Alternatives to Incineration

• Scale of the Problem
• The GEF Project
• Stop Toxic Debt!
• Alternative Budget Initiative

Scale of the Problem

Alongside waste minimisation and segregation, the other key issue in medical waste management is how best to treat the unavoidable waste.

In the past, incineration was the technology of choice but it inevitably produces dioxin, one of the most toxic and persistent pollutants known to science — and most industrialised countries insist on complex and costly control measures to capture it. The resulting waste — such as fly ash — then has to be disposed of as hazardous waste.

The scale of the problem is amply illustrated by the fact that, in 1994, the US Environmental Protection Agency announced that medical waste incinerators were responsible for 40% of the entire country's air dioxin pollution.

Most incinerators in Asia have few or no pollution control devices, and so will release large quantities of dioxin, which can then enter the food chain. In rural areas where the smallest and most polluting incinerators are often found, it's not uncommon to see chickens scratching in the dust where the ash has been dumped — with the result that dioxin ends up transferred to their eggs (pdf). Dairy products are also particularly vulnerable to contamination of this type.

Part of the problem is that medical waste often contains a lot of PVC, and the chlorine in it is a vital ingredient in dioxin. Because of this, the World Health Organisation recommends that PVC waste not be incinerated; and Indian legislation rules it out entirely. For more information, see our PVC materials.

The Stockholm Convention, which has been signed by over 150 countries, requires that best environmental practices and best available technologies are used to reduce the amount of dioxin from incineration.

There is ample proof that this can be done. In the last 20 years, the US has closed 99% of its medical waste incinerators, going from over 6,000 in 1988 to fewer than 60 at the end of 2008.

The Philippines demonstrates that it is possible to eliminate incineration totally. In the cities, infectious waste is dealt with by centralised facilities running autoclaves or microwaves; and in 2004, HCWH-Southeast Asia helped the Philippines Department of Health prove that it was possible to manage the waste from a country-wide vaccination program without resorting to open burning or incineration. Read more about the PMEC Campaign.

HCWH first published a guide to non-incineration technologies and how they work in 2001. An updated report (pdf) on the successful PMEC Campaign was produced in 2004. The most widely used technologies are autoclaves and microwaves which use heat to kill microbes in waste, after which it can be disposed of with ordinary municipal waste.

The alternative technology report was followed by an inventory of alternative technology suppliers around the world. We identified 113 companies supplying to sixty countries. We will continue to update this inventory periodically. Manufacturers wanting to have their products included should email Alejandra AT hcwh.org.

On top of the environmental benefits, alternative technologies are usually more economical than incineration. The World Health Organisation has developed a Health Care Waste Management Costing Tool to help decision makers working at the facility, district or national level compare the capital and operating costs of the various options.

The GEF Project

Together with the World Health Organization and the United Nations Development Program, Health Care Without Harm is implementing a Global Environment Facility funded initiative.

The project is titled "Demonstrating and Promoting Best Techniques and Practices for Reducing Health Care Waste to Avoid Environmental Releases of Dioxins and Mercury." It has been developed primarily under the GEF mandate to assist developing countries in meeting the objectives of the Stockholm Convention on Persistent Organic Pollutants.

The $10 million project will demonstrate dioxin and mercury-free medicine within model health care facilities. It is set to begin its implementation phase in eight participating countries: Argentina, India, Latvia, Lebanon, the Philippines, Senegal, Tanzania and Vietnam.

The project's overall objective is to reduce environmental releases of dioxins and mercury by promoting best techniques and practices for reducing and managing health care waste.

We will meet this objective through the following components which each participating country will implement in collaboration with national governments, participating NGOs, professional associations, universities, hospitals and clinics.

• Developing model urban and rural hospitals that demonstrate approaches to eliminate dioxin and mercury
• Establishing national training and education programs on health care waste management to serve respective countries and the regions in which they sit
• Assuring that new management practices and systems piloted by the project are nationally documented, promoted, disseminated, replicated, and institutionalized
• Collaborating with Stockholm Convention National Implementation Plan preparation process
• Disseminating and replicating project results regionally and globally

We are also collaborating with University of Dar es Salaam in Tanzania to build and test low-cost, small- to medium-size non-incineration technologies for use in developing countries. The technologies will be manufactured using local resources and a range of energy sources including solar energy. The goal of the GEF project is to promote and replicate these technologies in other countries.

Stop Toxic Debt!

In 1995, the Philippine Department of Health (DoH), responding to public criticism and negative coverage in the popular press regarding the improper disposal of infectious medical waste in the country, launched a project to improve the management of medical waste by DoH-controlled hospitals in the country.

Dubbed "The Austrian project for the establishment of waste disposal facilities and upgrading of the medical equipment standard in DoH hospitals," the project's key component was the purchase of 26 medical waste incinerators called Multizon, which were manufactured by Liechtenstein-based Hoval and were supplied to the DoH by VAMED, an Austrian company. The project was financed by a loan from Bank Austria Aktiengessellschaft.

The incinerators were distributed throughout the various DoH-controlled hospitals nationwide. However, within a couple of years of operation, the incinerators started eliciting complaints from various groups. In 1999, the Philippine legislature also passed the Clean Air Act, which banned the incineration of medical waste starting in 2003.

The DoH, in cooperation with the WHO, subjected the incinerators to a comprehensive emission test, the results of which showed egregiously high emissions. In one incinerator tested, dioxin emissions were eight hundred seventy times the limit set by the Clean Air Act.

The incinerators were shut down by the DoH in 2003, but the Philippines is allocating roughly US$2 million a year to pay for the loan connected with the failed project. The last payment is to fall due in 2014.

HCWH-Southeast Asia is leading the campaign to cancel the Austrian loan connected with the medical waste incinerators. See the report, Toxic Debt: The Onerous Austrian Legacy of Medical Waste in the Philippines.

Alternative Budget Initiative

While calling for the cancellation of the incinerator loan, HCWH- Southeast Asia is at the same time proposing to redirect the appropriation for the debt payments to the delivery of health services instead. This is in partnership with various concerned groups in the Philippines that are working to achieve the Millennium Development Goals.

In recognition of the campaign, the Philippine Congress suspended the interest payments for the incinerator loan in the national budget it passed in 2008. Furthermore, it appropriated an additional 100 million pesos (about US $2 million) for the DoH to purchase autoclaves for the disinfection of medical waste.