Poisonous time bomb: Iraq's struggle with medical wastes
Shafaq News/ Iraq is facing a critical issue with the improper management of its medical waste, posing serious health risks and environmental threats. The failure to address this problem has led to a growing public concern and has worsened the health of communities across the country.
According to the World Health Organization’s 2023 report on health system challenges in Iraq, the country's medical waste management remains inadequate, largely due to limited resources, political instability, and an overburdened healthcare system.
Abu Ghraib Hospital: A Health Crisis
One glaring example of Iraq's struggles with medical waste management is Abu Ghraib General Hospital, located west of Baghdad. This hospital, like many others in Iraq, has adopted a dangerous and environmentally hazardous practice of burning medical waste in open pits. The burning takes place in the heart of a residential neighborhood, directly affecting local communities.
From 5:00 p.m. until the early hours of the morning, toxic fumes pour into the air, exposing residents to dangerous pollutants such as dioxins and furans, which are carcinogenic and have long-term health consequences.
According to witnesses, toxic gas emissions from Abu Ghraib General Hospital have caused some residents to flee the area.
Activist Jamal Al-Tai shared the alarming impact of these emissions, "These toxic fumes affect those with chronic illnesses and the general population in the area, to the extent that residents are unable to go outside due to the smoke. The incinerator is positioned right in the middle of a residential neighborhood".
In response to these concerns, the Iraqi Ministry of Environment issued Instruction No. 3 in 2015, mandating the proper segregation, collection, and disposal of medical waste. This includes the isolation of hazardous waste from other materials, proper processing, and disposal at specialized facilities like high-temperature incinerators. However, as demonstrated by the Abu Ghraib situation, these guidelines are not always followed, particularly in hospitals with limited resources or lack of infrastructure, as noted in a 2015 review by the Iraqi Ministry of Environment.
Nature And Classification Of Medical Waste
Medical waste is divided into two primary categories: liquid and solid waste. Liquid waste includes materials such as laboratory water, fixatives, and diagnostic chemicals, all of which must be treated before being discharged into sewage systems to prevent contamination.
Solid waste is further divided into regular and hazardous types:
• Regular waste: Non-hazardous items like paper, packaging, and plastic, managed through standard disposal practices.
• Hazardous waste: Includes potentially infectious materials, sharps (such as needles and scalpels), pharmaceutical residues, chemical agents, and radioactive waste, all of which require specific treatment methods to prevent contamination and health risks.
According to Louay Al-Mukhtar, spokesperson for Iraq’s Ministry of Environment, healthcare waste is legally recognized as a separate category that demands meticulous management based on its nature and risk.
Al-Mukhtar emphasized, "Any human activity produces types of waste that have characteristics related to that activity. Medical waste, or 'healthcare facility waste,' is a special category that requires careful management according to its nature," as reported to Shafaq News. He also explained that hazardous medical waste requires specific treatment methods, including high-temperature incineration, autoclaving (steam sterilization), and microwave sterilization to safely neutralize the materials.
In Iraq, the treatment methods for hazardous medical waste are often less advanced compared to those used in many developed nations. For instance, while many hospitals around the world rely on high-temperature incinerators that burn medical waste at temperatures exceeding 1000°C, Iraq still faces significant challenges in implementing such technology. Instead, many healthcare facilities in Iraq resort to burning waste in open pits or using outdated incinerators, which can release harmful emissions like dioxins and furans, substances that are linked to cancer and other long-term health issues. This method is not only inefficient but also environmentally damaging, as toxic smoke affects nearby communities.
Many other methods are also applied globally, yet not in Iraq. Along with the high-tech incinerators already mentioned, autoclaves and other chemical treatments are proven to be effective.
For example, in Europe and North America, waste is often segregated at the point of origin into categories like sharps, pharmaceutical waste, and biohazardous materials. These items are then treated according to their specific risk level. Autoclaving, which uses high-pressure steam to sterilize waste, is commonly employed for biohazardous waste, while pharmaceutical waste and sharps are typically incinerated at very high temperatures to ensure the destruction of harmful agents. These methods prevent the release of toxic substances into the environment and protect public health.
In contrast, Iraq’s medical waste management system lacks the infrastructure and resources to implement these global best practices. Although the Ministry of Environment has issued guidelines on waste segregation and disposal, including the use of designated containers for hazardous waste and the construction of specialized treatment units, the country's hospitals often lack the required technology and trained personnel to follow these protocols effectively.
Al-Mukhtar’s statement on the importance of specialized bags, containers, and trained staff underscores the difficulty Iraq faces in addressing these issues. "Each category requires specific bags and containers for collection, and it is essential to have an administrative structure and trained personnel in every healthcare institution," he said, referring to the Ministry's 2024 guidelines.
Ultimately, the gap between Iraq’s medical waste management practices and those followed in more developed countries highlights the urgent need for investment in waste treatment technologies, staff training, and better infrastructure to protect both public health and the environment.
Impact Of Medical Waste In Iraq
Iraq generates approximately 0.5 kilograms of medical waste per capita daily, as estimated by the Iraqi Ministry of Health, which is significantly higher than the global average of 0.3 kilograms in countries with comparable healthcare infrastructure. However, the absence of effective waste management systems means much of this waste is mishandled, leading to widespread contamination, particularly in urban centers like Baghdad and Basra.
• Health risks to humans: Healthcare workers, waste handlers, and residents living near healthcare facilities are at constant risk of exposure to infectious materials and hazardous chemicals. The World Health Organization (WHO) reported that 32% of healthcare workers in Iraq experienced needle stick injuries or exposure to contaminated waste materials in 2023, compared to the global average of 18% in low-income countries. This elevated risk creates a substantial threat of disease transmission, including HIV, Hepatitis B, and Tuberculosis.
A healthcare worker in Baghdad interviewed by the WHO stated, "We handle medical waste with limited protective equipment, exposing us to infections daily. The system urgently needs reform."
• Environmental degradation: Improper disposal practices significantly harm Iraq's environment. Hazardous waste, including pharmaceutical residues, heavy metals, and toxic chemicals, often seeps into soil and groundwater supplies. The Iraqi Ministry of Environment's 2024 report revealed that 25% of groundwater samples near healthcare facilities in Baghdad and Basra contained detectable levels of pharmaceutical contaminants, including antibiotics and cytotoxic drugs. In rural areas, these contaminants threaten agricultural productivity and food security. Additionally, the open burning of medical waste releases dioxins and furans, both classified as carcinogenic by the WHO, further polluting the air and contributing to higher rates of respiratory illnesses.
• Public health crisis: Iraq’s fragile healthcare infrastructure exacerbates the dangers posed by improper medical waste disposal. According to the WHO's Global Public Health Report (2023), over 5.2 million deaths annually worldwide are linked to inadequate medical waste management, and Iraq is disproportionately affected. Communities near dumping sites report a 45% higher incidence of respiratory illnesses and gastrointestinal diseases compared to those living further away, as detailed in a 2023 study by the Iraqi Red Crescent.
One resident from Al-Sadr City, where untreated waste is routinely dumped, lamented, "Our children are always sick because of the waste. We are surrounded by contamination, and no one helps us."
• Vulnerable populations: The burden of improper medical waste management disproportionately affects vulnerable populations, including children, the elderly, and individuals with chronic conditions. According to a 2023 UNICEF report, children living within 1 kilometer of open medical waste dumping sites in urban areas such as Al-Sadr City are 70% more likely to suffer from developmental disorders due to prolonged exposure to contaminated air, water, and soil. In rural regions, the elderly and immunocompromised individuals face elevated risks of respiratory diseases caused by toxins released from burning waste.
Governmental And Non-Governmental Efforts
Efforts to tackle Iraq’s medical waste management crisis have involved both governmental and non-governmental organizations (NGOs). While some progress has been made, challenges like political instability, resource shortages, and inconsistent enforcement have hindered substantial improvements.
The Iraqi government has implemented several initiatives aimed at addressing the medical waste crisis, led by the Ministry of Environment and the Ministry of Health. Instruction No. 3, issued by the Ministry of Environment, outlines procedures for waste segregation, collection, transportation, and disposal, marking a step toward formalizing waste management standards. Additionally, the Ministry of Health, in partnership with the United Nations Development Programme (UNDP), secured a $25 million investment in 2023 to establish specialized incinerators and medical waste treatment units in urban areas.
However, progress has been uneven. According to the UNDP's 2024 report on Iraq's health infrastructure, only 25% of hospitals in Iraq have been equipped with modernized waste disposal systems. Many facilities still rely on outdated practices, such as open burning or uncontrolled dumping, which exacerbate environmental and health risks.
Majid Shangali, Chairman of the Parliamentary Health and Environment Committee, highlighted this disparity in an August 2024 interview with Shafaq News, stating, "Despite progress in some areas, the majority of hospitals lack access to specialized treatment facilities. Our goal is to establish waste treatment units in key locations, such as Medical City and certain sectors managed by the Popular Clinics."
In addition to infrastructure development, the Iraqi government has launched pilot programs for training healthcare workers on waste segregation and safe disposal techniques. These programs, however, have been limited in scope and lack sufficient funding to ensure nationwide implementation.
NGOs have also played a critical role in addressing the gaps left by government initiatives. Organizations such as the Green Iraq Foundation and The Iraq Environmental Conservation Network have launched public awareness campaigns emphasizing the dangers of improper medical waste disposal. These campaigns aim to educate both healthcare workers and local communities about the health and environmental risks posed by poor waste management practices.
The Green Iraq Foundation, in its 2024 campaign report, detailed its efforts to distribute over 10,000 medical waste segregation bins and provide protective gear to healthcare workers in underserved areas. Additionally, the organization has funded small-scale waste treatment projects, including autoclaving units in rural clinics where government resources are scarce. These efforts have helped mitigate risks in regions most affected by inadequate waste management systems.
NGOs have also invested in capacity-building programs, offering workshops to train healthcare professionals on the proper techniques for waste handling. In an official statement, a representative from the Iraq Environmental Conservation Network noted, "Our goal is to bridge the gap where governmental systems are failing, empowering healthcare workers to manage medical waste safely and effectively."
Despite these efforts, progress remains slow, with significant shortcomings in regulatory enforcement and infrastructure development. A 2024 survey by the Iraqi Ministry of Health revealed that 40% of healthcare facilities lack adequate segregation practices, while over 60% of medical waste continues to be burned in open pits or dumped in municipal landfills. Furthermore, many rural and conflict-affected areas are excluded from both government and NGO programs, leaving millions of residents vulnerable to the health and environmental impacts of improper waste disposal.
Corruption and inefficiency further exacerbate the issue, with a 2024 Transparency International report indicating that funds allocated for waste management projects are often mismanaged or diverted, "We are forced to reuse protective equipment and handle medical waste without proper disposal facilities. Promises are made, but we see little change on the ground", a healthcare worker from Mosul told Shafaq News.
Activist Voices And Calls To Action
Through protests, public awareness campaigns, and collaboration with international organizations, activists have pushed for systemic changes to improve the safety of healthcare workers, residents, and the environment.
Activists have used social media and community outreach to highlight the dangers of improper medical waste disposal. Through platforms like Facebook, X, and Instagram, activists have shared graphic images and stories from local communities affected by hazardous waste practices. They have also organized public forums and workshops to educate healthcare workers and the general public on the risks of improper waste management, as noted in social media campaign reports from 2023.
Moreover, in 2023, a series of protests erupted in Baghdad and Basra, calling for urgent government action to address the medical waste crisis. Activists demanded that the government increase investment in modern incinerators, enforce existing environmental regulations, and allocate more funds to hospitals for waste treatment facilities. These protests, backed by local communities, have forced the issue of medical waste management onto the national agenda.
Activists have also called for greater collaboration with international organizations to secure funding and expertise for medical waste management projects. They have specifically requested technical assistance from WHO and the United Nations Environment Programme (UNEP), as well as funding for waste treatment infrastructure. These activists believe that with proper international support, Iraq can overcome the barriers to effective waste management, as stated in their joint statements with these international organizations.
