In the UN Report of the Special Rapporteur on the adverse effects of the movement and dumping of toxic and dangerous products and wastes on the enjoyment of human rights, a picture is painted of grossly inadequate clinical waste management.
“In the present report, the Special Rapporteur focuses on the adverse effects that the unsound management and disposal of medical waste may have on the enjoyment of human rights.
While approximately 75 to 80 per cent of the total waste generated by health-care establishments does not pose any particular risk to human health or the environment, the remaining waste is regarded as hazardous and may create a variety of health risks if not managed and disposed of in an appropriate manner. Hazardous health-care waste includes infectious waste, sharps, anatomical and pathological waste, obsolete or expired chemical products and pharmaceuticals, and radioactive materials.
In many countries, significant challenges persist with regard to the proper management and disposal of health-care waste. The amount of waste generated by healthcare facilities in developing countries is increasing owing to the expansion of health-care systems and services, a situation exacerbated by the lack of adequate technological and financial resources to ensure that health-care waste is managed and disposed of in a manner that is safe for human health and the environment.
Medical waste is often mixed with general household waste, and either disposed of in municipal waste facilities or dumped illegally. In health-care establishments where hazardous medical waste is incinerated, open burning and widespread deficiencies in the operation and management of small-scale medical waste incinerators result in incomplete waste destruction, inappropriate ash disposal and dioxins emissions, which can be even 40,000 times higher than emission limits set forth in the Stockholm Convention.
Contaminated sharps is the category of medical waste that attracts the most attention. Needle-stick injuries and reuse of infected sharps expose health-care workers and the community as a whole to blood-borne pathogens, including hepatitis B virus, hepatitis C virus and Human immunodeficiency virus (HIV). However, each type of hazardous medical waste presents hazards that jeopardise the enjoyment of human rights.
The present report contains several examples of the adverse impact that the improper management and disposal of medical waste continue to have on the enjoyment of human rights in many countries. Nevertheless, the international community has to date paid little attention to this issue, despite the fact that a significant number of people – including medical staff, patients, workers in support services linked to health-care facilities, workers in waste disposal facilities, recyclers, scavengers and the general public – are potentially at risk of injury and/or contamination through accidental exposure to health-care waste.
Certainly, in many parts of the world standards are dangerously low and effective regulation almost non-existent. Contracts exists, for example between US and Canada where, in the latter, regulation of clinical waste management is delivered with something of a delicate hand. Regulation is relaxed, and much is left to the integrity of waste producers and the disposal industries. By contrast, the highly prescriptive US model is beset with rules and regulation, though many problems exist and there are whole areas – home healthcare and diabetic needles are prime examples – that escape regulation almost entirely.
The UK is criticised for its export of clinical wastes to Brazil though this case was largely overstated at the time and is now reflecting badly in both Brazil, which cried wolf, and the Environment Agency that over-managed its media activities in a case that in the end was more likely a non-entity but which is now listed as a significant failure in waste management practice by the United Nations.
The UN report makes for good reading, though one think is painfully apparent. There is little hard evidence but much opinion. References are given, but are to UN and WHO documents, or to news reports. Those sources are mostly important and may support in part some of the comments made, though they do not provide the hard evidence that is required. The UN report should therefore be taken largely as an opinion piece, to afford an opportunity for reflection on difference approaches to regulation and waste management practice. Sadly, in such cases a report of this kind is seen as evidence to support some regulatory knee-jerk reaction that does no god and possibly much harm to the overall improvement is waste management standards.