Medical Waste in Cairo: Impact and Health Problems

It poses a waste management challenge, increases disease transmission and threatens public health.


Cairo’s Medical Waste: An Overview

Medical waste has a daunting nature and poses a waste management challenge, beyond the capacity of many municipalities and garbage collectors in Cairo, Egypt. Mismanagement of such waste constitutes serious long term threats to people’s health and the environment. The most dangerous of these is the contraction of infectious diseases.

Hospitals, small clinics, pharmacies, medical supply manufacturers, and residences create medical waste at different levels making it almost impossible to track. According to an article by Egypt Independent, “there are other underlying factors that affect the process of medical waste management such as professional negligence, law enforcement, education, lack of resources and cases of illegal waste trading.”

According to the Mediterranean Environmental Technical Assistance Program (METAP), some common mismanagement practices include, selling waste without consideration for the content or final destination of the waste. Other practices include waste disposal in public dumps, illegal dumping in vacant lots and public places, discharging into the sewer network, or open burning.

Medical waste has a direct impact on municipality workers, hospital workers, and informal solid waste collectors. According to a 2014 article by the International Journal of Preventive Medicine, “health impacts could also entail musculoskeletal, gastrointestinal and infectious diseases as well as injuries caused by work-related accidents.”

The unit for treating hazardous waste.

Three Cairo University hospitals send their medical waste to one treatment unit.

Nihal Maher, resident doctor at Cairo University Kasr Al Ainy public hospital discussed some of the drawbacks of dealing with medical waste. “Some medical waste workers don’t understand the value of protection while on the job, for example when dealing with waste or the incineration process,” said Maher.

A 2013 report for solid waste management claims Egypt produces almost four million tonnes of medical waste per year. The Ministry of Health and Population published an estimate of generated waste, based on the number of beds in public and private hospitals, clinics and medical centers.

The report states that Cairo has 34,603 beds that produce 17,301Kg of medical waste per day with only 13 incinerators available. “However, most of those incinerators do not work with a mandatory competence and do not comply with health and environmental requirements,” the report also affirms. Out of the 17,301Kgs of medical waste produced daily, only 4,000 Kgs are treated.

"Some medical waste workers don't understand the value of protection while on the job, for example when dealing with waste or the incineration process." - Nihal Maher  
Medical waste workers weigh the garbage before taking it to the recycling and sterilization process.

“Workers dealing with medical waste are supposed to wear gloves and are supposedly protected, but this is not enough because sometimes they’re in a hurry and there is a bulk of waste,” said Maher. The overcrowding of some public hospitals is one contributor to inefficiency medical waste management and spread of disease.

“The lack of public awareness and school education about the weight of proper solid waste management for health and well-being of citizens severely confines the use of community-based approaches,” as mentioned by the report. The public awareness needs to extend past public and private hospitals to reach communities receiving this waste knowingly and unknowingly.

The education and health awareness of one of Cairo’s main informal garbage collectors communities also known as the Zabaleen located on the Muqattam Hills, remains the responsibility of local NGOs. These NGO’s work within the proximity of Manshiyet Nasser, a slum settlement on the outskirts of Cairo where the Zabaleen are located.

Cairo's main informal garbage collector community, also known as the Zabaleen located on the Muqattam Hills. 

The Zabaleen collect all types of garbage from around Cairo, sort and recycle at home

Organizations such as the Association for the Protection of the Environment (APE) and the Spirit of Youth Association (SoY) are engaged in grassroots initiatives not only attempt to segregate waste on-site and direct it to alternative proper facilities, but also provide medical help to individuals who have contracted diseases from hidden syringes and other medical waste.

APE has been working on a various health projects in Manshiyet Nasser offering direct services to the community. “We divided the Zabaleen area into five sectors, and a team of 12 women operate together to spread awareness about different diseases under the supervision of a professional doctor,” said Christina Makram, a member of the health unit team at APE.

These women come from the Zabaleen and directly know the members in the community. 

“We go to all homes, even if there is garbage we still reach out to everyone in churches and mosques, anywhere possible to reach people to spread awareness,” explained Makram.
"We divided the Zabaleen area into five sectors, and a team of 12 women operate together to spread awareness about different diseases under the supervision of a professional doctor." 
- Christina Makram
APE divided the Zabaleen areas into five sections to maximize door to door effort.

The underground trading of medical waste has been a main contributor to the spread of various diseases amongst the Zabaleen. Even though banned by the government, the practice still continues secretly. One of the most common diseases found across the garbage collectors is the blood borne Hepatitis C virus (HCV). 

According to the WHO, “HCV kills an estimated 40,000 Egyptians a year and at least 1 in 10 of the population aged 15 to 59 is infected.”APE and SoY both have Hepatitis C project involving screening and treatment, aiming to eliminate the spread of the virus among garbage collectors in Muquattam.

The 2014 article reveals that “Egypt’s HCV epidemic was a result of medical waste. It dates back decades when glass syringes used during a mass vaccination campaign were not properly sterilized between use, explained Dr. Manal Hamdy El-Sayed from Egypt’s National Viral Hepatitis Committee.”

“If our checkups find someone is infected with Hepatitis C, we send them over to a public hospital where the medicine is prescribed, and we help administer this treatment every month,” explained Hanan El Leithy, member of the liver health unit at APE.

“We get hurt while separating the garbage, we catch diseases, but the association (APE) is helping us with the treatment,” Ayoub Nabih, one of the Zabaleen explained.

The government is trying to halt medical waste trade while NGOs raise awareness to the Zabaleen.

Manshiyet Nasser, Mukkatam, Cairo.
“We (the Zabaleen) used to collect medical waste from hospitals and sort it here, a large segment had Hepatitis C, but this practice is decreasing because awareness in increasing,” Nabih added. 

The government is trying to stop this practice from the source but it is difficult to track.

“Today, Egypt has improved as opposed to before, paramedical personnel never used to follow these rules, and couldn’t really understand the consequences,” Maher said. Law 4/1994 defines methods of sound environmental management of hazardous substances and waste. It sets requirements in coincidence with the Basel Convention of 1989 controlling trans-boundary movement of hazardous waste and its disposal, which Egypt had ratified in 1993.

“However, the issues of extra financial burdens need to be addressed. It is believed that this can best be done with governmental interventions through different possible mechanisms to ‘subsidize’ such services at the initial stages,” as proposed by the Hazardous waste management in Egypt: status and challenges article. Efforts need to be maximized at both the micro and macro level to be sustained.

"Most of the public/private operators in the hazardous medical waste management sector lack knowledge and expertise to implement their jobs in a safe manner," according to the Ministry of Health 2013 report.
Taken outside public hospital medical waste facility.


Photo Essay: Medical Waste Treatment in Cairo, Egypt

The medical waste management and treatment system needs to be more efficient and less dependent workers' effort. A more effective and advanced system is needed.