Kuwait City, Karachi and the Iranian city of Ahvaz all experience some of the highest temperatures in the world. Such extreme heat, combined with poor air quality and planning, can have grave effects, especially for their poorest residents

While Kuwaitis may be convinced that they’re living in the hottest city on the planet, there is at least one place that may be able to top it – if not for highest-ever temperature, then certainly for the impact of heat on its population. Iran’s Ahvaz, in the oil-rich province of Khuzestan, sometimes exceeds 50C in July. Yet it’s not so much the heat as the pollution that makes life unbearable for Ahvaz’s 1.5 million residents.

The city previously ranked number one in the air-quality survey by the World Health Organization (WHO) – number one being the worst. Factory emissions, traffic fumes and dust storms combine to create an atmosphere that’s visibly stifling: during the day the air can appear almost sepia. It’s not until after dark that the city, under the glow of neon lights and suffused with the scents of street food, comes to life.

Heat, though, does exacerbate problems with air quality. According to the World Bank, it is already difficult to breathe in some of the Middle East’s largest cities and a recent report, titled Turn Down the Heat, hints that the situation will only get worse under climate change – although better projections are needed. The data doesn’t tell us exactly what impact the heady mix of extreme heat and air pollution has on the people of Ahvaz, or other cities in middle- and low-income countries, but we do know it’s likely to be worse for those who are too poor to get out. ... While the official figures may be underestimates, they are expected to rise under the influence of climate change. One 2015 study predicts that urban India will see at least a doubling of heat-related deaths before the end of the century, based on summer temperature increases of up to 3C. Another study found that deaths in Seoul increased by around 8% on heatwave days, with older people and those with no education at greater risk. Similar patterns have been seen in Sao Paulo, where 2014 brought some of the hottest, driest weather on record for the city.