In 2010, three months before her seventh birthday, Ella Roberta suddenly developed a chest infection and a severe cough. Her mother, Rosamund Adoo-Kissi-Debrah, took her to the local hospital in Lewisham, South East London, where she was initially diagnosed with asthma.
In the following months, she got worse and began suffering from coughing syncope—coughing episodes so violent that they caused her to black out due to a lack of blood supply to the brain. “She had one of the worst cases of asthma ever recorded,” Kissi-Debrah recalls. “They didn’t really know what was wrong as she didn’t present as a normal asthmatic. They tested her for everything, from epilepsy to cystic fibrosis. Her condition was extremely rare.” So rare, in fact, that Kissi-Debrah couldn’t find a single case of a child suffering a cough from coughing syncope in the scientific literature. “It was only common in long-distance lorry drivers,” she says.
In the next three years, Ella was admitted to hospital about 30 times. On February 15, 2013, shortly after her ninth birthday, she suffered a fatal asthma attack.
Her original death certificate stated that she had died from acute respiratory failure. “At the inquest, it was established that some of it might be due to ‘something in the air,’” Kissi-Debrah says. None of the medical experts consulted had mentioned the possibility that air pollution could have triggered Ella’s syncope. That possibility came to light only after Kissi-Debrah was contacted by a reader of the local newspaper who had read about her story and suggested that she check the air pollution levels on the day Ella died. Indeed, that day the levels of nitrogen dioxide caused by the traffic on heavily congested South Circular Road, near where they lived, had far exceeded set limits.
With the assistance of her lawyer, Kissi-Debrah applied to the High Court to quash the verdict of the first inquest and request a second one, which was one granted. “My lawyer, Jocelyn, outlined on a graph all the times Ella had been admitted to the hospital, and then she got the data from the monitors near the house,” Kissi-Debrah recalls. The pattern was clear: There was a spike in air pollution prior to Ella experiencing coughing syncope. “Twenty-seven out of 28 times. As far as I’m concerned, that’s scientifically significant.” Furthermore, they showed that, on average, dioxide emissions and particulate matter levels in Lewisham far exceeded World Health Organization (WHO) guidelines.
After nine days of deliberation, the inquest concluded that “Ella died of asthma contributed to by exposure to excessive air pollution.” It added: “Ella’s mother was not given information about the health risks of air pollution and its potential to exacerbate asthma. If she had been given this information she would have taken steps which might have prevented Ella’s death.” The cause of death on Ella’s death certificate was amended. To this date, she remains the only person in the world to have air pollution on her death certificate.
Given the evidence at the inquest, the coroner also issued a Prevention of Future Deaths Report, which had a series of recommendations, such as ensuring that national air pollution levels be in line with WHO guidelines, that the public in England and Wales be made aware of the risks of air pollution, and that health professionals be educated on the health impacts of air pollution and inform patients accordingly.
“The coroner felt that other children were at risk of dying,” Kissi-Debrah says. “He made it very clear, actually, that unless the air was cleaned up, more children would die.”
Currently, 600,000 children worldwide die every year from breathing polluted air. In London alone, a quarter of a million children suffer from asthma. “The only time in this country no child has died from asthma was during the first lockdown,” Kissi-Debrah says. Ten years on from the death of her daughter, she continues to campaign for the legal right to clean air. As part of her campaign, she is lobbying for the approval of the Clean Air Bill in the UK, also known as Ella’s law: a parliamentary bill that establishes the right to breathe clean air.
“It is our right to breathe clean air, and it is the government’s duty to clean up the air and ensure that the UK targets are in line with WHO targets, as currently, they are not,” she says. “This isn’t a party political issue. It’s about our health. It’s about our future.”
This article appears in the July/August 2024 issue of WIRED UK magazine.
