Ambient (outdoor) air pollution causes over 9,000 deaths every year, with coronary artery disease and stroke each killing more than 3,000 people in Nepal in 2012, according to findings made public by the World Health Organization on Tuesday.

The new analysis of 103 countries found that 36 people out of every 100,000 die in Nepal from outdoor air pollution leading to heart diseases, lung cancer, chronic obstructive pulmonary disease and stroke.

The 2016 version of the WHO ambient air quality database looked at the exposure of human health to tiny particulate matters of 2.5 microns and 10 microns respectively, small enough to enter through the respiratory system and having serious health consequences. The air pollution data was collected from 3,000 locations across the globe between 2008 and 2015.

“Air pollution in Nepal is a major killer, causing more fatalities than road accidents that kill around 2,000 people every year,” says Bhusan Tuladhar, technical advisor for South Asia, UN-Habitat. Various scientific reports and findings, including the Environment Performance Index (EPI) 2016 prepared by the Yale University, listed Nepal among the top four worst performers in protecting the human health and environment from degrading air quality.

Outdoor air pollution, mostly the PM2.5 and PM10 pollutants, kill around three million people every year, mainly from non-communicable diseases, said a WHO study published in 2014.

“Air pollution continues to rise at an alarming rate, and affects economies and people’s quality of life. It is a public health emergency,” the 2016 report said. It stated that 92 percent of the population breathes in air that breaches the WHO limits, with China topping the list as the worst country in outdoor air pollution, followed by India and Russia, in terms of the number of deaths annually.

“Dust particles suspended in the air from construction works and vehicular emissions are the key causes of the increasing cases of respiratory and other health problems related to air pollution in Kathmandu,” said Kabir Nath Yogi, in charge of the Respiratory Diseases Unit at the Tribhuvan University Teaching Hospital. According to him, people of all ages are affected by poor air quality, with patients of chronic respiratory diseases at high risk. “During winter, the concentration of suspended particulate matters such as dust, smog, fog and smoke is significantly high and leads to higher exposure to air pollution than during the rainy season,” Yogi said.

Using proper masks, educating people on the increasing risks of exposure to harmful air pollutants and regular check-ups are some of the precautionary measures to be taken, he said.