Living with Mount Etna's ash

When Emilia Privitera started coughing relentlessly in March 2021, she initially worried she might have caught COVID-19 again. After testing negative, she suspected a seasonal allergy. But the cough persisted for weeks, accompanied by a strange hissing sound in her lungs. A specialist found something unexpected: almost imperceptible ash particles stuck in her lungs.

Privitera lives in Nicolosi, a town near Catania, perched on the slopes of Mount Etna, Europe's highest and most active volcano. At every eruption, which can occur multiple times a year, her symptoms return. Hundreds of other residents in the area face similar challenges.

In recent weeks, intense eruptions grounded hundreds of flights for a week. While the fiery displays draw international attention, less focus is on the people living with steady volcanic ashfall, which can reach thousands of tonnes a day during intense activity, blanketing towns across the region.

Health impacts of fine particles

Volcanic ash consists of very fine particles of rock, minerals, and volcanic glass, and can get stuck on roofs and streets for years. It can act as a mineral-rich fertiliser, but inhaled particles pose health risks, especially when stirred up by wind or vehicles.

A 2013 paper on Etna's 2002 eruptions found a significant increase in emergency department visits for acute respiratory illnesses, cardiovascular conditions, and eye irritation during the eruption. Daniele Lombardo, co-author of the study, explained that fine ash can penetrate deep into the lungs, triggering inflammation, oxidative stress, and respiratory irritation.

The University of Palermo conducted studies that found elevated rates of thyroid cancer in populations living near Etna, according to reports.

Nunzio Crimi, a pulmonologist in Catania, cut his summer vacation short due to emergency calls from respiratory patients. He reported an eight per cent increase in medical appointments during the early August eruptions. The Sicilian Department of Civil Protection also reported an increase in hospital ER visits in Catania province.

Crimi noted that patients with pre-existing respiratory conditions, especially those weakened by past pneumonia or COVID, can experience serious worsening due to ashfall.

Cleanup challenges and secondary exposure

Riccardo Castro, a local politician and medical executive at the main hospital in Acireale, said delayed ash collection and inadequate disposal infrastructure prolong residents' secondary exposure to fine particulate ash, exacerbating health risks. He warned that using air blowers to clear streets reintroduces ash into the air rather than permanently removing it.

Residents like Delia Zappalà of Nicolosi said they have had to collect bags of ash themselves, as the municipality did not provide proper collective removal or guidelines. The Sicily Region and its civil protection department did not respond to a request for comment.

Paolo Roccaro, an environmental engineering professor at the University of Catania, said Sicily lags behind Japan in technology and planning for ash removal systems. He noted that despite decades of frequent eruptions, ash removal is treated as an emergency rather than a persistent problem requiring planning and mitigation.

In March, Sicily passed a decree reclassifying volcanic ash from hazardous waste to a reusable raw material, allowing its use in construction, such as a partial cement replacement. Roccaro hopes this will improve coordination of ash removal.

Lessons from Iceland

In Iceland, the 2010 Eyjafjallajökull eruption had lasting health effects. Researcher Gunnar Guðmundsson found that respiratory symptoms and psychological distress persisted for years among the most heavily exposed residents.

Berglind Hilmarsdottir, a farmer in Dyrafjord, said cattle can die from fluoride poisoning if they eat contaminated grass. Fluoride in ash can form acids in animals' digestive systems, damaging the intestinal lining and potentially causing internal bleeding. It can also interfere with calcium in the bloodstream, weakening bones and, in severe cases, causing teeth to deteriorate.

Protective measures and individual responses

Crimi suggested that wearing a mask during intense volcanic activity is the best way for citizens to protect themselves. Privitera wears a mask during intense ashfall, calling it a "palliative." Her cough and respiratory symptoms persist for weeks even after eruptions end, a pattern shared by many in the region.