North Macedonia’s government imposed emergency measures in the capital city, Skopje, and in three other cities due to high levels of air pollution. Skopje was ranked as the third most polluted city in the world on 24 December, with pollution levels 28 times higher than the World Health Organization’s air quality threshold. Following the calls for action from environmental groups, the new rules curtail sports events and outdoor activities on days with high pollution, reduce use of official vehicles, provide shelter for homeless people, enhance emergency services and home visits to those with chronic illnesses and limit construction work to a six-hour interval. Companies were urged to excuse pregnant women and those over the age of 60 from work. The soaring air pollution in North Macedonia and in the whole Western Balkans region has sparked health fears, insecurity, and debate over the lack of action to address the crises.