In Pakistan, recent studies have shed light on the alarming state of affairs of hospital waste management. The improper management of hospital waste disposal should be considered a matter of immediate concern, and the way this waste is disposed of in the status quo should set off alarm bells over the impacts on public health and the environment. Reckless disposal practices in hospitals across the country continue to serve as a breeding ground for infectious diseases and widespread environmental degradation.
One of the most glaring issues is the mingling of hazardous biomedical waste with regular municipal waste, leading to cross contamination and the spread of infections. Medical waste, which includes syringes, needles, bandages, and expired medicines, often ends up in open air dumps or is incinerated without proper precautions, releasing toxic fumes and pollutants into the air.
Furthermore, inadequate infrastructure for waste disposal exacerbates the problem. Many hospitals lack dedicated facilities for the safe disposal of medical waste, forcing them to resort to makeshift solutions that are both inefficient and hazardous.
The consequences of this negligence are dire. Exposure to contaminated medical waste can lead to the transmission of infectious diseases such as HIV, hepatitis, and respiratory infections. Moreover, the environmental impact is substantial, with the potential for soil and water pollution, as well as harm to wildlife and ecosystems.
"I have witnessed first hand in Islamabad the appalling sight of medical waste being carelessly discarded into streams and open fields."
Experts emphasize the urgent need for stringent regulations and enforcement mechanisms to address the issue of hospital waste management in Pakistan. Proper training of healthcare personnel in waste segregation and handling techniques, along with the establishment of centralized treatment facilities, is crucial to mitigating the risks associated with medical waste disposal.
Dr. Mustafa Alam, a public health expert, revealed a troubling reality surrounding hospital waste management in Pakistan. Despite regulations mandating the installation of incinerators in major hospitals for the proper disposal of medical waste, it has been observed that either these facilities are absent altogether or they remain dysfunctional for prolonged periods.
"I have witnessed firsthand in Islamabad the appalling sight of medical waste being carelessly discarded into streams and open fields," the doctor disclosed. "Participating in numerous meetings convened by the environmental protection agency, it became abundantly clear that this is a critical issue requiring immediate attention. However, frustratingly, no viable solutions were forthcoming."
A physician, who is the head of a major government run hospital in Peshawar, under the condition of anonymity, emphasized the critical nature of unaddressed hospital waste management as a looming health emergency. Despite its urgency, the government appears to be showing minimal interest in tackling the issue. The doctor highlighted a distressing practice where scrap dealers, often employing children, engage in the hazardous collection of hospital waste without proper protective measures, handling it with bare hands.
This unsafe handling not only exposes these workers to significant health risks, but also leads to the indiscriminate disposal of needles into streams and open fields. Consequently, used needles pose a grave threat to anyone who might inadvertently come into contact with them.
Medical experts have observed a steady rise in the number of HIV patients in the last decade or so, attributing this trend primarily to factors such as unsafe blood transfusions and the reuse of syringes among drug users, as well as careless practices in hospital equipment sterilization
He elaborated that according to regulations, the Water and Sanitation Services Peshawar (WSSP), a governmental body, is mandated to oversee the collection of hospital waste from all public hospitals in Khyber Pukhtunkhwa. However, regrettably, they have opted to outsource this responsibility to scrap dealers. These dealers, in turn, fail to adhere to proper protocols for managing hospital waste. Instead of incinerating it as required, they sell it in the market, thereby creating a situation where the waste may be reused or released into the environment, posing a grave danger to the general public.
This candid admission highlights the systemic challenges plaguing the healthcare sector in Pakistan, where the absence of effective waste management measures poses significant risks to public health and the environment. The revelation underscores the urgent need for concerted efforts to address these deficiencies and implement robust strategies to ensure the safe and responsible disposal of hospital waste nationwide.
Dr. Mustafa Alam emphasized that while the Hospital Waste Management Rules of 2005, assign this responsibility to individual hospitals, it remains confined to their premises alone. However, he underscored the necessity for both federal and provincial authorities to assume oversight of waste management operations across public and private hospitals, as well as medical clinics.
The Hospital Waste Management Rules, 2005 are made under Section 31 of the Environmental Protection Act, 1997 of Pakistan to address the safe and environmentally responsible management of medical and hospital waste within the country. It extends to whole of Pakistan.
Medical experts have observed a steady rise in the number of HIV patients in the last decade or so, attributing this trend primarily to factors such as unsafe blood transfusions and the reuse of syringes among drug users, as well as careless practices in hospital equipment sterilization. According to government statistics, approximately 39 percent of HIV/AIDS cases are linked to the reuse of syringes, medical equipment or blood transfusions.
According to a 2010 study on healthcare waste management in Pakistan, hospital waste has been consistently mishandled and inadequately managed by both hospital staff and administration. This mismanagement poses significant environmental and health risks within hospital premises as well as to the broader population. The study aimed to provide qualitative insights by observing ten major public and private hospitals in Rawalpindi and Islamabad, Pakistan.
According to an SRO issued in 2022, each hospital shall have a Hospital Waste Management team. A hospital waste management team shall be responsible for the preparation, monitoring, periodic review, revision, or updating, if necessary, and implementation of the hospital waste management plan, and for supervision of all actions taken in compliance with the provisions of these rules.
The findings revealed that almost all of the hospitals did not prioritize healthcare waste management (HCWM). Practices related to waste segregation, handling, storage, transportation, and disposal fell well below the standards set by the World Health Organization (WHO) and the 2005 Pakistan biosafety rules. Additionally, none of the ten hospitals had established HCWM protocols and regulations, resulting in staff neglecting best practices. This neglect contributes to a host of health and environmental repercussions, impacting not only the immediate vicinity but also patients and hospital staff.
According to an SRO issued in 2022, each hospital shall have a Hospital Waste Management team. A hospital waste management team shall be responsible for the preparation, monitoring, periodic review, revision, or updating, if necessary, and implementation of the hospital waste management plan, and for supervision of all actions taken in compliance with the provisions of these rules.
The Government of Pakistan has enacted laws and regulations to address hospital waste management. These laws outline guidelines for the segregation, collection, transportation, treatment, and disposal of medical waste to ensure the safety of healthcare workers, patients, and the general public. Additionally, they emphasize the importance of adopting environmentally friendly practices to minimize the impact of medical waste on the ecosystem.
Despite the existence of these laws, their enforcement and implementation remain major challenges. Many healthcare facilities lack the infrastructure, resources, and training necessary to adhere to proper waste management protocols. As a result, medical waste is often mishandled, leading to the contamination of water sources, soil, and air, and increasing the risk of infectious diseases.
According to experts with whom this correspondent has consulted, the primary responsibility for implementing laws concerning hospital waste management lies with the Pakistan Environmental Protection Agency (PEPA). PEPA has a dedicated section tasked with addressing this issue. However, regrettably, it has failed to fulfill its duties effectively. Despite multiple attempts through phone calls and emails, this correspondent’s requests for an interview with the Director General or any other relevant official of PEPA with the intent of inquiring about their strategies for addressing this significant public health concern have been ignored.
Dr. Mustafa Alam said that an estimated half a million tons of medical waste is produced each year in Pakistan and, if not managed properly, can harbor infectious agents such as bacteria, viruses, and parasites. Efforts must also be made to raise awareness among healthcare professionals, policymakers, and the public about the importance of responsible waste management practices and the potential consequences of negligence in this regard.
Failure to address these issues could have far-reaching implications for public health and environmental sustainability in Pakistan. Urgent action is needed to prevent further harm and ensure the safe and effective management of hospital waste across the country.