Environmental impact assessments (EIAs) effectiveness and accessibility by the public is determined by local environmental enforcement and regulation. Massive energy infrastructure projects like China's Belt and Road initiative (BRI) could accentuate social and economic costs, as regulation is deferred to host countries with varying levels of domestic enforcement. To fill major gaps in the public evaluation of EIA practices and results, our objective here is to present an open-source approach for evaluating localized air pollution health impacts for BRI-financed coal-fired power plants. This analysis focuses on one specific problem, additional attributable mortality from stroke, ischemic heart disease, and chronic obstructive pulmonary disease for adults ages 25–84 from fine particulate matter (PM2.5), known to be major risk factor for premature deaths globally. As a concrete example, we examine the case of the Port Qasim power plant located near Karachi, Sindh Province, Pakistan. We present results for two main scenarios: a base case, assuming fully operational pollution control technologies, in particular electrostatic precipitators (ESP); and an alternative case without ESPs. All material and methods for replicating this analysis for the case study and for other projects are available in our institutional open repository. Our approach can be applied immediately to virtually any source location in the world, due to the public and global availability of input data. SynopsisWe present an open-source approach for evaluating localized health impacts due to fine particulate matter emitted from coal-fired power plants.