ASEAN's failed haze pledge leaves doctors treating smoke-scarred lungs in Kalimantan

Dr Asma Zafirah no longer requires satellite images to determine when Kalimantan is burning. The physician observes the crisis manifesting directly in the examination rooms of her clinic in Sarawak, reading the evidence in the watery eyes and laboured breathing of her patients, and in the empty school benches as parents keep their children indoors to shield them from the toxic air that drifts across the border.

Southeast Asia's transboundary haze crisis was supposed to have been brought under control six years ago. The Association of Southeast Asian Nations had pledged to eliminate the cross-border haze problem by 2020. That deadline came and went, yet Kalimantan continues to burn.

The smoke is not merely an irritant. Repeated and prolonged exposure to haze triggers a cascade of harmful effects in the human body, causing inflammation, precipitating asthma attacks and unleashing a range of other respiratory problems that fill clinics like Asma's.

"That is already a signal that their body is not simply being irritated," Asma said. "It is having a clinically significant response to the exposure."

The consequences of unchecked exposure extend far beyond temporary discomfort. Over time, the damage becomes lasting and systemic. The exposure can scar lung tissue, impair the cardiovascular system and elevate the risk of cancer. PM2.5 particles, so microscopically fine that they can cross from the respiratory tract into the bloodstream, transport the damage throughout the entire body.

These ultra-fine particulates are small enough to breach the lung barrier and enter the circulatory system, spreading their toxic effects far and wide through organs and tissues. What begins as respiratory distress evolves into cardiovascular illness and potentially life-threatening conditions including cancer.

The regional response, once presented as a collective solution to a shared environmental and public health emergency, has failed to protect the communities that Asma treats. The 2020 target to eliminate transboundary haze represented ASEAN's commitment to addressing a crisis that annually blankets parts of Southeast Asia in choking smoke from forest and peatland fires, primarily originating from Indonesia's Kalimantan region and affecting neighboring countries including Malaysia and Singapore.

For frontline medical professionals like Asma Zafirah, the failure of the regional pledge translates into a continuing stream of patients suffering the health consequences of air quality that routinely deteriorates to hazardous levels during fire season. The physical evidence of policy failure presents itself in every laboured breath she monitors and every inflamed airway she examines in her Sarawak clinic.