Hot, dusty, and unhealthy
Barrak Alahmad, PhD ’22, is studying the health impacts of heat and air pollution in Kuwait
December 30, 2021 – As a child growing up in Kuwait, Barrak Alahmad would sometimes wake up to windows darkened with soot from dust storms. “I used to love it, because it meant that we wouldn’t do our morning exercises that day, and could go straight to the classroom,” he recalled.
It was only after earning a medical degree at the University of Liverpool in the U.K. and practicing medicine as a junior doctor at Al Adan Hospital in Kuwait that he realized the negative health effects such air pollution could cause. “Fine particulate matter can go deep inside the lungs and get into the bloodstream and cause all sort of problems, including systemic inflammation and respiratory and cardiovascular disease,” he said.
He repeatedly saw migrant workers, who were otherwise young and healthy, come into the hospital with acute respiratory problems from working outside. “These are people whose access to health care is not optimal, so they are vulnerable to these exposures,” Alahmad said. “I started to connect the dots and think about why we were seeing these patients.” Now, as a PhD candidate in population health sciences at Harvard T.H. Chan School of Public Health, Alahmad is exploring the health impacts not only of air pollution, but also of extreme heat in his native country—the hottest in the world.
“When you are doing clinical work, you can only treat one patient at a time,” he said. “But with so many exposures in Kuwait that are amplified unlike anywhere else in the world, there are a lot of research questions associated with the health of the population rather than individuals.”
As climate change increases temperatures worldwide, he added, Kuwait can be a bellwether for understanding the effects of heat and pollution more generally. “I’m focused on doing research on Kuwait not only because I am from Kuwait and I care about it,” Alahmad said, “but also because I feel there is a contribution that we as researchers can make to the entire world.”
Killer heat
After earning a master’s degree at Johns Hopkins Bloomberg School of Public Health, Alahmad came to Harvard Chan School in 2018, where he has been working with Petros Koutrakis, professor of environmental sciences and head of the Exposure, Epidemiology and Risk Program. Koutrakis has spent decades conducting comprehensive air pollution studies throughout the world. “Working with my mentors at Harvard has opened up channels for international collaborations with institutions in Europe, the Middle East, and the U.S. that have all contributed to the work I’ve been able to do,” Alahmad said.
For his first study at Harvard Chan School, he explored the health effects of extreme heat in Kuwait, which can reach temperatures of 50 degrees Celsius (122 degrees Fahrenheit) on its hottest days. Alahmad obtained 15 years of historical mortality data from the country’s ministry of health, correlating that with temperature data. He found that on extremely hot days, the death rate doubled compared to days with more moderate temperatures. For foreign migrant workers, the effects were even more drastic—the death rate for non-Kuwaiti males tripled on those days.
“With climate change, those temperatures are projected to increase even more, so the future is not looking very optimistic,” said Alahmad, who is now working on a new study to project how mortality in the country may increase in the future based on different climate-change scenarios. He hopes his findings will inform the overall science around climate change as well as provide impetus for Middle Eastern governments and industry to mitigate the impact of extreme heat by developing warning systems or limiting outdoor exposure on particularly hot days.
Dust collector
In other research, Alahmad is examining the effects of those dust storms that would interrupt his morning exercises when he was a kid. In preliminary investigations, Alahmad found that air quality measurements made by the Kuwaiti environmental protection agency and the U.S. embassy were inaccurate because excessive heat and dust conditions had interfered with monitoring equipment. For a recent study, he used particulate samplers specially designed by Koutrakis to remove larger particles and capture smaller particles—the ones especially dangerous for health—on a special foamy surface that prevents the particles from bouncing off. Alahmad’s research showed that, from October 2017 to October 2019, annual air pollution levels in Kuwait were four times higher than the standard set by the U.S. Environmental Protection Agency, with 44% of particulates in Kuwait City coming from man-made sources and another 38% caused by dust storms. The findings point to the need for tight construction to keep dust from entering homes during storms, as well as a regional approach to mitigate air pollution more generally, including that caused by oil and gas operations in the Middle East.
During the height of the COVID-19 pandemic, Alahmad returned to Kuwait, where he volunteered on COVID-related projects for the ministry of health, including developing mathematical and epidemiological models of coronavirus transmission in the country and examining its disproportionate effect on migrant workers. At the same time, he kept his watch set to Eastern U.S. time—seven hours behind Arabian Standard Time—and worked late into the night to continue collaborating with his Harvard Chan School colleagues.
Now back in Boston, Alahmad hopes that his work can fill in gaps in global data on the health effects of heat and air pollution by shedding light on how those exposures impact Middle Eastern populations. “When we try and estimate the global burden of climate impacts, we can’t just use studies on temperature from hot places in the U.S.,” he said. “Infrastructure is different, access to health care is different, so we’d expect health outcomes to be somewhat different as well.”
“Very few studies have investigated air pollution and heat effects in Arab populations,” noted Koutrakis. “Therefore Barrak’s work is of great importance.” He added, “I’ve had the privilege to advise many bright students, and Barrak is one of the best. It is so important to train talented young researchers from regions that desperately need qualified, dedicated, and hard-working individuals.”
photo: Kent Dayton
