Medical Waste Management in MENA

Healthcare sector in MENA region is growing at a very rapid pace, which in turn has led to tremendous increase in the quantity of medical waste generation by hospitals, clinics and other establishments. According to a recent Ministry of State for Environmental Affairs report, Egypt generated 28,300 tons of hazardous medical wastes in 2010. In the GCC region, more than 150 tons of medical waste is generated in GCC countries every day. Saudi Arabia leads the pack with daily healthcare waste generation of more than 80 tons. These figures are indicative of the magnitude of the problem faced by municipal authorities in dealing with medical waste disposal problem across the MENA region. 

Magnitude of the Problem

The growing amount of medical wastes is posing significant public health and environmental challenges in major cities of the region. The situation is worsened by improper disposal methods, insufficient physical resources, and lack of research on medical waste management. Improper management of medical wastes from hospitals, clinics and other facilities in MENA pose occupational and public health risks to patients, health workers, waste handlers, haulers and general public. It may also lead to contamination of air, water and soil which may affect all forms of life. In addition, if waste is not disposed of properly, ragpickers may collect disposable medical equipment (particularly syringes) and to resell these materials which may cause dangerous diseases.

Medical waste management method in MENA is limited to either small-scale incineration or landfilling. The practice of landfilling of medical wastes is a matter of serious concern as it poses grave risks to public health, water resources, soil fertility as well as air quality. In many Middle East and North Africa countries, medical wastes is mixed with municipal solid wastes and/or industrial wastes which transforms medical wastes into a cocktail of dangerous substances. 

The WHO policy paper of 2004 and the Stockholm Convention, has stressed the need to consider the risks associated with the incineration of healthcare waste as a typical medical waste incinerator releases a wide variety of pollutants which may include particulate matter, heavy metals, acid gases, carbon monoxide and organic compounds. Sometimes pathogens may also be found in the solid residues and in the exhaust of poorly designed and badly operated incinerators. In addition, leachable organic compounds, like dioxins and heavy metals, are usually present in bottom ash residues. Due to these factors, many industrialized countries are phasing out healthcare incinerators and exploring technologies that do not produce any dioxins. Countries like United States, Ireland, Portugal, Canada and Germany have completely shut down or put a moratorium on medical waste incinerators. 

Promising Treatment Options

The alternative technologies for healthcare waste treatment are steam sterilization, advanced steam sterilization, microwave treatment, dry heat sterilization, alkaline hydrolysis, and biological treatment. Nowadays, steam sterilization (or autoclaving) is the most common alternative treatment method. Advanced autoclaves or advanced steam treatment technologies combine steam treatment with vacuuming, internal mixing or fragmentation, internal shredding, drying, and compaction thus leading to as much as 90% volume reduction. 

Microwave treatment is a promising technology in which treatment occurs through the introduction of moist heat and steam generated by microwave energy. Alkaline digestion is a unique type of chemical process that uses heated alkali to digest tissues, pathological waste, anatomical parts, or animal carcasses in heated stainless steel tanks. Biological processes, like composting and vermicomposting, can also be used to degrade organic matter in healthcare waste such as kitchen waste and placenta.