Medical waste solution needed in Yemen [Archives:2007/1080/Health]

August 27 2007

Bushra Al-Anesi
For Yemen Times

Yemen is unable to manage its medical waste. It burns waste in an open landfill in Al-Azraqeen. This is causing health problems and environmental pollution. The proposal for a central incinerator is on hold, while problems with cost, location and safety and environment issues are addressed.

The simple solution, a sophisticated incinerator that could handle all waste (hazardous and non-hazardous together) is considered too expensive for a developing country. Furthermore the hospital incinerators lack safety because of their emission of dioxin (see box). Additionally, most of the hospitals are located in residential areas.

The cheaper alternative is to separate non hazardous waste and burn it; and to bury hazardous waste in a specially designated site.

Five years ago, the Social Fund Development allotted a budget of $1.2 million for establishing a central incinerator to burn medical waste produced by hospitals and health care facilities in Sana'a, whose population is around 1.8 million.

This proposal came after a comprehensive study that included field surveys of 50 hospitals and health centers. This revealed that all of the hospitals and health centers in Sana'a produced an estimated 22 tons of medical waste daily. This quantity contained approximately six tons of contagious and dangerous waste. The study was presented to the General Authority of Yemen Environment Protection, as well as the Center of Environmental Consultations in Egypt (ECOSe/vcom).

The study gave the opportunity for environmental experts, doctors and officials to discuss the ability of Yemeni government to build modern incinerators to get rid of the medical wastes. Some experts suggested establishing two incinerators with a daily holding capacity of four tons of medical waste each. This is in addition to the placement of micro units inside every hospital, which are programmed to sort waste.

In 2005, these suggestions and recommendations became a project funded by the Social Fund Development and municipality. They stated that components for the project included the main site along with other buildings with an area of 3,600 m2. There was one hall for treating dangerous wastes, one storage room and one room for waste recycling. The project also included one maintenance workshop, administrative facilities, a treatment unit, special equipment and other accessories.

However, the project scheduled to start operation the beginning of this year has not been completed. Fifty percent of the remaining construction is still awaiting financial support. Therefore, the incinerator, which is supposed to be in the southeast direction of the landfill in Al-Azraqeen, 16km away from the city center is not yet working.

There are many reasons for the delay. The most important are cost and environmental impact. The General Authority of Environmental Protection said that the incinerator has direct impacts on the population, soil, air and water. It is also close to residential areas near the landfill (Al-Azraqeen).

Because of this the environmental authority sent a letter to the Social Fund for Development informing the organization of its rejection of the incinerator, because “it does not meet certain environmental conditions”. According to the letter the social fund wanted to burn all medical waste in this incinerator, whereas the environmental authority stipulated that contagious waste is only to be burned via the thermolysis

Incinerator (decomposition of compounds by heat.) . The authority also requested the social fund to import a rotary fern incinerator if it wanted to burn all waste. The cost of the rotary fern is very high. The authority stated that the current incinerator does not meet all requirements of environmental protection in terms of reducing dioxin emissions and other gases.

Abdu-Baqi Ghailan, officer for water and environmental projects at the Social Fund for Development, commented on Environmental authority's letter saying, “people must be realistic. Yemen will not be able to afford a highly sophisticated incinerator. The social fund will have to accept the specifications of the agreed-upon incinerator.” He added that the current situation is very miserable as medical waste is burned in open air, causing environmental pollution and health problems.

Ghailan also pointed to the financial problems that faced the project. “The Yemeni government, represented by the municipality now has two choices: accepting simple technology despite its dangers or pay an unaffordable amount to obtain sophisticated and modern technology valued at roughly $5 billion.”

Eng. Ali Al-Thoubhani, manager of the poisons and dangerous wastes unit in the Environmental authority insisted the necessity of inviting the private sector to contribute to purchasing a modern incinerator based on the principle “those who contaminate the environment must pay.”

World health organization expert, Raqi Zankali says that Yemen, being a developing country, cannot afford the costs and maintenance of a highly sophisticated incinerator. He proposes a low-cost program to manage medical waste. The program depends on classifying medical waste. That is separating the general waste or solid waste, (packaging materials, food scraps, bottles), from the hazardous medical waste, that is contaminated and considered as a source of potential infection. Hazardous Medical waste includes used needles, anatomical remains, used chemical disinfectants and pesticides. Such waste should be stored separately and properly, and then taken by certain cars to be buried in special location.

Hospitals' Incinerators

Of 47 incinerators located in Yemeni hospitals, only three are operative. Four health facilities, namely Ath-Thoura hospital, Al-Saba'een hospital and blood transfer center as well as its branches in Sana'a and Aden decided to obtain medical incinerators.

Regardless of the sophistication of those incinerators, burning medical waste is dangerous to human health. The British Association for Environmental Medicine says that Medical waste incinerators are a major source of toxic air emissions, especially dioxin and cadmium. They are connected to cancer of the liver, lungs, and stomach.

Exposure to these substances affects the immune system and weakens its ability to resist disease. They also affect woman's reproduction. A study conducted by a specialist of infertility in Syria showed that dioxin increases the production of INHBIN, a poisonous substance that demolishes the ovaries. It consequently causes miscarriages and weakens fertility.

The American Agency for Environmental Protection confirms that dioxin is a cancerous. The agency says that dioxin is transferred via air, entering primary food substances even in areas far away from the site of emission. Meat, milk derivatives, eggs and fish are the main foods through which dioxin is transferred. It accumulates in fat tissue. Babies are exposed to dioxin five times more than adults, due to the high proportion of fat in a mother's milk.