Summer in Mongolia reveals a vast land of beauty—green steppes stretch beneath expansive blue skies, herds of livestock graze freely and horse-mounted herders ride clad in traditional dels. But when winter arrives, especially in the capital, Ulaanbaatar, the scene changes dramatically. A dense black haze blankets the city. Visibility drops, eyes and throats burn, breathing becomes difficult, and people, especially children, fall ill and die.

This seasonal crisis arrives given the smoke pouring from burning coal. Approximately 55% of Ulaanbaatar’s 1.6mn residents live in gers, traditional felt-covered tent-houses, located in the sprawling ger district on the city’s periphery. Without access to the centralised Soviet-era heating system available to apartment dwellers, these households burn coal to survive sub-zero temperatures. On average, a ger consumes five tonnes of coal each winter. And many residents, facing economic hardship, resort to burning any available material, including plastic, tyres or banned raw coal. For them, heat is a matter of survival.

The city’s topography worsens the problem. Located in a basin surrounded by mountains, Ulaanbaatar suffers from the trapping of emissions from power plants, vehicles and household stoves beneath a stagnant layer of air. In winter, PM2.5 concentrations, made up of tiny particulate matter that can enter the bloodstream, have been measured at 27 times the level considered safe by the World Health Organization (WHO).

When an inhabited area is located in a basin surrounded by mountains, in smog season the environs trap emissions beneath a stagnant layer of air (Credit: Bundesarchiv, Bild 183-1989-1218-003 / CC-BY-SA 3.0).

Children are especially vulnerable. Their faster breathing rates and smaller lungs make them more susceptible to pollution-related diseases. Cases of respiratory illness continue to rise steadily. Pneumonia remains the second leading cause of death among children under five in Mongolia. According to local doctors, it is increasingly common for young children to be hospitalised multiple times before their first birthday due to recurring respiratory infections.

Recent research underscores the urgency. A 2024 study published in Environmental Research found that air pollutants, including PM2.5, ozone and sulfur dioxide, intensify the severity of viral infections. The study analysed over 16,000 influenza-related hospital visits in Ulaanbaatar and concluded that pollution exposure significantly amplifies viral risk, particularly in children under five. Short-term exposure alone was linked to increased hospitalisations.

This interaction between pollution and viral exposure compounds the health crisis in the ger district. Doctors and school health workers report that no child breathing Ulaanbaatar’s winter air escapes unscathed. One mother, Uyanga, whose five-month-old son was hospitalised with pneumonia and later developed a secondary infection, said she had no choice but to leave the city for three months, exhausting her family’s savings, in a desperate attempt to protect her children. All three of her children had been hospitalised with respiratory illnesses before their first birthday.

The health effects of Mongolia’s air pollution crisis are not limited to respiratory infections alone. A 2024 report by the Health Effects Institute and UNICEF ranked air pollution as the second leading cause of death for children under five globally, with Mongolia among the most affected countries. Prolonged exposure increases the risk of stillbirth, low birth weight, chronic bronchitis, impaired lung development and even neurological damage in young children.

Indoor air pollution, particularly from the coal stoves used in gers, is a critical but often overlooked factor. While Ulaanbaatar’s outdoor smog draws international attention, many children are also breathing dangerously polluted air inside their homes and classrooms. In winter, with homes sealed against the cold, toxic particles from indoor stoves can accumulate to lethal concentrations. The problem is exacerbated by limited ventilation and the use of low-quality fuel, including toxic or banned coal.

A major birth cohort study published in Scientific Reports in January highlighted the cumulative impact of household air pollution (HAP) on child health. Tracking more than 1,200 children in Ulaanbaatar over three years, researchers found that even modest increases in HAP exposure were linked to higher rates of pneumonia, developmental delays and growth deficits, including reduced height and weight-for-age scores. The effects were most pronounced in the first year of life but persisted through 36 months. The findings show that HAP is not only a respiratory hazard but also a serious developmental risk, contributing to stunting, underweight conditions, and neurodevelopmental impairment. With millions of children across Mongolia and neighbouring Central Asian countries exposed to similar conditions, the study carries significant public health implications.

Government attempts to mitigate the crisis have fallen short. The 2019 shift from raw coal to compressed briquettes briefly improved air quality, but the gains have since plateaued. The briquettes are now linked to increased carbon monoxide poisonings, with over 800 deaths reported since their introduction. Many households attempted to switch to electric heaters but quickly abandoned them due to unaffordable electricity costs.

Public frustration has grown. In early 2025, a petition demanding a formal review of air quality policies gained 71,000 signatures in just three hours, prompting a rare parliamentary hearing. Among the signatories was Enkhuun Byambadorj, a 23-year-old activist whose mother’s illness spurred her into action. “The government has looked at this issue from only one perspective,” she said, calling instead for a “holistic, cross-sector” approach. Such an approach is essential because the problem is not only complex but also expensive to solve, and many seemingly obvious solutions end up creating new problems.

City officials have announced limited measures. Deputy Governor Amartuvshin Amgalanbayar stated that 20,000 households would transition to gas heating, aiming for a 15% reduction in emissions. However, the plan would require sustained gas supplies year after year, and even with a 15% cut, pollution levels would remain dangerously high. Another 20,000 families are slated to move from the ger district into apartments beginning from this year. The move eliminates their need to burn coal. Yet this figure is small compared to the roughly 800,000 residents still living in gers.

Moreover, relocating large numbers of families to apartments creates additional problems. Water consumption rises sharply, with one average shower using more water than a ger household typically consumes in a week. Ulaanbaatar is already facing water shortages. The city’s ageing Soviet-era infrastructure, including its electrical and heating grids, is, meanwhile, already at or beyond capacity and could not support a mass transition to apartment living.

A long-delayed metro system for the capital, first proposed more than a decade ago, is scheduled for completion by 2028 and is expected to help reduce vehicle emissions, which contribute an estimated 30% of Ulaanbaatar’s air pollution. Still, many remain sceptical, noting that similar plans have repeatedly failed to materialise. Moreover, the metro is unlikely to serve the entire city, meaning most residents will continue relying on cars and buses for daily transportation.

Meanwhile, air quality monitoring remains severely under-resourced. Only two specialists are assigned to Ulaanbaatar’s monitoring stations, and funding is minimal. “If you heard the actual budget,” said one state meteorologist, “you would laugh.”

Ulaanbaatar’s pollution crisis is not new, but the scale of suffering, especially among children, is worsening rapidly. Each year, tens of thousands of Mongolians abandon nomadic herding and move to the capital in search of work, swelling the city’s ger population. Meanwhile, rising incomes have led to a surge in car ownership, adding to the already toxic air. Without effective solutions, conditions will continue to deteriorate, and more children will die.

Antonio Graceffo, PhD, China-MBA, is an economist and analyst. He has spent over 20 years living in Asia, including seven years in China, three in Taiwan and four in Mongolia. He conducted post-doctoral studies in international trade at the School of Economics, Shanghai University, and holds a PhD from Shanghai University of Sport and a China-MBA from Shanghai Jiaotong University. Antonio has authored seven books on Asia, with a focus on the Chinese economy.