At 9 on a cold January morning, Sami Iqbal got ready for work at his home in Lahore’s old quarter, a stone’s throw from the historic Badshahi Mosque. It was 6 degrees Celsius and the city was beginning to come alive — chai stalls in the vicinity pushed open their shutters and the doughy smell of flatbreads puffing up in iron skillets filled the air. Iqbal wrapped a muffler around his face before revving up his Honda motorbike to begin his day as a bike-taxi rider.

Iqbal is a self-employed gig worker who works across multiple ride-hailing apps, including Careem, Bykea, and inDrive. As he set off for his first job that day, the city was covered in a thick, poisonous smog. He drove through visible specks of reddish dust and other particulate matter, breathing through his muffler and trying to ignore the metallic, almost sulfurous stench permeating his nostrils.

“I’ve been ill for a week,” Iqbal told Rest of World, his voice hoarse. “It’s probably because of the smog. I’m on the road for so long.”

Lahore is the most polluted city in the world, according to Swiss air quality monitoring platform IQAir. In November, the air was so poisonous that authorities issued a citywide lockdown, closing schools, markets, and parks for four days, and advising people to stay indoors.

Other cities in South Asia have similarly alarming levels of air quality: Eight out of the top 10 most polluted cities globally are in the region. Causes include rapid urbanization, construction, vehicular pollution, coal-fueled power plants, crop burning, and the operation of brick kilns. Air quality in the region is at its worst from October to February due to atmospheric conditions which cause pollutants to be trapped closer to the ground.

Exposure to this pollution can have serious health impacts — from headaches and breathing difficulties to heart and lung disease, stroke, and cancer. For gig workers, who often have no choice but to work in the smog, the effects are clear. By the end of a day’s work, Iqbal said, his whole body feels lifeless. “I also experience exhaustion, I get a lot of headaches. I get body aches,” he said…

…Pollution-related conditions can have long-term health impacts. The 2023 Air Quality Life Index, carried out by the Energy Policy Institute at the University of Chicago, found that air pollution shortens lives by an average of 11.9 years in New Delhi, 8.1 years in Dhaka, and 7.5 years in Lahore. A nonprofit called Fair Finance Pakistan has estimated that air pollution leads to at least 128,000 deaths every year in the country. In India, pollution has led to more than 1.6 million premature deaths, according to a 2019 study by The Lancet. And in Bangladesh, the World Bank projects that air pollution will be responsible for 186,000 premature deaths by 2030. 

Although pollution can affect anyone exposed to it, delivery riders are particularly vulnerable owing to the nature of their work: They are outside for extended periods of time, often on congested streets, with little shelter from the smog.

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