North Macedonia, located in the centre of the Balkan peninsula, has over two million inhabitants. It is one of the countries most affected by air pollution in the world and the rate of premature deaths is higher than in most EU States. World Health Organization considers air pollution as a “public health emergency” and it indicates 8.8m early deaths each year making air pollution a bigger killer than tobacco smoking. It is the single largest environmental health risk in Europe. North Macedonia air pollution can be attributed to emissions from the former Socialist Yugoslav era industries, exhaust loosely regulated vehicles, burning of outdoor waste and domestic heating. Every year 2,574 people die prematurely as a direct result of air pollution, reports EU Research Result website. According the WHO Ambient Pollution Database for 2018 ranks capital city of Skopje, about 600.000 inhabitants, as Europe’s most polluted capital. In the recent years some of its cities are regularly among the european most polluted ones with exceeding safety levels of mean concentrations of both PM 10(particles less than 10 micrometers in diameter) and PM 2.5 (particles less than 2.5 micrometers in diameter) by up to 20 times. PM2.5 can penetrate deeply into the lung, irritate and corrode the alveolar wall, and consequently impair lung function. According to a recent Pilot Study Report of European Union a third of all deaths in Skopje Region are attributable to particulate air pollution. It is, in addition to mortality, associated with chronic disease, such as cariovascular diseases, respiratory diseases, as well as cancer. During the winter season government suggest to remain at home and avoiding outdoor activities. Air pollution can cause, in addition to health problems, psychological effects as depression. The winter low temperatures make the situation worst, because of the emissions resulting from the use of fossil fuels for heating buildings. The mayor of Skopje, Petre Shilegov confirmed that around 60,000 households use low-quality wood and coal for heating, reported the local news agency Makfax. Citizens use even textiles, plastics and waste to heat their homes because of the lack of a reliable gas supply and the high cost of electricity. The average low income (minimum salary is 260 euros), and energy poverty are just two of the issues making Skopje such a polluted city. Another reason is its natural position: it is located in a valley surrounded by mountains that trap the fog. The situation is further complicated by a temperature inversion, a natural phenomenon which causes warm air to remain above cool air and which contributes to the greenhouse effect.