“Man is both creature and moulder of his environment, which gives him physical sustenance and affords him the opportunity for intellectual, moral, social and spiritual growth. …  Both aspects of man’s environment, the natural and the man-made, are essential to his well-being and to the enjoyment of basic human rights even the right to life itself”. (Stockholm concluding session)

In the realm of healthcare, where every action is guided by the noble intent to preserve and improve lives, a significant yet often overlooked aspect silently poses a formidable threat. Hospital waste, a dangerous mix of biohazards, lethal chemicals, and infectious agents, emerges as the second most hazardous waste globally. Its mismanagement not only jeopardizes the environment but also infringes upon the fundamental right to life as in a country where the Constitution does not expressly recognize the right to a clean environment, the landmark Shehla Zia v WAPDA case ingeniously broadened the horizons of fundamental rights by including the right to a safe environment under Article 9(Right to life). Within this context, the pressing concern of hospital waste management gains profound significance globally. World Healthcare Organization recognizes it by stating that:

“Hospital waste is a major environmental problem, posing serious threat to public health and environment.”

This article identifies different types of hospital waste and the ways they are disposed. It scrutinizes the diverse categories of hospital waste, ranging from infectious agents to lethal pharmaceuticals, originating from hospitals, clinics, labs, dental facilities, and pharmacies. In a landscape where healthcare personnel often grapple with the complexities of waste management, especially in developing nations, this article sheds light on the imperative need for refined regulatory structures and enlightened practices.

Pakistan is one of those developing countries which is striving to cope up with the challenges posed by the hazardous waste emanating from the hospitals and other health care facilities. Generally, for the protection of environment, Pakistan Environmental Protection Act, 1997 has been enacted which aims to protect, conserve, restore and improve the environment, prevent the pollution and encourage sustainable development. Section 16 assigns the Federal or Provincial assembly to direct particular measures to the person who is perceived to have been omitted the provisions of the Act, with regards to protections of environment.

Hospital Waste Management Rules, 2005 are also passed by the Federal government which lay down the procedures for the health care waste management including the rules for segregation of hazardous from non-hazardous waste, disposal, storage, collection and inspections by the Healthcare officers. Although, the legal framework has provided the guidelines but the lack of implementation renders the preservation difficult. The intoxicants and the hazardous chemicals disturb the ecosystem and effect the ozone layer. Other than that, certain diseases are caused due to the intoxicants found in the hospital wastes. The used syringes and needles cause infection, several drug resistant micro-organisms also spread from such wastes which contaminate the environment.

The disposal of untreated medical wastes in the places where landfills are not built appropriately might result in the pollution of drinking, surface and ground waters. If chemical disinfectants used to treat medical waste are not handled, stored and disposed in an ecologically responsible manner, chemical compounds may be released into the environment. Although waste incineration is a common practice, insufficient incineration or the burning of inappropriate materials causes the release of pollutants into the air and the production of ash residue. Dioxins and furans being the human carcinogens which have been linked to a variety of harmful health consequences, can be produced when materials that contain or have been treated with chlorine are burned.

Considering these health and environmental hazards, a petition (PLD 2018 Peshawar 94) was filed against the hospitals which caused the threat to environment by handling and disposing the hospital waste inefficiently. EPA visits were conducted in several private and public hospitals for inspection. In one of the hospitals, incinerator was installed but was not functional and it was observed that majority of the waste was not disposed according to the set criteria in Environmental Protection Ordinance. In others, proper segregation of waste was not being carried out. Following this inspection, certain instructions were given to the hospitals by the court. Incineration and shedding were suggested as the latest methods for efficient management of hospital waste. Whereas the former is proved to be more effective as it leaves only 5% of residue, which is easy to dispose. Along with this, certain guidelines were presented to the hospitals for carrying out proper disposal and to the authorities for keeping a check and balance on the hospitals.

Other than the domestic laws, Pakistan has signed several conventions for protecting the environment, among which the conventions related to chemical and hazardous wastes include Vienna Convention for the Protection of Ozone Layer 1985, Rotterdam Convention on Prior Informed Consent (PIC) for certain Hazardous Chemicals and Pesticides in International Trade 1998, which obliges the signatory parties in global trade of particular hazardous chemicals for protecting the environment, Basel Convention on the Control of Trans-boundary Movements of Hazardous Wastes and their Disposal 1989 aims to protect the environment against the dreadful impacts of hazardous wastes, Montreal Protocol on Substances that deplete the Ozone Layer 1987, and Minamata Convention on Mercury 2013. All these conventions collectively impose a duty on the state to take suitable measures for the preservation of environment pragmatically, the situation is different.

Despite the fact that substantial efforts have been made in order to achieve safe handling and disposal of clinical waste, inefficient management practices are still used from the point of first collection to the point of disposal. One significant obstacle is inadequate infrastructure for waste collection and removal. Numerous medical care facilities, particularly in rural areas, lack access to proper waste management systems, leading to haphazard disposal practices. Moreover, the absence of awareness among healthcare workers and the general public about the dangers related with improper waste disposal intensifies the issue.  Inadequate training and education regarding waste segregation and disposal lead to potentially hazardous situations. Additionally, the majority of healthcare facilities in underdeveloped nations are struggling financially and searching for affordable ways to dispose medical waste.

Hospital waste management in Pakistan is a complex challenge that demands comprehensive solutions. While the legal framework exists, its effective implementation necessitates a multi-pronged approach and a commitment to continuous improvement. For achieving better waste management, Pakistan should:

1. Establish vigorous mechanisms for continuous supervision and monitoring of healthcare waste management in hospitals. Regular audits and inspections should ensure compliance with waste disposal guidelines. This will hold healthcare facilities accountable for their waste management practices.
2. Direct its hospitals to create specialized committees dedicated to healthcare waste management. Regular meetings at the facility level should be scheduled to review waste management protocols, share best practices, and address emerging challenges promptly.
3. Invest in continuous training and education for healthcare professionals. This training should cover waste segregation, handling, and disposal protocols. Informed healthcare workers are essential to reducing the risks associated with improper waste management.
4. Public sector hospitals, in particular, should establish efficient supply chain management systems to ensure a steady and uninterrupted flow of healthcare waste management supplies based on their requirements.
5. Collaborate with the developed nations for implementation of hospital waste management plans as this is a global issue.
6. Encourage evidence-based research in Pakistan’s healthcare waste management sector. By supporting research initiatives, the country can develop tailored solutions that align with local needs and resources.
7. Develop policies and amend the laws in order to make them in line with the modern challenges and incorporate use of technological advancements in the waste management. These technologies can help hospitals to segregate waste, track waste movements, and dispose of waste safely.

In conclusion, addressing the healthcare waste management challenge in Pakistan requires a holistic approach that combines legal enforcement with practical strategies. By implementing these recommendations and fostering collaboration between healthcare institutions, regulatory bodies, and research entities, Pakistan can make significant strides toward safer, more efficient, and environmentally responsible healthcare waste management. This, in turn, will protect public health, minimize environmental harm, and contribute to sustainable healthcare practices across the nation.