In Ulan Bator, winter stoves fuel a smog responsible for one in 10 deaths

They call Mongolia the "land of blue sky"; its spectacular desert, forest and grasslands are blessed by sun for two-thirds of the year. But climb to a snow-dusted hilltop overlooking Ulan Bator and you see a thick grey band hanging over the city. In the coming weeks, as temperatures plummet, the smog will spread across the streets and into homes, shutting out the light.

While Beijing's "airpocalypse" has made headlines worldwide, it pales beside the haze of the Mongolian capital. Ulan Bator is the world's second-most polluted city, superseded only by Ahvaz in Iran, according to World Health Organisation research.

Pollution is a common problem for quickly developing countries. But the biggest issue is not the smokestacks on the horizon – Mongolia's manufacturing sector remains minute – nor the vehicles jamming the capital's streets. Rather, it is the collision of urbanisation and traditional culture: 60-70% of winter pollution comes from the old-fashioned stoves heating the circular felt tents or gers that sprawl across the slopes around the city.

More than half of the city's 1.2 million inhabitants live in the impoverished ger districts, burning coal, wood and sometimes rubbish to cook and keep warm. Ulan Bator is the world's chilliest capital, with temperatures dipping as low as -40C in January.

"As soon as people start getting cold they start up their stoves, and that's when the smog begins. It looks like thick fog and every year it's getting worse. It's only a bit of an exaggeration to say you could get lost in it," said Otgonsetseg Lodoisambuu, who lives in a district to the north of the city with his children. "The little one stays inside all the time in the winter, but my older son is in first grade now, so we have to take him to school; I just put a scarf over his face. The only time it's OK to let the kids out is between one and two in the afternoon, when people let their fires die down because they have finished cooking.

"In the morning it hurts my throat as soon as I go outside. It must be hurting my lungs, too."

Ulan Bator's pollutant levels of PM2.5 – tiny particulate matter, which can penetrate deep into lungs – are six or seven times higher than the WHO's most lenient air-quality guidelines for developing countries. The result, say researchers, is that one in every 10 deaths is caused by air pollution – on their most conservative estimate.

Ryan Allen, of Simon Fraser University, in Canada, who led the study, said the true figure could be as high as one in five. The study did not consider the effects of indoor air pollution, excluded the deaths of those aged under 30 and was based on data from a centrally located government monitoring site, in a relatively less polluted area of the city.

He and his Mongolian co-researchers are now studying how pollution affects foetuses and whether using air filters could reduce the impact; Ulan Bator's public health institute has warned of a sharp increase in birth defects in the capital as well as a 45% rise in the number of patients with respiratory illnesses between 2004 and 2008. The World Bank has estimated that pollution-related health problems cost the country £290m annually.

Dr Byambaa Onio, vice-director of the Bayanzurkh district hospital, arrived in the capital 46 years ago, when it was "a nice, clean city"; now the pollution levels are "disastrous", he said – and are producing a growing number of patients.

Like many of the capital's residents, he and his wife rarely open the windows in winter. But when they set up an air purifier at home, to test how severe the problem had become, they were shocked to see how dirty the filter became in just two days. "We've continued to use the purifiers, so my wife and I are breathing clean air – but others don't," he said.

Nor do others have the option to buy their children masks and decamp to a home outside the city at weekends, as the couple do, he notes. The residents of ger districts are hit twice over: pollution levels can be double those of the city centre, and they cannot afford to take evasive measures.

Joint research by the World Bank and National University of Mongolia suggests that halving ger stove emissions could cut year-round levels of the larger PM10 particles by a third. Foreign donors and Mongolian authorities have spent millions of dollars subsidising the distribution of 128,000 "clean" stoves in the last year and attempting to step up the production of clean fuels.

Galimbyek Khaltai, deputy head of the city's air pollution agency, says PM2.5 levels have already fallen by around 25% since the programme began. Other experts believe it is too early to judge its effectiveness because the monitoring network is not rigorous enough and unusually high levels of wind and snow last year are likely to have affected data.

Jugder Batmunkh is one of the keenest advocates of the stove replacement project. The 63-year-old is raising her grandchildren in a ger district to the north of the capital; last year she developed asthma, which her doctor blamed on pollution.

Disposing of the ashes from gers is easier and cleaner with the new model. When you take the cover off, the ger does not fill with smoke as it tended to do before. But the biggest advantage for her is its efficiency: it uses just half as much coal. Her family burn through just one bag a day now, saving themselves perhaps 45,000 tugriks (£16) a month – in an area where the average income is around 600,000 tugriks.

Most of her neighbours in Bhayan Khoshuu have bought the appliances, but not all are so enthusiastic. Some have heard rumours that the new stoves might explode; others are unimpressed by their performance.

Twenty-two-year-old Nadmid Rentsenosor's recent purchase is standing idle. "It takes too long to heat up, so it warms the place much more slowly – we are still using the old one instead," she said.

The city is launching a two-month campaign to show people how to use the stoves and minimise emissions. But even if officials can persuade everyone to adapt, the resulting fall in pollution will be vulnerable to fresh shifts in Ulan Bator's development. As its economy grows, construction projects are under way around the city, churning up dust, and more vehicles sit in traffic jams on the streets. The city's population continues to swell and another bitter winter could bring a fresh surge of migrants to the ger districts; many of the current residents moved to the capital from desperation when their livestock died in extreme weather conditions.

"Clean stoves reduce air pollution, but that's a short-term project. Our long-term project has to be to build affordable apartments," said Galimbyek of the air pollution agency.

The scale of demand is daunting and the quality of new buildings will be as important as the quality. Much of the city's housing dates from the Soviet era: it lacks double glazing and in many cases has just 5mm of basic polystyrene insulation on the concrete walls, said Graham McDarby of Gradon Architecture, a British firm now working on flats in the city. Raising current building standards to European levels could dramatically improve energy efficiency. "If you've got quality insulation and it's air-tight, the family in there will generate enough heat," he said.

The country also has its first wind farm, not far from the capital. There are ambitious plans for a new subway system, which should help cut traffic pollution.

But the ultimate problem, said Galimbyek, was that there were simply too many people in the capital: its size has tripled since 1979 and it has over a third of the country's population. It is where all the universities are located, and much of Mongolia's employment. To make Ulan Bator a healthier place, he believes, it has to stop mushrooming, which means that rural areas have to be developed instead. That might sound like a radical prescription, but drastic changes are needed. "For years we thought the effects of air pollution fell on a straight line: if you reduced it by 10 units, it didn't matter whether you were at the higher or lower end. What we seem to be learning more recently is that it is a curve, not a straight line, and actually you get the biggest bang for your buck in lower [pollution] conditions," said Allen.

"In a city like Ulan Bator you would actually need to have quite a dramatic reduction in air pollution before you started to see really good improvements in public health."

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