How Australia’s Wildfires Have Impacted Children’s Health

A four-year-old boy who needs medication twice a day to help him breathe. A young girl with troubling mobility issues who has difficulty balancing. Babies born underweight, early and unwell.

More than three years after one of Australia’s worst wildfire seasons on record, its toxic legacy is becoming clearer—and exposing the potential health risks that lie ahead for increasingly fire-prone regions from America and Europe to Asia and Africa.

The Black Summer fires raged across eastern Australia for months, killing 33 people and spewing out smoke that contributed to another estimated 429 deaths. Between July 2019 and March 2020, blazes consumed 24 million hectares of land—an area roughly equivalent to half of California—ravaging forests, cars, metals, plastics and thousands of buildings.

Millions of Australians breathed in the particles.

Interviews with more than a dozen medical professionals, researchers and climate experts, as well as mothers who were pregnant or had very young children at the time of the fires, point to a lasting health burden. The children’s ongoing symptoms, their families say, all followed weeks of exposure to bushfire smoke either before birth or during their early months of life. According to the parents, some of the babies were born prematurely with blackened placentas.

Academic studies in Australia and the US indicate that wildfire smoke can lead to premature labor, low birth weight, impaired lung development and higher use by children of some prescription drugs. And researchers are racing to find out more.

The World Health Organization is poised to release a landmark report on the health impacts of wildfire smoke in the coming months. It will include advice for communities on reducing its effects, according to Stanford University’s Mary Prunicki, who worked on the report. Mother and Child 2020—a major Australian project surveying almost 1,000 families who lived through Black Summer—is investigating the possible long-term health risks for children.

Wildfire smoke is just one part of a global air pollution problem that contributes to 7 million early deaths a year, according to the WHO. The dirty brew of poisonous gasses and airborne particles tiny enough to enter the bloodstream is a known risk factor in heart failure and lung disease, and can lead to speech impairment and muscle weakness. So far, wildfire smoke remains less well-studied than urban air quality.

However, meteorologists warn that wildfires will become more frequent and destructive as temperatures rise. The financial burden has already become too big to ignore: As much as $36 billion a year in the US alone. Long-term health problems will only add to that bill, weighing on health care providers and economic productivity.

An El Nino climate pattern looks increasingly likely to return this year, bringing hotter weather to what is already the driest inhabited continent on Earth. But Australia’s wildfire problems are far from unique. California is bracing for a delayed but dangerous fire season, while this month’s Canadian wildfires have shut down oil wells and gas pipelines and forced tens of thousands of residents to evacuate.

Rebecca McGowan is the lead doctor at a primary care clinic overseeing 25,000 patients in Albury, a regional city more than three hours’ drive from Melbourne that was badly affected by Black Summer smoke.

“What was alarming to me is that I was looking after women at birth who were delivering preterm babies who were small, babies that had diseased placentas,” McGowan said. She’s seen many newborns and young children with respiratory issues at her practice.

Since the fires, McGowan has become an outspoken advocate for more research into the long-term impact of smoke exposure on pregnant mothers and on very young children.

“At the height of the Black Summer, walking around Sydney would be equivalent to smoking 37 cigarettes in one day,” she said. “Closer to the fires it would be more than that.” While a firm link between the smoke and various longer-term health impacts remains unproven, “we can extrapolate a little bit. We are not just flying blind.”

“We can definitely say the climate emergency is impacting the next generation,” she said. “What else do we need for people to pull the finger out and take this urgently?”

In some places, the Black Summer blazes raged all the way to the coast, forcing residents onto the sandy shorelines to wait for help.

A four-hour drive south of Sydney near the village of Nelligen, Casey Douglas, 32, said Black Summer smoke kicked off a spiral of ill health for her son Colt, who was a year old at the time of the fires. He wheezes, struggles with his speech and fine motor skills, and is missing developmental milestones, Douglas said. Now age four, Colt needs breathing medication morning and night.

“He’s been the sickly kid in the family ever since,” Douglas said, adding that medical professionals have been hesitant to draw any associations between Colt’s health and the smoke. “No one’s quick to link anything to the fires here,” she said. “But I know in my heart that the breathing issues happened straight after the fires, if not during.”

The family evacuated from their property to nearby Batemans Bay in December 2019, but the air in the town soon became so thick with soot that Colt’s tears left lines of ash down his face. When the toddler’s breathing became dangerously labored, a local doctor prescribed Ventolin (salbutamol), a medication used to improve breathing by relaxing muscles in the airway. Colt hasn’t stopped using the drug since, Douglas said.

She was three months pregnant at the time with her third child. Laura was born “small and skinny,” Douglas said. Her doctor told her the placenta wasn’t as healthy as Colt’s, leaving Douglas questioning whether smoke inhalation was to blame. Now almost three years old, Laura also used Ventolin last year after playing on the family’s horse-breeding property left her breathless and coughing incessantly, but has otherwise been unaffected so far.

Douglas’ older daughter, Hayley, was five years old at the time of the fires and has so far avoided the breathing issues her brother has faced.

Bushfire smoke contains hundreds of substances including tiny aerosolized particles, carcinogens and harmful gasses like nitrogen dioxide and carbon monoxide, said Fay Johnston, a professor of environmental health at the University of Tasmania, Australia. She is one of the world’s leading air-quality experts and has spent two decades studying the consequences of exposure to pollution.

Breathing in this mixture “will activate your stress responses and your immune responses,” Johnston said, which produces effects such as increased levels of the stress hormone cortisol, higher blood glucose or greater strain on the cardiovascular system.

“These are all tiny changes designed to look after you in the face of a threat. But in their own right, they’re what’s responsible for most of the health effects we see in large-scale population health studies,” Johnston said.

Limited data means doctors are often hesitant to draw direct links between wildfire smoke and health outcomes. But these factors can contribute to a wide range of illnesses depending on an individual’s predisposition, she added.

The longer the exposure to wildfire smoke, the more grave the consequences can be.

“Anything more than two or three days, you’ve got to start taking very seriously,” Johnston said.

“There was no way I could stop it,” she said. “There were no air purifiers and things like that you can get now, thanks to Covid.”

Condon, who lives about three hours northeast of Melbourne in the small town of Tangambalanga, gave birth to her daughter Charli in April 2020. Her postpartum report described the placenta as “gritty”—a quality that has been linked to smoking during pregnancy, yet Condon has never smoked.

A gritty texture is a sign of calcification, which can be associated with preterm birth, low birth weight and even stillbirth. A healthy placenta should be soft and spongy, doctors told Bloomberg Green.

Charli, now three years old, had trouble breathing initially after birth. She soon stabilized, although last winter a doctor prescribed Ventolin for three months as she struggled to get rid of a persistent cough. No doctor asked about Charli’s history at the time, Condon said.

Condon’s sister-in-law, Katie Thompson, 30, remembered smoke filling the entry of Wodonga Hospital the day her son Artie was born in December 2019. Artie had difficulty breathing straight after birth and was put on a continuous positive airway pressure machine to improve air supply to his lungs.

“If there wasn’t a fire, would that have happened?” Thompson said. She asked at her baby’s six-week checkup whether respiratory issues might resurface, but said doctors told her not to worry.

Now age three, Artie struggles with thunderstorm asthma, Thompson said. The condition is triggered by high pollen levels combined with stormy weather and can be fatal. The causes are not fully understood, but moisture in the air during a thunderstorm can swell pollen grains that then burst, generating tiny fragments of pollen. Even cold mornings can trigger a “wheezy” cough for Artie, according to Thompson, and he also used Ventolin after a bad cold last year.

When he contracted Covid in June last year, Artie was much more unwell than family members without underlying health conditions, Thompson said. “He was on the floor, out of it,” she said. “When he gets sick, he gets really, really sick.”

Obstetricians working over Black Summer told Bloomberg Green they delivered babies in smoke-filled medical theaters. They saw blackened placentas, an unusual number of preterm births and worse.

“There were three stillbirths in a place that has approximately 300 births a year,” said Michael Holland, an obstetrician and gynecologist of 20 years in Moruya, a small town about half an hour south of Nelligen. Australia’s overall stillbirth rate is fewer than eight per 1,000.

“To have three stillbirths at term, which is a very uncommon procedure, is either a very bad coincidence or it’s related to something,” said Holland, who is now a member of state parliament, and the government’s parliamentary secretary for health.

Australian Medical Association president Steve Robson saw many babies born small and with breathing difficulties during the fires. He said many clinicians are cautious about directly linking wildfire smoke to health problems.

“A lot of people don’t understand the science around bushfire smoke and it really has only matured in the last year or two,” Robson said.

He has grown more convinced of a link in the years since Black Summer.

“I’m becoming increasingly confident, looking at the data,” he said. “We know that these particles seem to cause inflammation in the placenta and affect the way nutrients are transferred from mother to baby.”

“It seems to be having a measurable effect on the way babies are formed,” he said. “Every bit of information we get really tells the same story.”

The fire at the Hazelwood mine burned for more than six weeks, blanketing the surrounding area in smoke. Researchers including the University of Tasmania’s Johnston found that children who were exposed to the fumes in utero had a higher-than-average uptake of steroids to treat asthma and croup during their first two years of life. Toddlers younger than two years old who breathed in the smoke were more likely to need antibiotics in the two years after the fire, and skin cream prescriptions to treat eczema in the second year after it. They also visited the doctor more often.

Meanwhile, airborne particles from wildfires inhaled during pregnancy were a factor in 14% of preterm births and 8% of low-weight births in New South Wales between 2016 and 2019, according to a study of more than 330,000 deliveries by Monash University in Melbourne.

“It just tips a few more kids into that very low birth weight category,” Johnston said. “With that low birth weight category comes risk for all sorts of other diseases as you go through life.”

Globally, premature birth is the leading cause of death in children under the age of five, according to the WHO.

Research in California linked wildfire smoke to reduced birth weights, while a separate study in Colorado of more than half a million births found greater instances of diabetes and hypertension in smoke-exposed pregnant women.

The body of evidence keeps growing.

A study by the University of California at Merced last year said the impact of wildfire smoke on pregnancy is likely to be similar to that of air pollution—stillbirths, premature births, birth defects, restricted fetal growth and a range of other complications. More investigation was warranted, the study said. Another recent US study using satellite imagery to look at smoke exposure puts the research on a new footing, AMA president Robson said, describing the findings as “really concerning.”

“Particles from burnt wood seem to have a profound pro-inflammatory effect on airways,” he added. Children and babies “have small airways, they have an increased respiratory rate and it seems to promote the small, very toxic particles lodging in babies’ airways.”

The Australian government acknowledged in a guidance note in 2021 that exposure in utero to air pollution is one of many factors that could impact a child’s development. However it noted that not all studies found a link between pollution and later developmental changes.

“Those that have were mostly conducted in situations where air pollution was very severe or persisting, and the outcomes identified were usually small and not likely to be of importance to the ongoing health of the child,” the note said.

Still, United Nations Environment Program Chief Scientist Andrea Hinwood classified wildfire smoke as a major health threat, and said even nations that aren’t accustomed to them will have to find ways to cope.

“There are potentially long-term consequences for the health of our children,” Hinwood said. “We need to make sure we protect them.”

“We aren’t doing the planning and prevention bit.”

Children who are repeatedly exposed to smoke over a number of years may be at greater risk, said Sotiris Vardoulakis, a professor of global environmental health at the Australian National University who is also advising the Mother and Child 2020 project.

That’s in keeping with one of the biggest US studies into the long-term effects of air pollution on children. The Children’s Health Study, which began in 1992 and enrolled more than 5,000 school kids in California, found more than a decade later that those who breathed in more tiny particulate matter, nitrogen dioxide, acid vapor and elemental carbon—much the same as wildfire smoke—had significantly lower lung function at age 18.

The damage, the report concluded, was “unlikely to be reversed.”

Even as these locations grab headlines, fires are hitting regions like Southeast Asia and sub-Saharan Africa—places where the population skews younger, and which can least afford to carry the economic and social burden of widespread long-term ill health.

The world is almost certain to experience its warmest year on record by 2027, the World Meteorological Organization, a specialized UN agency, said this week.

The precise longer-term effects of wildfire smoke inhalation are still not well understood. But as research in this field accumulates, so does the list of worrying health findings. And catastrophes like Black Summer are dramatically more likely to occur in the coming decades because of climate change, according to the UN Environment Programme.

“We are destined to repeat” these events, said McGowan, the doctor in Albury. “It’s the definition of stupidity.”

“It just goes on and on,” Spears said. “It’s usually more questions than answers.”

Spears traced Mia’s struggles to a five-week period in early 2020, when she was in the first trimester of her pregnancy and the sky over Tura Beach was a haze of black smoke and fluttering burnt gum leaves. Spears and her children evacuated to Canberra, but when they found the air in the Australian capital was even worse, the family returned home.

At her 29-week pregnancy check in May 2020, Spears said a midwife told her that her child would arrive early because of smoke exposure, and that women in the area were giving birth to sickly babies. That evening, Spears sent an email to the New South Wales state inquiry into the blazes. She said she had been told there were four newborns receiving special care at the local hospital, a higher number than ever before.

“Please help us and our babies, so this never happens again,” she wrote.

Spears was induced a week early after Mia’s growth plateaued. According to the midwives, her placenta was partly calcified and blackened—as if Spears was a heavy smoker, despite never having been one.

Spears said Mia didn’t crawl until after her first birthday and struggles to climb; she was late to eat solid food and has hip dysplasia, the medical term for a hip socket that doesn’t fully cover the ball portion of the upper thigh bone. She is undergoing tests for cerebral palsy. Smoking cigarettes during pregnancy can increase a baby’s risk of being born with the disorder, which affects a person’s ability to move, maintain balance and posture.

Spears said doctors were reluctant to directly connect Mia’s health problems with wildfire smoke. “They didn’t want to be seen as the person who correlated one thing to the other,” Spears said. “But no one’s said it’s not that, either.”

She added that authorities should have told her more about the risks posed by wildfire smoke when she was pregnant. “If we can’t look after our babies and our children, what’s the point?”

In the wake of Black Summer, policy makers are grappling with the immediate risks of wildfires. A government inquiry known as a Royal Commission in October 2020 called for nationally consistent air quality information, health advice and interventions.

This month, the government allocated more than A$10 million to improve communications systems for emergency workers during crises, and a further A$8.6 million to stockpile supplies like shelters and water purifiers.

In an emailed response to questions from Bloomberg Green, the Australian federal government said its scientific research agency and the Bureau of Meteorology are working on a prototype smoke-forecasting system, while all jurisdictions had agreed on a “nationally consistent framework for public air quality information and health advice.” It said it has stepped up community education and guidance.

The government added that the National Emergency Management Agency has funded grants to support Indigenous fire-management research and practices, as recommended by the inquiry, including A$19 million through the Black Summer Bushfire Recovery Grants Program.

NEMA is due to publish a report in coming weeks on progress since the 2020 Royal Commission.

David Templeman, who was director-general of the government body Emergency Management Australia from 2000 to 2006 and is now a member of the lobby group Emergency Leaders on Climate Action, said there has been “minimal progress” on air quality issues raised in the Royal Commission and the subsequent Senate committee hearing.

Air quality information can be “quite technical,” he said. “What is the national education plan around this?”

Progress on the use of Indigenous fire and land management techniques has been almost non-existent, according to Victor Steffensen from Firesticks, an organization that promotes and provides training in traditional burning methods.

Scientists say the few million dollars the government allocated to studying the physiological impact of prolonged bushfire smoke is inadequate. One of the key studies in Australia aiming to determine the longer-term impact of wildfire smoke on children, Mother and Child 2020, said it will run out of money this year after failing to secure government funding.

McGowan, the doctor, and Johnston, the academic, said a range of practical measures would help families in bushfire-prone areas. Their suggestions—more granular than those in the government inquiry—include a ready supply of masks and Ventolin, subsidized air purifiers, community centers with filtered air systems and safe evacuation locations for at-risk groups. Such resources need money and planning.

The federal government referred questions about the provision of equipment such as masks and air purifiers to state and territory authorities. Representatives for the New South Wales government didn’t respond to requests for comment by deadline. The Victorian government said it runs regular safety campaigns and is “always willing to consider how we can better support the community.” The Australian Capital Territory said its strategy to manage the impact of wildfire smoke includes setting up community refuges with air filters and making buildings more resilient to smoke. The approach aims to “inform, protect and educate,” a spokesman said.

Condon and Thompson argued that pregnant women and young children should be prioritized during fires, with measures such as evacuation places with filtered air and readily available masks. Douglas suggested an information booklet for mothers in rural areas, with guidance on what to pack in a bushfire “go bag,” or survival kit.

“I would love to know that when the next significant fire comes, which is probably pretty soon, that we learned something from the last one,” Condon said.