch to electric vehicles, including buses, will help clean up the air, although particulate matter is still created by tyres and brakes.

Ella Kissi-Debrah inquest
Rosamund Kissi-Debrah said she will be asking Environment Secretary George Eustice to make amendments to the Environment Bill (Kirsty O’Connor/PA)

– So what will happen now?

Ms Kissi-Debrah has said she will be asking Environment Secretary George Eustice to make amendments to the Environment Bill to enshrine WHO limits and to achieve them in the shortest possible time.

She is also calling on him to ensure that there is a duty to inform the public and train the medical profession.

Meanwhile, clean air zones are being introduced in some cities to tackle pollution from traffic.

The Government has said it will carefully consider the recommendations of the report and respond in due course.