Twice a week, thick black smoke rises from Swakopmund’s MediClinic Cottage incinerator and if the wind is right, residents nearby get whiffs of incinerated medical waste floating into their yards and homes.

The black smoke is from the plastics, such as syringes and drip bags, contained in the medical waste. Predictably, extending the incinerator’s old steel chimney with a stainless steel chimney several metres taller but did not solve the problem completely.

Many hospitals, towns, regions and countries struggle with ineffective or defective clinical waste incinerators that are themselves polluting and dangerous. The only alternative, landfill disposal, is unacceptable due to the persistent problem associated with illicit salvage and the often high water table that almost guarantees groundwater and drinking water contamination in the absence of secure sanitary landfill conditions.

WHO commissioned and supported several studies of simple and reasonably effective incinerator designs for resource-poor regions. Sadly, population growth has far exceeded the capacity of that incinerator that would necessitate a substantial and costly fuel supply to operate for the required hours.

Discontinuous operation and fuel starvation due to limited cash resource is a matter for governments, the UN and WHO, and the World Bank. Until that can be resolved, such poor operational standards will persist.