JAKARTA, Indonesia (AP) — Against the backdrop of smokestacks from a nearby coal power plant, the sky above Edy Suryana’s village stays grey for months at a time, while ashes and the stench of smoke hang in the air.

Suryana has spent more than three decades living in the shadow of the power plant in northern Java, just 60 miles from Jakarta, Indonesia’s most populous city. She and other villagers have watched as their loved ones suffered from coughing fits, itchy skin and other health problems that many believe are partly because of the ever-present smog.

Pollution is causing a rise in respiratory illnesses and deaths in northern Java, including Jakarta, experts say. Smog in the metropolis of 11.2 million people comes from a combination of the coal-fired plants, vehicle and motorcycle exhaust, trash burning and industries, and many in the city are demanding that the government take action.

Emissions from coal-fired power plants contribute to greenhouse gases that rise into the atmosphere and help heat the planet, a key focus of the United Nations climate conference, or COP28, which begins next week in Dubai.

Countries like Indonesia are struggling to balance rising demand to power industrialization with the need to cut carbon emissions and protect public health.

In 2010 Suryana watched as his sister-in-law died from lung problems. In 2019, the dirty air seemed to worsen his daughter’s bout of tuberculosis.

“We’ve clearly suffered an impact,” he told The Associated Press.

Data gathered by IQAir, a Swiss air technology company, regularly ranks Jakarta as one of the most polluted cities in the world. Blue skies are a rare sight and the air often smells like petrol or heavy smoke. Normally healthy residents complain of itchy eyes and sore throats on days when pollution levels soar past levels considered safe by the World Health Organization and Indonesian government.

Air pollution potentially contributed to more than 10,000 deaths and 5,000 hospitalizations in Jakarta in 2019, according to research conducted by Vital Strategies, a global health public health nongovernmental organization that is headquartered in New York.

Pollution levels get and stay so high that it’s not safe for people to do outdoor activities without risking short and long-term damage to their health, said Ginanjar Syuhada, a health analyst at Vital Strategies.

But not everyone is able to stay inside.

Misnar, a street vendor who spends his days working outdoors -- and like many Indonesians only uses one name — went to the hospital on September and spent days in a special air chamber to treat his pneumonia, which was worsened by routinely working outdoors in the polluted air, said Misnar’s eldest daughter, Siti Nurzanah.

His doctor recommended that Misnar stay home after he left the hospital. But he makes his living selling items on the street. So his only option is to rely on face masks to help filter the dirty air he breathes.

“I want my father to stay at home. My father is old, 63, the air is bad with his health condition,” Nurzanah said.

Acute respiratory infections and pneumonia cases have been increasing, according to a spokesperson from Indonesia’s Ministry of Health, who also recognized that Jakarta’s air pollution has exceeded WHO safe limits.

Data from the Jakarta Health Agency show that the number of residents treated for pneumonia from January to August was more than double the same period the year before, at 9,192 cases.

The number of patients visiting Jakarta’s Persahabatan Hospital, a national respiratory referral hospital, with acute respiratory infections and pneumonia from January to August likewise doubled.

The heavy smog takes a toll on the economy.

“If we calculate it in terms of economic value, it could potentially cause economic losses, from a health perspective, of around 40 trillion rupiah (more than $25.2 billion) a year,” said Syuhada, the health analyst.

“It’s working age people who suffer symptoms of prolonged coughs and colds,” Feni Fitriani Taufik, a pulmonologist at Persahabatan Hospital told The Associated Press. “They used to have it for only three to five days. Now, after two or three weeks the cough still lingers.”

Solving the pollution issue is complicated.

Emissions from burning coal, which is highly polluting but relatively cheap, contribute up to a third of Indonesia’s air pollution according to Siti Nurbaya, Indonesia’s Environmental and Forestry Minster. The country has pledged to cut emissions in coming decades, but it still provides most of Indonesia’s energy needs.

Millions of vehicles and motorcycles spew emissions as workers commute to and within the city. The Indonesian government has called on residents to use public transportation and has given regulation and financial incentives to residents who want to shift from using gas or diesel-fueled vehicles to electric vehicles.

Public transport remains limited and electric vehicle uptake has been slow: Transportation Minister Budi Karya Sumadi at a national seminar in September said that there were 26,100 electric vehicles and 79,700 electric motorbikes currently operating in Indonesia in 2022— less than one percent of the over 17.2 million registered cars and 125.2 million motorbikes in Indonesia.

The government is pushing to have more than 530,000 electric vehicles on the road in Indonesia by 2030.

To make a real dent in the pollution, the government also needs to tighten regulations for emissions from factories and industries in and near Jakarta, according to research from Vital Strategies.

“They should. Because industry is contributing 30% to 40% of the air pollution in Jakarta, in addition to emissions from transportation,” Syuhada said.