A coroner has ruled that air pollution contributed to the death of a nine-year-old girl in what is thought to be the first case of its kind in the UK.
Ella Kissi-Debrah died in 2013 after suffering a fatal asthma attack. She had endured numerous seizures and made almost 30 hospital visits over the previous three years.
Assistant coroner Philip Barlow gave his findings at Southwark Coroner’s Court after a two-week inquest. A previous inquest ruling from 2014, which concluded Ella died of acute respiratory failure, was quashed by the High Court following new evidence about the dangerous levels of air pollution close to her home.
Giving his narrative conclusion over almost an hour, the coroner said: ‘I will conclude that Ella died of asthma, contributed to by exposure to excessive air pollution.’
Setting out the medical cause of death, he said: ‘I intend to record 1a) acute respiratory failure, 1b) severe asthma 1c) air pollution exposure.’
Ella lived 25 metres from the South Circular Road in Lewisham, south-east London – one of the capital’s busiest roads.
A 2018 report by Professor Sir Stephen Holgate found air pollution levels at the Catford monitoring station one mile from where Ella lived ‘consistently’ exceeded lawful EU limits over the three years prior to her death.
The fresh inquest had been listed under Article 2 – the right to life – of the Human Rights Act, which scrutinises the role of public bodies in a person’s death.
The Department for Environment, Food and Rural Affairs (Defra), the Department of Health, the Department for Transport, Transport for London, the Mayor of London’s Office and Lewisham Council were all named as interested parties in Ella’s death.
Mayor of London Sadiq Khan said the coroner’s conclusion was a ‘landmark moment’ and called pollution a ‘public health crisis’.
The coroner said ‘air pollution was a significant contributory factor to both the induction and exacerbations’ of Ella’s asthma.
During the course of her illness between 2010 and 2013, he said, ‘she was exposed to levels of nitrogen dioxide and particulate matter in excess of World Health Organisation guidelines’.
He added: ‘The principal source of her exposure was traffic emissions.
‘During this period there was a recognised failure to reduce the level of nitrogen dioxide to within the limits set by EU and domestic law, which possibly contributed to her death.’
The coroner said Ella’s mother had not been given information which could have led to her take steps which ‘might’ have prevented her daughter’s death.
Mr Barlow said: ‘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.’
Ella’s mum, Rosamund Kissi-Debrah, said ‘we’ve got the justice for her which she so deserved’ following the ruling.
The inquest heard Ella was an active child who loved sports and music and dreamed of becoming a pilot.
Her mum described her as ‘the centre’ of her family’s world.
She played multiple instruments including the cornet – despite her asthma – the banjo, guitar, piano and steel pans, a two-week inquest at Southwark Coroner’s Court heard.
The inquest heard she was ‘extremely healthy at birth’ and ‘extremely active’ as a baby, with trips to the swimming pool and local gymnastics club.
But in the three years before her death in 2013, Ella suffered multiple seizures and was in hospital 27 times.
Her mum said: ‘It got to the point we were just waiting for the next (seizure) to happen.’
She added that she and doctors had been ‘looking in the wrong direction’ for the cause of her daughter’s breathing difficulties, adding there was ‘no rhyme or reason (for the episodes)’.
On the night of February 14, 2013, Ms Kissi-Debrah described her daughter ‘screaming’ as she left her with paramedics to try to get her other two children into the ambulance so they could leave for the hospital.
She said: ‘When I came to the ambulance she looked awful, the person I had left to get the twins was not the person that I met in the ambulance – when I saw her in the ambulance I knew she was going to have a seizure, she was so bad.’
Describing the efforts of doctors to resuscitate Ella, she said: ‘They tried and they tried and they tried.’
Ella died at 3.27am on February 15.
She told the inquest that ‘moving (house) would have been the first thing’ the family would have done had they known the risks air pollution posed to Ella.
Ms Kissi-Debrah said she knew about car fumes, but had never heard of nitrogen oxides – among the most dangerous forms of air pollution.
She said environmentalists understood the problems of air pollution but among the general population ‘there’s a lot of education to be had’.
Speaking at a press conference following the inquest, she said: ‘Yes, this was about my daughter, getting air pollution on the death certificate which we finally have, and we’ve got the justice for her which she so deserved.
‘But also it’s about other children still as we walk around our city of high levels of air pollution.’
Mr Khan said in a statement: ‘The coroner has today concluded that air pollution played a role in the tragic death of nine-year-old Ella Adoo-Kissi-Debrah in 2013.
‘This is a landmark moment and is thanks to the years of tireless campaigning by Ella’s mother Rosamund, who has shown an extraordinary amount of courage.
‘I’m delighted that I have been able to support the family in their efforts to get the original inquest overturned and securing today’s important finding. Today must be a turning point so that other families do not have to suffer the same heartbreak as Ella’s family.
‘Toxic air pollution is a public health crisis, especially for our children, and the inquest underlined yet again the importance of pushing ahead with bold policies such as expanding the Ultra Low Emission Zone to inner London.
‘Ministers and the previous Mayor have acted too slowly in the past, but they must now learn the lessons from the Coroner’s ruling and do much more to tackle the deadly scourge of air pollution in London and across the country.’
Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, called on the Government to outline a public health plan to protect against ‘toxic air’ immediately.
She said: ‘Our hearts go out to Ella’s family who have fought tirelessly for today’s landmark outcome.
‘Ella’s legacy has firmly put the spotlight on the invisible dangers of breathing dirty air for everyone but particularly for the millions of people in the UK with asthma and other forms of lung disease, whose lives are impacted on a daily basis as a result of inadequate air quality laws and policies.
‘Today’s verdict sets the precedent for a seismic shift in the pace and extent to which the government, local authorities and clinicians must now work together to tackle the country’s air pollution health crisis.’
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