Dangerous levels of air pollution “made a material contribution” to the death of nine-year-old Ella Kissi-Debrah in London in 2013, a coroner has ruled following a second inquest into the child’s death.
The landmark result, following a two-week inquest at Southwark Coroner’s Court, means air pollution has been listed as a cause of death for the first time in the UK.
In a detailed conclusion lasting almost an hour, assistant coroner Philip Barlow said: “I will conclude that Ella died of asthma, contributed to by exposure to excessive air pollution.”
He said he intended to record the cause of death as acute respiratory failure, severe asthma and air pollution exposure.
Ella’s mother Rosamund Kissi-Debrah and two siblings were at the court in south London for the ruling.
The first inquest ruling from 2014, which concluded she died of acute respiratory failure, was quashed by the High Court following new evidence about the dangerous levels of air pollution close to her home.
Mr Barlow said: “Ella’s mother was not given information about the health risks of air pollution and its potential to exacerbate asthma.
“If she had been given this information she would have taken steps which might have prevented Ella’s death.”
Ella died in February 2013, having suffered a fatal asthma attack.
Before her death she had endured numerous seizures and been admitted to hospital more than 30 times in three years.
When she was six, Ella had to be placed in a medically induced coma for three days to try to stabilise her condition.
“It got to the point we were just waiting for the next [seizure] to happen,” her mother told the inquest.
By the summer of 2012, Ella had been classified as disabled and often had to be carried by piggyback to get her around, the court heard.
The family had lived 25 metres from the South Circular, one of London’s busiest roads, in Lewisham, but while the family were aware of some of the risks of vehicle pollution, Ms Kissi-Debrah said she and the doctors treating Ella had been “looking in the wrong direction” for the cause of her breathing difficulties.
She told the inquest she had never previously heard of nitrogen oxides – among the most dangerous forms of air pollution – and said education on the issue needed to be better.
Sir Stephen Holgate, professor of immunopharmacology at the University of Southampton, told the inquest Ella’s “exceptionally rare” condition, in combination with her surroundings, had put her at “exquisite” risk.
A 2018 report he wrote found that levels of pollution at Catford monitoring station, a mile from Ella’s home, “consistently” exceeded lawful EU limits over the three years before her death.
Sir Stephen said it was “almost certain” that Ella’s asthma would have been “substantially less severe” if the concentration of pollution in the area had been within the limits. He believes she would have improved if she had moved to a “much less polluted” area.
Sadiq Khan, the mayor of London, said: “This is a landmark moment and is thanks to the years of tireless campaigning by Ella’s mother Rosamund, who has shown an extraordinary amount of courage.
“I’m delighted that I have been able to support the family in their efforts to get the original inquest overturned and securing today’s important finding. Today must be a turning point so that other families do not have to suffer the same heartbreak as Ella’s family.
“Toxic air pollution is a public health crisis, especially for our children, and the inquest underlined yet again the importance of pushing ahead with bold policies such as expanding the ultra-low emission zone to inner London.
“Ministers and the previous mayor have acted too slowly in the past, but they must now learn the lessons from the coroner’s ruling and do much more to tackle the deadly scourge of air pollution in London and across the country.”
Sian Berry, Green Party co-leader and mayor of London candidate, said: “History has been made today, and we can finally see a measure of justice for Ella and for her mother Rosamund, who had fought so bravely to bring this case.
“Now we must see emergency action from all levels of government: the prime minister, the mayor and every local council, to eliminate the sources of deadly air pollution.”
Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, said: “With immediate effect the government needs to set out a health protection plan to protect us all from toxic air.
“Our hearts go out to Ella’s family who have fought tirelessly for today’s landmark outcome.
“Today’s verdict sets the precedent for a seismic shift in the pace and extent to which the government, local authorities and clinicians must now work together to tackle the country’s air pollution health crisis.”
Additional reporting by PA