The silent crisis: Medical waste management in Nepal
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| Photo: Mumtahina Tanni |
Nepal’s healthcare system has expanded significantly over the past two decades, with increased numbers of hospitals, clinics, and diagnostic centers in both urban and rural areas. However, this progress has brought an unintended consequence: a dramatic rise in medical waste. From used syringes and contaminated bandages to expired pharmaceuticals and pathological remains, medical waste has become a silent environmental and public health crisis.
Although the government has issued strict warnings time and again and insists on following prescribed guidelines, the current situation has not improved so much. Due to lack of infrastructure and coupled with negligence by hospitals and municipalities, the situation has only turned bad to worse in recent years.
Current situation of medical waste management in Nepal
In practice, medical waste management in Nepal is highly unsatisfactory. Studies indicate that only a fraction of healthcare facilities—primarily large, private hospitals in Kathmandu—segregate, treat, and dispose of waste properly. The majority of smaller clinics, nursing homes, and even some public hospitals mix infectious waste with general municipal solid waste. This mixed waste often ends up in public landfills or, worse, dumped illegally along riverbanks and open grounds. A 2021 report by the Health Environment and Climate Action Foundation found that nearly 70% of healthcare facilities in Nepal lacked a functional waste management plan.
Unfortunately, still many hospitals across the country collect and burn hazardous medical waste without any fear of contaminating the surrounding environment---This is a common practice in many districts.
Government guidelines to hospitals
The Government of Nepal has not been entirely inactive. The National Healthcare Waste Management Guidelines, first introduced in 2014 and revised in 2019, provide a comprehensive framework. These guidelines mandate that hospitals must segregate waste into color-coded bins (yellow for infectious, red for sharps, blue for pharmaceutical, etc.), use personal protective equipment for waste handlers, and install on-site treatment facilities like sterilizers or incinerators for hazardous waste. The guidelines also require hospitals to maintain waste registers and submit annual reports to the Ministry of Health and Population. Furthermore, the Solid Waste Management Act, 2011, and the Environment Protection Act, 2019, indirectly enforce proper disposal, with provisions for penalties against polluters.
However, only making fabulous laws are not enough, their proper implementation is actually more important. Due to lack of regular inspection and poor legal enforcement, many hospitals openly defy rules. Moreover, even if a hospital is found guilty, but due to political approach the hospital owners walk away with no fine or a nominal fine.
Need for proper medical waste management
The need for proper management is not merely regulatory but necessary. Medical waste is classified as hazardous because it can contain pathogens, sharp objects, chemical toxins, and radioactive materials. Without proper treatment, it poses severe risks to sanitation workers, scavengers, patients, and the general public.
It is therefore utmost necessary to have proper management of medical waste materials. Hospitals must take responsibility to perform segregation, disinfection and safe disposal of medical waste. Let’s not forget that hospitals are the places where patients get rid of illness, it should not be the place of ailments itself.
Lackluster attitude of hospitals and poor performance of municipalities
The primary obstacle is not lack of laws but lack of will. Many hospital administrators view waste management as an unnecessary expense rather than a core responsibility. Budget allocations for waste treatment are minimal, and staff training is virtually non-existent. Nurses and cleaners often receive no instruction on segregation; needles are thrown casually into open bins, leading to frequent needle-stick injuries. Private hospitals, chasing profit margins, outsource disposal to unlicensed street collectors who dump waste in rivers. Municipalities are equally responsible. Local governments are responsible for collecting and treating all waste within their jurisdiction, but most do not differentiate between household waste and medical waste. Municipal landfill sites are unmonitored, allowing toxic liquid from decomposing medical waste to contaminate groundwater.
It is found that only a few municipalities are equipped with hazardous waste treatment facilities. Moreover, they don’t have separate vehicles to carry those highly contaminated waste. As a result, chances are always high for the medical waste handlers and people in general to get affected by such highly contaminated matters.
Possible health hazards
The health consequences are already visible. Ragpickers, who often work without gloves or masks, suffer from increased rates of hepatitis B and C, tetanus, and HIV. Medical experts say that though HIV transmission from solid waste is rare, the risk is not zero. Hospital waste bins overrun with used syringes pose a danger to children playing nearby. A study in the Journal of Nepal Medical Association found that over 40% of municipal waste workers in Kathmandu had experienced needle-stick injuries.
It has been reported that many rural based hospitals actually dump waste in nearby rivers. This way they contaminate the entire river water. Medical experts have warned by saying that multidrug-resistance bacteria from hospital waste actually pollute environment that later cause to antibiotic resistance. This is a serious matter that must not be overlooked at any cost.
Lack of infrastructure
Infrastructure deficit is another critical bottleneck. Even well-intentioned hospitals struggle because Nepal has no centralized, state-run hazardous waste treatment facility except for a few rudimentary sites. Autoclaves and shredders are expensive to import and maintain. Spare parts are scarce, and technical expertise is limited. Many hospitals purchased incinerators decades ago, which now lie broken and rusted.
Many countries have well developed medical waste tracking system. It tracks vehicles carrying hazardous medical waste right from hospitals to final disposal sites. This practice ensures the safety and security of people in general. Unfortunately, Nepal doesn’t have such sophisticated system in practice.
Possible solutions
The medical waste crisis in Nepal is solvable, but it requires a multi-pronged approach. First, strengthen enforcement of existing guidelines. The Ministry of Health should conduct unannounced audits, impose substantial fines, and publicly name non-compliant hospitals. Second, invest in decentralized infrastructure. Instead of every small hospital buying expensive incinerators (which often operate poorly), cluster hospitals into zones, each served by a common treatment facility using affordable technology. Third, a public-private partnership for waste collection is more necessary now than ever before.
In the meantime, municipalities can hire professional, private companies to collect and transport medical waste. These companies can handle such task more professionally. At the same time, medical professionals must provide compulsory training and awareness programs for hospital staff, waste handlers and local officials.
Over the years the numbers of hospitals have
significantly increased in many cities so are the patients. In a situation like
this Nepal cannot ignore its medical waste problem any longer. If the flow of
patients regularly increases at the same pace and hospitals continue overlooking
government guidelines, this will certainly collapse the entire health sector of
the country. However, strong determination, community engagement and committed
leadership can win the trust of the people in our medical services.
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