Only through collective responsibility can we tackle this overwhelming health problem
The Covid-19 pandemic has put a spotlight on the public health and environmental risks of medical waste management. The use of disposable PPE, like face masks, gloves, aprons, etc, has sky-rocketed and increased waste volume, in health care, at home, and elsewhere, with each used PPE being a potential infection source.
The PPE waste is exacerbating pre-Covid-19 shortfalls in safe and environmentally sound management of medical waste. Medical waste management rules have been issued in 2018, yet implementation falls short in ensuring separation, containment, and safe and environmentally sound disposal of medical wastes.
The observed littering of medical waste items on streets, in waterways, and disposal yards is testimony of waste leaked from the waste management system. Many items are made of high value plastics or other materials, and hence attractive to scavengers, potentially exposing them to pathogens or hazardous substances. It is high time to prioritize implementation of modern medical waste management practices and techniques to keep people, communities, and the environment safe.
Biomedical waste items, whether infectious, toxic, radioactive, or non-hazardous, can pose threats to people and the environment at their source, during collection and transport, in final treatment or incineration, and through uncontrolled re-use, recycling, littering, and burning. This is impeding progress towards the Sustainable Development Goals (SDGs), particularly on good health and well-being (SDG4) and sustainable consumption and production (SDG12).
Imagine some infected cotton has mixed up with other waste and been dumped randomly so that leaching takes the pathogens into the eco-system, pollutes water, soil, and everything which comes in touch with it. Think of a syringe being re-used without sterilization, or plastics from medical waste being illegally sold without disinfection. Where a small amount of medical waste is mixed with a larger volume of municipal or other solid waste, the entire waste mass becomes hazardous, posing threats to public health.
If medical waste is burned in an uncontrolled manner, the fumes will contain dioxines and furanes, among the most toxic persistent organic pollutants (POPs) that are regulated under the Stockholm Convention. The medical waste scenario is scary, yet it is unfolding before the eyes of the general public.
The scale and dispersed nature of medical waste generation may easily overwhelm. As of today, just for the Covid-19 response, about 654 government and 5,055 non-government hospitals along with 9,061 testing centres are generating Covid-19 medical waste -- many of them without an appropriate disposal and resource recovery process. The Daily Star last year had estimated that at least 14,500 tons of medical waste was generated in Bangladesh during April 2020 -- the initial month of the Covid-19 pandemic, and this may have further increased.
This has come on top of medical waste already generated from routine medical care in hospitals and other health care facilities.
Covid-19 waste is essentially no different from other medical waste. Good practices and techniques exist to deal efficiently and safely with medical waste, through a four-pronged approach: Segregation of waste items with packaging and labeling at source; application of best available techniques and best environmental practices for treatment of each fraction; strict containment of the medical waste all the way from its source to final disposal or disinfection; and use of appropriate PPEs by all waste handlers.
This approach is already reflected in the Medial Waste Management Rules 2008 for Bangladesh. However, the necessary mechanisms for implementation have not been set up, which require involvement of Department of Environment (as environmental regulator), Directorate General of Health Services (as health sector regulator) and Local Government Division as city corporations are accepting medical waste for disposal.
Moreover, unfortunately, there is lack of awareness, standard operating protocols and skills, shortfall in monitoring and inspection, and insufficient capacity and performance constraints of biomedical waste collection and treatment infrastructure -- and an apparent unwillingness to accept medical waste management as an integral component of any modern health service.
The United Nations Industrial Development Organization (UNIDO) has already supported several member states, including India, China, and Iran, to develop efficient medical waste management systems, through development and promotion of standard operating protocols, training, and demonstration of best available techniques and best environmental practices. Within the framework of its integrated support for sustainable plastic use and marine litter prevention, funded by the Royal Government of Norway, UNIDO will also support Bangladesh on modern, safe, and environmentally sound medical waste management.
Regular health care and pandemic control will unavoidably generate medical waste that will contribute to the spread of illness and diseases if not taken care of properly. It is both necessary and urgent to accept collective responsibility and then mobilize and operationalize the necessary partnerships, resources, and facilities to make safe and environmentally sound management of medical waste a reality in Bangladesh.
René Van Berkel is UNIDO Representative and Head of Regional Office in India and SMGB Arafat, is UNIDO’s National Expert in medical waste management in Bangladesh. Disclaimer: the views expressed in this column are those of the writers.