Residents of New Delhi are no longer willing to remain silent about the harsh environmental reality in which they’ve been living for years as pollution has reached such dangerous levels that just inhaling can be compared to smoking 50 cigarettes a day. Doctors warn: “We are in a state of emergency, we are shortening our lives.”

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Residents of India’s capital are suffocating as pollution hit a dangerous level and doctors are warning that everyone is now at risk. As of yesterday (Tuesday), the air quality index in New Delhi reached 451- the “severe” level; according to the Central Pollution Control Board, any reading over 100 is considered “unhealthy”. This means that all 18 million people living in New Delhi will be affected by dangerous pollutants that lodge in the lungs. Some parts of New Delhi even passed the maximum level of poor air quality.

According to Dr. Arvind Kumar, Sir Ganga Ram Hospital’s chairman for chest surgery, New Delhi’s air quality levels equal to smoking 50 cigarettes a day. “We are in a state of emergency,” he said. “Schools should be shut, we need to bring these levels down. We are shortening our lives.”

Doctors with the Indian Medical Association have recommended that the city cancel its upcoming half marathon, scheduled for November 19, to protect the participants from inhaling dangerous pollutants.

As winter approaches, New Delhi’s air quality becomes an even bigger threat, as the cold air traps the dangerous polluting particles closer to the ground and prevents them from scattering into the atmosphere. The fireworks from the Diwali celebrations only make things worse, adding to the pollutants already being released by diesel engines, coal-fired power plants and toxic emissions from various industries in the city.

Residents of New Delhi are calling on the government and society to work to protect the environment; on Tuesday, the #Smog hashtag was the most active topic in New Delhi’s Twittersphere.

In 2014, the World Health Organization defined New Delhi as the most polluted city in the world. A report published in the Lancet medical journal last month claimed that pollution killed 2.5 million people across India in 2015.