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. 2025 Jan 21;9(1):e34–e40. doi: 10.1016/S2542-5196(24)00308-5

Sand and dust storms: a growing global health threat calls for international health studies to support policy action

Tiantian Li a,b,*, Aaron J Cohen c,d,e, Michal Krzyzanowski f, Can Zhang a,b, Sophie Gumy g, Pierpaolo Mudu h, Pallavi Pant c, Qian Liu i,j, Haidong Kan k, Shilu Tong b,l, Siyu Chen m, Utchang Kang n, Sara Basart o, N'Datchoh Evelyne Touré p, Ali Al-Hemoud q, Yinon Rudich r, Aurelio Tobias s, Xavier Querol s, Kenza Khomsi t, Fatin Samara u, Masahiro Hashizume v, Massimo Stafoggia w, Mazen Malkawi x, Shuxiao Wang y,z,aa, Maigeng Zhou ab, Xiaoming Shi a,b, Guibin Jiang i,j,ac, Hongbing Shen ad,ae
PMCID: PMC11755727  PMID: 39855230

Summary

Sand and dust storms increasingly threaten global environmental and public health. To date, 150 countries are directly affected, with more than 100 classified as non-dust source regions. With climate change, these storms are expected to become more frequent and severe. Despite international awareness and initiatives, such as those led by the UN, crucial knowledge gaps continue to hinder effective, evidence-based public responses to sand and dust storms. In this Viewpoint, we review existing gaps in health research and highlight four key research priorities: the comprehensive health effects of sand and dust storms, including short-term and long-term exposures, diseases, regions, and health outcomes; the key particle sizes and toxic components of particles during sand and dust storms; the design of multicentre studies accounting for region-specific exposure patterns; and research on health outcomes attributable to particulate matter mixtures dominated by windblown dust versus other sources. We urgently call for international, collaborative, and multidisciplinary health studies considering sand and dust storm exposure characteristics and for the adoption of scientifically robust epidemiological methods in these studies.

Introduction

Sand and dust storms occur when strong winds lift sand and dust from dry soils into the atmosphere, transporting particles over vast distances.1 Approximately 2 billion tonnes of dust are emitted into the atmosphere annually.2 The frequency and intensity of sand and dust storms has intensified in many world regions due to climate change and anthropogenic activity.3, 4, 5, 6 This trend poses an escalating threat to both the global environment and public health.7, 8, 9 These sand and dust storms predominantly originate from a vast dust belt that stretches from the west coast of north Africa across the Middle East to central, south, and east Asia. However, dust particles can travel thousands of km from their source due to atmospheric circulation.10, 11, 12, 13, 14, 15 According to a UN report, more than 150 countries are directly affected by sand and dust storms, with 45 identified as primary sand and dust storm source regions.16 The effects of sand and dust storms are extensive and mainly contribute to poor air quality in nearby and distant regions, heightening concerns about health implications.

Trends

The frequency of sand and dust storms from Asia and Africa, two of the world's largest dust-emitting regions,17 were declining,18, 19 yet have intensified again in the past decade.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 For dust originating in east Asia, several regions have had increasing dust emissions—primarily driven by worsening desertification in Mongolia7—and record-breaking sand and dust storms have occurred in the past 5 years. For instance, in March, 2021, China had its most severe sand and dust storm in a decade. During this period, the concentration of PM10 in Beijing peaked at 3600 μg/m3, which was 80 times higher than the 24 h average PM10 concentrations (45 μg/m3) recommended by WHO air quality guidelines.20 In spring 2023, sand and dust storms originating from Mongolia repeatedly swept across east Asia, affecting countries such as China, South Korea, and Japan.21 China had an unprecedented surge in the frequency of sand and dust storms during 2023, with four in March and eight by mid-April, marking the highest frequency in a decade.21 Moreover, seasonal patterns of sand and dust storms in Asia are shifting. Central Asian countries, such as Uzbekistan, Tajikistan, and Turkmenistan, which typically have sand and dust storms between late spring and early summer, had unusually extreme sand and dust storms during November, 2021, with Uzbekistan recording its worst sand and dust storms ever.22, 23 These changes indicate an expansion of the sand and dust storms season.

For dust originating in Africa, there have been growing effects on the Mediterranean region over the past five decades; the western Mediterranean has seen a rising trend in the frequency of sand and dust storms, with an average increase of 0·7 dust days yearly since 1948.24 A 2022 study showed a rise in sand and dust storm frequency across Europe since the mid-1900s,24 accompanied by intense sand and dust storms. For example, the Canary Islands had an intense sand and dust storm event in February and March of 2020 that originated from the Sahara Desert. During this event, peak hourly PM10 concentrations exceeded 600 μg/m3 and daily PM10 concentrations surpassed the EU limit of 50 μg/m3 for more than 30 consecutive days.25 This event also affected Portugal, France, and the UK.26 Saharan dust can also travel across the Atlantic, reaching North, central, and South America.27, 28, 29 In the summer of 2020, the Caribbean Basin and southern USA had the most powerful dust storm in 50 years, nicknamed Godzilla; originating from the Sahara Desert, this sand and dust storm event lasted 15 days, with peak 24 h average PM10 concentrations in Puerto Rico surpassing 450 μg/m3.26, 30 The National Oceanic and Atmospheric Administration reported an increase in the frequency of sand and dust storm events in the USA from 20 in 2000, to 238 in 2022;31 these statistics reflect the combined dust contribution from the USA's mainland and Africa.31

Sand and dust storms will become more severe and frequent under the changing climate.32 These changes, including the increasing frequency of extreme weather events—such as drought and wind erosion—have exacerbated desertification and windstorms and created environmental conditions conducive to sand and dust storms, which climate models predict will become even more pronounced in the coming years.2, 7, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 A study on future projections for east Asia in a high-emission scenario forecasts an annual increase of 3·0% in dust emissions during March (the month known for high-frequency sand and dust storms) from 2015 to 2100.36 Similarly, the UN reports that some countries, such as Iraq, could witness 300 dust events per year within the next 10 years due to multiple drivers.42

Responses

Given the growing threat of sand and dust storms, international authorities have prioritised addressing this issue over the past two decades.9, 32, 39 The World Meteorological Organization was the first to implement a sand and dust storm response action by establishing the Sand and Dust Storm Warning Advisory and Assessment System in 2007; it now includes regional nodes covering Asia, northern Africa–the Middle East–Europe, Pan-Americas, and the Gulf Cooperation Council countries.43 Recognising that sand and dust storms could undermine the achievement of the Sustainable Development Goals in low-income, middle-income, and high-income countries, the UN General Assembly (UNGA) adopted its first resolution on combating sand and dust storms in 2015 and has maintained active engagement on the issue ever since.44, 45, 46, 47, 48, 49, 50, 51, 52, 53 Following the strategy for a global response to sand and dust storms raised by UNGA in 2018, the UN Coalition to Combat Sand and Dust Storms—consisting of more than 15 UN and non-UN organisations—was formally launched in 2019; the WHO-led working group focused on the health effects of sand and dust storms and is one of five major working groups.46, 54 In the following years, a series of initiatives were launched by the members of the Coalition. For example, in 2022, the Secretariat of the UN Convention to Combat Desertification launched the sand and dust storms toolbox, providing countries with practical resources to address this escalating environmental challenge.55 In 2023, UNGA reiterated its concern by designating July 12 as the International Day of Combating Sand and Dust Storms to raise global awareness of sand and dust storms and their consequences for human health and environmental wellbeing.56 During the inaugural International Day of Combating Sand and Dust Storms, the UN characterised sand and dust storms as a forgotten form of extreme event.

Despite growing recognition by the international community of the urgency needed to address sand and dust storms, the evidence needed to quantify their burden of disease and guide public health responses remains insufficient. Since 2016, WHO has recognised the adverse health effects of sand and dust storm exposure and considered setting specific air quality guidelines. However, they concluded that this is not feasible due to insufficient evidence on the quantitative and qualitative health risks associated with sand and dust storms.9 Instead, WHO developed a good practice statement focusing on personal exposure mitigation; monitoring and reporting; and local interventions, such as early-warning systems and short-term air pollution action plans to reduce indoor and outdoor exposure. The statement also emphasised the need for targeted health studies.9

Despite these concerns, national and regional policies addressing sand and dust storms remain scarce, even in the regions most directly affected.57 More comprehensive epidemiological evidence is needed to design an effective public health response to sand and dust storms and persistently high levels of windblown dust. Although evidence from several dust-related health studies and burden of disease assessments suggests there are severe health effects of sand and dust storms,8, 58, 59, 60 essential knowledge gaps hinder a more effective public health response at the time of writing.61

Areas requiring focused epidemiological research

First, information on the sand and dust storm-related spectrum of disease and long-term health effects remains scarce. Existing studies indicate that short-term sand and dust storm exposure increases the risk of cardiovascular and respiratory mortality and morbidity.8, 62 A 2020 systematic review showed there was increased mortality risk associated with circulatory diseases (2·33%) and respiratory diseases (3·99%) on sand and dust storms days compared with non-sand and dust storms days.58 A study has also identified a spectrum of cardiopulmonary diseases associated with sand and dust storm exposure, including ischaemic stroke, intracerebral haemorrhage, hypertensive heart disease, myocardial infarction, and chronic obstructive pulmonary disease.63 The short-term and long-term effects of sand and dust storm exposure, particularly across different age groups, sexes, population structures, geographical regions, and sociobehavioural contexts, remain largely unexplored. Furthermore, diseases, such as those of the nervous system, genitourinary system, and mental health disorders, have not been investigated concerning sand and dust storms exposure.8, 58, 64, 65, 66, 67 Although the mechanisms linking sand and dust storms to human respiratory disorders have been proposed, they still require validation in population-based health studies.68 In addition, aerosol composition analysis has shown that sand and dust storms can act as carriers for bacteria, fungi, and pathogens,69, 70 thereby potentially affecting the spread of infectious diseases.65 For instance, sand and dust storms might exacerbate respiratory infections by facilitating the deeper penetration of bacteria into the respiratory tract, as seen in some instances of meningitis.71 Meningitis is a substantial cause of death among children aged 5–14 years in western sub-Saharan Africa, a region known as the meningitis belt, where seasonal sand and dust storms are common.39, 72 With ongoing climate change, this region could face worsening sand and dust storm conditions, contributing to increased outbreaks of meningococcal meningitis.11, 61, 72, 73, 74 Similarly, rising prevalences of Valley fever in the USA and Kawasaki disease in Japan are suspected to be associated with sand and dust storms.75, 76, 77 Finally, it remains unclear whether the health effects of sand and dust storms vary over time, particularly in regions undergoing a resurgence of sand and dust storms following a period of decline.

Second, the key particle size distributions and chemical compositions during sand and dust storms are not well characterised. The particles range in size from 1 μm to 62·5 μm (including dust in the form of silt and clay) and greater than 62·5 μm (sand grains); both of these particle sizes, specifically dust particles, have been frequently found thousands of km from their sources.39 Existing studies have primarily focused on inhalable particles, specifically PM10.78, 79, 80, 81, 82 However, less attention has been paid to PM2·5, although some studies have reported that the health effects of PM10 are mainly attributed to PM2·5.83 Furthermore, evidence suggests that the coarse fraction of PM2·5–10 poses a higher risk for cardiovascular and respiratory mortality during sand and dust storm events than other dust metrics, such as dust PM10.84 However, the effects of coarse particles remain underexplored, despite the fact that the high concentration of PM10 during sand and dust storms is largely due to the substantial presence of coarse particles, as indicated by a low PM2·5:PM10 ratio.85 Understanding the extent to which the coarse fraction drives the health effects of PM10 during sand and dust storms requires additional research.

There is also little evidence regarding the chemical components of particles during sand and dust storms. During dust outbreaks, a mixture of particulate matter from natural and anthropogenic sources can affect both the source and receptor regions.86 Dust particles—particularly PM2·5—can be easily transported over long distances, accumulating toxic and hazardous substances (eg, anthropogenic pollutants and microorganisms) along the way and thereby increasing their toxicity.58, 87, 88, 89 Toxicology studies suggest that PM2·5 during sand and dust storms exhibit more substantial toxicity than normal days (non-sand and dust storm days).90, 91 However, population-based evidence and the mechanisms through which specific components contribute to this increased toxicity remain insufficiently understood. The little data on the chemical composition of particles and their contributions from natural and anthropogenic sources during sand and dust storms events call for more detailed investigation. Moreover, climate and land-use changes could further alter the chemical composition of dust particles, necessitating additional studies to quantify the corresponding health risks.38

Third, epidemiological research focusing on the characteristics of sand and dust storm exposure patterns is restricted in its geographical scope. Although the increasing frequency of sand and dust storms is a global concern, existing studies designed to estimate their short-term effects using the ecological time series method8 have primarily focused on selected regions of east Asia, southern Europe, and the USA.92 However, sand and dust storms mainly originate from a broad dust belt and dust particles can travel long distances, affecting more than 100 non-source regions.2, 39 Sand and dust storm exposure patterns can vary across regions due to differences in dust sources and transport trajectories, resulting in spatial heterogeneity of health effects. Therefore, studies designed to estimate short-term effects might not be the best design for geographical regions with unique exposure patterns, such as the eastern Mediterranean, which typically has prolonged periods of sand and dust storms. For instance, observers in Jordan recorded 24 h average PM10 concentrations consistently greater than 100 μg/m3 for nearly a month during a single sand and dust storm event, with low concentrations (eg, 30 μg/m3) observed outside this period.93 There have been similar occurrences in Iran, with particularly high seasonal PM10 concentrations and the longest continuous sand and dust storm (114 h) on record in 2001.94 By contrast, in 2021, during China's most severe sand and dust storm in past decades, PM10 concentrations in Beijing spiked to greater than 8000 μg/m3, but then rapidly declined within 2 days.7, 95 Hence, multicentre studies in both source and transboundary regions that consider region-specific characteristics of exposure patterns are needed to understand how sand and dust storms affect population health globally. Due to the absence of consistent exposure assessment methods of sand and dust storms, and the use of analytical models in epidemiological studies that hinder comparing findings across various studies, these multicentre studies should also adopt a standardised modelling approach to ensure the generation of comparable evidence.96, 97 Moreover, long-term exposure studies using causal modelling32 are essential, particularly for regions near primary dust sources that frequently have sand and dust storms, such as countries in sub-Saharan Africa.

Finally, epidemiological evidence on the differences in health outcomes caused by particulate matter mixtures dominated by windblown dust versus those of other substantial sources is needed. Although elevated concentrations of fine particles from windblown dust can lead to adverse health effects, they are unlikely to affect cardiovascular and respiratory morbidity and mortality to the same extent as fine particles from combustion sources.98 Some global mortality assessments have excluded sand and dust (inaccurately deemed natural or non-anthropogenic) from their exposure estimates.99, 100, 101, 102 A study in southern Europe observed that a 10 μg/m3 increase in dust PM10 (with a lag of 0–1 days) was associated with a 0·65% rise in all natural-cause mortality, which was higher than the 0·55% increase seen for non-dust PM10.78 However, empirical evidence on the differences in the magnitude of adverse health effects and the composition of sensitive disease spectrums between dust particulate matter and non-dust particulate matter remains insufficient and additional research is needed. Additionally, the combined effects of dust particles with particulate matter from other sources and other air pollutants—such as ozone—or meteorological factors—such as temperature—remain poorly understood.

Calls for international health studies

To fill these knowledge gaps, we call for the establishment of a global collaborative network and for international health studies. The global collaborative network will aim to unite global multidisciplinary researchers, methodologies, technologies, and data resources to build research protocols exploring the health-oriented definition and exposure assessment methods of sand and dust storms, the epidemiological models, and other factors. Studies can then be conducted consistently across different global regions with varying sand and dust storm exposure patterns.

Such studies should cover five areas. First is to develop and apply models to estimate region-specific short-term and long-term exposures to dust particulate matter. Second is to investigate the acute and chronic health effects of sand and dust storm exposure across dust emission and receptor regions over various periods, focusing on a range of diseases linked to particulate air pollution and possible health outcomes, such as mortality and morbidity. This analysis will provide exposure–response relationships to quantify health risks for the global population. Third is to estimate the health effects of different sizes and components of particles during sand and dust storms, clarifying the toxicity of each. Fourth is to compare the health effects of particulate matter primarily driven by windblown dust and sand and dust storms to those of particulate matter dominated by other sources, particularly regarding their influence on the composition of the sensitive disease spectrum and the magnitude of adverse health outcomes. The final area is to estimate the effectiveness of public health interventions to reduce population exposure during sand and dust storms.

With sufficient epidemiological evidence and global exposure estimates for windblown dust, it should be possible to estimate the global disease burden attributable to this increasing source of air pollution. Such estimates would inform and support the development of sand and dust storm-specific response strategies, including those recommended by WHO and other international agencies, including early warning systems and short-term air pollution action plans to reduce dust exposure.

In summary, a global evidence-based response to sand and dust storms is essential for both source and transboundary regions to develop effective mitigation and adaptation strategies. Strengthening the knowledge base on sand and dust storm exposure, adverse health effects, and the attributable burden of disease is crucial. Equally important is evaluating the public health impact of these strategies.

Contributors

Declaration of interests

PP is employed by the Health Effects Institute, a non-profit corporation that receives balanced funding from the United States Environmental Protection Agency, the worldwide motor vehicle industry, and philanthropic organisations, and serves as Chair of the Governing Board for OpenAQ, a non-profit organisation providing universal access to air quality data. This is a voluntary position with no financial renumeration. All other authors declare no competing interests.

Acknowledgments

This study was supported by the National Natural Science Foundation of China (82425051 and 82241051; TL), the National Key R&D Program of China (2023YFC3708302; QL), the Chinese Academy of Sciences Project for Young Scientists in Basic Research (YSBR-086; QL), and the National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (2024NITFID407; CZ and 2024NITFID601; TL). The views expressed in the article are those of the authors and do not necessarily reflect the views of the Health Effects Institute, or its sponsors.

Acknowledgments

TL, AJC, and MK conceived the manuscript, established the international cooperation network, and coordinated the writing and revision process. TL, AJC, MK, and CZ prepared the first draft, which was reviewed and edited by all authors, culminating in agreement on the final version.

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