The air smells burnt in Lahore, a city in Pakistan´s east that used to be famous for its gardens but has become infamous for its terrible air quality. Toxic smog has sickened tens of thousands of people in recent months. Flights have been canceled. Artificial rain was deployed last December to battle smog, a national first. Nothing seems to be working. Lahore is in an airshed, an area where pollutants from industry, transportation and other human activities get trapped because of local weather and topography so they cannot disperse easily. Airsheds also contribute to cross-border pollution. Under certain wind conditions, 30% of pollution in the Indian capital New Delhi can come from Pakistan´s Punjab province, where Lahore is the capital. There are six major airsheds in South Asia, home to many of the world´s worst polluted cities. Experts are calling for greater cross-border cooperation among countries such as Pakistan, Bangladesh and India to address air pollution together rather than working in silos on a city-by-city basis. But it´s a tall order when political relations in the region are fraught. Ties between India and Pakistan are broken. Their interactions are riddled with animosity and suspicion. They have fought three wars, built up their armies and developed nuclear weapons. Travel restrictions and hostile bureaucracies largely keep people from crossing the border for leisure, study and work, although the countries make exceptions for religious pilgrimages. “There´s a recognition among the technical and scientific community that air pollution doesn´t need a visa to travel across borders,” said Pakistani analyst Abid Suleri, from the nonprofit Sustainable Development Policy Institute. The culprits and problems are the same on both sides of the India-Pakistan border, he said, so it makes no sense for one province to implement measures if a neighboring province across the border isn´t adopting the same practices. Regional and international forums offer opportunities for candid discussions about air pollution, even if governments aren´t working together directly or publicly, Suleri said, adding that countries should treat air pollution as a year-round problem, rather than a seasonal one arriving with cold weather. “Airshed management needs a regional plan,” he said. “But 2024 is an election year in India and Pakistan, and government-to-government cooperation hasn´t reached that level.” Pakistan is weeks away from voting in national parliamentary elections. So far, only the former foreign minister and political party leader Bilawal Bhutto Zardari has pledged heavy investment in climate adaptability, following record-breaking floods that killed more than 1,700 people. In India, air pollution doesn’t figure as a core issue that people would vote on, said Bhargav Krishna, a fellow at the New Delhi-based Sustainable Futures Collaborative think-tank. But the experience or impact of climate change could make people think about how they vote. Krishna said that regional elections sometimes see air pollution-related promises. “It was a feature of every party´s election manifesto in the New Delhi elections in 2020,” he noted. According to the World Bank, a regional airshed management policy would involve countries agreeing to set common air quality targets and measures that everyone can implement, meeting regularly to share their experiences and, if possible, setting common air quality standards. The global body said almost 93% of Pakistanis are exposed to severe pollution levels. In India, it´s 96% of the population. More than 1.5 billion people are exposed to high concentrations of air pollution in these two countries alone. It estimates around 220,000 deaths a year in Pakistan´s Punjab can be attributed to causes related to bad air. Gray haze hangs pall-like over Punjab’s homes, mosques, schools, streets and farmland. There are 6.7 million vehicles on Lahore’s roads every day. Construction, emissions and waste are rife. There is scant visibility at major intersections after dark. Smog shrouds landmarks like the Mughal-era Badshahi Mosque. The shopping website Daraz has reported a spike in searches for air purifiers and face masks since last October, especially in Punjab. Pulmonologist Dr. Khawar Abbas Chaudhry laments the deterioration of Lahore, which he describes as a “once beautiful” city. The hospital where he works is part of the Bill Gates-backed Evercare Group that has hospitals in the region, including India and Bangladesh, and in East Africa. Chaudhry says he has seen a 100% increase of patients sickened with respiratory illnesses this winter. He attributes this rise to air pollution. There are forums within Evercare to discuss issues like air pollution, and he and colleagues, including those from India, talk about smog’s health impact. But this dialogue is only happening within one institution. “Countries, governments, departments need to be involved,” said Chaudhry. “They need to meet regularly. Ultimately, people need to reach out and that could put some pressure on movers and shakers on both sides of the border.” Pratima Singh, a senior research scientist at Bengaluru-based Center for Study of Science, Technology and Policy, has researched air pollution in India for over a decade. She said South Asian countries could emulate the European Union model of collaboration to deal with pollution challenges, formalize new policies and share data and best practices. After India launched its National Clean Air Programme in 2019, authorities quickly found it was crucial for cities to understand what was happening in surrounding areas — and the boundary kept expanding. “Everyone started realizing that airshed management is essential if we want to actually solve the problem,” Singh said. The director of Punjab´s Environment Protection Department, Syed Naseem Ur Rehman Shah, is proud of local achievements to fight air pollution. Emissions from industry and brick kilns are under control, farmers can soon buy subsidized machinery to end the menace of crop stubble burning, and there is a drive toward getting electric three-wheeled tuk-tuks, motorbikes and buses on the roads, he said. Although things are getting better, Shah said it will take time. He has gone to India to discuss climate change and said a regional body, the South Asian Association for Regional Cooperation, provides opportunities for countries to talk about air pollution. But he acknowledges the absence of formal cooperation at a ministerial level with India. A screen in a monitoring room, called the Smog Cell, showed Pakistan´s Air Quality Index to be higher than China´s that day. Shah said the province only exceeds World Health Organization-recommended levels for PM2.5 – fine particulate matter that can be inhaled. Everything else about the air quality is within parameters, he said. His assessment is of little consolation to Pakistani poet and former ambassador Ata ul Haq Qasmi, who is in Evercare for respiratory issues exacerbated by air pollution. “If my friends aren´t in hospital, they should be,” he said. “You only have to step outside for it (the smog) to grab you.”