An Observer based in Peshawar, Pakistan's sixth-largest city, sent us photos of piles of toxic medical waste spilling into public streets outside the city's Lady Reading Hospital. Hospitals in the city are failing to dispose of medical waste safely, which can lead to environmental and health problems for the local population.
Lady Reading Hospital is the largest hospital in Khyber Pakhtunkhwa province, with 13,000 inpatients daily on top of the 7,000 outpatients who come in for treatment and leave within 24 hours.
An average 1,700 kilograms of waste is generated in a teaching hospital every day, according to World Wildlife Fund (WWF) Pakistan. Hospitals are required by national and provinicial legislation to segregate medical waste such as used medical equipment, pharmaceutical products and human waste, and to dispose of it separately. Instead, many hospitals all over Pakistan dump their hospital waste in general waste sites without segregating, disinfecting or treating it first.
A video sent by our Observer in Peshawar.
Our Observer Musarrat Ullah Jan, a journalist in Pakistan, says that this is what happens at Lady Reading Hospital. He said that the problem of medical waste has been going on for years – with no apparent end in sight.
“Children pick through used syringes to sell on used medical equipment”
All around the hospital you can see a lot of used items like syringes and used operation equipment. They have no incinerator to deal with medical waste. They just put it in the dustbin or on the roadside. It’s on a main road.
When I was taking videos and photos, I saw around eight people sorting through the rubbish. Even children are rubbish-picking. They are trying to collect different items like old syringes to sell them on. They are not aware that it is dangerous. Or if they are, they say that they can’t get a job so they do this. I talked to different people doing it, and they said they could get around 100 rupees for two kilograms of used syringes [around 0.80 euros]. I spoke to some children around nine years old who said that sometimes they cut themselves picking up sharps [sharp medical items like scalpels or syringes]. They don’t even wear masks.
The plastic from syringes is recycled to make new medical equipment. Factories wash the used syringes and then pack and sell them to the market. Drug dealers buy the second-hand syringes, and they are sold to hospitals as well.
The inside of a scavenger's bucket of collected syringes. Screenshot from a video made by Musarrat Ullah Jan. Viewable on YouTube here.
The waste is increasing in every hospital. And it’s not only in Peshawar; it’s in lots of other districts in the same province [Khyber Pakhtunkhwa]. In some areas, they just burn the waste on the roadside, in others they put it in rivers or canals. It’s not only a health issue, but an environmental issue. We are killing not only humans but also fish and other wildlife and animals in the river.
Catheters used as catapults
Our Observer said that drug dealers and users pick through the piles of rubbish to find syringes and needles that they can use or sell. Other scavengers sell on other used medical equipment like blood bags, urinary drainage bags, and catheters, which can be repurposed into catapults for children to play with.
Hazardous chemicals leach into the canal
Dr Hizbullah Khan is the head of the Department of Environmental Sciences at the University of Peshawar. He says that toxic waste and waste that has not been fully incinerated is frequently dumped in the Hazar Khawani area just outside of the city, which has a canal running through it. “The soil in this area is very porous, so different chemicals leach through the soil and reach the water," he explained. "Chemicals from medicines and pharmaceutical products go into the water, and radioactive waste from the radiotherapy centre is dumped too. The canal water is used primarily for irrigation purposes, but sometimes people swim in it, and farm animals drink from it."
WWF Pakistan says that 10-25 per cent of healthcare waste is infectious waste or "sharps". The infectious waste has the potential to contaminate the rest of the waste. Contact with this infectious waste can lead to skin, respiratory and gastroenteric problems, haemorrhagic fevers and viral hepatitis.
Dr Mukhtiar Zaman is the medical director of Lady Reading Hospital. Dr Zaman recognises the challenge that this represents – bearing in mind that each bed produces about 3-4 kilograms of waste a day.
“We have two incinerators but neither of them are working at the moment. We had a problem where the dioxin levels were too high on one of the incinerators [dioxins are a toxic, carcinogenic compound that is a by-product of incineration], so we had to stop burning stuff with it because it was having a negative impact on the environment. We have ordered two more incinerators and in the meantime, we segregate the waste within the hospital and then transport the waste to the another medical complex, where it is burnt in one of their incinerators. Obviously this is a very costly process for the hospital.”
When questioned about the piles of waste outside the hospital, Dr Zaman said that this was due to the hospital’s site in the middle of a bustling city, and that the rubbish was the result of local markets, shops, and the public littering.
In January 2017, lawyer Saifullah Muhib Kakakhel filed a petition with the Peshawar High Court saying that hospitals were not following standard operating procedures regarding waste management. The Pakistan Environmental Protection Agency responded by monitoring the waste management of hospitals in the Khyber Pakhtunkhwa province, of which Peshawar is the capital, in May 2017. The report said that: “Out of the nine public and five private hospitals in the province, no one has proper and adequate arrangements for waste products.”