The Issue

Medical waste can cause pollution and disease if it is not handled properly. Infectious waste, especially sharps, poses a risk to anyone who comes into contact with it. The WHO estimates that 40% of hepatitis cases and 12% of HIV cases worldwide are caused by occupational exposure.

Hospitals also produce small amounts of chemical, pharmaceutical and radioactive waste, which need specialist handling. Added to this, there will be large amounts of more ordinary trash — including packaging, paper and food — which can make up around 80% of the waste stream. A large hospital can produce a ton of waste every single day.

In many developing world hospitals, all of this trash is mixed together and burned in low tech, highly polluting incinerators, or in the open with no controls whatsoever. It is now well established that incinerating medical waste produces large amounts of dioxin, mercury and other pollutants. These end up in the air, where they can be transported thousands of miles to contaminate the global environment, or in the ash, which is frequently dumped without thought for the load of persistent toxins that it carries.

If it is not burned, medical waste can end up dumped with municipal garbage. Wherever this happens, rag pickers face a daily danger, especially in those countries where it is possible to resell some components of the waste — for example, syringes — for illicit re-use.

One of the difficulties in ensuring medical waste is properly dealt with in poorer countries is the lack of funding. Many donors that conduct essential work to strengthen healthcare services, provide medical supplies or organize immunization programs do not include any provision for medical waste management.

The World Health Organisation has called on all donors to make sure they provide an adequate budget for this to prevent the possibility that people or the environment suffers from the waste that these vital projects create. (See WHO Core Principles for Achieving Safe and Sustainable Management of Health-Care Waste). Health Care Without Harm is working with partners around the world to counter the threat from medical waste.

• Waste Minimization, Training, Research and Model Hospitals
  We are helping hospitals to reduce the amount, toxicity and impact of the waste they produce through training on segregation and choosing low waste, low toxicity products. In 2005, HCWH-Southeast Asia conducted a Health Care Waste Assessment Project (HWAP) in four tertiary hospitals in Metro Manila. The process was then replicated in the whole province of Northern Samar wherein HCWH-Southeast Asia conducted a Preliminary Health Care Waste Assessment in one provincial hospital and 8 district hospitals in 2007. In 2008, HCWH-SEA partnered with the local government of Baguio City and seven tertiary hospitals for another model of the Health Care Waste Assessment Project. The objectives of the HWAP are: to document the good practices of the hospitals/ health care facilities in the proper management of their health care waste and to come up with a baseline data on the total health care wastes being generated in one locality.
• Alternative Technologies
  HCWH has produced reports on the various non-burn technologies that are available for medical waste and manufacturers supplying to some 60 countries. In the Philippines, HCWH-Southeast Asia is involved in a campaign for the cancellation of a defunct Austrian medical waste incinerators project and alternative budget initiative for alternative technologies. In 2004, HCWH-Southeast Asia documented a nationwide vaccination program and showed that disposal of immunization waste is possible without incineration.