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Poisonous Medical Waste Invade Syria (1/2)

17 March 2007

It is called the toxic gas, or the “yellow toxin”. One liter is enough to instantly kill one million people and inflict other diseases and disabilities on another million. These are but some hair-raising figures about dioxin emissions from medical waste incinerators, cited in an academic research “Management of Solid Medical Waste” by engineer Sonia Abasi.

A field survey conducted by this reporter on seven of the 14 incinerators serving Syrian hospitals showed that the seven violate effective legislation on destroying medical waste by burning, as well as on the treatment of resulting dioxin emissions which spread it in the vicinity.

The seven hospitals covered under the three-month survey are: The Children’s hospital in Damascus, Assad University Hospital in Damascus, Al Muwasat Hospital in Damascus, The National Hospital in Latakia, Assad University Hospital in Latakia, Aleppo University Hospital and Ibn Khaldoun Hospital in Dweirina, Aleppo.

Fourteen incinerators in Breach of International Standards

According to the latest Index for the Management of Medical Waste, there are 14 incinerators treating the waste of public and private hospitals in Syria. The fact sheet, published in 1999 by the ministries of environment and health, states that neither of these incinerators uses the mandated degree of heat needed to destroy dioxin and lack basic equipment used in the treatment of gasses. The World Health Organization (WHO) Index on Dioxin Standards warns inadequate parameters can produce Dioxin, which, according to the International Agency for Cancer Research (IARC), is a “categorical” cause for human cancer.

Government authorities, namely the ministries of health and environment, that released the report, have been, therefore, knowledgeable of the fact since 1999; they read the “the management of sanitarium waste” bulletin published by the WHO, which maintains that people living close to these incinerators are strongly exposed to dioxin, and are, therefore, potential cancer victims.

However, no official decision was taken during the following eight years to close down these unsafe furnaces. Sadeq Abu Watfa, the aide to Minister of Local Government and the Environment, said the government believes using incinerators to discard hospital waste is a provisional need, given the limited resources at hand, prior to the adoption of a new strategy that employs eco-friendly and healthy techniques.

Meanwhile, the people exposed to Dioxin emissions live under threat. According to WHO studies, the average age for dioxin to dissolve in the human body is seven years.

The harmful effect of dioxin on people living in neighboring areas could appear either at an early stage or later on, according to a report released by the British University of Birmingham.

 People Protest
Since authorities were reluctant to reach a decision about the incinerators, complaints from people who have been mostly affected by these furnaces forced the shutdown of some of these sites, the head of Solid Waste Department at the Ministry of Environment, engineer Rula Aba Zeid, said in an interview with Al-Thawra newspaper.

A report published in 2001 by the Department of Public Water Contamination, pointed out that Ibn al Nafees Group of Hospitals and the private Al Shami Hospital were among those who took these measures.

Engineer Riad Qabiqli, former head of the solid waste plant in Damascus, said that until his last day in office in early 2006, he knew that all sanatoriums in the capital had closed their incinerators 10 years before.

However, the field survey conducted by Tishreen newspaper showed this was not the case at all, as some of these sites – those serving the two largest hospitals in Damascus; Al Muwasat and Assad University – are still operating.

Incinerators of Damascus University Hospitals

In her post-graduate thesis last year, Abbasi studied the management of medical waste at all incinerators run by the University of Damascus.
One of the chapters in her dissertation focused on incinerators. In response to a set of questionnaires distributed to officials in these hospitals, she found out that the 50-year-old Al Muwasat incinerator is still operating, following maintenance works in 2004. In addition, it also burns the medical waste of Al Muwasat Hospital, the Nuclear Medicine Center and the Cardio-Surgical Center. The 17-year-old incinerator at Al Assad University Hospital incinerator is still working, along with a 25-year-old one at the Children’s Hospital, which is only used for burning paper waste. An incinerator at al Jildiyah Hospital was reported as inoperative .

The survey also noted that all these incinerators lack the minimum filtering or gas treatment techniques, thus emanating Dioxin in the heart of the capital, especially the Children’s Hospital incinerator. The Stockholm Agreement believes the whitening material in papers is a dreadful source of Dioxin when treated by burning.

This complements what officials at Al Muwasat Hospital, disclosed to this reporter. Dr. Shadia Khudari, medical chief, and Muhamad al Haj, head of engineering, said the incinerator is used for burning furnishings and paper.
Chemist Fuad Al ‘Ik, head of the chemical safety department at the Environment Public Committee, warned that the burning of furniture and the remains of human bodies from surgeries emits Dioxin, as well as Chlorine.
This is consistent with the statements of the medical chief at Assad University Hospital in Damascus, Dr. Ghassan Hummos, and of the health safety officer, Samy Hamed, who said the incinerator burns down the blood sacks, medicine sachets, human remains and dirty sheets on a daily basis, at a temperature reaching 1,200 degrees. The improper gas treatment and burning of this material, contrary to the stipulations mandated by the Stockholm Agreement and the WHO, is enough to spread dioxin in the environment. Mr. Hamed stated: “he does not approve of the use of incinerators, as they generate cancerous Dioxin”.

Aleppo University Hospital Incinerator

Aleppo University Hospital incinerator is the biggest such facility still running in this city. It burns various kinds of plastic and medical waste, as stated in an official report made available by the head of the engineering office, Ms. Iman. Earlier. Last year, the president of Aleppo University asked her to undertake an assessment of the condition of the incinerator before inaugurating a new incinerator, which will be inaugurated in 2007.

Based on that report and following a field visit to the present site, it was noted that the 25-year-old incinerator does not fulfill the minimum requirements of combustion and does not employ any filtering or gas treatment methods.

Compared to the WHO index on Dioxin standards, this incinerator is a potential generator of Dioxin due to its non-compliance with the recommended degree of burning and because of its non-observance of the conditions of plastic burning.

While WHO establishes that dioxin spreads over a minimum radius of 20 km, the incinerator at Aleppo Hospital, stationed on top of a hill, spreads out this cancerous gas over a wider area.

Ibn Khaldoun Hospital incinerator in Aleppo
Aleppo’s Department of Sanitation employs two incinerators at Ibn Khaldoun Mental Hospital in Al Dweirneh to burn medical waste. Both are rather small.

Our visit coincided with repair works at the site after a short circuit started a fire. The superintendent of medical waste at both incinerators said the temperature varied between 1,000-1,200 degrees.  He added that his wish to apply sophisticated gas treatment techniques was thwarted by the authorities, who “got back to us with a brief message: shortage of funds”.

The dean of the School of Technical Engineering at Aleppo University, Dr. Abdul Hakim Banoud complained that almost all incinerators in Syria,  including those in Aleppo, take it easy on applying rules regarding the minimum degree of burning, which should be at 1,200 degrees at least.
Dr. Abdel Hamid Bannoud, who also head the environment committee at the Syndicate of Syrian Engineers, called for the need to ensure proper care when dealing with gas emissions at these incinerators, instead of focusing only on the filtering of these emissions, to avoid Dioxin.

Head of Sanitation Department in Aleppo, Engineer Muhamad Hazzani, said he was absolutely against destroying medical waste by burning. He called for promoting and introducing new eco-friendly techniques, such as sterilization and disinfection among others.Assad University Hospital Incinerators in Latakia

Latakia has two incinerators serving the two biggest hospitals: Al Assad University Hospital and the National Hospital.

The first one, 22, operates at a relatively low degree, barely exceeding 800, and therefore is not adequate to prevent the emission of Dioxin, according to Adnan Ismael, the engineer in charge at the site. He said  Ismail, said there was an attempt to increase the temperature, which resulted in shattering the ceramic walls of the adjacent rooms, instead of breaking down the cancerous Dioxin. The furnace operates for three hours every day but lacks the minimum conditions required for filtering or treating the emissions.

Head of the Solid Waste Department in Latakia, Muhsin Shariba, revealed the results of some field tests he ran on this incinerator for ten days in a row. He said the degree of heat was far below the average needed to kill bacteria or germs or to destroy cancerous Dioxin.
The site serves, besides Assad University Hospital, the Military Hospital, and the Blood Bank.

 The National Hospital Incinerator of Latakia
This site is relatively new, working for 4 hours twice daily, at a temperature reaching 1,000 degrees. The incinerator, which started working in 2001, takes care of the waste dumped by public and private sanatoriums in Latakia, in addition to the National Hospital, according to the engineer in charge, Haitham Zuwaifa.

Mr. Shariba, maintained however that the primary and secondary incineration levels are 600 and 900 degrees.

A Japanese agency put the primary and secondary burning temperatures at 500 and 840 degrees respectively. The study was conducted by JAICA, in 2002, on behalf of the Ministry of Local Government, and the Environment. It assessed the condition of the incinerator which was in its second year of operation at the time. Notwithstanding the conflicting results, all are inconsistent with international health standards that recommend a minimum of 800 and 1,100 degrees, respectively, for the primary and secondary incinerations.

There was not one single provision that lays down the regulations of incineration or treatment of gasses in the technical regulations of this incinerator. Moreover, the site suffers from the inefficient operation, maintenance and neglect by the manufacturer, and does not have any viable gas-treatment system.

A study carried out by the dean of the Higher Institute for Environmental Research at Tishreen University, Dr. Haitham Shaheen, revealed that all incinerators operating in Latakia are in breach of internationally recognized restrictions on the emission of Dioxin.


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