Imdadullah Khan routinely rifles though a garbage bin in front of Lady Reading Hospital, in Peshawar, Pakistan. "I am looking for used syringes, drips, needles in the garbage so that I can sell it and earn money for my family," says the 25-year-old waste-picker, who has been engaged in this business for 15 years. Khan earns about $5 a day by selling what reusable medical refuse he collects from garbage dumps across the city to scrap dealers.
Khan wasn't aware of the grim fact that he's at high risk of contracting a lethal disease just by dint of his profession. According to Pakistan's environment ministry, the country's healthcare facilities generate nearly 250,000 pounds of medical waste per day. Much of this untreated waste is dumped at regular municipal garbage sites, leaving waste-pickers like Khan extremely vulnerable to exposure to infectious diseases and toxins.
The management of medical waste -- refuse generated by hospitals, laboratories, clinics and other healthcare institutions that may be contaminated by blood, body fluids, radioactive materials, or other potentially infectious materials -- requires special care and attention. It's usually recommended that all medical waste materials be segregated at the point of generation, and appropriately treated and disposed of safely. But, in Pakistan, where solid waste management is already a matter of major concern, unsafe disposal of medical waste is further exacerbating the problem, impacting the environment and health of tens of thousands of people.
According to WWF Pakistan, very little of the country's medical waste is handled according to international standards. Part of the problem is that that Pakistan doesn't have a well-established waste segregation system and most healthcare facilities, whether public or private, either don't have adequate knowledge about how to dispose of medical waste or don't bother follow standard guidelines.
Medical waste from healthcare institutions is often being dumped in the open and mixed with municipal waste, says Rahman, an environmentalist and retired professor of Department of Environmental Sciences, University of Peshawar. He says that such unregulated dumping of medical waste not only pollutes the environment, but also contributes to the spread of certain diseases by exposing health care workers, waste handlers, patients and the community at large to toxins and infections such as hepatitis, diarrhea, food-borne illnesses, skin infections, tuberculosis, and strains of antibiotic resistant bacteria.
Some medical facilities do sort out their hazardous waste and have incinerators where they burn infectious waste, but many of these incinerators remain out of order. The incinerator in Peshawar's Hayatabad Medical Complex, for instance, has-been out of service since 2012 and bandages and syringes are being thrown into an open pit on the premises. Scavengers and drug addicts visit the area and steal used needles, syringes, and other items to use again.
Besides, medical incinerators bring with them a different set of problems. Research has shown that burning medical waste can cause air pollution as incinerators emit dioxins, mercury, metals, and other pollutants including residual ash that are harmful to the environment and to public health. According to the US Environment Protection Agency, medical waste incineration is the third largest source of dioxin in air emissions.
Adil Zareef, founding member of Sarhad Conservation Network, a Peshawar-based nonprofit working on environmental and cultural issues, says that, furthermore, the incinerators used in Khyber Pakhtunkhwa province (where Peshawar is located) are substandard -- the chimneys are of low quality which incinerate the waste at low temperature and discharge the toxic gases. He says low incineration temperature does not burn the waste completely and that the residue ash, which is not disposed o fproperly, mixes with local water supplies.
Due to lack of awareness, people frequently handle the waste with bare hands, raising the likelihood of spreading communicable and environmental diseases, says Dr. Muhammad Shah with the Institute of Kidney Diseases in Peshawar. Municipal workers and waste handlers, especially, are at risk of exposure to infectious materials and of being injured by discarded needles. To make matters worse, drug addicts often rummage through garbage dumping sites and steal used syringes, needles, blood bags, and other material to use or sell. Shah says that reuse of syringes and other medical equipment leads to the spread of Hepatitis, HIV/AIDS, cholera, respiratory complications, typhoid and other infectious and lethal diseases.
Although Pakistan has passed various laws that address hazardous and medical wasteland require healthcare facilities manage their waste responsibly -- including Pakistan Biosafety Rules 2005, Punjab Biosafety Rules 2014, Hospitals Waste Management Rules 2005, Punjab Hospitals Waste Management Rules 2014 -- and has signed a number of international treaties to protect the environment, there hasn't been a comprehensive effort to enforce these regulations.
The country's environmental protection agency has repeatedly expressed concern about this issue, but it lacks the authority to take punitive action against facilities that violate regulations. Over the years, local and national authorities have made sporadic attempts to address the issue, but there is still no permanent mechanism in place that would help rectify the situation.