Killer haze from forest fires that raged across Indonesia last year may have caused more than 100,000 premature deaths in Indonesia, Singapore and Malaysia, according to a new report that suggests a drastically higher death toll than Indonesian government figures.
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Harvard and Columbia University researchers used air pollution readings to calculate exposure to the deadly smoke.
"We estimate that haze in 2015 resulted in 100,300 excess deaths across Indonesia, Malaysia and Singapore," says the report, which was published in Environmental Research Letters journal on September 19.
It says this is more than double the estimated number of deaths as a result of haze in 2006, with much of the increase due to fires in Indonesia's South Sumatra province.
"Exposure to air pollution increases the risk of death from a number of ailments including stroke and respiratory illnesses," one of the researchers from Harvard University, Dr Shannon Koplitz, told Fairfax Media.
Indonesians were the worst affected with an estimated 91,600 excess deaths.
However Indonesia's disaster agency said just 24 people had died due to the 2015 fires, 12 of whom were killed fighting the fires and 12 from respiratory problems as a result of the haze.
"There is nothing like that (91,000 premature deaths)," Sutopo Purwo Nugroho from the National Disaster Management Agency (BNPB) told Fairfax Media.
"It is not true. The data is not valid. If there were high numbers of people dead we would have stated it in our almost daily forest fire press releases last year."
Last year the agency estimated that 43 million Indonesians were exposed to the smog in Sumatra and Kalimantan alone and there were half a million cases of respiratory tract infections.
Forest fires are an annual event in Indonesia, caused in part by "slash and burn" agriculture techniques, where farmers light fires to quickly and cheaply clear land.
Last year's dry conditions, exacerbated by the El Nino effect, resulted in the worst haze in the region since 1997.
Six Indonesian provinces declared a state of emergency, schools were closed in Singapore, Malaysia and Indonesia, flights were grounded and warships were put on standby to evacuate people from the toxic haze.
The fires strained relations between Indonesia and Singapore, where air pollution levels also skyrocketed.
"Indonesia's fires are probably the biggest global environmental disaster of the 21st century," Erik Meijaard, an Indonesian-based honorary associate professor at the University of Queensland wrote in The Jakarta Globe last year.
Greenpeace Indonesia forest campaigner Yuyun Indradi said on Monday that now the scale of the death toll was known, failure to act immediately would be a crime.
"Now fires are back again," he said. "Industry and government must take real action to stop forest clearing and peatland drainage for plantations."
Forestry and Environmental Ministry spokesman Novrizal told Fairfax Media Indonesia had done many things to prevent a repeat of last year's haze crisis.
These included an education campaign about the danger of burning to clear land and a crackdown on companies found guilty of setting fires.
"A civil court sentenced a company to pay compensation of about one trillion rupiah," he said.
"We do joint patrols, with the TNI (military), police, forestry ministry and local people in all areas."
He said this had resulted in a decrease of hotspots around Indonesia by 82 per cent in 2016 compared to the same period last year.
The Harvard and Columbia university researchers developed a tool to help governments identify which fires have the highest potential to cause damage to human health.
"Our goal with this work is to provide a tool that can help stakeholders make evidence-based decisions related to fire and land use strategies, even as extreme haze events are unfolding," Dr Koplitz told Fairfax Media.
With Karuni Rompies
