According to the United Nations Conference on Environment and Development, around 5.2 million individuals face major health hazards each year as a result of medical waste mismanagement in various countries, including Bangladesh, with 4 million of them being children. In Bangladesh, there is no precise information about this. Many diseases spread in Bangladesh as a result of improper medical waste disposal.
Bangladesh currently does not have a hygienic or standardized modern system for disposal of medical waste. Medical waste management is one of the most important parts of health, but it appears the Ministry of Health or the Department of Health is not concerned about it; the 2008 legislation on safe disposal of medical waste is very weak and not up-to-date.
In Bangladesh, medical waste is disposed of through city corporations, a system that is archaic and is not even in use because it contradicts the 2008 law. Even if there had been a minimal effort to implement the law, I would not have seen bags of used waste (syringes, needles, pus-soaked gauze, bandages) lying in the dustbins around the country's hospitals, a class of people selling syringes collected from dustbins, or one of the country's hospitals selling syringes collected from dustbins.
Because of this mishandling, the majority of the country's 40,000 women and children waste collectors are afflicted with numerous ailments.
According to the Bangladesh Medical Waste Management and Processing Rules 2008, it is stated to construct an authority consisting of three members in each department of the country under the chairmanship of the divisional director of the health department.
The aforementioned body may grant a license to a competent individual or institution for medical waste management and processing. According to the guidelines, the licensed person or institution must handle and process medical waste in a way that has no negative impact on human health or the environment.
Furthermore, the conditions for medical waste treatment specified in Schedule 6 of these rules must be followed. Medical waste management and processing records should be preserved for a minimum of three years.
The rules also specifically mention that before storage, transportation, treatment and disposal, medical waste should be segregated at the place of generation. It is specifically noted that untreated medical waste cannot be stored for more than 48 hours. This medical waste can be stored only in specific and protected areas.
Rule 5 would grant three sorts of licenses: (1) wrapping and storing, (2) collection and transportation, and (3) refining and removal to a third party to deal with the disposal mechanism. According to Rule 7, wastes must be kept separate from other general garbage during collection, wrapping, storing, and transportation.
However, practically all hospitals dispose of their garbage by mixing it with ordinary waste and not sterilizing it. Because there are no designated sites for the disposal of medical waste, the trash is dumped in canals or open dumping zones, endangering the ecosystem and food chain.
For hospital waste disposal, the government entered into an arrangement with the private organization Prism Bangladesh Foundation in 2018. As a result, Prism is working on medical waste disposal in several major cities, including Dhaka. However, they face a number of challenges, including a lack of machinery, waste collecting trucks, and people. Furthermore, limited awareness of health workers engaged in hospitals is a serious impediment to proper medical waste management.
The Covid-19 outbreak has damaged the already fragile features of Bangladesh's health system, revealing its backward and corrupt image. Even if we exclude all other aspects of the health system from the discussion, the picture is bleak.
In hospitals, there are irregularities in the storage of medical waste. According to Bangladesh Medical Waste Management and Processing Rules 2008, each waste storage container should have a colour code based on the type of waste, and there are instructions to use World Health Organization-approved symbols, but there is a lack of compliance in hospitals.
Overall, 29% of hospital trash containers are not colour tagged, and the majority are unlabeled. Moreover, hospitals do not use symbols on containers depending on the type of waste. All types of waste are kept in the same container without storing the waste in the right container even though there is a colour code.
Observations also show that waste is not disposed of in designated containers but is left next to it. Besides, there is a lack of separation and careful management of chemical and radioactive waste.
To overcome this situation, Medical Waste Management and Processing Rules 2008 should be made more stringent. For a safe medical waste disposal system, the Department of Environment, city corporations, and Bangladesh Medical and Dental Council should work together.
A modern and scientific medical waste management institutional system is a necessity. Waste management courses should be integrated into all fields of health education, including medical education, dentistry, and nursing. In all hospitals, the health budget must legally appropriate funding for the safe disposal of medical waste.
Sabrina Pervin Shanta is a freelance contributor.
