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Primitive management of waste and medical waste in Baghdad... another danger threatening the population
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Baghdad Today - Baghdad
Youssef Salam (34 years old), with his wife and two young sons, finds no way to provide for their daily living, other than digging through the hills of waste surrounding the city of Nahrawan, southeast of the capital, Baghdad, where they live, and taking out what plastic and metal materials they can sell.
“This is our work. We collect everything suitable for recycling, then we sell it by weight to middlemen or workers in recycling plants.” He looks at a group of women and young men busy searching a short distance from him: “Almost all of us suffer from skin or chest diseases... We know that this constitutes "A threat to our lives, but we have no other way to live."
He raises the sleeve of his worn-out shirt, revealing his arm, which appears to be sore in some parts: “Doctors at the health center here, as well as a well-known doctor whose clinic I visited, told me that I suffer from eczema due to contact with medical waste that I often find here.”
He enumerates their types: “syringes, tubes, gonorrhea feed bags, cannulae, medication boxes, caps, and many others.” Because he works with his bare hands, as is the case with the vast majority of waste collectors in Nahrawan, the infection has spread to him.
According to the testimonies of workers in health institutions, environmental activists, and government officials, tons of solid medical waste thrown out by hospitals, governmental and private health institutions, and medical clinics on a daily basis, finds its way to various landfill areas that adopt traditional methods to dispose of their waste, the most famous of which is through landfilling, so that it penetrates the soil and mixes with the water. Subterranean.
There are two main landfill areas in Baghdad that have obtained environmental approval, one is located in the Al-Nabai area next to Al-Karkh, and the second is in Al-Nahrawan next to Al-Rusafa.
According to environmental expert Dr. Ibrahim Al-Sudani, each of them can accommodate a limited portion of the waste thrown out by the capital, which amounts to 10,000 tons per day according to official figures, while the other ends up in dozens of different collection and landfill areas that do not have environmental approvals, and do not rely on scientific methods for waste. Waste disposal.
In addition to the environmental pollution resulting from these landfills, there is other pollution resulting from “burning medical waste” in health institutions, with the gaseous emissions it produces, which specialists confirm are dangerous to public health, as well as liquid health waste that leaks from health institutions through sewage canals directly into rivers. Including the Tigris, as hospitals do not have special units to treat them.
Solid medical waste and waste
Muntadhar Mansour, a public health doctor, indicates that the waste rate ranges between 4.8 to 4.2 kg per bed per day, while other sources indicate lower numbers than that.
According to the statistical summary for the year 2022 issued by the Ministry of Planning, there are 295 government hospitals out of 450 hospitals throughout Iraq, and in the capital, Baghdad alone, there are 105 government and private hospitals and 463 health centers. If the average bed capacity was 50 beds for each of these hospitals, it would be There are 5,250 beds in Baghdad alone, and when multiplied by the daily waste generation rate per bed and assuming that it is 4 kilograms, we will have 21 tons of medical waste in the capital alone.
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This large number of waste and solid medical waste that Baghdad hospitals alone throw away daily, the bulk of it goes to those landfills, according to a health expert who asked not to mention his name, in addition to what is put away by health centers, private and public health laboratories, and doctors’ and nurses’ clinics that do not have incinerators.” All of which contribute to polluting the environment with hazardous substances.”
The expert confirms that the disposal of these large quantities of waste daily is not done properly. “Hazardous medical waste is not separated from others in many hospitals, and in some of them, medical waste is mixed with regular waste and waste, and its harm may befall the workers themselves in health institutions.” As well as cleaners in the municipal sector, those who dig up waste, and residents close to sanitary landfill or waste collection areas.”
There are those in the Ministry of Health who disagree with what the health expert said regarding the volume of medical waste per bed. Sources in the Ministry confirm that the medical waste generated from each bed amounts to only 0.5 kilograms, but they do not deny that the total quantities are large in any case.
About 20 tons of medical waste are left behind daily in Baghdad hospitals, a large portion of which is not treated in incinerators.
Two sanitary landfill areas in Baghdad!
According to the statistical summary of the Ministry of Planning for the year 2022, there are only 74 sanitary landfill sites that have obtained environmental approval throughout Iraq, except for the Kurdistan region, compared to 146 landfill sites that have not obtained this approval.
The Ministry of Environment, in the words of its Director of Urban Environment, Louay Sadiq, confirms that “only 30% of landfills throughout Iraq conform to environmental standards, and that most of them are dilapidated because more than 40 years have passed since their construction,” while the Director of the Air and Noise Control and Evaluation Department in the Ministry, Ali Jaber noted that Iraq has only two regular sites for sanitary landfill, one in Kirkuk and the other in Basra.
Sources from municipalities and public works confirm that the number of unpermitted environmental landfills increased in 2023 to reach 169 sites, and with regard to the capital, Baghdad, the Baghdad Municipality indicates that there are two sanitary landfill areas subject to the supervision of the Ministry of Environment in (Al-Nubai next to Karkh and Al-Nahrawan next to Rusafa) and that there is a landfill project The health facility in the Albu Aitha area is newly constructed.
Employees at the secretariat confirmed that there are random waste dumps created by citizens themselves, and they are not environmentally licensed and their number is unlimited, and they pose a danger to public health, because they may contain hazardous waste, including medical waste.
Environmental activist Ali Saeed believes that medical waste causes many diseases, including cancer, and says that he is aware of dozens of disease cases caused by it. He said that the official government agencies “never moved to address the problem,” as he put it.
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Ali Saeed points out that poor families depend on what their members pick up from waste collection places and do not take any means of protection to protect themselves from its danger, so they are vulnerable to diseases, the least of which are skin and respiratory.
Employees from the primary health care sector in the Nahrawan region support what the environmental activist Ali said, and confirm that contact with medical waste is dangerous because it often contains microbes and viruses that are rapidly transmitted and spread, in addition to chemicals that are dangerous to humans.
Many employees in official health and non-health institutions, with whom the author of the investigation communicated, warned in firm terms of the dangers of this waste, but they, like their predecessors, demanded that their names and job titles not be indicated for fear of being exposed to administrative penalties from their references.
To confront these risks, health employees in the Nahrawan area, where the waste dump is located, confirm that their sector is keen to provide occupational and environmental safety lectures to workers and everyone who has direct contact with medical waste, such as hospital employees, cleaners in emergency departments, municipal workers, and even people who pick up waste for the purpose of selling.
The safety directives they provide focus on the requirements for dealing with medical waste, such as providing personal protective equipment, including gloves for the hands, covering the nose and mouth, and even the eyes and ears, in addition to educating cleaning workers on how to deal with these wastes.
After a tour he conducted in a number of hospitals in the capital, Baghdad, the author of the investigation concluded that the solid medical waste that reaches the landfills is due to a lack of commitment to separating it from regular waste in hospitals.
A nurse in the emergency department of one of the large hospitals in the capital confirmed that the health and environmental regulatory authorities always direct the sorting of medical waste, and this is being done. However, he added: “Thousands visit the hospital every day, and this creates enormous pressure, especially in the emergency department, and the waste The resulting total work in the hospital’s departments, lobbies and laboratories is large, and it is difficult to sort them all.”
Medical incinerator emissions
The author of the investigation did not obtain accurate statistics regarding the number of hospitals and health institutions that have regular medical incinerators for treating hazardous solid waste, but he verified that they do not exist in many of the hospitals he inspected.
The last environmental survey of medical services activity in Iraq conducted in 2015, which included 1,480 health institutions, including 307 government and private hospitals, reveals that the number of incinerators in government and private hospitals is 195, and in other health institutions is 336, and the number of chimneys in all of them is 236, and the number of filters The number of filters in it is only 45. This confirms that more than 100 hospitals and about 850 health centers lack regular incinerators.
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Director of the Environmental Awareness Department at the Ministry of Environment, Salah al-Din al-Zaidi, believes that medical waste is disposed of safely by burning it in regular medical incinerators owned by many government hospitals in Baghdad, and work is currently underway to establish a modern medical incinerator with a larger capacity in the Medical City Hospital. It is the largest medical center in the country.
But he added: "The great danger of medical waste is evident in people's work to deal with it and sort it."
In response to a question directed by the author of the investigation to employees in the Ministries of Health and Environment, the answers unanimously agreed that the basic design of any hospital requires the presence of an incinerator to dispose of waste and waste that the hospital administration finds necessary to burn, to prevent the transmission of disease infections, and that the absence of incinerators or the failure to maintain and update them is an existing problem. Its responsibility lies with hospital management.
Yasser Al-Hamdani, a UNICEF advisor in Iraq, points out the efficiency of medical waste incinerators in treatment, but at the same time he acknowledges that the fumes and gases resulting from incineration are environmental and health pollutants that affect neighboring areas and hospital workers, including doctors.
Environmental expert Dr. Ibrahim Al-Sudani says that the random burning of medical waste and failure to observe the controls and standards of the Ministry of the Environment in the process of disposal results in “toxic fumes and gases such as dioxins that result from burning plastic or other gases depending on the components of the medical waste, for example if it is organic materials, carbon dioxide or other materials are released.” Medically, it produces oxides of sulfur, nitrogen, or mercury.”
(Audio recording by environmental expert Ibrahim Al-Sudani)
The World Health Organization confirms this in a report published on its official website in November 2023, and that dicocins can cause problems related to reproduction and growth, harm the immune system, interfere with hormones, and cause cancer.
The same warnings are expressed by Louay Sadiq, Director of Urban Environment at the Ministry of Environment, who says that dioxins resulting from the random burning of various types of waste are “carcinogenic gases that spread widely and are slow to disappear from the atmosphere, and the world has moved towards examining food products and breast milk to determine the concentration of dioxins in them.”
Some residents of areas adjacent to hospitals that contain medical incinerators are aware of these risks. Ali Mohsen (32 years old), whose house is located next to Sheikh Zayed Hospital, in the Karrada area in central Baghdad, says that his family members are very afraid of the hospital’s incinerator emissions. “We are all constantly worried about being exposed to health problems now or in the future as a result of smoke, and my neighbors also have them.” The same concern.
Mohsen appeals to the responsible authorities in the Ministries of Health and Environment to find some solution, or at least to reassure him and his neighbors that these incinerators operate with high efficiency and are monitored so that their emissions do not pose a fatal danger.
The Ministry of Health’s response to his appeal came through its spokesman, Dr. Saif Al-Badr, as he confirmed that the Ministry of Health has taken measures to ensure that modern methods are followed for disposing of medical waste using special choppers and incinerators, while adhering to international standard standards to preserve the safety of the environment and society.
Dilapidated incinerators
In Imam Ali Hospital, located in the heart of Sadr City, east of the capital, Baghdad, there is an old incinerator for medical waste that is about four decades old. At the time of its construction, it was considered an ideal solution to confront the threat of the spread of diseases and epidemics. However, due to wear and tear and neglect of maintenance, it has become a cause of pollution, and even the spread of Diseases according to workers there.
A technician who has been working in the incinerator for more than a decade, after stressing the necessity of not mentioning his name, states that the high costs of maintenance and the difficulty of purchasing new spare parts as a result of their high prices, prompted the hospital administration to carry out temporary or alternative maintenance. He added: "This led to the incinerator being unable to perform its function properly."
This means that improperly treated gaseous emissions are coming out of the incinerator, and thus may have caused the spread of diseases and polluted the city’s skies.
Undersecretary of the Ministry of Health and Environment Dr. Jassim Al-Falahi confirms that “most of the medical institutions in Iraq now lack or do not have rational mechanisms for dealing with medical waste, and if they exist, they are not with the required efficiency, including the shredding and autoclave methods, which are the common methods for dealing with waste.”
Al-Falahi attributes this to “the outdated infrastructure of hospitals that were built a very long time ago, unlike modern hospitals in which consideration was given to adding the latest technologies and taking into account environmental and health controls.”
Qusay Muhammad, who is responsible for managing the incinerator in the infection control unit at Imam Ali Hospital, and who specializes in surgical internal medicine, only warns of the danger of medical waste, whether solid resulting from waste collection operations or untreated gases. “The infection may be transmitted to and from one of those dealing with it,” he said. It is transmitted to others in the medical institution or outside it.”
He warns that medical waste that is not burned goes to sanitary landfill areas, “and here it will be the turn of the exhumators to take it out and sell what is suitable for sale, which is a very dangerous matter.”
In turn, the director of Al-Alawiya Maternity Hospital in Baghdad, Dr. Asan Al-Nayazi, warns of the dangers of medical incinerators located in health facilities, and the importance of modernizing and maintaining them, as she stressed that “their harmful emissions contain toxic substances and viruses that cause serious diseases to the local population.”
Iraq ranks first in the Arab world in air pollution rates
Media Director of the Ministry of Environment, Amir Ali Al-Hassoun, confirms that the gases that are emitted from improper medical waste incinerators “are considered one of the most important and dangerous air pollutants in Iraq.”
While the expert in water management strategies and confronting its pollution, Hamza Ramadan, enumerates the different types of air, soil and water pollution that threatens humans and the environment, “the exhausts of millions of cars and operating vehicles, the electricity generators that no residential neighborhood is devoid of that operate on diesel, and the various industrial and human activities,” warning. Pollution is now exposing the lives of tens of thousands of people every year to the risk of cancer, the rates of which are rising.
He stresses the need for relevant state agencies to develop the necessary plans to reduce this pollution and address its causes, which include “disposing of heavy hospital liquids by throwing them into river water without treatment, and the presence of medical incinerators in which waste is not burned properly.”
According to the Financial Supervision Bureau’s report for the year 2018, medical waste treatment suffers from a lack of resources and infrastructure, as 84 out of 147 hospitals in Baghdad and the governorates lack the required treatment units, which increases the challenges in safely disposing of waste.
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The lack of accurate figures on the amount of medical waste disposed of by health institutions hinders its safe monitoring and disposal
Liquid medical waste
Medical waste varies from one hospital or health institution to another, depending on the services provided therein, but most of these wastes include biological materials that are considered one of the most dangerous categories, because they contain a mixture of viruses, bacteria, and human organs.
According to workers in health institutions, some of this waste finds its way into rivers, whether it passes through treatment units or without, as there are no drainage networks for heavy sewage in most Iraqi regions, and there is no treatment for this water before it is discharged into the rivers.
In addition, there are chemical waste resulting from the use of chemicals inside hospitals. Such as nickel and lead, which pose a danger based on their uses and are among the most important carcinogenic causes of diseases, such as radiographic imaging waste. All of these materials were monitored at monitoring points on the Tigris River in Baghdad Governorate, according to the researcher in the field of environment and pollution, Ammar Al-Sudani.
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A health employee in the capital, Baghdad, specifies the type of liquid medical waste: “The water resulting from washing the emergency department, which is mixed with various types of bacteria and viruses, as well as the water resulting from washing medical tools and supplies and the hands of workers, and washing facilities, lobbies, etc.”
He explains that most hospitals and health institutions do not have treatment units for this water, and it is discharged through sewers, eventually flowing into rivers or mixing with groundwater.
In response, Ministry of Health spokesman Saif Al-Badr states that hospitals are working to treat medical waste using modern treatment units, and confirms that there is no random dumping of waste into rivers. I limit myself to this, refraining from adding more details.
But comments by environmental researchers and activists confirm the opposite, and a report by the Iraqi Observatory for Human Rights issued on March 22, 2023 states that the Medical City Complex alone dumps the waste of more than 1,000 patients daily into the nearby Tigris River.
Commenting on a question we directed in this regard to the Ministry of Environment, the Director General of the Environmental Awareness and Information Department, Amir Ali Al-Hassoun, merely said that its cadres are carrying out inspection campaigns on health facilities in the country, monitoring the environmental situation, separating medical waste from regular waste, and enhancing awareness of compliance with environmental standards.
He did not deny that governmental and private health institutions had monitored cases of throwing waste and heavy water into rivers. Regarding its procedures against violators, he said: “The authorities that detected violations will be informed and reports will be submitted to the Ministry of Health to take appropriate measures.”
Confirming the pollution occurring, regardless of its type, the Undersecretary of the Ministry of Health and Environment, Dr. Jassim Al-Falahi, holds state institutions responsible, saying that “the large rates of pollution in water sources, air and soil are borne by 95% of state institutions and ministries.”
Mishandling of medical waste
Legal memory indicates that Iraq made efforts to find solutions to waste in general, including hazardous/medical, as it established the Supreme Authority for the Human Environment in 1972, and passed the Environmental Protection and Improvement Law in 1986. In 2011, it joined the Basel Convention on the Control of the Transport of Hazardous Waste and disposed of across borders.
The Iraqi Constitution also emphasized the importance of health care in an environment free of pollution, in accordance with Article 33, which stipulates the right of every individual to live in a healthy environment, and the state’s pledge to protect the environment and biological diversity.
However, specialists believe that there is a deterioration in the environment in Iraq due to pollution, and the most important factors for this are medical waste. Government institutions, such as the Ministries of Health and Environment, are completely unable to confront this challenge due to limited resources, a weak budget, and a lack of personnel.
In an attempt to deal with this problem, the Ministry of Health and Environment issued instructions for the management of hazardous waste, in the year 2015, defining hazardous waste as that which causes or is likely to cause, as a result of its contents of materials or their decomposition, serious harm to humans and the environment. It is considered hazardous waste if it is a mixture of Hazardous waste with non-hazardous waste.
The instructions obligated the producer of hazardous waste to identify the types of waste, work to reduce its quantity and quality, and treat it at the source of its production using environmentally sound methods.
This is not enough for environmental specialists, as they see medical waste as a major danger that the Iraqi legislator must address through new legislation that requires all parties to deal with it to avoid its harms.
But the jurist, Montazer Hamid, is not confident that the concerned authorities will implement any new legislation as long as the legislation in force is not implemented, and thus it will become just ink on paper, according to his expression.
(Audio recording by legal expert Montazer Hamid)
He says: “The problem is not in the law, but in its application. We have Law No. 27 of 2009 to protect and improve the environment, but it is ineffective due to health institutions not respecting its provisions and not implementing them, which aim to protect and improve the environment by removing and treating damage and preserving public health and natural resources.” and biodiversity in cooperation with the competent authorities.”
The reason for this is the failure to form or activate environmental protection and improvement councils in all governorates, which hinders the development of effective environmental policies at the local level.
Former member of the Human Rights Commission, Ali Al-Bayati, believes that the methods followed by health institutions, medical clinics, laboratories, etc., in disposing of medical waste constitute a cause of pollution.
He points out that the Commission observed a small number of waste incinerators in hospitals, a lack of maintenance, and a general failure to follow procedures for safe disposal of medical waste. In addition, there is the lack of a triple treatment system for liquid waste in most hospitals, and the poor quality of bags for medical waste, in addition to the lack of sufficient training for the personnel specialized in dealing with this waste.
While the reports of the Financial Supervision Bureau over the past four years prove monitoring operations of throwing medical waste without treatment, and waste incinerators stopping working for long periods in several hospitals in southern and central Iraq, including Baghdad.
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Solutions and treatments
Environmental expert Radwan Ali says that the ideal solution for treating solid waste lies in treating it by contracted specialized companies, imposing strict control over medical incinerators and water treatment units in hospitals, and imposing deterrent penalties on violators.
He warns that hospitals or other government health institutions are not the only ones responsible for the leakage of untreated waste and medical waste, but also private health laboratories, pharmacies, doctor and nursing clinics, research and medical centers at universities, and even homes with patients.
He called for the adoption of modern sorting projects by specifying special containers for foodstuffs and others for plastic, paper, glass, and metal: “If this becomes a way of life, the risk of hazardous waste leakage will be eliminated, or at least reduced, and its environmental damage will be limited.”
Experts suggest various solutions to address the problem from its roots, such as establishing medical waste and waste treatment plants, using “steam sterilization to reduce harmful emissions from medical waste, isolating it in closed circuits and recycling it for reuse.”
The authorities responsible for these stations can provide the necessary tools and equipment for health institutions to deal with medical waste in safe and effective ways, such as containers and tools for collecting and separating waste, while providing engineering design and planning services for the infrastructure related to medical waste management.
Sources in the Ministry of Health stated that many governmental and private health institutions are already contracted with companies and contractors for waste management, their number in 2015 reaching a total of 506 companies and contractors, but they all recorded a note on these companies, which is the lack of commitment to separating medical waste from others, and much of it leaked through Other sources that cause environmental pollution.
Amid the whirlpool of multiple sources of pollution of the air, soil, and water due to medical waste, governmental efforts have emerged in recent years to manage waste and benefit from its outputs, as the head of the National Investment Authority, Dr., announced. Haider Muhammad Makiya, on April 26, 2024. The waste treatment and electrical power generation project in the Nahrawan area will soon be transferred to one of the advanced companies specialized in treatment technology.
Makiya says that the project will operate with a system of complete network incineration (fourth generation upwards) of waste at a rate of (3000) tons per day, which constitutes about a third of the waste disposed in the capital, Baghdad, amounting to more than (9000) tons per day, which constitutes an environmental danger that increases in size year after year in The population continued to increase and the traditional treatment of it was through primitive landfilling and burning.
• The investigation was completed under the supervision of the “NERIJ” network within the environmental journalism project managed by the Internews organization.
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