Poisonous Medical Waste Invade Syria (2/2)

At a time when the Western world is seeking to cut down the use of medical incinerators because they spread toxic emissions, and despite opposition from Syria’s Ministries of Health and of Environment, four new incinerators have arrived in the country under a new deal, according to an investigation conducted by Al Thawra newspaper.

These incinerators have been installed at the main garbage dump in Damascus, the central hospital for laborers in Harasta (formerly Al Bayrouni), the Martyr Ibraheem Naameh Hospital in Jabala, and at Al Haffa Hospital. In tandem, plans for the purchase of four heavy duty waste burners for Damascus, Aleppo, Homs, Latakya and Tartous were announced by the ministry of local administration in 2005.

This violates the World Health Organization’s (WHO) declaration which advises against the excessive use of such burners. The British Society for Environmental Medicine warned that the use of incinerators was a blatant breach of the Stockholm Agreement, which the Syrian Government endorsed in 2005. The accord seeks to reduce the level of toxic emissions in the air.

Second Scenario
According to the official index for the management of medical waste, cremation remains the safest method. The index, issued, in 1999 by the ministries of health and of environment, also “calls for building a sufficient number of such cremators in the country.”

In 2004, the Syrian government agreed against the use of incinerators. This step follows the publishing of a national directive on the management of solid waste in Syria, which acted as a charter for handling medical and community waste nationwide.
A French company, which took part in drafting the national directive, was keen on the exclusive use of  autoclave or chemical diffusion in treating medical waste. Nevertheless, and because authorities in Damascus and Homs had by then made arrangements and organized tenders to purchase incinerators, the masterminds of the national directive had to add a second scenario. The second scenario approved the use of waste burners as well, according to both environmental expert, engineer Amir Bukhari, and the head of the solid waste department at the ministry of local administration, engineer Rula Abazeid. Ms. Abazeid contributed to drafting the directive which was put into practice in 2005.

The question remains, how could the planners, together with the French company, allow this to happen, given the damaging implications and the higher prices of incinerators compared to eco-friendly systems? “The directive does not recommend the use of incinerators,” explained Bukhari, “but it is mandatory to mention it, and advise, as such, on its devastating impact.” This, he said, has made both the authors of the directives and the French company, come out clean.
Meanwhile, a comparative study reviewed the prices of incinerators and the cost of their operations compared to those of autoclave and chemical diffusion. The study concluded that the total cost of running an incinerator is double that for the first against the second options for sterilization.

Notwithstanding the above, the national directive supported the use of incinerators as maintained by the second scenario. Hence, this okayed the setting up of new waste burners in Damascus, Aleppo, Homs, Latakya, and Tartous.Al Bayrouni Incinerator

Reportedly, among the information received by authors of the national directives, which prompted the inclusion of the second scenario, was that the incinerators that arrived at Al Assad University Hospital in Damascus and the Central Laborers hospital in Harasta were brand new. However, the incinerator at Al Assad Hospital is 17 years old, while the incinerator at the latter hospital, whose name has been changed to Al Bayrouni Oncology Hospital, has not been used yet.

Additional information also presumed the two waste burners were aided with gas treatment equipment. This is totally inconsistent with the public index published by ministries of health and environment on the management of medical waste, which maintains that both incinerators lack this adequate technology.

New Damascus Incinerator
The main garbage dump incinerator in the capital itself was another reason for adding the second scenario, according to Bukhari and Abazeid.
During the last quarter of 2005, Damascus municipality bought a new Indian incinerator that burns at a degree of 1,100. Engineer Maurice Hadad, who manages the waste disposal plant, revealed that the text on the treatment of emissions was attached to the original procurement contract. The latest research and studies recommend the degree of burning to be 1,200, rather than 1,100, stressing that 1.150 is no more acceptable.

When asked whether the solid waste plant had a gas treatment warranty from the manufacturer, Haddad said: “supposedly yes”. But the deal does not actually bind the Indian company to do periodical tests on emissions so as to maintain a zero level Dioxin, he explained.

To meet this end, Haddad asked all heads of the laboratories run by the public committee for the environment to test emissions and ensure there is no Dioxin discharge from the incinerator. But regrettably, observing this requisite is not possible at this time, neither in Syria or elsewhere across the Middle East, as there is no Dioxin measuring equipment in the whole region, according to the head of the chemical safety, Fuad Al I’kk and ozone safety chief, Khalid Qalali.

Homs Incinerator

The waste dump incinerator in Deir Baalaba, Homs, was another reason that prompted the addition of the second scenario to the national directive.

Presently, Homs municipality is planning to re-advertise a tender to purchase a central incinerator, after the first proposal, in 2005, failed for administrative reasons. Engineers Abdel Hadi Najjar and Hassan Darwich, who head the departments of technical services and sanitation in Homs. They said district authorities were keen on having the new incinerator follow European Union specifications, especially those dealing with the degree of burning and gas treatment methods. They would like the plant to be managed by the winning bidder for the coming five years, and insist the incinerator should have the capacity to handle four times the waste of a day.

Najjar and Darwish did not rule out the risks of using incinerators, but neither did they agree that autoclave technology is the ideal substitute for waste burning. The latter, they said, it not suitable for handling large amounts of medical waste and therefore, it would be more sensible to use waste burners to reduce the massive quantities of waste.

Greenpeace, however, maintains that big hospitals, with over 1,000 beds, in a number of countries worldwide, are employing the autoclave technique as the technology is fit for handling large demand..Dioxin in the Air
Japanese expert, Masayoki Schida, warned of dire consequences brought by the new incinerators, and also of the impact of toxic Dioxin on residential and agricultural areas, particularly those around the main dump in Deir Baalaba, 1.5 km from Homs. Schida is a consultant on solid waste with the ministry of local administration and the environment.

The International Agency for Cancer Research (IARC) said Dioxin emissions spread through the air over long distances. Furthermore, they build up in fertile soil without decomposing, ecologist Sonia Abbasi noted in her study on medical waste at Damascus University hospitals.

The American Agency for Environment Protection mentioned in its assessment report that Dioxin is a cancerous substance, no matter what the degree of exposure is. It spreads through the air and finds its way into the food system in areas relatively far from the source of emissions. Meat, dairy products, eggs, and fish are the main carriers of Dioxin, which builds up, later, in fat tissue. It warned that infants are fifty times more at risk than adults, as the fat level in the feeding mother’s milk is fairly high.

Meanwhile, the American Environment Advocacy Fund announced that the level of Dioxin fell remarkably in the United States, with a similar decrease in the number of waste burners. Incinerators started closing down after research was published confirming the cancerous formation of Dioxin. A chronology of the number of waste burners showed 6,200 of them in 1988, dropping to 5,000 in 1994, and 115 only in 2005. In this respect, a Greenpeace report predicted that most of these incinerators would go out of business very soon, noting that Japan has shut down 4,600 out of the 27,000 incinerators on its territory. This move, which comes in keeping with the strict regulations enacted in 1999 on the danger of emissions, is expected to continue, the Japanese Agency for Environment Protection said.

Two Different Strategies

In its latest report on the management of medical waste, the World Health Organization gave some good advice on ways to handle active incinerators, such as, moving incinerators away from residential areas, applying a minimum 800 degrees to start combustion, isolating and sorting out waste by removing plastic and chlorine-containing material, namely blood bags, in addition to monitoring and treating emissions, etc.

In the long run, WHO said its objective would be to promote the use of alternative techniques to dispose of medical waste, and hence eliminate the risk of Dioxin-related diseases.

An international campaign was launched to close incinerators and replace them with new eco-friendly and cost-effective methods. The approach provided for the following: setting up a specialty-driven administration in each hospital and sorting out waste by type, in preparation for recycling or for treatment using the safest, latest low-cost technology, (namely the microwave system, chemical and thermal treatments, autoclave, and treatment by oxidation and chemical analysis).

In Syria, the Ministry of Health developed a “health ministry strategy to manage solid waste” in 2005 and passed it on to the minister of local administration who is in charge of solid waste management over Syrian territory.

The plan recommends the autoclave technique, which is highly efficient and was adopted in Europe and the United States. Contrary to this are the traditional waste burners that proved their inefficiency in many ways. They are more expensive, release untreatable toxins and cause sterility and physical hindrances. Besides, they need a relatively high degree of burning, ideally between 1,200-1,600, which requires unadulterated fuel and an incinerator with high capacity and sustainability.
Engineer Sadeq Abu Watfa, from the Ministry of local government, said he “personally is against the use of incinerators, noting that autoclave is applied nowadays by most hospitals in Europe.”
Abu Watfa, who is the minister’s aide, and head of the executive committee for the implementation of the so-called solid waste management directive, said waste burners were effective only under one condition –burning the carcass of dead animals in case of an epidemic outbreak.

Notwithstanding all the above, incinerators are mushrooming in Syria, protected by the terms of the second scenario which, apparently considers them effective.