ELLA'S LIFE
AND HER LEGACY
““My daughter Ella was a playful, happy child growing up in South East London. Healthy at birth, with a lust for life, she didn’t develop asthma until just before her seventh birthday. A few weeks after her ninth birthday, she suffered a fatal asthma attack. Ella is the first person in the world to have air pollution listed as a cause of death on her death certificate. ””
Rosamund Adoo Kissi Debrah
THIS IS HER STORY
THE EARLY YEARS
Ella was born in 2004 in Lewisham Hospital, South East London. At 8lbs, she was a healthy baby girl. Energetic and fun-loving, she grew up in London with a keen interest in sport, especially enjoying time she spent in the swimming pool. She started ‘Little Kickers’ at Millwall FC when she was just two, and by four she had graduated to gymnastics.
Ella also loved books, and had a reading age well beyond her years. Her creativity and love of music meant she spent many happy hours playing different instruments and making up songs - often taking a starring role in shows put on by Jigsaw Performing Arts, the local drama and dance school. Her big dream, however, was to be an air ambulance doctor and to rescue people from tricky spots, something she was inspired to be after seeing the Red Arrows fly by.
EVERYTHING CHANGES WHEN ILLNESS BEGINS…
Three months before her seventh birthday, Ella developed a chest infection that turned into a persistent cough. It sounded a lot like whooping cough but a doctor diagnosed her with asthma. Rosamund, her mum, didn’t initially worry at the mention of this common childhood complaint - 5.4 million people in the UK are asthmatic, 1.1 million of them children - and life continued as normal.
Now in Year 2, Ella was continuing to enjoy her busy and fun-packed life. She easily made friends at school, and felt secure at home, cared for by a loving mother and revelling in the attention and adoration of her younger twin siblings.
That changed when, soon after the asthma diagnosis, Ella coughed so much she blacked out; she had suffered a ‘coughing syncope’ caused by lack of oxygen to the brain. Fortunately a neighbour with first aid skills was on hand to resuscitate her. She was admitted into hospital and released the following day, but a week later it happened again. This time she was put in a medically induced coma and woke up three days later. She went from being a happy, healthy child to being disabled by asthma.
The next two years were filled with a barrage of tests to find out what was causing Ella’s ill health. These examinations ranged from sleep and bacterial studies, to tests for everything from epilepsy to cystic fibrosis. They only revealed she was atopic (sensitive to allergens) but couldn’t ascertain the cause of her asthma.
In 2012 she was put in the care of Dr Colin Wallace, a respiratory consultant at Great Ormond Street Hospital, and was well enough to enjoy a summer full of activities and fun, which included the 2012 London Olympics. However, the coughing returned in September and Ella was in and out of hospital.
A life cut short. On 15th February 2013, just three weeks after her ninth birthday, Ella died of a fatal asthma attack.
She had over 30 emergency hospital admissions between the first diagnosis of asthma and her death, just over two years later. Throughout her short life and illness, there had been no mention of air pollution being a possible factor in relation to her illness.
On Ella’s original death certificate it said she died of acute respiratory failure. At no point in her illness did any medical professional mention that air pollution could be an asthma trigger, alongside traditional triggers such as pollen or the weather.
ELLA’S
LEGACY
THE FOUNDATION
Rosamund was determined that some good should result from her daughter’s premature death, but didn’t know where to start. It was Ella’s consultant, Dr Wallace, who first suggested to Rosamund that a Foundation may be a fitting way to commemorate Ella and improve the lives of children with asthma in South East London. The Ella Roberta Foundation was launched at Ella’s primary school on what would have been Ella’s tenth birthday.
POLLUTION MATTERS
It was then that Rosamund began to realise there may be a link between her daughter’s death and air pollution. A local resident contacted her after a piece was published in the local paper, and suggested she should; “have a look at the air pollution levels on the night Ella died”. Rosamund did some research and discovered that the heavily congested South Circular, near where they lived, had illegal levels of nitrogen dioxide caused by traffic.
At the same time Professor Sir Stephen Holgate, a consultant respiratory physician at the University of Southampton, was examining Ella’s medical papers and coming to a similar conclusion. He reported that in his opinion the severity of her asthma, and also her death, were linked to the high levels of air pollution in the area where she lived.
A NEW INQUEST
The impact of air pollution had never been previously considered by medics caring for Ella and was not looked into at the inquest into her death, so Rosamund decided to seek legal advice. She started to work with Jocelyn Cockburn, a human rights lawyer, soon afterwards.
Because of the new evidence that cast doubt on Ella’s cause of death, in January 2019 the Attorney General, Geoffrey Cox QC MP gave his consent for the family to apply to the High Court for a fresh inquest into Ella’s death. Rosamund subsequently applied to the High Court to quash the findings of the first inquest and a second inquest was granted.
The new inquest, in December 2020, looked at the role air pollution played in her death. It examined what government departments, local authorities and the then Mayor of London had done to reduce illegal levels of air pollution where Ella lived. It became apparent that throughout Ella’s life, nitrogen dioxide emissions in Lewisham exceeded both EU and national levels and particulate matter levels were above the World Health Organisation (WHO) guidelines.
THE FINDINGS
At the end of a nine day inquest the Coroner, Philip Barlow, concluded:
“Air pollution was a significant contributory factor to both the induction and exacerbations of her asthma. During the course of her illness between 2010 and 2013 she was exposed to levels of nitrogen dioxide (N02) and particulate matter in excess of World Health Organisation Guidelines. The principal source of her exposure was traffic emissions. During this period there was a recognised 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.”
His conclusion was: “Ella died of asthma contributed to by exposure to excessive air pollution”.
His narrative findings included that “excess levels of nitrogen dioxide and particulate matter, PM10 and PM2.5, were a health risk especially to children with asthma” and that “the health impacts of air pollution have been acknowledged for many years .”
The case made legal history by ruling that air pollution was one of the causes of the nine-year-old’s death.
PREVENTION OF
FUTURE DEATHS
Occasionally, the evidence from an inquest will show that there is a risk that future deaths could occur and in these cases the Coroner must publish a Prevention of Future Deaths Report (PFD) so these risks can be addressed by those responsible. This happened in Ella’s case and in April 2021, the coroner reported three concerns which pose an ongoing risk to life:
1. National air pollution limits for particulate matter are set at a far higher level than World Health Organisation (WHO) guidelines. The WHO guidelines should be seen as the minimum requirements. Legally binding targets based on these levels would reduce the number of deaths.
2. There is low public awareness about air pollution. Greater awareness would help people reduce their exposure to air pollution. The issue needs to be available at a national as well as a local government level including increasing capacity to monitor air quality.
3. Patients are not being advised about the impact of air pollution on health and this needs to be addressed in medical and nursing training and education at undergraduate, postgraduate and professional guidelines levels.
The Coroner’s PFD provides powerful leverage for change. He has put the Government, and all of us, on notice that a failure to reduce air pollution to safe levels and increase understanding of the health risks posed by air pollution will cost lives.
For more on how what we do relates to the Coroner’s report, please visit: