VOICES | HYWEL DAVIES Ventilation a matter of life and death Awaab Ishak 13 December 2018 21 December 2020 The tragic death of Awaab Ishak should be a very clear reminder to us all of the fundamental importance of the Building Regulations requirement to provide adequate ventilation in any habitable building, and not just in a pandemic, says Hywel Davies A waab Ishak was born in December 2018, the first son of refugee parents from the Sudan. Two years and eight days later, he died of cardiac arrest brought on by severe respiratory problems. He lived in a one-bedroom flat in Rochdale. In 2017, before he was born, his father raised concerns with the borough housing body about mould in the flat. He was advised to paint over the mould, and is thought to have done so then and on further occasions. However, because of his limited English skills, he did not understand the need to use a paint intended for this purpose. Because of the recurring mould problem, in July 2020 the family instructed solicitors to raise a claim for disrepair and began to seek advice from health professionals. A health visitor who visited in July 2020 wrote to the borough raising concerns about mould in the flat and the potential impact on Awaabs health. Within a week, a disrepair manager visited and found mould on the kitchen and bathroom ceilings and walls that required treatment, and evidence of mould in a bedroom cupboard requiring more specific treatment. There was no evidence of structural problems or leakage. The manager did not observe the ineffective mechanical ventilation in the bathroom, a poorly working fan, or total absence of mechanical ventilation in the kitchen. That was identified four months later by a technical inspector who visited after the health visitor resent her letter in November. But it emerged at the inquest that it is widespread policy when claims are made not to take remedial action until it has been agreed with the claimants solicitors, so no action was taken in Awaabs home. The Coroners Report sets out the findings of the Home Office and paediatric pathologists that Awaab had severe granulomatous tracheobronchitis, a condition that is usually a longstanding process taking weeks or months to develop. The court was told that the presence of granulomas is evidence of a long-term inflammatory process, worsening with continued exposure and very rare in young people. The distribution observed fitted a pattern of something entering the airways and causing the granulomas. The court was told that this fitted with fungal infections. Together with the history and circumstances and post-mortem findings, the only explanation, in the pathologists opinion, was that death was due to chronic exposure to fungus. The coroner found, as a matter of fact, that the medical cause of Awaabs death was acute airway oedema with severe granulomatous tracheobronchitis due to environmental mould exposure. The coroner heard from Richard Blakeway, the housing ombudsman, who reported increasing numbers of complaints relating to this issue, with emerging common themes. One theme is an over-reliance on the contribution of a tenants lifestyle as the cause of the problem, or blaming tenants instead of preventing problems. The coroner found that the most likely cause of any damp or moisture in 2020 was, more likely than not, due to normal daily living activities, and stated that there is no evidence that the ways of living by the family were in anyway excessive. The idea that those in rented housing should be expected to cook, shower and wash their clothes less frequently is simply ridiculous. Awaab Ishak died just eight days after his second birthday 18 December 2022 www.cibsejournal.com CIBSE Dec 22 pp18-19 Hywel.indd 18 25/11/2022 14:37