But as the health emergency caused by the coronavirus pandemic has taken centre stage, the battle to dispose of infectious waste appears to have been sidelined by both government and private consumers.
Mismanagement of the infectious biomedical waste from the hospitals and other health care facilities may lead to transmission of diseases like typhoid, cholera, hepatitis and AIDS through syringes and needles, warns Dr Mushtuq Husein, a public health expert.
“Pathogens from abandoned or reused medical wastes like a syringe may enter a human body leading to injury or even death. The diseases can spread through animals too,” he said.
The toxic chemicals in untreated trash has may pollute the soil, water and air, said Shahriar Hossain, the general secretary of the Environment and Social Development Organisation.
“These waste materials may enter the environment and penetrate the food chain and have disastrous consequences by infecting the animals and fish.”
The hospitals and healthcare facilities in Bangladesh generate at least 248 tonnes of medical waste per day, and 86 per cent of the garbage contaminated with bodily fluids or other infectious materials are not properly managed, according to a research conducted by BRAC.
The government drafted a medical waste management and processing policy in 2008, but it has not been put to practice.
Proper management of medical waste was also made mandatory in the National Environment Policy 2018.
Most of the hospitals in the country do not follow the policies to ensure a proper health care waste management system.
IN A SHAMBLES
The city hospitals, both government-run and privately managed, have undergone modernisation over the past years, but they do not have proper a waste management system in place.
The waste management policy covers a separate set of directives for two types of contagious and nine types of non-contagious wastes.
A private organisation, Prism, has been collecting the contagious wastes from the Dhaka hospitals and destroying those, while the twin Dhaka city corporations remove the non-contagious wastes.
bdnews24.com visits to many of the hospitals in the city found they did not have the six different colour-coded waste containers required by rules.
Yellow containers are meant for disposing of hazardous waste, red containers for sharp wastes such as needles and syringes, blue containers for radioactive wastes, green containers for recyclable wastes and the black containers are for general wastes. The colour code, however, is not maintained anywhere and the wastes are disposed of indiscriminately.
General wastes were found disposed of in the containers for contagious wastes while hazardous wastes like personals protective equipment or PPE, mask, medicine bottles were found in the containers for general wastes.
The medical waste containers are supposed to be covered, but most of the containers at the Dhaka Medical College Hospital were uncovered. Worse, many hospitals have no containers for contagious wastes.
The collapse of the clinical waste disposal system was also blindingly obvious at Bangabandhu Sheikh Mujib Medical University, Ibrahim Cardiac Hospital and BIRDEM Hospital where the hazardous wastes were not segregated from non-hazardous garbage.
Bio-hazardous wastes like medicines, syringes, vaccine bottles, PPEs, masks, gloves and blood stained plastics are found in the general waste containers in these hospitals.
In BIRDEM Hospital and Ibrahim Cardiac Hospital, cleaners pick bottles and other objects from the heaps of general waste to resell those but they do not use proper safety gear or clean.
One of the waste pickers, who identified himself as Sumon, said they were aware of the health hazards posed by the contagious waste mixed up with the general waste.
“Sometimes, hazardous materials like syringes, pipes, scissors come with the general wastes; we don’t take those out, load them onto the city corporation vehicles,” he said.
“We take vaccines every now and then for protection against diseases. None of us is sick right now, but anyone may get diagnosed with a disease if we undergo tests. We may even contract AIDS!” Sumon added, in a tone of resignation.
According to the protocol, rubber or plastic tubes and bags must be cut before disposal to prevent reuse. But most of the hospitals do not follow the rule.
A staff member at the Shahid Suhrawardy Medical College Hospital was found sorting the plastic waste materials from the general waste to sell those to the scrap material traders.
Blood-stained bandages are discarded in front of the emergency department at the National Institute of Traumatology and Orthopaedic Rehabilitation or NITOR.
In many cases, the city hospitals do not even dispose of such clinical waste, while it is required to be destroyed within 48 hours.
Two separate city corporation teams collect the general wastes every fortnight while they collect the contagious wastes every seven to 10 days, said ‘Shohag’, a security guard at Kingston Hospital in Mirpur.
“It takes repeated phone calls for them to arrive and only when the trash room is full,” he said.
According to the Environment Conservation Policy 1997, a hospital must have an environment certificate after setting up a waste treatment plant and liquid waste treatment plant.
Most of the hospitals, however, do not have the certificate. They just dispose of the medical wastes and evade the responsibility for waste treatment. There is no management for liquid waste, and therefore, it gets into the water bodies.
Authorities in the hospitals admitted to the mismanagement but blamed the patients and cleaners for their mistakes leading to the mix-up of general and hazardous wastes.
The entire health sector lacks in waste management system, said Dr Uttam Barua, the director at Shahid Suhrawardy Hospital. “As far as I know, the waste materials are mixed up when we give them to Prism. It happens not only to our hospital, but also to others. Clinical waste is not being managed properly.”
“It is an issue to be determined by the government. We’ll follow if they ask us to do it locally,” he said about the hospital not having a waste management system of its own.
The Dhaka Medical College Hospital has two unused incinerators, but the authorities have no plans to start those, said Brig Gen AKM Nasiruddin, the director of DMCH.
“The health ministry took an initiative to start microwave-based waste treatment in our hospitals. But it has halted because of the COVID-19 pandemic. We hope to resume it soon,” he said.
Khandaker Anisur Rahman, the executive director of Prism Bangladesh Foundation, blamed the hospital authorities for the mismanagement in waste collection and treatment.
“Nothing can be done unless they (hospital authorities) are made aware. They care only about making money and tend to spend less on the waste disposal system,” he said.
“We don’t get all types of medical wastes or plastic wastes. Many of the private hospitals sell those off to make money,” he added.
Prism collects the solid waste from 1,030 government and private hospitals.
“Is it possible to collect millions of litres of liquid waste? These are flowing into the river through the drains. No one thinks about it,” Anisur said.
He blamed a lack of coordination at the policy-making level for the crisis.
“The local government ministry is blaming the health ministry. Why are they trying to blame each other when they haven’t decided whose responsibility is this? It’s about time they stop fooling around and speak responsibly,” Anisur said.
The health ministry and the Directorate General of Health Services are responsible for managing the infectious medical waste while the city corporation is in charge of managing the general wastes, according to the rules.
The DGHS’s incapability is the reason behind the mismanagement of medical wastes, believes Commodore M Saidur Rahman, the chief waste management officer of Dhaka North City Corporation.
“DGHS is responsible for this, but they’re incapable. Hospitals should not get permission to run unless they have a proper waste management system. And if they are permitted, the authorities see to it that they’re using incinerators to burn the waste. But they’re (DGHS) not monitoring them.”
The DNCC will ‘soon’ introduce a modern waste management system, he said.
“A decision must be made on the issue. A step needs to be taken against it, but it is not happening. There wouldn’t be any problem if the departments did their own job,” said Air Commodore Badrul Amin, the chief waste management officer of Dhaka South City Corporation.
“We can’t do anything when the hospitals send us the wastes all mixed up. We don’t have the authority to tell them anything.”
“We’re looking into the issue of waste management. We’ve already given directives to the hospitals. Some of them are abiding by the rules while some are not. We’ll give them suggestions and take measures against them if they don’t comply,” said Farid Hossain Mia, the director (hospital) of DGHS.
Local Government Minister Tajul Islam wondered how the hospitals are running without a proper waste management system.
“The hospitals must have their own management system and equipment. They should do the disinfection and incineration. It’s their responsibility. We’ll pressure them,” he said.
“We told the DGHS that each of the medical centres must have it (waste management system). We can’t do it from outside.”
The director of waste materials and chemicals in the Department of Environment declined to speak to bdnews24.com on the issue.
Dr AKM Rafique Ahammed, the director-general of DoE, did not respond to phone calls.
“There’s not enough infrastructure to implement the 2008 law. The problem became evident gradually. There’s a lack of coordination between the DGHS and the DoE. They opted for different ways,” he had said in a recent discussion.
“Generation after generation will be affected if the wastes are not managed properly and enter the food chain. And the way Prism is burning the waste, it is harming the environment. A proper waste management system is possible when everyone – the city corporations, local government ministry, health department – comes forward and works together.”