Champa's eyes are surrounded by dark circles and her face is thin and drawn. It began with a fever, pain in her limbs, and she was then diagnosed with Tuberculosis.
"I was diagnosed with TB two years ago now," she said. "I have been on medication but I am not getting any better. I have difficulty breathing and even talking is hard. It has been five-six years, ever since the plant started, our problems have started too."
Champa is one of hundreds of thousands of people in India whose health and lives are being blighted by the country's surge in coal-based electrical power generation.
India today ranks third in the world in the production of carbon dioxide and is burning more coal than ever before, with 66% of power generated by coal fired thermal power plants.
Future plans are for expansion, with the 12th five- year plan ending in 2017 adding 76GW of coal-fired power capacity and with the 13th five-year plan (between 2017-2022) adding another 93GW -- an aggressive industrial response to a growing population, a middle class hungry for modernity, and an energy policy that holds coal powered energy as integral to the development of the country's economy.
According to The Lancet's Global Burden of Diseases Study (December 2012), outdoor air pollution -- from power stations, other industry, transport, and domestic fuel burning for heat and cooking -- is among the top 10 causes of death in India. Regulations do exist in India, but are rarely enforced.
"In India we do have ambient air quality standards," said Sarath Guttikunda, chemical engineer and director at Urban Emissions in New Delhi. "But, we have found these regulations lag behind the numbers that we have seen in Europe, United States and even in China, and there is a lot of room for improvement."
In the first ever report focusing on the health impacts of the coal industry in India, scientists estimate that in 2011-2012, air pollution from coal fired power plants alone was responsible for 80,000-115,000 premature deaths. Diseases caused by pollution included 20.9 million asthma attacks, bronchitis and respiratory conditions and cardiovascular disease. These health impacts are estimated to cost India $3.3 billion to $4.6 billion per year in medical expenses and lost work days.
Singrauli - India's "Energy Capital"
Singrauli, known as the "energy capital" of the country, is the industrial hub of north-central India. It produces 10% of the country's coal based power, and straddles the border of the states of Uttar Pradesh and Madhya Pradesh.
Priya Pillai, Senior Campaigner for Greenpeace India has worked on the ground in the area for over three years. "There are nine thermal power plants and eleven operational mines, and this is concentrated in one district. That's the Singrauli region. And it's because of this that you'll find the large number of cases of asthma of tuberculosis of skin diseases, of cancer," Pillai explained.
Singrauli was once covered in forest and rich agricultural land, but the region's coal lies underneath these forests, meaning that they are being cleared at an alarming rate, further threatening endangered species and displacing tribal communities to make way for this energy juggernaut.
The landscape is now one of industrial devastation and critical levels of pollution, recently rated the third most polluted industrial cluster in the country by the comprehensive environmental pollution index. Air, water and soil have all been affected.
The open cast mines that scar the landscape resemble vast craters, streaked black with coal, trimmed green at the edges with what is left of rapidly dwindling forest. Huge dump trucks and cranes appear like miniatures in the distance, barely visible through the poisonous haze that hangs in the air.
Milky white stagnant ash ponds, hold the by product of the industry, fly ash. Experts warn of acute health problems related to coal and the ash that it produces, which contains toxic heavy metals including mercury, arsenic, lead, nickel, barium and even radioactive substances such as uranium and thorium. Black spiky stalks of dead foliage poke out of the sludge in these ponds, testifying to its toxicity.
Man-made mountains of waste rubble, excavated and dumped, gradually bury villages. Coal-filled train bunkers and conveyor belts, some as long as 25km, snake from mines to thermal power plants, These stacks dominate the skyline, looming over human settlements and pumping out smoke which can reach as far as 400k, choking communities below. The air is permanently clouded, limiting visibility, with the smell and taste of coal dominating the senses. Everything is blanketed in a layer of dust.
Chilika Dand, in the Sonebhadra district of Singrauli, Uttar Pradesh, is one of the most critically affected displacement communities, with many people having been moved, often forcibly, numerous times to make way for coal excavation by an industry that is making them sick.
The village of around 12,000 people, is surrounded by multiple power plant stacks emitting putrid smoke. There is a railway line and road both carrying coal and a fully operational open cast mine just 50 meters away. Villagers claim that at night, filters are removed from the stacks, and ash falls and settles on rooftops like toxic snow.
There is a constant industrial hum of engines revving and the scrape of metal on stone. Twice daily explosive blasts, and the subsequent patter and thud of debris are more reminiscent of the sounds of war than of development. Few of the concrete rehabilitation blocks of 30 x 50 feet escape cracked walls due to tremors from the blasts.
Manonit G Ravi, an activist and resident of Chilika Dand shouted over the noise of engines to make himself heard. "The entire village vibrates with the blasts. Sometimes they are so big and loud, people run out of their houses thinking there might be an earthquake."
Sanitation is a big problem, as the allocated plots leave little room for toilets. In summer, asphyxiating dust fills the air, and in winter and rainy seasons, there is a constant septic sludge underfoot. The smell, a mix of human and animal excrement, combined with acrid industrial pollution makes the air gritty, stinging eyes and making breathing a struggle.
Residents of Chilika Dand say that illness and disease is rife in the community, with cancer, kidney failure, diabetes, vitiligo (the blanching of skin through pigment loss), hair loss and psychosis widespread, all linked to contaminated water, coal ash, particles in the air and high levels of mercury present in the environment.
The World Health Organization states that even minimal exposure to mercury may cause health problems, including neurological damage to unborn fetuses and children, and is considered "one of the top ten chemicals or groups of chemicals of major public health concern." Coal fired power stations are sited as one of the main ways that mercury is released into the environment.
Siraj Un Nissa, a resident of Chilika Dand and mother of eight has Vitiligo. Her hands, arms and mouth are blanched, and her whole body is patchy where pigment has been lost. "I have been sick for the past eight years," she said. "The dust is making it hard for us to live here. No electricity. We get it for one hour and it's gone. We don't have a proper house to live in, just a make-shift shelter. We don't have anything. No one cares about the poor."
Jharia, in neighbouring Madhya Pradesh, has almost disappeared. The remote village is being buried under waste from a nearby mine opened in 2006. A thin sliver of green and only around 30% of its population is all that remains of this forest dwelling community of Harijan people, squashed against a sheer, slowly encroaching, man made cliff of debris.
Bandhu Saket, resident of Jharia explained how their health has been affected by the mine."My youngest grandson gets so unwell, his teeth start chattering and his eyes enlarge, it feels like he will not get better," he said. "It never used to be like this. Ever since the companies have come, since the vehicles have been driving back and forth, since the blasting has started, illness and disease have been spreading. They dump things in all directions and when it is summertime, with all the dust, one cannot see anything so how can you expect anything else but to get sick!"
There was once a well that provided drinking water to the village, but the company filled it in. Now Bandhu Saket said they are forced to drink "whatever we find in the drains or irainwater collected."
Manbasia, also from Jharia, is a mother of three. Supporting herself against a huge rock from the mine, she struggled to control the emotion in her voice, and spoke shakily of illness and disease in what is left of her community. "I can't see very well, my chest hurts, my feet don't allow me to sit down or stand up," she said. "We have no one here to help or support us. If someone is dying, there is no one to look after them or save them. Who are we meant to turn to?"
Dr. R.B. Singh
Dr. R.B. Singh worked in the area for over 20 years, treating the local population in their homes, in the small private practice that adjoins his home, and the Singrauli District Hospital next door. He attributes the huge increase in death, sickness and disease to the growth of the industry in the region.
"Since the time the new industries have come here and the coal mine belt has progressed," he said. "The patients we see in our new Out Patients Department present themselves with skin diseases and lung diseases, bronchitis, asthma and silicosis, and because of the contaminated drinking water, amoebiasis and other abdominal ailments, which have increased. I have come across bone cancer, mouth cancer, cervical cancer, breast cancer. In children, bone cancer -- and in middle aged people, mouth cancer -- these are common here."
There is a constant stream of patients outside Dr Singh's private practice, all needing attention and treatment. The District Hospital next door to his practice is in desperate need of facilities. A dilapidated shell with dark corridors, a blood splattered maternity ward and rainwater coming through gaps in the ceiling. Wards are crowded but very quiet, with beds full, people lying on the floor and a distinct absence of staff.
"We have a problem with a lack of doctors as most of them qualify and go abroad. They do not want to work in these small places," said Dr. Singh.
Sarath Guttikunda, Director at Urban Emissions, New Delhi is a chemical engineer and air pollution expert. "When you are focusing on outdoor air pollution two things which are really important, one is your lungs, and other one is your heart. Among the respiratory problems, the main one is the asthma," he said. "People who are already suffering from asthma are obviously going to get affected even more, and children and older generation people, they are the ones that we see are getting affected the most."
Gaiman Prasad Kanojiya, a school teacher in Lojhara village, said that sickness is rife in his students, with coughing and sneezing a constant sound in the classroom. Absenteeism is common due to ill health, and parents are deeply worried about their children.
"When I go to teach, there are 216 children," he said. "Out of those, if only 100 or 150 of them turn up, it makes us wonder why the children haven't turned up. When we inquire, the child's guardian tells us that their child has been unwell or that because we had to go to the hospital, they didn't make it to school, or that for the past 15 days she's been sick and lying in bed. These kind of problems come up a lot."
All over Singrauli, locals speak of sickness, their land and livelihoods being taken away, and promises of rehousing, education, employment and healthcare from industry that haven't materialized.
Rangeet Gupta is a local activist and youth worker living and working in the area. He said that after "persistent reminding" industry still has not delivered the services that it promised. That means that proper healthcare, among other things, remains available only to people who can afford it, or those who work for the industry.
"In this area of ours, there isn't even a decent hospital for the displaced community, they have nothing at all, no schools, no doctors, no hospital, no roads, not even an arrangement for hygiene and sanitation. They have just been abandoned," said Gupta.
Champa, like so many others, experienced this first hand, buying her own medicine when she has the money to do so, and going without treatment when she can't afford it.
"We receive no help from the people at the plant at all. Since the health problems started because of the plant, we have not been given so much as a single tablet by them or the government."
As the health situation gets more critical, scientists, medical professionals and environmental campaigners all predict that if India pushes forward with the planned expansion of coal-fired power generation and regulations remain unenforced, the consequences to human life will be even more devastating.
"The calculations that we have done for the current number of power plants, we have seen close too 100,000 premature deaths, and if we are going to triple the number of power plants and don't do anything about the regulations, we will at least triple this number, and looking at health impacts of the air pollutions in the range of 300,000 premature deaths," said Sarath Guttikunda.
Doctor Singh warned that the atmosphere in Singrauli will be polluted "to such a degree that it will not be viable to live here any more." Champa, Manbasia and their families, along with hundreds of thousands of other people, face a future of poverty, sickness and death with no means of escape. Manbasia reflected, "Now, with the dust and smoke bellowing, there are people getting sick. And if you don't have the money like us, what do we do? Kill ourselves?"
Sarah Stirk is a journalist and filmmaker with The Ecologist Film Unit in the United Kingdom.