Flee or fall ill: For many Hanoi residents pollution makes choices stark

His old house in Hanoi’s Nam Tu Liem district had "every convenience" like shopping and other facilities and proximity to schools and offices. But his family was constantly ill. His children, aged three and five, had persistent coughs, while Duc himself suffered from several bouts of throat inflammation and breathing difficulties every year.

"Some nights I’d wake up at 2-3 a.m. unable to breathe," he says. "In the morning, I’d ride my motorbike straight to the Hoa Lac [Hi-Tech Park in Hanoi’s suburbs] to breathe some fresh air."

Last year Duc and his family moved to Gia Lam district on the outskirts to an apartment complex surrounded by greenery.

Though this meant a longer commute to school and work, "at least the air is more breathable, and there is less dust," he says.

Hanoi’s Ring Road 3 is often shrouded in smog in the mornings and evenings. Photo by VnExpress/Ngoc Thanh

Hanoi and HCMC have some of the worst air quality in Asia.

Hanoi is ranked the 10th most polluted city globally, with PM2.5 fine particulate matter levels consistently higher than average. It is estimated that over 40% of the city’s population is exposed to double the national average levels of PM2.5. Every year, as the seasons change, many residents, especially children and the elderly, fall ill.

At the end of October Nguyen Ngoc Be, 47, of the northern Nam Dinh Province traveled to Hanoi to begin a new job as a security guard at nearly double the salary he earned in his hometown.

But after just three days he fell ill with chest tightness, breathing difficulty and a high fever, and had to return to Nam Dinh.

Once he became better he returned to Hanoi for his job, but each time he felt suffocated.

"The doctor said it was due to the dry weather and severe air pollution in Hanoi affecting my health," he says.

But by mid-November, after less than a month in Hanoi, he quit his job and vacated his rented room. The unfruitful trip cost him VND2 million (US$79) in travel expenses and medical care, and his wife, a vendor in a local market, had to take two days off to care for him.

Nguyen Minh Tan, deputy director of the Hanoi Department of Natural Resources and Environment, says nearly 1,100 people are hospitalized annually with cardiovascular diseases and nearly 3,000 with respiratory illnesses due to the increasing levels of PM2.5.

The Global Burden of Disease report said deaths from PM2.5 exposure in Vietnam increased from 26,000 in 1990 to 42,000 in 2015.

Tan estimates air pollution reduced the income of inner-city residents by about 20% between 2011 and 2015.

A Hanoi resident installs an air purifier in his room. Photo by Ngoc Bich

A 2020 study by the Hanoi-based National Economics University estimated that air pollution costs Vietnam US$10.82-13.63 billion annually.

These could be broken down into tangible losses like healthcare and air purifier costs and indirect ones such as deaths and the impact of illness on labor productivity and the country’s image internationally.

"It is not just patients affected by air pollution who suffer income losses but also their caregivers," Dr. Nguyen Cong Thanh, head of the economics, resource management, and environment faculty at the National Economics University, points out.

A study led by Thanh and published in the international journal Economic Analysis and Policy in 2021 said if Hanoi could maintain an average annual PM2.5 concentration at 10 μg/m3, it would prevent 4,200 premature deaths a year and avoid mortality costs of VND6.3 trillion.

Duc says he was willing to pay whatever it took to completely cure his chronic throat inflammation, but nothing worked despite trying all sorts of medication.

His work requires frequent client meetings, but his persistent cough forced him to continuously postpone and cut back on work.

"When I took the bus, my constant coughing made people move away though I had a mask on and the driver remind me to keep away from the air-conditioner," he says.

Be acknowledges his low immunity and inability to cope with Hanoi’s polluted air.

"The medicine, coupled with the illness, will make you not even know when you might die, so I returned to the countryside to a poor but healthy life."

Thanh says solutions to prevent pollution include planting trees, developing green transportation, improving the quality of used materials, and planning low-emission zones.

Meanwhile, families need to protect themselves by wearing masks, closing doors if they live near roads, installing air purifiers and anti-bacterial air conditioning systems, and, if possible, relocating away from congested roads and polluted areas, he adds.

Dr Hoang Duong Tung, president of the Clean Air Network Vietnam, says pollution is at its worst at 1-7 a.m. and during rush hour.

So it is advisable to keep windows closed while sleeping and limit going out during rush hour if possible, he says.

"Nowadays mobile phones have apps that alert you to air pollution," he adds. "People should install them to avoid going out during high-risk times when not necessary."

He believes that switching to public transport, walking or cycling, and reducing garbage burning are urgent, cost-free solutions that can help save oneself from pollution.

Duc’s family operates a farm in Quang Binh in central Vietnam to serve both as an economic development site and a refuge from the city’s dust. Photo courtesy of Duc

Realizing that Hanoi’s air pollution cannot be resolved overnight, Duc built a farm in Quang Binh in the central region seven years ago, spent a year there breathing clean air and consuming wild honey, which cured his throat inflammation.

"The total cost of the honey I consumed was equivalent to one doctor’s visit in Hanoi," he says.

Currently he spends three months each year in Quang Binh to handle his business while living amidst nature.

"My financial situation is not stable yet, and so I can’t move back permanently now, but I’ve decided to leave Hanoi as soon as the opportunity arises."