Ella – a vibrant and playful Londoner who loved gymnastics, swimming and football – was just nine years old when she died.
For the first six years of her life, Ella was the picture of health. Everything changed after she picked up a bad chest infection in October 2010.
In the years that followed, she was admitted to hospital on 27 separate occasions, suffering from severe asthma – including hypoxic seizures that saw her stop breathing. On 15 February 2013, one of these attacks finally claimed her life.
Based on these simple facts, an inquest the following year, at Southwark Coroner’s Court, ruled that Ella died from acute respiratory failure and severe asthma.
What the coroner did not consider, however, is that Ella lived only a few dozen metres from London’s South Circular. Each day, this busy ring road carries thousands of cars, buses and lorries that belch out particulate matter and other air pollutants.
Now Ella’s mother, Rosamund Kissi-Debrah – armed with new research from asthma expert Professor Stephen Holgate and backed by a prominent civil liberties lawyer – is fighting to open a fresh inquest that will list air pollution as a causative factor on Ella’s death certificate.
If Kissi-Debrah succeeds, it will be the first time that air pollution has ever been explicitly linked to a named individual’s death – with potentially far-reaching implications.
Decision on new inquest due
During Ella’s short life, her mother, like most people living in big cities, wasn’t fully aware of the dangers the road posed. She says that during all the years of Ella’s treatment, none of the doctors she dealt with raised the possibility that air pollution could be a factor.
All she knew when Ella died was that she needed answers.
“After Ella’s death I remember feeling that I had let her down,” she said. “I was determined to establish how a nine-year-old girl with asthma was dead. Following Ella’s inquest, I was no closer to understanding what had caused her asthma attacks and why they could not be controlled or prevented.”
Kissi-Debrah set up the Ella Roberta Family Foundation in an attempt to find out more about childhood asthma. It was only then that she began to understand that air pollution from the congested road could have played a role in Ella’s ill health.
She approached Jocelyn Cockburn, civil liberties partner at London solicitors Hodge Jones & Allen, who began building a case for a new inquest.
Their case gathered momentum this year when Holgate came onboard and examined data from pollution monitoring stations close to the Kissi-Debrahs’ home. He found that air pollution levels often exceeded EU limits. More damningly, he pointed to spikes in local air pollution that coincided with many of Ella’s asthma attacks. He concluded that air pollution was undoubtedly linked to Ella’s illness and, ultimately, her death.
In June 2018, Cockburn presented this new evidence to the Attorney General, and called for a fresh inquest. She and Kissi-Debrah followed up with a 100,00-signature petition on 31 August.
“What I am trying to do is what every parent would do in my situation, which is simply to get to the truth about why my beautiful daughter and the twins’ big sister is no longer with us,” said Kissi-Debrah. “I would like whatever contributed to her death to be officially recognized on her death certificate. Ella suffered greatly in the last year of her life and it is right that this should be reflected.”
A spokesperson for the Attorney General said that the application, which is under review, must satisfy him that there is a reasonable prospect of it succeeding in the High Court, which “will ultimately decide whether it is in the interests of justice for a new inquest to be held”.
Cockburn believes that the case for a new investigation is now “overwhelming”.
“It doesn’t make sense that so much information is now available about the health impact of air pollution and the link to thousands of the deaths in the UK and yet there has been no direct link made to an individual death,” said Cockburn. “Ella’s case illustrates the hard-hitting human impact of air pollution.”
The invisible killer
This, perhaps, is the crux of the problem. Air pollution is called the invisible killer for the very reason that, in many places these days, we don’t see it or even really notice that we breathe it in.
“The smog of the 1950s was due to coal burning in domestic fires and industry,” Holgate said. “In today’s society the picture is different. The pollution is invisible and is a silent killer. Coal fires are no longer causing us the problem – now tiny toxins and particles are being poured into our air from cars, lorries and buses and we are breathing them in day by day.”
The statistics are there for all of us to see.
Billions of people live near busy roads or in cities with poor air quality: nine out of ten people worldwide are exposed to levels of air pollutants that exceed World Health Organization safe levels. This leads to over four million deaths each year.
In 2016, exposure to the smallest form of particulate matter reduced average global life expectancy at birth by approximately one year. Research from the United Nations Children’s Fund (UNICEF) shows that breathing in particulate air pollution can damage brain tissue and undermine cognitive development in young children.
Other studies have linked air pollution to lower intelligence levels, with the average impact equivalent to one lost year of education, and to an increased risk of dementia, with those living closest to major traffic arteries up to 12 per cent more likely to be diagnosed with the condition.
But statistics are so easily ignored. It is only when we see a human face linked to the issue that we truly begin to understand that air pollution can kill us, our family and our friends. Even without the legal implications of having air pollution listed on a death certificate for the first time, this is why Ella’s case could be so significant.
“If I had been aware of the dangerous levels of air pollution and the impact of poor air quality on Ella’s health, I would have changed our day-to-day life to reduce the impact,” Kissi-Debrah said.
Change is in the air
Kissi-Debrah’s battle could give a real boost to a growing global movement to address air pollution.
BreatheLife – a global network headed by the Climate and Clean Air Coalition, the World Health Organization and UN Environment – is running cleaner air initiatives that cover 42 cities, regions, and countries and reaches over 94 million citizens.
London is part of this commitment, with Mayor Sadiq Khan – himself an asthma sufferer – fully committed to improving air quality. In fact, Khan wrote to the Attorney General in support of a new inquest for Ella.
“As you may know, I am committed to improving air quality in London, achieving legal limits as quickly as possible, and then meeting even tighter World Health Organization guidelines by 2030. Cases like Ella’s are a key part of why I have attached such importance to this issue,” he wrote.
“As a result, it would be extremely helpful for a new inquest into Ella’s death to be held. I, and others with air quality duties, need to better understand the role that air pollution may have played in order to ensure that the most ambitious measures are taken at every level of government so that – if air pollution was the cause – no other child ever again dies as a result of the air they breathe.”
In June this year, Khan announced that London’s Ultra-Low Emission Zone would be expanded to include the North and South circular roads. According to his office, the new zone will be 18 times larger than the Central London ultra -low emission zone. An estimated 100,000 cars, 35,000 vans and 3,000 lorries could be affected by tighter standards in the expanded zone each day.
“These bold measures will deliver a major improvement to Londoners’ health by reducing the toxic air quality that is currently responsible for thousands of premature deaths and other serious conditions,” his office said in a statement. “Expanding the ultra-low emission zone beyond central London and strict standards for heavy vehicles across London will result in more than 100,000 Londoners no longer living in areas exceeding legal air quality limits in 2021, a reduction of nearly 80 per cent.”
Across the UK, organizations like Living Streets are also taking up the fight, encouraging kids to walk to school to avoid petrol fumes polluting their lungs when their parents drop them off and pick them up. Many schools are working towards eliminating cars on the school run.
All of these, and other, measures should mean that fewer children will suffer as Ella did. But experts and campaigners believe stronger and faster action is needed. In the end, this is why Kissi-Debrah and her supporters want Ella’s death certificate to reflect what they believe to be the true cause of her death.
“This is clearly an issue of great concern to the public,” said Cockburn. “There is a real need to understand what role air pollution played in Ella’s death – not least to learn lessons to ensure that other children do not suffer the same fate.”