Sofia is one of the most polluted cities in Europe. It constantly breaches both World Health Organisation (WHO) and European Union (EU) air quality safety levels, increasing the risk of heart disease, lung cancer, respiratory diseases and stroke.


Dr. Alexander Simidchiev is a pulmonologist who for more than three decades has dedicated himself to the cause of lung health. His main interests are related to the prevention and epidemiology of major pulmonary diseases and the impact of air pollution as a preventable cause for human disease.

Measurements of particulates exceed the World Health Organization’s (WHO) safety limits for 97.2% of Bulgaria’s the population.

With the third highest mortality rate (per 100.000 population)1 from air pollution in the world, after North Korea, and Bosnia and Herzegovina, WHO estimates that poor air quality costs the equivalent of 29.5% of the country’s GDP2 through reduced productivity and the costs to the country’s health services.

Bulgaria’s main sources of PM10, and fine particle pollution PM2.5 (particles 2.5 microns or smaller) are household burning of fossil fuels or biomass, and transport. Production of electricity by burning of coal in thermal power plants and other industrial processes are a major contributor to unhealthy air. Coal plants are responsible for almost all of the country’s sulfur-dioxide and the majority of nitrogen-oxides emissions, causing smog and acid rain.

In 2017, Bulgaria was the first country to be sentenced by the EU Court of Justice to take action to improve air, and the country is still facing potential high fines. The country is also out of step with EU goals to reduce greenhouse gas emissions. In 2017, Bulgaria ranked third in the EU in growth of carbon dioxide emissions. Today, health practitioners are coming together to raise the importance of safe, clean air for their patients and the climate.

City Stories

Silvia Velikova - Bulgarian National radio, mother of 4 children.

We need to stop taking clean air for granted because we don’t actually know what i’ts like to breathe pure and clean air. Clean air is something we need to cherish, and we have to make an effort to ensure its quality and healthiness. We have to do this not only for us, but also and especially for our children, and the future generations.

Dr. Alexander Simidchiev – University Hospital Lozenets in Sofia

Dr. Alexander Simidchiev is a pulmonologist who for more than three decades has dedicated himself to the cause of lung health. He is one of the leading experts in pulmonary function diagnostics in Bulgaria. Having specialized in Essen-Germany and Paris-France, he is one of the first East European members of the European Respiratory Society since its founding in 1991. His main interests are related to the study of pulmonary function, the prevention and epidemiology of major pulmonary diseases and the impact of air pollution as a preventable cause for human disease. Dr. Simidchiev has over 60 publications, including a Cochrane review and a medical invention. Currently he is Chairman of the Executive Board of the Association Air for Health, working to make the vision of his children and grandchildren breathing  cleaner air come true.

Dr. Rada Markova - First Children's Advisory Clinic in Sofia

Dr. Rada Markova graduated medical school with the «Golden Hippocrates» (summa cum laude). In 2004 she acquired a degree in childhood diseases and in 2011 she additionally qualified as a specialist in childhood lung disease. She has specialized in the USA and Austria. Since the beginning of her career, Dr. Rada Markova has worked as a pediatrician at University Children’s Clinics, where she has been consecutively a resident, registrar, assistant professor and lead assistant professor. In September 2012 Dr. Rada Markova became one of the founders and medical director of First Children’s Advisory Clinic in Sofia. In October 2016, Dr. Rada Markova defended her PhD. Her Scientific Interests include chronic lung disease in childhood and environmental factors contributing to lifelong lung health.

Academic Professor Dr. Bogdan Petrunov – The National Centre of Infectious and Parasitic Diseases (NCIPD)

Academic Professor Dr. Bogdan Petrunov is a full member of the Bulgarian Academy of Sciences and one of the leading authorities in the field of immunology and allergology in Bulgaria. He is the founder of the first allergy laboratory in Bulgaria to develop specific diagnostics and immunotherapeutics for the diagnosis and treatment of allergic diseases. His main scientific interests are related to the study of allergenic factors and the influence of air pollution on immunological reactivity. Acad. Petrunov has published more than 225 scientific papers, many of which (over 85) in the most prestigious international journals and has participated in the writing of 14 monographs. Chairman of the Bulgarian Society of Allergology, Member of the Management Board of the International Bulgarian-Japanese Research Foundation «Hasumi». Since 2007 he has served as a representative of Bulgaria in the European Medical Scientific Council of the European Commission.

Valentin Petkov - Orlov Most

Valentin Petkov is a fitness guru and multiple times European and world champion of bodybuilding. Along with his impressive competitive career, he is also a sculptor who sculpts bodies and characters. Initially he graduated Philosophy at Sofia University and in 2008 he further graduated Sport, Fitness and Health at the National Sports Academy. «What excites and motivates me is to work with people to achieve overall transformation that a person can experience. I mean not only the visible change of the body from an aesthetic point of view. If a sculptor changes a piece of granite and turns it into a sculpture, for example, I can not change anything in my work if the person in front of me does not want to change. The air inspires and develops all that I work for, and as an active cyclist I take care to minimize pollution so that it allows me to achieve high physical results without harming my body.

Anna Borisova - The National Palace of Culture

Me and my family, we live in the suburbs. The neighborhood mainly consists of houses. In the winter, most of the households heat with coal and wood. My 4-year old son is suffering from bronchial asthma. There are windless days every winter. During those days the air becomes so full of smoke, we can hardly go outside our house. Due to the poor air quality my son’s asthma gets worse and his attacks increase. Most of our family friends with children have to always keep a nebulizer at home – it is so obvious that respiratory tract diseases are the most common diseases among small children and babies.   In my opinion the problem could be easily solved. The municipalities in some regions like ours could financially stimulate households to use more effective and more eco-friendly heating systems. In my household for example, we use pellets which make no smoke and have less negative effects on the air quality. The traffic is also a huge problem even in our far-from-the-city area. Most of the cars are more than 20-years old with no catalytic converters. That is also a great part of the pollution source. We are all dreaming to live a healthy life and to see our children grow healthy and happy – and it would be such an easy and yet big step for the authorities to help us create and breathe better air.  

Ivan Mihailov - Sofia Thermal Power Plant

A patient with bronchial asthma. The poor air quality makes his asthma worse, which puts him at higher risk of an asthma attack and lead him to the choice to become one of the cofounders of Air for Health Association.
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I want clean air in my city to protect our health and our climate.

Health and medical experts are becoming increasingly concerned about air pollution. We have continuously spoken out about the enormous health risks of poor air quality. As health professionals, we are key in leading the evidence-based actions on clean air for better public health.

We invite doctors; nurses; public health practitioners; allied healthcare professionals; concerned patients, and citizens to join the Unmask My City initiative in Bulgaria; and become involved in policy deliberations for more health-protective air quality standards at national level.

Contact us and indicate how you can get actively engaged in the Clean Air debate. Together, we can demand clean air for better health in Sofia, and in Bulgaria.
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Photos: Milena Kotzeva [1] [2]