9-year-old Ella Kissi-Debrah is now the first person in the UK to have air pollution listed as a cause of death. Philip Barlow, the inner south London coroner, made this legal history.

He said, "Ella Kissi-Debrah’s death in February 2013 was caused by acute respiratory failure, severe asthma and air pollution exposure."

Ella Kissi-Debrah lived 25m (82ft) from the busy South Circular Road in Lewisham, south London. The nine-year-old had suffered numerous seizures – making 27 visits to the hospital with breathing problems in the three years before her death.

A first Inquest, in 2014, ruled that Ella died of acute respiratory failure caused by severe asthma. This was quashed in 2019 and a new Inquest ordered after new evidence into the risks of air pollution was revealed in a 2018 report by leading expert Professor Sir Stephen Holgate. 

The coroner further said she had been exposed to "excessive" levels of air pollution. Levels of nitrogen dioxide (NO2) near Ella's home exceeded World Health Organizations' guidelines, Mr. Barlow said.

He added, "there was a recognized failure to reduce the levels of nitrogen dioxide, which possibly contributed to her death. There was also a lack of information given to Ella's mother that possibly contributed to her death."

He said that during Ella’s life, nitrogen dioxide emissions in Lewisham, where Ella lived, exceeded legal limits, both EU and national levels. Particulate matter levels were above the WHO guidelines, he said.

The coroner said the health effects of air pollution had been known for many years and children and those with asthma were particularly at risk. He found that air pollution both induced and exacerbated Ella’s particular form of severe asthma.

According to a report in 2018 by Prof Sir Stephen Holgate, unlawful levels of pollution were detected at a monitoring station one mile from Ella's home, which contributed to her fatal asthma attack. Prof Sir Stephen Holgate said Ella had been "living on a knife-edge" in the months before her death. The inquest heard Ella's family did not know of the risks posed by air pollution.