Bio-medical waste has always been a concern for environmental and public health safety. The COVID-19 crisis has further exacerbated the problem.
India’s pollution watchdog – Central Pollution Control Board (CPCB), on 18 March 2020, came out with detailed guidelines on the management of COVID-19 waste. Since then, CPCB has made amendments thrice — the latest one being on 10 June 2020. COVID-19 has not only emerged as an enormous public health challenge but also come out as a tough test for CPCB, SPCBs, health care facilities, local bodies and communities.
As per a written reply by Ashwini Kumar Choubey (Minister of State, Health Ministry), there are 2,60,889 health care facilities registered in India generating about 608 Metric Tonnes of bio-medical waste daily. Out of this, 528 Metric Tonnes (almost 87%) is treated and disposed of either through CBWTDF or Captive disposal facility (installed within the campus of the health care facility). A report by Parliamentary Standing Committee has estimated that by 2022 India would be generating 776 metric tons of bio-medical waste each day.
Common Bio-medical Waste Treatment and Disposal Facility (CBWTDF) plays a crucial role in medical waste disposal. However, there are only 200 CBWTDFs in 28 states, leaving Goa, Andaman Nicobar, Arunachal Pradesh, Lakshwadeep, Mizoram, Nagaland and Sikkim without the disposal and treatment facilities. Apart from CBWTDF, there are 12,296 Captive disposal facilities installed by the healthcare facilities within their campus. However, the report by the Parliamentary Standing Committee clearly states that 200 CBWTFs are inadequate to handle bio-medical waste from more than 750 districts of India.
In Mumbai, 20,000 kilos of medical waste was being generated daily before the pandemic began. Now, the city is generating an additional 1500 kilos of COVID-19 waste. Mumbai’s only disposal facility at Taloja is running at full capacity. As a result, BMC has taken the decision to establish 30 new incinerators to dispose of the COVID-19 waste. Pune’s Pimpri Chinchwad facility is also operating under severe load. The plant’s efficiency has reduced as the load of COVID-19 waste has increased substantially.
In Uttarakhand, the government has decided to install four more biomedical biomedical disposal facilities in the hill state. Earlier, in Haridwar, a media report highlighted that out of total 306 health care facilities in the holy city, only 61 have proper arrangements for scientifically disposing of medical waste. In Delhi, the total incineration capacity stands at 37 tonnes per day and 70-75 percent is already being utilized.
In 2018, 27427 cases of violations under the Bio-medical Waste Management Rules 2016 were reported by the health care facilities and CBWTDFs. Out of which 16960 health care facilities and CBWTDFs were served show-cause notices by the concerned SPCB or CPCB. For the last three years, the CPCB has issued 46,442 notices to health care facilities and CBWTDFs.Such limited treatment and disposal infrastructure is a major challenge. The problem of bio-medical waste is now exponentially rising along with the COVID-19 cases in the country. Several cities have reported that their CBWTDFs are running beyond their original capacities.
The case of sanitation workers and waste segregation
Along with infrastructure, two other challenges are also making India’s fight against ‘COVID-19 waste’ difficult viz. non-segregation and risk of infection to sanitation workers.
Several news reports have highlighted the lack of segregation as one of the major constraints in ensuring the scientific management of medical waste. Today, waste from most of the home quarantines is going out in a mixed state — organic waste, plastic waste and medical waste. This is resulting in deterioration of the disposal facilities and increasing their maintenance costs. The mixed waste is adding to the burden of the facilities, resulting in unscientific disposal of waste and thereby increasing the risk of spreading the infection.
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The sanitation workers remain the most vulnerable category of frontline workers serving the nation, especially during a pandemic. In Vijaywada, seven sanitation workers recently tested positive. Delhi has witnessed the death of 15 workers and around 40 positive cases amongst the sanitation workers. The list goes on.
While CPCB has kept on revising the guidelines, NGT, on the other hand, has directed for more strict compliance and monitoring of the law by SPCBs and CPCB. In its judgement dated 21 April, the green court directed the CPCB to record the data of bio-medical waste generation and disposal through online means and on a real-time basis. Therefore, CPCB came out with an app called “COVID19BWM” which made it mandatory for the health care facilities, CBWTFs and SPCBs to update their data on a regular basis, helping CPCB to keep a tab on the issue.
In the same order, the NGT has expressed the need to come out with model plans on medical waste management at village level, district and state level. NGT has also emphasized on the need to train personnel from local bodies and health departments and provide them with adequate PPE kits.
However, the NGT orders have often ignored the brutal realities that are existing on the ground. Limited manpower, increasing healthcare facilities, rising home quarantines, infected staff and above all this the people who are refusing to segregate the waste in their homes, have made the COVID-19 crisis complex and tough to deal with. Having said this, the CPCB needs to take this as a challenge and work on war footing.
What can be done to effectively manage COVID-9 waste?
Revamping disposal infra, building capacities amongst the local bodies, providing technical support and ensuring mass communication on issues of segregation can be good ways to progress.
Issuing advisories on wearing reusable or cloth masks to general or non-infected persons, avoiding the use of single-use plastics, open spitting and urination will also help in tackling the crisis. Call for innovators/startups must be made to provide reusable PPE kits and provide low-cost, affordable and safe options for disposal of medical waste. For ensuring transparency and accountability, data generated by the online app must be made public.
The government must not think of penalizing the violating health care facilities, disposal facilities or handling agencies – their participation is critical at this stage. Rather, some kind of post-pandemic action should be thought about.
We are sitting on a ticking bomb. The COVID-19 waste has the full potential to contaminate our lands and water bodies. It is both an environmental and a health hazard which requires sustained government action and proactive citizen engagement.
Rishabh Shrivastava is an independent journalist. He tweets at @Writer_Rishabh.