New Report: Human Toll from Western Balkan Coal-fired Power Plants

Health Impact in Romania

Around 19,000 people are estimated to have died over the past three years as a result of air pollution from Western Balkan coal-fired power plants, according to a report released on September 7 by CEE Bankwatch Network and the Centre for Research on Energy and Clean Air. Of these, more than 50 per cent (10,800) were in EU countries, almost 30 per cent (6,500) in the Western Balkans and the remainder in neighbouring countries. Total emissions of coal power plants resulted in health costs between EUR 25.3 billion and 51.8 billion. Nearly 12,000 of these deaths resulted from the fact that the plants included in NERPs exceeded their ceilings between 2018 and 2020. More than half of these deaths occurred in EU countries, with 7,000 deaths affecting EU citizens, 3,700 deaths in the Western Balkans, and 960 in other regions affected by Western Balkan pollution.


Estimated number of deaths caused by Western Balkan coal-fired power emissions exceedances in the EU, the Western Balkans, and other neighbouring regions, 2018 to 2020

Deaths EU Western Balkans Others Total for all regions
2018 2,320 1,180 320 3,820
2019 2,220 1,160 300 3,680
2020 2,490 1,350 340 4,180
Total 7,030 3,690 960 11,680


In 2020, the country suffering the most from these emissions exceedances was Italy, with 605 deaths, followed by Serbia. Italy also had the most deaths attributed to Western Balkan exports, with 195 deaths. Greece and Serbia followed closely behind, with 180 and 165 deaths, respectively.


Top ten countries with the highest number of deaths due to electricity exports and emissions exceedances of Western Balkan coal plants, 2020

Affected country Deaths due to emissions exceedances
Italy 605
Serbia 600
Hungary 390
Romania 360
Bosnia and Herzegovina 280
Greece 240
Bulgaria 220
Ukraine 215
Croatia 181
Albania 145


Affected country Deaths due to electricity exports from WB to the EU
Italy 195
Greece 180
Serbia 165
Albania 110
North Macedonia 105
Romania 95
Hungary 80
Bulgaria 75
Bosnia and Herzegovina 70
Ukraine 60

The tables show the impacts of emissions exceedances from Western Balkan power plants, including transboundary impacts on countries outside the region, broken down by affected country.


Coal-fired power plants’ health impacts in the five Western Balkan countries are not restricted to only deaths but include other health impairments as well. The emissions exceedances for 2018, 2019 and 2020 of all the coal plants combined caused a total of around 130,000 days of asthma symptoms in asthmatic children living in the EU. Over 11,000 children were affected by bronchitis for the three years combined in the EU, just over 50 per cent of the total cases of bronchitis cases in children.

Emissions exceedances from Western Balkan power plants caused a total of 1.2 million workdays lost in 2020 alone. Hospital admissions due to cardiovascular and respiratory symptoms amounted to 3,000, with the EU having an estimated total of 1,800 hospital admissions. Over 6 million days were lost to restricted activity with almost two thirds (3.5 million) affecting EU countries, and a third (2 million) affecting Western Balkan countries. All of these in turn cause losses in productivity.

The modelled results show that between EUR 6.0 billion and 12.1 billion is estimated to have been incurred in costs in 2020 due to emission exceedances from the Western Balkans’ coal plants. Close to three quarters of these (73 per cent) relate to people and countries in the EU (EUR 4.4 to 8.9 billion), 21 per cent or between EUR 1.3 to 2.6 billion to Western Balkan countries and the remaining 6 per cent to other countries. The costs are borne both at the individual and national levels; through personal costs for medical treatment, increased national healthcare budgets and reduced productivity (which exacerbates the economic impact).


Top 10 countries with the highest health costs due to total emissions of Western Balkans’ coal power plants (EU and Western Balkan), 2020

Country Total cost, EUR million (central value) Total cost, EUR million (95% confidence interval)
Italy 2,993 1,965–3,957
Serbia 1,675 1,086–2,231
Hungary 1,508 985–1,999
Romania 1,321 863–1,752
Greece 847 555–1,120
Croatia 661 432–877
Bulgaria 649 423–862
Bosnia and Herzegovina 627 408–831
Poland 547 359–723
Germany 448 295–590


Looking at the costs on a country-level, EU countries bordering the Western Balkans, such as Italy, Greece, Croatia, Hungary, and Romania, bear the biggest health cost burden of the transboundary air pollution from coal – all estimated at central values of over EUR 1 billion in 2020. Italy is estimated to have endured the largest health damage costs in 2020, with a range of EUR 2.0 billion to EUR 4 billion. These economic burdens may also aggravate existing health, social and economic inequalities, and put pressure on healthcare systems and budgets that have already felt increased strain due to the COVID-19 pandemic.

The report, Comply or Close, launched to mark the International Day of Clean Air for blue skies, finds that nearly 12,000 of these deaths were due to breaches of legally binding pollution limits. More than half of these preventable deaths took place in the EU, which imports 8 percent of the electricity produced by these heavily polluting plants.

Air pollution from coal plants in Serbia, Kosovo, Bosnia and Herzegovina, North Macedonia and Montenegro affects not only people in their own countries but also those in neighbouring EU countries, particularly in Romania, Hungary, and Greece, according to the report.

“This report lays bare the human toll from the continued breaches of coal-based electricity in the Western Balkans. Governments of the region must immediately begin a rapid and just transition to sustainable energy systems, with EU support,” said Pippa Gallop, Southeast Europe Energy Advisor at CEE Bankwatch Network.

The Large Combustion Plants Directive – an EU directive to reduce emissions of dangerous substances, adapted for countries parties to the Energy Community Treaty – legally requires these countries to rein in air pollution from their power plants since 2018. Yet, as the report finds, in 2020, the Western Balkans’ 18 coal plants emitted two and half times as much sulphur dioxide (SO2) as all 221 coal power stations in the EU combined.

The new report reveals the extent to which coal plants in the Western Balkans have not only been flouting the countries’ legal obligations, but also taking an immense toll on people’s lives in the region and beyond.

According to the analysis, 3700 people have died in the Western Balkans and 7000 in the EU only because of Western Balkan coal power plants breaching pollution limits between 2018 and 2020. Nearly a thousand more people are estimated to have died in other regions due to choking air pollution from the same power plants.

In the three years since air pollution limits became obligatory under the Energy Community Treaty, coal-fired power plants in Serbia, Bosnia and Herzegovina, North Macedonia and Kosovo have been emitting SO2 at levels that are at least six times the legal limit.

In Serbia alone, coal plants that are subject to the National Emissions Reduction Plan emitted in 2020 more SO2 than the entire EU coal power plant fleet.

By the end of 2019, Serbia only had four wind power plants connected to its transmission system. In 2020, Serbia exported its electricity mainly to four EU countries – Bulgaria, Croatia, Hungary, and Romania. The percentage of coal in 2018 in exports to these four countries ranged between 59 per cent and 64 per cent, but in 2020 the share of coal in exports had risen to between 66 per cent and 70 per cent.

Last year, Bosnia and Herzegovina’s Ugljevik power plant was the region’s worst polluter, single-handedly breaching the combined SO2 ceiling for all four countries. The unit, just like Serbia’s Kostolac B, has a desulphurisation system fitted, but it has not been put to use. Worse still, an additional 700 MW of new lignite capacity is still planned at the Ugljevik power plant.

All four countries with National Emission Reduction Plans – Serbia, Bosnia and Herzegovina, Kosovo, and North Macedonia – are currently facing dispute settlement cases for failing to comply with the pollution limits in the Plans in 2018 and 2019. Another dispute settlement case was opened against Montenegro in April 2021 after the Pljevlja power plant continued operating beyond its 20,000 hours quota under the Large Combustion Plants Directive’s “limited lifetime derogation”.

“Those Western Balkan Governments which have not yet done so, must set a date for an urgent coal phaseout”, said Davor Pehchevski, Balkan Air Pollution Campaign Coordinator at CEE Bankwatch Network. “For power plants which cannot be closed immediately, governments must limit their operating hours until emissions standards are met, in order to save lives”.

“In parallel, investments in energy efficiency measures and renewable energy must be urgently stepped up and plans for a just transition for coal workers and communities need to be drawn up together with all relevant stakeholders, especially the affected communities.”

According to the report, the electricity generated by these coal plants and traded with the EU in 2020 — although making up a tiny fraction of EU electricity consumption — produced as much SO2 as half of the EU’s coal power plants combined.

“As our report shows, when the EU trades electricity with its Western Balkan neighbours, it bears both the impacts and part of the responsibility for the resulting out-of-control air pollution. The EU must also help countries in the Western Balkans to move beyond coal by taxing fossil-fuel based electricity imports and ensuring effective enforcement of the Energy Community Treaty”, said Lauri Myllyvirta, Lead Analyst at the Centre for Research on Energy and Clean Air.

“Western Balkan governments cannot dream of EU membership while ignoring pollution control rules. To avoid this kind of flagrant non-compliance, enforcement of the Energy Community Treaty must be made a priority. The European Commission and EU governments must introduce effective penalties,” concluded Ioana Ciuta, Energy Coordinator for the Western Balkans at CEE Bankwatch Network.

The Western Balkans exported 25 TWh of electricity into the EU from 2018 to 2020, amounting to 8 per cent of total coal-fired power generation in the Western Balkans. Hence, the EU plays a significant role in sustaining coal-based electricity in the region.

The EU’s imports of electricity from the Western Balkans make up only a miniscule 0.3 per cent of the EU’s total electricity consumption, but the emissions implications are extreme: the SO2 emissions associated with these imports are 50 per cent of the entire emissions from all power plants in the EU in 2020. This is because power generation in the Western Balkans emits around 300 times more SO2 per unit of electricity produced than power generation in the EU. Moreover, in 2020 the total SO2 emissions from coal-fired power in the Western Balkans were 2.5 times as high as the SO2 emissions from all coal plants in the EU.

The largest EU importers of this highly polluting electricity are Croatia, Greece, Hungary, and Romania. For 2018, 2019 and 2020 combined, Western Balkan countries exported 10.2 TWh of electricity to Croatia, 7.3 TWh to Greece, 2.4 TWh to Hungary and 1.7 TWh to Romania.


Health impact in Romania

Around 360 deaths per year are estimated in Romania due to thermal power plants in the Balkans that operate illegally, and other 95 attributed to coal-fired energy import from these countries. Romania imported during 2018-2020 1.7 TWh of electricity, a small amount compared to the annual consumption of 55 TWh, but with a great environmental impact.

In total, countries in Western Balkans exported 10.2 TWh in the last three years to countries in the European Union. Although this amount accounts for only 0.3% of the EU’s electricity consumption, sulphur dioxide emissions associated with these imports are equal to half of the SO2 emissions of all the 221 thermal power plants in the EU.

“The European Union is part of the Energy Community and has the power of legislative initiative, so the Member States, such as Romania, have numerous leverages available to increase environmental protection and health of the citizens in both Western Balkans and the EU. For example, the application of a carbon tax at the border in the energy sector that would discourage the production and export of energy with high emission intensity or imposing tougher sanctions to countries in the Energy Community for exceeding the pollution limits under the legislation in force,” says Ioana Ciuta, president of Bankwatch Romania and co-author of the report.

However, compliance with emission limits does not ensure a completely clean air. The difference of 7,000 deaths is assigned to emissions within the limits of the law. The European Commission updates once every 10 years the pollution standards depending on the best available technologies (BAT). In the EU, the new BATs have become mandatory in August 2021. However, in Western Balkans countries an older version of the Directive is in force, already obsolete in the EU since 2013.

“Coal-fired power plants in Europe or those part of the Energy Community must be gradually shut down, and by then they should comply with environmental legislation, this is the message of the report,” added Ioana Ciuta.

Most coal-fired power plants in Romania comply with the law on pollutants, but even so they affect the health of citizens. According to a report of the association, they cause 500 deaths per year and over 11,000 cases of respiratory diseases. Moreover, coal exploitation and burning has a major contribution to the amplification of the greenhouse effect, soil, and water pollution.

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