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View all search resultsWhen the fires are out, the health bill comes due
The rains may put out Indonesia’s forest fires, but the real disaster begins once the smoke clears, leaving thousands of rural children to bear a hidden, long-term health crisis alone.
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Haze from forest fires shrouds the Ampera Bridge in Palembang, South Sumatra on Sept. 6, 2026. (Reuters/Abriansyah Liberto)
T
he forest fire cycle in Indonesia usually ends when the first rains fall and the emergency posts close. The government announces that the fires are under control, and public attention moves elsewhere. For many families in Sumatra and Kalimantan, the epicenters of the disaster, that is when their health problems start to pile up.
The Health Ministry recorded 174,694 cases of acute respiratory infection between Aug. 18 and Sept. 21 in seven fire-affected provinces, four of them in Kalimantan. More than 40,000 of the cases were in children under five. Those figures count people who reached a health facility while the smoke was still thick. They leave out the deferred burden: children taken to a clinic weeks later, or never taken at all.
The 2015 fires show what that burden looks like. Sambodo et al. examined national health insurance claims across Sumatra and Kalimantan, and found the clearest changes in the six months after the fires ended. Compared with pre-fire levels, primary care visits by young children rose by about 17 percent, while their hospital visits fell by about 16 percent.
The rise was concentrated in cities and the fall in rural areas. The researchers read this as a sign that many rural children missed the care they needed, and urged the government to focus on helping them catch up once the fires subsided.
Some of the burden only appears much later. Rosales-Rueda and Triyana followed children exposed to the smoke of the 1997 fires. Years afterward, those children were shorter and had lower lung capacity than children from areas without haze. Those exposed in the womb were still shorter 17 years on.
PRAKARSA's research helps identify who is most likely to carry this burden. Our report, “Broad Coverage, Fragile Protection: Indonesia's Universal Health Coverage in 2024”, shows an island sharply divided.
On the index of health service capacity and access that we compiled, North and East Kalimantan rank among the top six provinces nationally. West Kalimantan, where nearly half of Indonesia's hotspots were recorded in late August, ranks fifth from the bottom of 38 provinces. It has about 11 hospital beds for every 10,000 residents, compared with our index benchmark of 18, and one of the lowest densities of health workers in the country.
