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Dhaka Sunday,  May 29, 2022

Unlawful Trade Of Medical Waste: Silent Killer

Ohidul Alam

Municipal solid waste (MSW) is well-acquainted to us, but little people are familiar with medical waste (MW). Seemingly, MSW is considered as social and environmental burden. Therefore, its management has become a challenge for municipal authorities now, especially in developing countries like Bangladesh. Generally, about 68 to 84 percent MSW is organic or food waste in Bangladesh. However, almost 95 percent MSW is recyclable through different ways viz. mechanical, biological and thermal treatment. But mass people are not conscious about the associated health risks and environmental contamination with MSW recycling. Besides, a major part of MSW is non-hazardous, so it can be easily recycled but problem is with 1 to 3 percent hazardous wastes. These hazardous wastes comes from different sources such as hospital, industry, research institute, and a little from household wherein the major contributor of hazardous waste is MW ranging from 1 to 1.2 percent.

Bangladesh is a developing country and its communication system is still under-developed. Therefore, most of the healthcare facilities (HCFs) like hospital, clinic, maternity, and diagnostic centers are town centered. Currently, there are 29 government and 64 private hospitals which all are located within major cities; only a few in district level cities. In total 1683 registered hospitals, clinics, and diagnostic centers are in Bangladesh wherein 678 are government and 1005 are non-government. Only in Dhaka city 390 private clinics and 691 diagnostic centers are located while in Chittagong city 75 private clinics and 145 diagnostic centers. About 75 to 85 percent HCFs are residing in major cities such as Dhaka, Chittagong, Rajshahi, Khulna, Sylhet, Barisal, Comilla, Gazipur, Narayangonj and Rangpur. In contrast, a little number of HCFs is situated in rural areas except dispensary and private chamber where in district level some private clinics are establishing lately. This indicates that most of the HCFs are not scattered rather centered within some big cities.

Such growing number of HCFs along with patients generates a huge volume of MW every day; roughly an estimated value is 650 tons per day from whole country wherein Dhaka city merely generates 225 tons per day. The rest big cities generate Chittagong (52), Rajshahi (27), Khulna (23), Sylhet (16), and Barisal (11) tons per day MW. On the contrary, in small cities and rural areas all HCFs generate cumulatively 297 tons per day. However, per patient waste generation rate (WGR) is Dhaka (0.5), Chittagong (0.57), Rajshahi (0.3), Khulna (0.4), and Sylhet (0.15) kg per day while per bed WGR is 1.9, 1.28, 1.54, 1.2, and 0.93 kg per day respectively. Though overall medical WGR is low in Bangladesh compared to developed countries but in Dhaka and Chittagong city slightly high than other cities of Bangladesh.

Apparently, most of the people consider all MW as hazardous waste but major parts of it is comparable with domestic wastes varying from 65 to 88 percent; only around 12 to 35 percent is hazardous wherein its percentage is 12 to 23 in Bangladesh. Further, hazardous waste can be classified as infectious, sharp, recyclable, chemicals & drugs, and radioactive wastes. The physical composition of MW depends on many factors for example – geographical location, living & socio-economic status of people, and providing services by HCFs etc. Therefore, percentage of hazardous waste in Bangladesh is comparatively low than developed countries such as United States, Germany, United Kingdom, Canada and France.

Rapid and uncontrolled population growth is accountable for depletion of virgin sources of natural resources. Hence, globally government and traders are searching for alternate source of resources; recycling and resource recovery from MSW has been detected as potential source. Besides, it supports not only to minimize waste disposal cost as well environmental pollution. As a result, Bangladesh government is encouraging both NGO and private entrepreneurs to conduct MSW recycling program. Meanwhile, recycling of wastes by informal sectors has got popularity in Bangladesh. By recycling wastes, Bangladesh saves around Tk15 million and earn foreign currency every year too. Moreover, such business demands lower investment but more profitable and only in Dhaka city about 120,000 poor people are involved in this recycling enterprise.

Anyhow, recyclable MW is comprised of syringe, plastic, needle, metal, paper, gauge, and rubber. These wastes have high market value both in home and abroad because they can be recycled easily with low cost and have market demand too. Currently, about 16 billion injections are used worldwide, every single year and two major companies in U.S. recycle (70%) of HCW, diverting them from landfill. Similarly, two states in Australia have started recycling 16.5 tons PVC wastes annually to make industrial hoses and non-slip floor mats. However, such types of recyclable MW generates from the entire Bangladesh; approximately syringe (1.9), plastic (3.4), needle (0.8), metal (1.6), paper (1.2), gauge (0.8), and rubber (1.1) tons per day. All types of recyclable wastes are sold at a price Tk. 10 to 50 per kg wherein metals and plastics value is comparatively high. Still none of the HCFs follow appropriate source segregation system (color coding), though government has already introduced it in public hospitals. Consequently, all the recyclable MW is get mixed with MSW unconsciously.

MW demands special attention and care for safely management and disposal because it contains germs and toxic chemicals, so it is illegal to trade and recycle in all countries but in developing countries like Bangladesh unknowingly such unauthorized trade is continuing hereto. Both MSW and MW are recycled together without adopting any separation and pre-treatment. Further, recycled products are used for different purposes and consumers are not aware about its carrying germs. Consequently, these germs spread in different environments and ultimate result of which is human health. Bangladesh being developing country, literacy rate is comparatively low yet than developed countries. Hence, mass people are not concerned about such emerging silent contamination from MW recycling which is posing a potential human health risk. Additionally, collection and recycling of MW is performed manually in unhygienic environment without taking any pre-caution.

Though it is unlawful to trade and recycle MW but many people are directly or indirectly linked with such business in Bangladesh, especially in major cities. Different classes’ people are associated with such illegal trade for example staff of HCFs & waste management organizations, vhangary (small recycling shop), and illiterate poor (floating & slum) people. By collecting such wastes each collector earns Tk. 200 to 500 per day as well recycling industry also earn more profits with low investment. Consequently, recycling of waste business is providing both livelihoods and revenue. Lately, several NGOs are organizing training programs for small traders of recyclable waste with the collaboration of government but nothing about MW.

In developed countries MW is treated and disposed by closed incineration process but in developing countries, it is hardly noticed. Every HCF has its own bucket type incinerator for disposing infectious waste in Bangladesh but don’t make use of them to save fuel cost and labor. On the other hand, large scale public hospitals have their own incinerators which aren’t used due to shortage of energy supply. It is also found that almost every HCF arranges open burning of MW behind their campuses which is responsible for releasing toxic chemicals such as dioxins and furans into atmosphere. But government, department of environment and department of health are not paying any attention to control such unauthorized disposal of MW. Therefore, similar illegal disposal of MW is still popular among all HCFs and continued.

So, government should take immediate steps to stop such illegal trade and disposal of MW in Bangladesh. In contrast, centralized incineration plants should be introduced with energy recovery for hazardous MW and bring all HCFs under similar service. ICDDR, B in Dhaka, Rajshahi Medical College Hospital in Rajshahi and PRISM Bangladesh in Dhaka & Khulna are conducting such projects partially.  Finally, monitoring should be enhanced to check and control such unlawful trade and disposal of MW in Bangladesh.

The author is studying Masters of Environmental Engineering in UNEP-Tongji Institute of Environment for Sustainable Development (IESD), and research student in Institute of Waste Treatment and Reclamation (IWTR), College of Environmental Science and Engineering, Tongji University, Shanghai, China.

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