When Dr. Sunkaru Touray, a pulmonologist and co-founder of the Permian Health Lung Institute, visited The Gambia, his homeland in 2018, he expected to treat typical respiratory illnesses of smokers or asthma patients. Instead, he observed a different pattern: young, non-smoking women presenting with severe respiratory symptoms. After ruling out tuberculosis, lung function tests confirmed a mysterious reality. These women were suffering from severe, respiratory impairments with no obvious cause.
Searching for answers, Dr. Touray turned towards air pollution, an important risk factor for lung diseases and other non-communicable diseases that was, at the time, an under-recognized cause of illness and death in the country. From his experience in the United States, investigating seemed straightforward. In the US, a physician can pull up the air quality of a patient’s neighborhood just by knowing their address. However, when attempting to find similar information in The Gambia, he pulled a blank. There was simply no air quality data available.
This lack of infrastructure sparked an odyssey to begin measuring the air himself. “As a doctor, I figured out very quickly that I was not going to be able to make a meaningful impact by addressing this one patient at a time in a consulting room,” Dr. Touray said. He went on to co-found Permian Health.
Supported by the EPIC Air Quality Fund, Permian Health established the country’s first real-time PM2.5 monitoring network with 10 low-cost air quality monitors and a reference-grade air quality monitoring station. This hybrid network provides leaders and the public with real-time air quality data to effectively address the issue and take appropriate actions to mitigate the harmful effects of air pollution.
Mapping the Data and Linking Exposure to Health Impacts
Data collected over the past three years reveals a tough reality: air quality in The Gambia is poor, with particulate pollution concentrations being about seven times the World Health Organization recommended levels. This arises from a mix of environmental factors, such as Sahara dust storms, but also cooking with charcoal, waste burning and vehicle emissions.
The new data has served as a key catalyst for change in The Gambia, leading the National Environment Agency (NEA) to review its existing standards. And, along with installing low-cost sensors throughout the country, Permian Health installed a reference–grade monitor at the NEA headquarters—empowering the government to lead by example. The national monitoring network allows regulators to understand local air quality realities and develop better standards.
“That was a very deliberate decision, because we reckoned that if anyone is going to make meaningful use of that data, it has to be the government regulatory agency. So we were very eager to partner with them, and they were equally keen to receive the instrument and begin identifying gaps in the current regulatory environment in The Gambia,” Dr. Touray says.
A New Era of Clean Air Legislation
The Gambian government is now using the generated data to drive clean air policies. The collaboration between the government and Permian Health has supported the drafting of several legislative efforts.
The first, and most relevant, is the National Environment Management Act (NEMA) 2025: The cornerstone of the new legislative framework updates the over 30-years-old NEMA Act of 1994. It introduces among other things, new provisions on particulate matter and establishes a Committee to set National Environment Quality Standards. While PM2.5 limits have already been validated based on the WHO Air Quality Guidelines, they await for the NEMA bill to come back to the floor for a final vote before it goes to the President to be signed into law.
Along with the NEMA, there are two additional legislative efforts being considered:
- The Gambia Road Transport Bill 2025: A key move to replace colonial-era law from 1948 and address vehicle emissions. This bill has gone through the external validation process and is currently under review, prior to a final version being presented to the executive and the National Assembly.
- The Waste Management Bill 2025, which aims to update regulations and bridge gaps in the existing National Environment Management framework. This bill is currently going through stakeholder review prior to presentation to the National Assembly.
“These three laws at various stages of the legislative process will have an important role to play in Gambia’s effort to address air pollution as they will create the required legal framework to develop and enforce air quality standards with a view to protect public health and the environment,” says Dr. Touray. “Certainly, this data is going to be the foundation for our air quality standards as we expand and maintain the network in the years to come.”
Driving Compliance Through Partnerships
Along with collaborating with the government to bring about policy changes, Permian Health is using the data to improve public understanding of the air pollution challenge to drive individual and collective action. This involves a strategic three-pillar approach: advocacy, clinical services, and medical education. By bringing together a diverse group of stakeholders, ranging from the NEA and the Ministry of Health to community organizations, hospitals, and local advocates, Permian Health is building a coalition to address air pollution at its source. Early results are promising. While individual behavioural changes take time, nearly 300 people now track local air quality data through IQAir.
“A key part of this mission is ‘replicating’ expertise to ensure long-term impact, but you cannot do everything on your own,” says Dr. Touray.
Dr. Touray says that through a memorandum of understanding with the Ministry of Health and partnerships with the University of The Gambia and the School of Nursing, Permian Health is training young nurses and doctors to take insights back to their practice. These efforts focus on the “compelling case” of health impacts, pointing to air pollution as the “equal opportunity threat” that affects all members of society, particularly the most vulnerable and those from lower socio-economic backgrounds.
Institutionally, the Directorate of Public Health Promotion is developing new public health messaging around air pollution, and the Ministry of Health has begun correlating hospitalization data with air quality trends. Additionally, PhD students from the United Kingdom and Switzerland are using the data to fill critical gaps in the understanding of air pollution and health in The Gambia.
Moving towards change
Over the next few months, Permian Health will focus on sustainability and accessibility. A major milestone is the procurement of a second reference-grade monitor, funded by EPIC through the Air Quality Fund. It will be installed at the University of The Gambia to anchor a Clean Air Research Lab, the first of its kind in the country, to serve as a national hub for educating university students on air quality and its health impacts and training future Gambian atmospheric scientists.
Alongside this, Permian Health is launching a nationwide air quality awareness campaign in partnership with the NEA and a 300-household survey to provide the data needed to address waste burning under the upcoming Waste Management Bill. Additionally, EPIC’s network helped Permian Health connect with Carnegie Mellon University. They are now working together on source apportionment studies, which will be indispensable for better understanding the roots of pollution in the country.
“The EPIC Air Quality Fund was a very welcome development for us and a validation of the work that we were doing initially when we started off,” says Dr. Touray. “We actually did the sensor installations and launched the initiative using our own resources. But that recognition and the support that came along with the award from the Fund really propelled our ability to expand and scale at the pace and extent that we were able to progress in such a way that we went from no sensors to nationwide coverage within less than two years. It was a tremendous success that would not have been possible without support from the Fund.”
This story is the second in the EPIC Air Quality Fund Impact series that aims to showcase how the fund supports local governments and organizations in installing air quality monitors, providing open data to communities, and driving national-level impact in countries that could benefit the most. Does your country need a stronger air quality monitoring network? Apply by April 30 (11:59 PM CET) to become an EPIC Air Quality Fund Awardee.