The World Health Organisation (WHO) considers medical waste incineration a significant source of highly toxic dioxin, a known carcinogen that has been linked to birth defects, immune system disorders and other harmful health effects. In 1994, The US Environmental Protection Agency (EPA) identified medical waste incineration as the single largest source of dioxin air emissions in the United States.

In Europe, incineration is also responsible for about 4 percent of mercury emissions to the environment from human activities. Mercury is a potent neurotoxin that can cause developmental defects and harm the brain, kidneys and lungs. Other pollutants from incineration include furans, acid gases, heavy metals and particulates.

In 2000, stricter emission limits for medical waste incinerators were introduced in the European Union. This resulted in the closure of many incinerators and an increase in the number of nonincineration facilities for treating infectious medical waste. However, incineration remains the prevailing method of treating medical waste in Europe.

HCWH published Non-Incineration Medical Waste Treatment Technologies in Europe (pdf), a comprehensive evaluation of medical waste treatment technologies. The report concludes that there are viable alternatives to incineration that are safer, cleaner, do not produce dioxin, and are just as effective at disinfecting medical waste. These technologies can be used on all types of medical waste, including pathological and chemotherapy waste. Read also the summary of this report in French (pdf), German (pdf) and Russian (pdf).

Given that alternatives to incineration are available, a complete phase-out of medical waste incineration is possible and appropriate. This will require changes in national and EU laws, persuasion of hospital systems that non-burn approaches are both effective and environmentally preferable, public education, and better segregation and reduction of waste by hospitals.

Is Incineration Required?

The EU legislation does not impose any technology requirement for medical waste treatment; this is the responsibility of individual EU member states. While a handful of states require that certain portions of the waste stream (pathological waste, chemotherapy waste, recognizable body parts) be incinerated, many have no such requirements. To find out more about specific regulations on medical waste treatment, consult your national waste management plan issued by Ministry of Environment.

Key Resources

What's Wrong with Incineration (pdf)

Alternative Technologies Report

Evaluating Non-Incineration Alternatives (pdf)

Minimizing Harm, Maximizing Health (pdf)