Excessive air pollution from traffic fumes contributed to the death of a nine-year-old girl who died of a fatal asthma attack, a coroner has ruled.
Ella Kissi-Debrah is believed to be the first person in the UK to have air pollution listed as the cause of death on their death certificate, following the ruling by assistant coroner Philip Barlow at a second inquest into her death.
Mr Barlow also said there was a "recognised failure" to cut levels of pollutant nitrogen dioxide to within limits set by EU and domestic law, which possibly contributed to her death.
It marks the culmination of a long battle by Ella's mother, Rosamund Kissi-Debrah, to have the role of air pollution in her daughter's death recognised.
In the wake of the ruling she said: "We've got the justice for her which she so deserved."
But she added: "Also it's about other children still as we walk around our city of high levels of air pollution."
Campaigners called for immediate action to protect people from pollutants such as nitrogen dioxide and small particles known as particulate matter, which are linked to a catalogue of health problems and play a role in the equivalent of 40,000 early deaths a year in the UK.
Much of the country suffers from illegal levels of nitrogen dioxide, which comes from sources such as traffic, as towns and cities continue to breach limits that should have been met a decade ago.
Ella lived 25m from the South Circular Road in Lewisham, south-east London – one of the capital's busiest roads.
She died in February 2013, having endured numerous seizures and made almost 30 hospital visits over the previous three years.
A previous inquest ruling from 2014, which concluded Ella died of acute respiratory failure, was quashed by the High Court following new evidence about the dangerous levels of air pollution close to her home.
Giving his narrative conclusion at Southwark Coroner's Court after a two-week inquest, Mr Barlow said: "I will conclude that Ella died of asthma, contributed to by exposure to excessive air pollution."
Giving the medical cause of death he said: "I intend to record 1a) acute respiratory failure, 1b) severe asthma, 1c) air pollution exposure."
He said: "Air pollution was a significant contributory factor to both the induction and exacerbations of her asthma.
"During the course of her illness between 2010 and 2013 she was exposed to levels of nitrogen dioxide and particulate matter in excess of World Health Organisation (WHO) guidelines.
"The principal source of her exposure was traffic emissions.
"During this period there was a recognised failure to reduce the level of nitrogen dioxide to within the limits set by EU and domestic law, which possibly contributed to her death."
The coroner also said Ella's mother had not been given information on the health risks of air pollution which could have led her to take steps which might have prevented Ella's death.
A 2018 report by Professor Stephen Holgate found that air pollution levels at the Catford monitoring station one mile from where Ella lived "consistently" exceeded lawful EU limits over the three years prior to her death.
The fresh inquest had been listed under Article 2 – the right to life – of the Human Rights Act, which scrutinises the role of public bodies in a person's death.
Mayor of London Sadiq Khan said that the coroner's conclusion was a "landmark moment" and called pollution a "public health crisis".
He said the inquest underlined the importance of pushing ahead with policies such as expanding the Ultra Low Emission Zone to inner London to tackle poor air quality.
Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, called on the Government to set out a health protection plan, including efforts to make sure people are getting the information they need to protect their health.
"Today's verdict sets the precedent for a seismic shift in the pace and extent to which the Government, local authorities and clinicians must now work together to tackle the country's air pollution health crisis," she said.
Katie Nield, a lawyer for the environmental legal charity ClientEarth which has won three court cases against the Government over its failure to curb pollution in line with the law, said: "The inquest has thrown into sharp relief just how long the Government has known about the harm that air pollution wreaks on people's lives and how slow they have been to react."
She called on the Government to commit to a legally binding target to achieve WHO guideline levels of harmful fine particulate matter pollution by 2030 at the latest.