Lingering smoke in the Amazon caused concern on Tuesday among Brazilians who say that respiratory problems — particularly among children and the elderly — have increased as fires in the region continue to rage.
"The kids are affected the most. They're coughing a lot," said Elane Diaz, a nurse in the Rondonia state capital of Porto Velho, as she waited for a doctor's appointment at the city's 9 of July hospital with her son Eduardo, 5. "They have problems breathing. I'm concerned because it affects their health."
The number of people treated for respiratory issues increased sharply in recent days at the local Cosme e Damia Children’s hospital.
"This period has been very tough. The dry weather and the smoke causes many problems in children, such as pneumonia, coughing and secretion," Daniel Pires, a paediatrician and the hospital's adjunct-director told the Folha de Sao Paulo newspaper. "From August 1 to August 10, the median [number] of cases was about 120 to 130 children with respiratory problems. From August 11 to [August 20] it went up to 280 cases."
Growing fears over the health impacts are emerging as the number of fires in Brazil surges, with more than 77,000 documented by the country’s National Space Research Institute in the last year. About half of the fires occurred in the Amazon region, with most in the past month.
But, although breathing-related ailments appear to be on the rise, attention to the issue has largely been overshadowed by growing acrimony between Brazil and European countries seeking to help fight Amazon fires and protect a region seen as vital to the health of the planet.
At a summit in France this week, G7 nations pledged to help fight the flames and protect the rainforest by offering $20 million (Dh73m), in addition to a separate $12m from Britain and $11m from Canada.
But Brazilian President Jair Bolsonaro, a far-right climate sceptic who took office this year with a promise to boost development in Latin America's biggest economy, questioned whether offers of international aid mask a plot to exploit the Amazon's resources and weaken Brazilian growth.
On Tuesday, he said that his French counterpart, President Emmanuel Macron, had called him a liar and would have to apologise before Brazil considers accepting rainforest aid.
Macron has to retract those comments "and then we can speak", Mr Bolsonaro said.
In a video message, Brazilian novelist Paulo Coelho offered an apology to France for what he called Mr Bolsonaro’s “hysteria,” saying the Brazilian government had resorted to insults to dodge responsibility for the Amazon fires.
Meanwhile, in Brazil, a number of people said they supported Mr Bolsonaro despite local and international criticism of his handling of the crisis, exposing a divide that has split the country.
Grace Quale, a hospital laboratory technician, said that critics "want to overthrow our president", and that she didn't see a link between Mr Bolsonaro's environmental policies and the number of people getting treatment for respiratory problems.
Mona Lisa Pereira, an agronomist, also said criticism of the Brazilian government was skewed.
“Germany had already been helping through NGOs and they couldn’t prevent this,” Ms Pereira said. “It seems like this is the fire of a lifetime. But it’s not. We have fires every year.”
Others said in an open letter that the government's discourse and measures are leading to a "collapse in federal environmental management and stimulate environmental crimes inside and outside the Amazon".
More than 500 employees from the environmental regulator Ibama signed the letter and included a list of emergency measures they recommended, including more qualified management and employees, and a greater budget and increased autonomy.
The world's largest rainforest is an vital absorber of carbon dioxide, considered a critical defence against rising temperatures and other disruptions caused by climate change.
The government in the Amazonian state of Rondonia has given a warning that the burning of land can produce smoke that can "greatly influence atmospheric pollution, putting the life of many at risk".
Experts there said that when exposed to smoke, residents can suffer from rhinitis, sinus and respiratory problems, such as asthma and bronchitis, while chronic exposure can also lead to pulmonary illnesses, including lung emphysema.
"We've seen that [Porto Velho] has been taken over by smoke, so inhaling those antigens and pathogens can harm the whole city's population," Ana Carolina Terra Cruz, a specialist in pulmonary illnesses, told the state government website.
On Tuesday, some clouds and a blue sky were partly visible in the Porto Velho morning light. But by the afternoon, haze had again settled, with smoke so thick that it darkened the usually blazing sun.
Ms Pereira, the agronomist, said that smoke was "everywhere".
“It’s bad for everyone,” she said. “Not just our children.”