Afghans face killer in their own homes

Civilians of war-torn country have another enemy in their midst: the smoke from wood-fired stoves

Khan Mohammad's once long henna-stained beard is burned up to his chin, and his face is swollen and raw after a gas lamp exploded because it was placed too close to the family's wood-burning stove.

As temperatures drop well below freezing during the country's harsh winter, bombs and bullets from the nearly decade-long war against the Taliban are not the only threat – just trying to light a home and stay warm can be deadly. "We were using gas for a lamp and cooking food on the bukhari [stove], and the gas bottle was too close and got too hot," Mr Khan said of the explosion, which also hurt his 11-year-old son.

But aside from the threat of burns, the main problem posed by heating and cooking is the smoke, which the World Health Organisation said kills 54,000 Afghans a year. Most of those killed are children under five, it said. Globally, exposure to smoke from heating and cooking kills nearly two million people a year and causes millions more to fall ill.

More than 95 per cent of Afghanistan's 30 million people burn solid fuels, such as wood and coal, in their homes, making it one of the 10 countries worst affected by indoor pollution. By contrast, 2,412 civilians were killed by conflict-related violence and 3,803 wounded in the first 10 months of 2010, the most violent year since the Taliban were ousted from power in late 2001.

Afghan families typically use a wood-burning bukhari, a drum-shaped stove made of thin metal, or a sandali, a pit of burning coal under a small table covered by a heavy blanket, which people put their feet under to keep warm. Breathing the smoke can lead to childhood pneumonia, lung cancer, bronchitis and cardiovascular disease, while also contributing to climate change through greenhouse gas emissions.

Indoor pollution affects mainly women and children because they spend the most time at home. Afghanistan's acting minister of public health, Dr Suraya Dalil, said: "We're working ... to advocate measures that would reduce indoor pollution, including things like provision of electricity, that increase the safety as well as reduce pollution in the house." Afghanistan's infrastructure has been shattered by three decades of conflict, and even in the capital, Kabul, the electricity supply is unreliable. The war makes security a top priority even as authorities try to rebuild the aid-reliant economy.

Afghanistan is one of the poorest countries in the world, where children make up half the population. A quarter of children die before the age of five, and the average life expectancy is 44 years. Dr Bashir Noormal, director general of the Afghan Public Health Institute, said smoke from heating and cooking in Afghan homes "causes burns, carbon monoxide poisoning, respiratory illnesses and deaths".

He added: "Inhalation of smoke from coal, wood and straw has been related to lung cancer and cancers of the head and neck. Chronic exposure to wood smoke also significantly increases the risk of cervical cancer in human papillomavirus-infected women." The human papillomavirus can lead to cervical cancer. But, in a country devastated by war, Dr Noormal said there was no information on how many cancer cases could have been caused by indoor pollution.

Traditional cookstoves and open fires are the primary means of cooking and heating for nearly three billion people, according to the UN Foundation's Global Alliance for Clean Cookstoves. The alliance is working to produce clean cooking equipment and aims to have 100 million homes using clean and efficient stoves and fuels by 2020. In September, the United States committed $50m (£31.5m) over five years to the alliance.

Honorita Bernasor, a Médecins sans Frontières emergency doctor at Kabul's Ahmed Shah Baba hospital, said winter in Afghanistan always brings cases of burns and carbon monoxide poisoning. In December, the hospital treated nearly 100 cases of burns caused by heating or cooking. "We will be expecting more cases as the temperature falls," she said. "Bukharis are normally in the middle of the room, and the children run around and put their hands everywhere... We see a lot of carbon monoxide poisoning as well."

Qudratullah Nasrat, an emergency room doctor at the same hospital, said some of the symptoms of carbon monoxide poisoning, such as headaches and dizziness, were well known to Afghans.

"A lot of people treat themselves by sitting outside to breathe the fresh air," he said. "They get to know the symptoms."