Ahmad Rashid rushed his two young children to a private clinic near his home in Kabul last week after they appeared short of breath and could not stop coughing.
Asinad, 3, and one-year-old Usman were diagnosed with pneumonia induced by dangerously high levels of pollution in the Afghan capital this winter.
"They gave them antibiotics and injections for the younger one because syrups didn't work on him. It has been a week and they are not much better," Mr Rashid told The National.
Mr Rashid, an office assistant at a private company, and his wife also suffer from cough and breathlessness, and wear face masks outside the house.
“The doctor has advised us not to let the children out of their rooms because the air is so bad. We keep children indoors but even inside the house, we find layers of smoke and soot on the curtains and vessels coming from a hammam [public bath] close by that constantly burns rubber tyres,” he said.
The air in Kabul has been in the hazardous range for most of November and December, according to data from AIRNow, a service developed by the US State Department, with the Air Quality Index rising as high as 475. A reading of below 50 is considered good while anything above 100 is considered hazardous.
As the air quality in Kabul deteriorates to crisis levels, the rate of illness and even death due to pollution is rising.
Dr Nizamuddin Jalil, spokesman for the health ministry, said there were about 8,800 cases related to pollution recorded at 17 city hospitals in the last week of December.
"Majority were patients with cough, cold and fever, while about 20 per cent were pneumonia cases and about 5 per cent suffered from asthma and the air quality worsened their situation. This is a significant increase from last year,” he said.
It is not unusual for pollution levels in Kabul to rise during winter as the majority of residents use wood or coal-fuelled heaters to stay warm, but the spike this year follows a rapid growth in population as a result of urban migration and the arrival of people displaced by fighting in other areas of the country.
Simi Yousefi, a doctor in the emergency department of a private hospital in Kabul, said her poorer patients told her they burned whatever they could find for warmth.
"I found out that they burn plastic, rubber tyres and anything they can get their hands on to warm their homes during winter. They can't afford gas, nor do they have electricity from the government so they have to make do with anything they can to stay warm," she told The National.
After more than a decade working in emergency wards in Kabul, Dr Yousefi is surprised at the impact of the pollution.
“I have seen the worst of cases brought in who were victims of the war and insurgencies. But lately, I am seeing more cases of pollution-related illnesses than casualties of conflict,” she said.
“I can tell you that every day in the emergency department at least 80 per cent of the patients are coming with respiratory problems. There are some who are coming with conjunctivitis triggered by the bad air. I am dealing with many cases of nose, throat and lung inflammation, daily.”
She urged the government to act quickly to improve the air quality. “It breaks my heart to see Afghans continue to suffer. If it’s not the war then the air they breathe can kill them,” she said.
The government has been giving out free face masks in the worst-affected areas of Kabul, and Dr Jalil, the health ministry spokesman, said steps have been taken against businesses in the city that are causing more pollution than others.
“A high committee on air pollution has been set up and is chaired by the president himself. It comprises of multiple ministries and there is a three-month plan approved and in progress,” he said.
The interior ministry has made it compulsory for industrial parks, residential complexes and hotels to use filters on the exhausts of their heating systems, and have shut down those violating the codes.
The health ministry has dedicated three hospitals to deal with pollution-related emergency cases – two for children and one for adults.
But Mr Rashid remains concerned about his children growing up amid so much pollution.
“My kids stay indoors and we still find smoke on cups in our house; imagine what is the state of our lungs, especially of the little children,” he said.
“What did these little ones do to deserve to breathe such toxic air?”