Indonesia’s Peat Haze Puts 40,363 Toddlers in Clinics

Indonesia’s Health Ministry counted 174,694 acute respiratory infections in haze provinces from Aug. 18 through Sept. 21, 40,363 of them in children under five. Then Suyanti, the ministry’s director of environmental health, released the figures on Tuesday while peat and forest fires on Sumatra and Borneo kept feeding the smoke.

The caseload had stood at 113,336 on Sept. 9, a rise of 61,358 people in 12 days. Health posts are still taking new breathing cases as the dry season runs toward October.

174,694 Infections Across Seven Provinces

Suyanti spoke at the Coordinating Ministry for Political and Security Affairs in Jakarta. She said the tally covers acute respiratory infections in areas hit by forest and land fires, known in Indonesia as karhutla, and that 4,533 of those cases were still active on Tuesday, with the rest recovered.

The ministry is watching seven provinces: Riau, Jambi, and South Sumatra on Sumatra, plus West, Central, South, and East Kalimantan on Borneo. Fires have also burned in Papua, but those provinces are the ones inside the health count. About 12.5 million people in the seven provinces had already been exposed to the haze by Sept. 9, according to ministry figures released that week.

The climb did not start in mid-September. Ministry data put the caseload at 50,891 on Sept. 1, then at 113,336 eight days later, a rise of 62,445. The next 12 days added almost as many again.

THE CASE COUNT IN SEVEN PROVINCES

Those infections range from coughs and bronchitis to pneumonia. PM2.5 in the smoke, particles small enough to lodge deep in the lung, is the pollutant Suyanti named at the briefing. Indonesia is a country of more than 280 million people, and the haze has also drifted into Malaysia, Singapore, and the Philippines.

Why Toddlers Fill the Clinics

Children under five account for 40,363 of the 174,694 cases, or 23 percent. That share is why the ministry told local governments to consider distance learning when the air turns bad, a step it had already drafted in late August to keep children indoors.

In Pontianak, West Kalimantan, Popong Solihat, head of a public health clinic, said visits for breathing trouble rose as the smoke sat on the city. Her clinic treated 187 such cases in the first 11 days of September, against 422 for the whole of August. Dr. Muhammad Arief Trihapsoro, at the Sungai Durian clinic in the same province, said 50 to 70 people a day were coming in with coughs and sore throats when the ash was at its worst.

Kalimantan is carrying that load with almost no specialist backup. The Centre for Research on Energy and Clean Air, reviewing the ministry’s hospital registry, found Indonesia has nine dedicated lung hospitals: seven on Java, two on Sumatra, and none on Kalimantan.

WHAT THE HEALTH MINISTRY HAS SENT

• Oxygen gear: Concentrators and oxygen cylinders have been shipped to posts and hospitals in the seven provinces.
• Masks: Face masks went out with the same logistics run, and the public was told to wear them when the index worsens.
• Labs and staff: Community health laboratories are being readied to test air quality, and reserve health workers are being posted in districts and cities.
• School advice: Local governments were told to shift classes online when the air pollution standard index hits unhealthy levels, to cut children’s time outside.

Suyanti’s public advice was blunt and limited: stay in when the air worsens, wear a mask, and drink water. The ministry is treating symptoms. It is not putting out the peat.

Drained Peat Meets a Super El Niño

Indonesia fights land fires every dry season, which usually runs from July to October. This season is heavier because a strong El Niño has dried the islands, the same pairing that produced major fire years in 1997, 2015, 2019, and 2023. Mark Parrington, a senior scientist at the European Centre for Medium-Range Weather Forecasts working with the Copernicus Atmosphere Monitoring Service, said seasonal fire emissions and regional haze were already enhanced, consistent with those earlier El Niño years, and that the service would keep watching how the fires and air quality change.

Copernicus recorded intense fires in every recent El Niño year, and 2026 is following that line. The fires started in late July, first over West and Central Kalimantan, where peatlands hold water in a wet year and smolder for weeks once they are dry. Sumatra and South Papua later joined the map. Peat that has been drained for plantations no longer resists flame the way a wet bog does. Belgis Habiba, a forest campaigner at Greenpeace Indonesia, said companies that pull the water out leave ground that used to resist fire ready to burn.

The Forestry Ministry’s SiPongi monitor, which overlays Landsat images with hotspot checks and ground reports, shows 202,004 hectares burned from January through July, before the worst of August. That total is 47 percent higher than the same stretch of 2019, 80 percent higher than 2023, and 69 percent higher than 2025. On Sept. 20 the same system logged 1,532 high-confidence hotspots nationwide, 968 of them in Central Kalimantan. Authorities have sent more than 50 aircraft for water bombing and cloud seeding, with help from Japan and other partners, but peat fires often burn below the surface and relight.

We are mobilizing logistical assistance, including oxygen concentrators, masks and oxygen cylinders. We are also preparing community health laboratories to help test air quality and deploying reserve health personnel in districts and cities.

Then Suyanti, director of environmental health, Health Ministry, Jakarta press conference

That is a medical supply chain built for a land-use problem. The haze is not a weather accident sitting on top of healthy ground.

Five Companies Lose Their Forest Permits

On the same Tuesday Suyanti read out the clinic numbers, Forestry Minister Raja Juli Antoni announced that five forest-use permits on Kalimantan had been pulled. He said the move followed an instruction from President Prabowo Subianto that enforcement had to be as hard on large concession holders as on small players. The five firms held 92,464 hectares of concessions. Fires inside those concessions had burned 1,169.13 hectares.

THE FIVE PERMITS PULLED ON KALIMANTAN

Raja Juli said the holders had failed to keep their ground from burning. “Because they neglected and did not pay attention to these obligations, today I revoke the permits of these five companies,” he said. The burned slices inside those leases are a small share of the national fire. The permits came off after 174,694 breathing infections had already been logged. Neighbors in Malaysia and Singapore have watched this sequence on a loop for years: smoke first, then aircraft, then a handful of licenses.

Kalimantan Air Went Six Times Dirtier

The Finland-based Centre for Research on Energy and Clean Air, in an analysis dated Sept. 14, estimated that fire smoke caused 1,700 deaths in August across the 15 hardest-hit provinces. Non-fire pollution from power plants, industry, and traffic was linked to another 2,000 deaths in the same month, for a combined 3,700. Those are short-term deaths, occurring within days of exposure, modeled from satellite fields scaled to 171 ground monitors and Global Burden of Disease baselines. They are a different count from the ministry’s 174,694 clinic infections.

Java, with 160 million people, accounted for nearly 1,600 of the air-pollution deaths, and CREA attributed 90 percent of that Java toll to year-round urban emissions, not fire smoke. West Java 517, Central Java 421, East Java 352, Jakarta 144, and Banten 139. On a per-person basis the ranking flips. Residents of Central, West, and South Kalimantan faced a short-term death risk three to four times higher than people on Java, almost entirely from fire smoke.

AUGUST AIR IN NUMBERS

• Kalimantan PM2.5: Population-weighted daily levels rose from 20 µg/m³ in the first week of August to 60 µg/m³ in the second week, then to 100 to 120 µg/m³ by month’s end, a six-fold increase.
• National mean: Indonesia’s population-weighted daily PM2.5 averaged 29 µg/m³ in August, with fire contributing 27 percent, above the WHO 24-hour PM2.5 limit of 15 µg/m³.
• Peak exposure: On Aug. 18, the day after Independence Day, 41 million people, about 15 percent of the country, breathed air rated unhealthy or worse.
• Island split: About 69 percent of Kalimantan’s people, 12.3 million, were in that band at the peak; Sumatra and Java each saw about 25 million on their worst days.

By Aug. 31 the national exposure count had eased to 36.4 million, but 4.2 million were in very unhealthy air and 2.5 million in hazardous air. CREA’s analysts, including Katherine Hasan and Lauri Myllyvirta, wrote that in severe El Niño years karhutla has peaked in late September, October, and November, so August was the start of the curve, not the top.

The 2015 Season’s Unpaid Medical Bill

The 2026 clinic tally is not the largest Indonesia has posted. On Oct. 29, 2015, the National Disaster Management Agency said 529,527 people in Sumatra and Kalimantan had upper respiratory infections from that year’s haze. A Harvard and Columbia modeling study later estimated 100,300 premature deaths across the region from the 2015 smoke, including 91,600 in Indonesia, 6,500 in Malaysia, and 2,200 in Singapore. The World Bank put the 2015 episode’s cost above $16 billion, before long-term health and forest losses.

A 2022 health-impact study of peatland fires found that, on average, the smoke is linked to 33,100 premature adult deaths a year and that 2,900 infants die prematurely each year from the same particles, with most of the burden in Sumatra because more people live there. Those are long-run averages, not this season’s death certificate count. They describe the background risk that El Niño turns into a surge. In 2019, another fire year, a separate study estimated more than 87,000 excess deaths nationwide from fire-driven PM2.5.

The land under that smoke is the same drained peat and cleared concession belt that burned in those earlier years. A moratorium on new permits over peat and primary forest did not keep fire out of protected peat functions this season, and palm-oil leases again show up in burned-area maps. The 174,694 infections are what that unfinished cleanup looks like in a pediatric waiting room.

October Is When These Fires Usually Peak

The ministry’s own window on the 174,694 cases opened on Aug. 18 and closed on Sept. 21. The fire calendar is longer than that.

HOW AN EL NIÑO FIRE SEASON USUALLY RUNS

1. Late July 2026: Intense seasonal fires start over West and Central Kalimantan peat, then spread to Sumatra and South Papua.
2. Aug. 18, 2026: CREA’s exposure peak, with 41 million people in unhealthy or worse air; the Health Ministry’s ARI count begins the same day.
3. Sept. 1, 2026: Confirmed ARI cases reach 50,891 in the monitored provinces.
4. Sept. 9, 2026: The caseload hits 113,336; about 12.5 million people in the seven provinces have been exposed.
5. Sept. 21, 2026: The count reaches 174,694, including 40,363 children under five.
6. Sept. 22, 2026: Suyanti reports 4,533 active cases, and Raja Juli pulls five Kalimantan forest permits.
7. October to November: In 2015, 2019, and 2023, karhutla reached its climax in these months; MapBiomas has found that 61 percent of Indonesia’s fires over 25 years fall between September and November, with the peak in October.

BMKG has already said the dry pattern can last through October. Historical data from El Niño years shows these fires usually crest in late September, October, and November. The Health Ministry still had 4,533 active breathing infections on Sept. 22, and the peat under Kalimantan was not yet wet.

Disclaimer: This article is news reporting and analysis of government health figures, fire maps, and published research. It is informational only and is not medical advice, a diagnosis, or a treatment plan for smoke exposure, asthma, or any respiratory infection. Readers who have breathing symptoms, or who care for children in haze-affected areas, should see a licensed physician or a local clinic before changing medication, travel, or school plans. Case counts, air readings, burned-area totals, and fire-season outlooks reflect the cited sources on the dates given and will change as the dry season continues.