SARAJEVO (Reuters) – When winter arrives in the Western Balkans, it is not unusual for dense smog to envelop its cities, making it hard to breathe and impairing visibility. But this year, pollution levels are among the highest in the world and public anger is on the rise.

In recent days, the Bosnian, Macedonian and Kosovar capitals topped the charts of the world’s most polluted cities as the smog intensified due to heavy traffic, excessive use of coal, poor spatial planning and solid fuel based heating.

The air quality index measured by the U.S. Embassy in Sarajevo hit 383 on Tuesday, a level identified by the World Health Organization (WHO) as hazardous to health and almost ten times the average. In Pristina, the index registered 415 on Monday night and marked air quality in several Macedonian towns as very poor.

“This is all the result of a situation in which political elites treat the city as a construction plot which should be occupied at all costs rather than a place where people live,” Anes Podic of Sarajevo’s Eko Akcija environmental group said.

“You can feel how bad the air smells even inside the car or home,” said a taxi driver Mirsad Pobric.

According to the WHO, pollution costs Bosnia the equivalent of more than a fifth of its annual gross domestic product (GDP) every year – around $3.9 billion – in lost work and school days, healthcare and fuel costs.

Macedonia loses an equivalent of 3.2 percent of GDP a year to pollution, the World Bank said in a report, more than $360 million a year.

As a way of bringing more attention to the issue, the Embassy of Sweden has been using red lighting on its facade in central Sarajevo to reflect air quality each day. The deeper the red, the worse the pollution.

According to the WHO, 230 Bosnians die of air pollution per 100,000 citizens a year, compared to 0.4 in Sweden. The World Bank estimates that in Macedonia there are 1,350 deaths related to air pollution per year.

“Pollution is killing people of Bosnia and Herzegovina, therefore something really needs to be done,” Swedish Ambassador Anders Hagelberg told Reuters.

As part of efforts to combat the issue, Sweden has launched a four-year project in Bosnia that will bring together experts from its Environmental Protection Agency and local hydro-meteorological agencies and governments.

The aim of the program is to help improve air quality monitoring but also to bring more investment into energy efficiency.

Macedonia has launched its own program to combat air pollution to which the government allocated 1.6 million euros ($1.83 million) in next year’s budget. It aims to halve Skopje’s air pollution within two years by reducing taxes for central heating, restricting traffic and introducing stricter control of industrial emissions.

Activists say the funds allocated are insufficient and that the government’s response is inadequate.