Mukhtar Dar

Facing challenges of Bio-Medical Waste Management in Jammu and Kashmir

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The World Health Organization (WHO) states that improper disposal of Bio-Medical Waste (BMW) can cause the following diseases: Parasitic Infections, Lung Infections, Skin infections, HIV and Hepatitis B and C Viruses, Candida, Meningitis and Bacteremia. Above all, the people living nearby open BMW disposal sites can experience diarrhoea, headaches, chest pains, irritation of the skin, nose and eyes and typhoid.

As per the Bio-Medical Waste (Management and Handling) Rules notified by the Ministry of Environment and Forests in July 1998, it is the duty of every “occupier”, (in this case the heads of hospitals and other healthcare facilities) i.e. a person who has control over an institution or its premises, to take all steps to ensure that Bio-Medical Waste (BMW) generated is handled without any adverse effect on human health and the environment.

And to implement these rules more effectively and to improve the collection, segregation, processing, treatment and disposal of the BMW in environmentally sound management, the Central Government reviewed the existing rules and invited objections or suggestions from the public and these amended rules were called the Bio-Medical Waste Management Rules, 2016.

Bio-Medical Waste (BMW) is generated primarily by healthcare institutions including hospitals, nursing homes, veterinary hospitals, private clinics, dispensaries, blood banks and medical research institutes. And negligence, in terms of BMW management, constitutes an environmental and public health problem. It presents a potential hazard to people who generate it or individuals who handle or are exposed to it.

In India, the issue of BMW management has grabbed the attention of environmental activists and policymakers owing to the increase in the general population, advances in medical technology, with increased healthcare expectancy by the population; and all this has led to increase in the quantity and variety of Bio-Medical Waste generation across the country.

The situation is no different in the Union Territory (UT) of Jammu and Kashmir, where BMW management is a problem of great concern, both for healthcare institutions and civil authorities. In 2015, the International Journal of Innovative Research in Engineering and Technology (IJIRET) conducted research titled “Effects of plastic and Bio-Medical Waste on Rajouri Town”. The researchers found that 350.54g BMW was generated per bed in the hospital during the period of one month and 90-95% of it was being dumped in open.

This cursory study throws light on the Bio-Medical Waste management in Jammu and Kashmir – particularly in the rural areas because that’s where the need for BMW management is felt to be the greatest – and offers some key policy recommendations.

A cursory glance at Bio-Medical Waste management in Jammu and Kashmir

In accordance with the Bio-Medical Waste Management Rules, 2016, laid down by the Government of India with Amendments of 2018 and 2019, it is the duty of every occupier irrespective of the quantity of waste generated to take all necessary steps to ensure that Bio-Medical Waste is handled without any adverse effect on human health and the environment. All the  Bedded and Non-Bedded Health Care Facilities (HCFs) are required to establish a bar code system for bags or containers containing Bio-Medical Waste (BMW), to account for and track the waste being sent out of the premises, for further treatment and disposal through Common Biomedical Waste Treatment facility (CBMWTF) as per Rule 4-I of BMW.

As of 2018, there were 3688 government health institutions in Jammu and Kashmir including Public Health Centres (PHCs), Community Health Centres (CHCs), and Sub-Centres. Over the past one or two decades, a large number of “ill-equipped” Public Healthcare Centers, Sub-Centres, dispensaries, veterinaries and medical Shops have been established in the rural areas of J&K. These healthcare facilities are producing large amounts of Bio-Medical Waste with no mechanism in place to safely transport and dispose of the same. At present, more than 35,000 medical shops are functioning and providing first-aid treatment in the rural areas of the Union Territory. On the one hand, these medical shops have the capacity to generate tonnes of BMW and on the other hand, the persons who run them are not equipped with the right training in BMW management. Also, the detailed estimate of BMW generated by the hospitals, private clinics, medical shops, dispensaries, households and other medical institutions in the UT remains unavailable. As a result, the precise impact of BMW on the environment and ecology is unknown due to the lack of data for validation.

The sensitive situation in the wake of COVID-19 prompted the Jammu and Kashmir State Pollution Control Board (JKPCB) to issue a draft model for Bio-Medical Waste management at Panchayat (village) and Subdivision levels. The model states that the segregation, collection, pre-treatment and storage of BMW is the responsibility of the hospitals, clinics, quarantine centres, isolation wards etc. So, for the safe disposal of BMW, Gram Panchayats, Panchayat Samitis, Group-Gram Panchayats, Gram Sewaks, Block/Tehsil level Offices, along with Zila Parishad were asked to ensure that they set up sufficiently robust BMW management mechanisms at the village levels.

However, the directions of the JKPCB have not resulted in any positive changes. The heaps of BMW along with other solid waste, which serves as a reminder of the aforementioned fact, can be seen dumped along the roadsides and banks of bodies of water – these places are, unfortunately, considered as places to dispose of the waste – in the majority of the villages.

Key policy recommendations:

The Union Territory of Jammu and Kashmir is facing a grim situation arising out of pollution due to pathological waste. There are three BMW treatment facilities in Jammu and Kashmir, out of which one is situated in Samba district of Jammu division, whereas two are located in Lasjan and Lasipora areas of the Kashmir division. However, a very few number of healthcare institutions and medical shops in rural areas are disposing of the BMW at the aforementioned treatment facilities.  And it is a fact that in rural areas, people consider the use of incineration as the preferred method of disposal of Bio-Medical Waste which is not environmental-friendly as the practice produces toxic gases giving rise to health complications.

The policy, practice (storage, collection, transportation and disposal), and compliance are crucial for setting up sustainable Bio-Medical Waste management mechanisms. The government should create awareness about Bio-Medical Waste management practices through the media and community-level communication interventions. Above all, the need for BioMedical Waste management should be supported through education, training, and the commitment of the healthcare staff and management.

Creating large dumping sites and adapting to the newer, widely, accepted, economical, and environmental-friendly technologies are the first steps toward addressing the grave problem of Bio-Medical Waste management. The use of hydroclave technology, or, more precisely, advanced “autoclave” technology – a safe and a closed-loop system that renders the waste safe, producing a finely shredded dry waste which is significantly lowered in size and weight – treatment and disposal methods for clinical waste is one of the environmental-friendly ways to look forward to.

The government should keep a close watch on the medical institutions to ensure that they are following the Bio-Medical Waste Management rules and averting any adverse effect to human health and the environment. Officials or individuals who fail to comply with these rules should be treated as offenders and summoned to make a court appearance, fined or imprisoned.

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