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April 21, 2017

Instruments of death


April 21, 2017

Biomedical waste comprises 15 percent of the total global healthcare waste. This has become an even bigger concern in developing countries like Pakistan where adequate waste management systems do not exist.

Healthcare facilities in the country generate two kilogrammes/bed/day of medical waste, out of which, approximately, 0.5kg per/bed/day includes infectious waste. WHO has classified this biomedical waste as “hazardous material that maybe infectious, toxic, or radioactive”. Lahore – the largest city of the largest province of Pakistan – houses approximately 60 hospitals and 500 clinics and, thereby, comprises more than 15,000 medical beds in the city. Imagine the magnitude of biomedical waste produced within just the city of Lahore each day.

The improper disposal of biomedical waste can lead to deadly infections such as HIV, HBV and HCV. The problem becomes more severe when the improper disposal of waste gives birth to black markets of contagious biomedical waste and the waste is disposed along with the city’s garbage. Such is the case of Lahore.

This brings attention to the need for the proper disposal of hazardous waste. WHO has identified a range of approaches to ensure the proper disposal of biomedical waste, such as burning contagious items and implementing segregated waste disposal.

Sadly, with no monitoring and implementation framework for the efficient disposal of biomedical waste, hospitals in Lahore have been given a free hand. More often than not, they mix infectious waste with general waste, thereby highlighting that there is no segregation of waste at the source. The problem is aggravated when this waste is left uncovered and unsafe in interim storage areas. It is transported to the main disposal depot in the same vehicle as the general waste and dumped in the final site without segregation.

The land dumping of biomedical waste – which is a common practice in Lahore – can contaminate the city’s drinking water supply. The improper disposal of biomedical waste is highlighted as one of the major reasons why Pakistan is unable to prevent or control Hepatitis B and C. As of 2015, over 20 million Pakistanis are infected with Hepatitis B or C.

Even more concerning is the emergence of two life-threatening ‘black markets’ due to the improper disposal of biomedical waste by hospitals in Lahore. The first involves the selling of used syringes and plastic bags to marginalised citizens who cannot afford these expensive medicines. The second involves the recycling of biomedical waste.

Public and private hospitals in Lahore are throwing biomedical waste into plastic scraps. This, in turn, gets picked up in the recycling process and is used for further production purposes. The inefficient disposal of waste is one hazard and, to top it all off, the problem of contagious biomedical waste enters our daily lives through recycled plastic products.

Despite the national and international standards for the proper disposal of biomedical waste, the conditions in Lahore are appalling, to say the least. There is no biomedical waste treatment plan in the city and, out of a total of 60 or more hospitals, only one incinerates waste. Furthermore, the incineration process at this hospital has neither been inspected nor monitored by the authorities to ensure proper incineration. Inadequate incineration or the incineration of unsuitable material adds to air pollution and causes harm to human lives.

Although the Punjab Environment Protection Agency (Pepa) has rules and regulations – enshrined under the Punjab Environmental Protection Act 2012 – it is unable to enforce and implement them. Following the amendment in the Pepa, the Punjab government announced the installation of a plant for hospital waste disposal in Lahore. Training sessions were conducted on how to efficiently dispose biomedical waste. Unfortunately, the plant has not been installed to date.

The root of this problem lies within our political structure where importance is given to matters concerning direct electoral votes for the next elections. The lack of funding and political interest in dealing with the health sector and the ignorance shown towards the issue of the proper disposal of biomedical waste violates the Hospital Waste Management Act 2005. Owing to these factors, the industry has taken a life-threatening course by supplying hazardous inputs to other industries and putting everyone’s life at risk.

More importantly, the time has come when our government needs to rethink its policies and pay more attention to the social sector instead of constructing roads and underpasses. With such dangerous standards setting in, there is an urgent need for improved reforms and the implementation of these rules and regulations – which are in accordance with WHO standards. There is need for severe punishments and fines for the management of hospitals which do not follow proper disposal procedures for biomedical waste.

Following the example of Lesotho, the government can also explore the public-private partnership with respect to setting up plants for the proper disposal of biomedical waste. Lastly, every hospital in the city, whether public or private, should have a separate department for the proper disposal of all medical waste through segregation. The head of this department should be held accountable for any future mishaps in terms of the improper disposal of biomedical waste.

The government cannot and must not allow the instruments of cure to become the instruments of death. The Lahore High Court should take notice of this matter as so many lives are at stake in one of the largest cities of the country.

The writer is a development consultant and is currently pursuing and MPhil in
development studies at the Lahore School of Economics.

Email: [email protected]



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