On 16 December 2020, HM Assistant Coroner for Inner South London, Philip Barlow, concluded that “air pollution exposure” was a contributory cause of nine-year-old Ella Adoo Kissi-Debrah’s death in 2013. This is the first time that a coroner has recorded air pollution exposure as a cause of death, and is thought to be the first time that air pollution has been listed as a medical cause on a death certificate anywhere in the world.


Ella Adoo Kissi-Debrah suffered from severe asthma from a young age. She died on 15 February 2013. An initial inquest in 2014 concluded that Ella had died from acute respiratory failure caused by severe asthma. In 2019, research by Professor Stephen Holgate, a professor of immunopharmacology and consultant respiratory physician, suggested that air pollution had contributed her death. On the basis of that new evidence, the High Court quashed the conclusion of the original investigation and ordered a fresh inquest.

The Assistant Coroner’s Conclusion

Following a two-week inquest, which heard extensive evidence and submissions, Ella’s medical cause of death was formulated as follows on the Record of Inquest:

1a Acute Respiratory Failure

1b Severe Asthma

1c Air Pollution exposure

In Box 3 of the Record of Inquest (how, when, where and in what circumstances Ella came by her death), the Assistant Coroner stated inter alia as follows:

Air Pollution was a significant contributory factor to both the induction and exacerbations of [Ella’s] asthma. During the course of her illness between 2010 and 2013 she was exposed to levels of Nitrogen Dioxide and Particulate Matter in excess of World Health Organization Guidelines. The principal source of her exposure was traffic emissions. During this period there was a recognized failure to reduce the level of NO2 to within the limits set by EU and domestic law which possibly contributed to her death.

Ella’s mother was not given information about the health risks of air pollution and its potential to exacerbate asthma. If she had been given this information she would have taken steps which might have prevented Ella’s death.

The Assistant Coroner is expected to issue a Prevention of Future Deaths report.

The Future

It is likely that this decision will have far-reaching consequences. It comes against a background of long-running litigation in relation to the UK’s breaches of air quality legislation. In R (ClientEarth) v Secretary of State for Environment, Food and Rural Affairs (No.3) [2018] Env LR 21 – the third such case – the Administrative Court reiterated that the government must produce action plans to reduce exposure as quickly as possible.

In short, this case is the first of its kind but is unlikely to be the last.

Patrick Limb KC and Thomas Herbert explored the above issues, and others, in their March 2021 webinar on ‘Clean Air and Tort Law‘. To view the webinar recording, please click here.