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Jahangirnagar University Journal of Law
Volume VIII: 2020
Published: 30 November 2020
Editor
Professor Dr. Rasheda Akhtar
Executive Editor
Tapos Kumar Das
Journal of the Faculty of Law
Jahangirnagar University
Savar, Dhaka
Jahangirnagar University Journal of Law
Volume VIII: 2020
Advisors to the Editorial Board
Professor Antony Anghie, SJD
Samuel D. Thurman Professor of Law
University of Utah, USA
Dr. Mohammad. Shahabuddin
Professor in Law, University of Birmingham, U.K.
Editorial Board
Editor
Professor Dr. Rasheda Akhtar
Dean (Acting), Faculty of Law, Jahangirnagar University
Executive Editor
Tapos Kumar Das
Chairperson (Acting), Department of Law and Justice, Jahangirnagar University
Members
Md. Rabiul Islam
Department of Law and Justice
Jahangirnagar University
Shaila Alam Asha
Department of Law and Justice
Jahangirnagar University
Suprobhat Paul
Department of Law and Justice
Jahangirnagar University
K M Shazzad Mohashin
Department of Law and Justice
Jahangirnagar University
Md. Abu Sayeed
Department of Law and Justice
Jahangirnagar University
Ferdous Rahman
Department of Law and Justice
Jahangirnagar University
Preeti Kana Sikder
Department of Law and Justice
Jahangirnagar University
Published by Jahangirnagar University
Savar, Dhaka-1342, Bangladesh
© Jahangirnagar University
ISSN: 2664-1054
Printed by: Momin Offset Press, Dhaka-1205
Price: Taka 200 q US $ 5
Jahangirnagar University Journal of Law
Volume VIII: 2020
Published: 30 November 2020
©
Jahangirnagar University
Contents
S M Masum Billah Testing Constitutional Metaphors: Some
Insights from Bangladesh
1 - 27
Md. Rabiul Islam Racial Dichotomy to Escalate
Discrimination: An Account of Legal-
historiography in Colonial India
29 - 46
Moha. Waheduzzaman Measuring Constitutional “Laws” and
“Conventions” in Same Parlance:
Critiquing the Idrisur Rahman
47 - 77
Tapos Kumar Das The Positive Complementarity: An
Alternative Approach for the ICC’s
Engagement
79 - 93
Preeti Kana Sikder Medical Waste Management and
Processing System in Post-COVID
Bangladesh: A Legal Analysis
95 - 112
Md. Waliul Hasanat
Md. Yamin Rahman
Virtual Classrooms in Bangladesh:
Assessing Child Vulnerability in the Light
of International Law
113 - 125
Rafea Khatun Medical Negligence Issues in Bangladesh:
An Urge for a Separate Medical
Negligence Law
127 - 146
Md. Abdur Razzak Non-State Actors and International
Human Rights Law: What Obligations for
Business Enterprises?
147 – 166
Jahangirnagar University Journal of Law, Vol. VIII, 2020
95
Medical Waste Management and Processing System in
Post-COVID Bangladesh: A Legal Analysis
Preeti Kana Sikder
*
Abstract: Medical wastes (MWs) have always been a serious issue in the domain
of public health. Such wastes generated in hospitals and clinics are disposed of
through a specific management and processing system. In light of the ongoing
global pandemic, urgency has developed in addressing the surge of MW and
their proper management. This paper aims to reflect upon the theoretical
significance of the laws relating to MW management and processing in
Bangladesh. By painting the picture of a sound medical waste management and
processing system, the paper continues to explore how the environmental legal
regime of Bangladesh can benefit from strengthening it.
Keywords: Medical Wastes, Legal Framework, Environmental Pollution,
COVID-19 Pandemic, Healthcare Services.
1. Introduction:
Medical wastes (hereinafter MWs), also known as biomedical wastes or health care
wastes, are part of the waste management issues leading to environmental
pollution worldwide. Generally, this term indicates wastes arising from hospitals,
clinics or institutions that provide healthcare services. In parallel, the medical
waste management and processing system refers to an organised system through
which MWs are collected and disposed of. Numerous problems occur when
harmful MWs are not carefully handled. However, such health hazards
accompanied by environment pollution are just tip of that iceberg. When the
problems caused by improper dumping of MWs are not addressed, many lives fall
in jeopardy. The reality is, even a very small amount of hazardous health care
waste can affect a large number of people as it constitutes a public health hazard,
if not managed properly.
1
The dangerous spread of novel coronavirus through surface contamination, which
has affected billions of people around the world and caused the COVID-19
pandemic, can be considered as a very practical portrayal of such risk. Current
scientific research has not provided evidence that waste management is a vector
*
Assistant Professor, Department of Law and Justice, Jahangirnagar University. The author can be
reached at: preeti@juniv.edu.
1
Ministry of Health and Family Welfare, Government of the Peoples’ Republic of Bangladesh,
Environmental Assessment and Action Plan: For the Health, Population and Nutrition Sector
Development Program (HPNSDP), (February 2011) 8
Jahangirnagar University Journal of Law, Vol. VIII, 2020
96
for the transmission of this deadly virus.
2
Nonetheless, considering that waste
workers are everyday on the streets despite isolation and quarantine measures
taken for the whole population, additional measures should be considered.
3
It is
widely reported that in response to this pandemic, hospitals, healthcare facilities
and individuals are producing more wastes than usual, including masks, gloves,
gowns and other protective equipment that could be infected with the SARS-CoV2
virus.
4
Concern regarding such increase has been shown by Keith Alverson
5
in the
following words: “The unfortunate reality worldwide is, however, that an
enormous amount of healthcare waste, including waste generated as a result of
our pandemic responses, is either mistreated with improperly maintained
technologies, or not treated at all.”
6
Therefore it is apparent that, the COVID-19
pandemic is causing unprecedented increases in MW generation, whose unsound
management can lead to additional environmental and health hazards.
7
At this
point, it is important to remember that, waste generation in healthcare
establishments cannot be regulated under the same framework for industrial
establishments. In case of industrial wastes, the concern stems from a very
different perspective where the nature of the wastes themselves can be altered
through careful initiatives and attempts can be taken at reducing the impact.
Whereas, regarding MWs, its generation is necessary for protection of lives and
well-being of people through generations. For these obvious but important
reasons, the MW management system has always required careful supervision. It
is of no surprise that, the process of collecting and disposing MW is subjected to
strict legal directions and organisational supervision in the modern world.
In addition, from a human rights perspective, the benefits of establishing a sound
MW management and processing system has many benefits. Back in July 2011, the
Special Rapporteur of the UNHRC presented his report at the UN General
Assembly on the adverse effects of unsound management and disposal of MW
which, he concluded, impacted the human rights of a significant number of people
including the medical staff, patients, workers in support services, workers in waste
disposal facilities, recyclers, scavengers, and the general public. He called on ―all
2
International Solid Wastes Association, Waste Management during the Covid-19 Pandemic, (April
2020) <https://www.iswa.org/fileadmin/galleries/0001_COVID/ISWA_Waste_Management _Dur
ing_COVID-19.pdf> accessed 1
st
June 2020
3
ibid
4
UNEP, Factsheet 1 – Introduction to Covid-19 Waste Management, (Covid-19 Waste Management
Factsheet 2020) < https://www.acrplus.org/images/project/Covid-19/UNEP_1_Intro_COVID-19_
waste.pdf> accessed 1
st
June 2020
5
Director of the United Nations Environment Programme International Environmental Technology
Centre
6
UNEP, Healthcare Waste: What to do with it? <https://www.unenvironment.org/news-and-
stories/story/healthcare-waste-what-do-it> accessed 3
rd
June, 2020
7
UNEP, Factsheet 4 - Policy and legislation linked to COVID-19 and pandemics, (Covid-19 Waste
Management Factsheet, 2020) <https://wedocs.unep.org/bitstream/handle/20.500.11822/32777/
FS4.pdf?sequence=1&isAllowed=y> accessed 1
st
August, 2020
Medical Waste Management and Processing System
97
relevant stakeholders, including States, international organizations and
mechanisms, the donor community, public and private health-care facilities, the
pharmaceutical industry and civil society to strengthen their efforts to achieve safe
and sustainable management of medical waste.
8
Being based on dignity, fairness,
equality, respect and autonomy, these rights ensure us freedom to control our own
lives. Therefore, waste management practices, which affect each and every person
on the Earth also has a unique relation with these inherent rights all of us are
entitled to. In the latest months, such importance has increased manifold in the
context of the COVID-19 pandemic which has spread globally in an
unprecedented rate. Deadly viruses, like the SARS CoV-2, become capable of
crippling the entire world’s functioning when necessary MW disposal practices
fail.
In Bangladesh, with the advancement of medical sciences, the nature of MW has
altered and is not limited to gauges and bandages anymore. Yet the scientific
evidence is very limited to determine the actual public health problems from MW
here.
9
However, few risks are very visible. Since our land is susceptible to frequent
flooding, waste from health care facilities can easily be spread with water and can
cause regular outbreak of water-borne diseases like diarrheal disease during and
after flooding, mainly caused by improper management of MW.
10
Moreover, the
amounts of infected waste is increasing here with fast spreading of blood- infected
HIV/AIDS incidence among certain groups of population.
11
Despite such risks,
very few healthcare establishments, taking help from both Governmental and
Non-Governmental institutions, follow the systematic procedure in disposing
their wastes. Most of such arrangements are confined within the Capital. As a
result, a large number of people are being exposed to life threatening
circumstances every day due to absence of proper management mechanisms.
Being already burdened with faulty waste management systems, it has become
difficult for us to address the threat accompanied with dysfunctional MW
management. Therefore, it is now crucial to investigate and establish how an
efficient medical waste management and processing system can save our lives.
This paper focuses on the significance of implementation of an effective system
which allows MW management and processing to be carried out without a glitch.
Therefore, the discussions explore the importance of getting such management
and processing system to be up and running rather than elaborating the most
8
UNEP, Compendium of Technologies for Treatment/Destruction of Healthcare Waste, (2012) 7
9
Emdadul H. Syed, Mahmuda Mutahara, and Mosiur Rahman, ‘Medical Waste Management
(MWM) in Dhaka, Bangladesh’ (2012) 24(3) HHCP p. 144 < https://www.researchgate.net/
publication/254096670> accessed 3
rd
June, 2020
10
Ministry of Health and Family Welfare, Government of the Peoples’ Republic of Bangladesh,
Environmental Assessment and Action Plan: For the Health, Population and Nutrition Sector
Development Program (HPNSDP), (February 2011) 17
11
ibid
Jahangirnagar University Journal of Law, Vol. VIII, 2020
98
effective practices of disposal and processing, which shall be an excellent field for
public health research by its own merit. For the purpose of this article, a sound
MW management and processing system can be defined as such which abides by
all the legal requirements. Recognising the interdependent nature of MW
management and processing activities, both of these steps will be referred as one
integrated system dedicated towards proper disposal of MWs.
Management and processing of MW indeed plays an exceptionally delicate role in
protecting the environment. That is why this paper puts forward the issue as to
why it is important to maintain a strong and effective MWM system in Bangladesh
from the legal perspective. After introducing the definition and nature of the MW
management and processing system in Bangladesh, the third part of the article
explores the basic legal framework dealing with steps and directions of MW
management and processing from both international and national perspectives. In
exploring that issue, the discussion focuses on the imminent risks posed by the
COVID-19 pandemic which are necessary to deal with through a proper
enforcement of the laws relating to MW. The third part of this paper explains how
this field of law is functioning in the societal and practical context of Bangladesh.
With this combined portrayal of functionality in display, it should be clearer for
the practitioners and policy makers to identify better course of action for
implementing a sound MW management and processing system.
Therefore, through a doctrinal approach, this paper aims at establishing the
significance of sound MW management practices within the environmental legal
regime. Being a qualitative study, the major discussion is put from a theoretical
angle. Legislation, treaties and policy documents have been consulted as primary
sources while organisational reports and journal articles were used as secondary
sources of research. At the end of this research, certain recommendations have
been made to clarify how establishing an effective MW management and
processing system can enhance environmental rule of law in Bangladesh.
2.
What is the Medical Waste Management and Processing System?
At the onset of embarking upon the core query of this research, it is important to
find out not only the nature and definition of MW but also the requirements of
sound MW management and processing practices. MWs have been defined as a
specific type of waste which is generated in the course of providing medical
services by the healthcare establishments, i.e. hospitals, clinics and diagnostic
centers. It is an integral part of any health-care service. As per Rule 2(v) of the
Medical Waste (Management and Processing) Rules, 2008, medical waste means
any solid, liquid, aerobic, or radioactive material generated from medical
treatment, antidote system, diagnosis or disease related research for humankind,
Medical Waste Management and Processing System
99
which causes harmful changes to the environment by being emitted, thrown or
stacked.
12
As these wastes are automatically generated in the course of various diagnosis,
monitoring and curative activities, a wide variety of MWs are piling up every day.
Judging by their toxicity, these wastes are mainly divided into two major
categories: hazardous medical waste and non-hazardous medical waste. Non-
hazardous wastes include food or paper wastes and some biological wastes as
well. So far as the kitchen wastes and non-clinical wastes are concerned, they do
not pose any great threat. On the other hand, when it comes to hazardous bio
wastes; a proper guideline for their disposal is a must. The WHO has provided an
estimate for average distribution of health-care wastes regarding planning of
waste management in developing countries such as Bangladesh.
13
Adhering to
such calculation, it can be deduced that approximately 80% of the total MW
generated in our country falls under the category of general health-care waste.
Among the rest 20%, pathological and infectious waste takes up 15%. While wastes
containing sharps take up only 1% waste, 3% can be contributed to generation of
chemical or pharmaceutical waste. That leaves even less than 1% of special waste,
such as radioactive or cytostatic waste, pressurized containers, or broken
thermometers and used batteries. Noting that there are multiple risks inherent in
MW including toxic chemicals and radioactive materials, the WHO has chosen to
use the term health care risk waste instead of medical waste.
14
Being germ laden,
hazardous wastes are the prime focus of MW management process. Even if these
wastes constitute smaller portion of the MW bulk, these are never negligible.
Moreover, the systematic process through which MWs are disposed of is widely
known as medical waste management system. This disposal process contains quite
a long list of activities due to the variations in the components of MW. There are
separate step-by-step directions to follow for each type of wastes. Some parts of
this process are often time consuming and require careful moves. As a result, it
tends to be a bit complicated as a system. Wastes that are deemed potentially
infectious may be treated prior to disposal by a number of different technologies
that either disinfect or sterilize them. These technologies include incineration,
steam sterilisation, dry heat thermal treatment, chemical disinfection, irradiation,
and enzymatic (biological) processes among others. In 2002 there were more than
one hundred specific technologies in use.
15
However, while defining the term
12
The Medical Waste (Management and Processing) Rules of 2008 also contains a detailed list of
medical wastes in its Schedule 1.
13
Emdadul H. Syed, Mahmuda Mutahara, and Mosiur Rahman, ‘Medical Waste Management
(MWM) in Dhaka, Bangladesh’ (2012) 24(3) HHCP 142 <https://www.researchgate.net/
publication/254096670> accessed 3
rd
June, 2020
14
Pollution Issues, ‘Medical Waste’, <http://www.pollutionissues.com/Li-Na/Medical-Waste. html#
ixzz6VjepqYMX>, accessed on 1st August, 2020
15
ibid
Jahangirnagar University Journal of Law, Vol. VIII, 2020
100
Medical Waste Management it is necessary to differentiate it from Medical Waste
Processing. It is not uncommon for us to use these two terminologies
interchangeably and sometimes even synonymously. Nonetheless, from a legal
perspective, there are concrete differentiations between these two concepts. While
the steps of collection, segregation, packaging, decomposing, incineration,
refining, purification and removal of MW have been defined as Medical Waste
Processing, the activities including transportation, storing, record keeping,
monitoring, observation and supervision of the whole process are defined as
Medical Waste Management.
16
Simple observation of these two abovementioned
definitions explains that medical waste processing takes place at an earlier stage
and involves activities that require direct handling of the waste. On the other hand,
the steps of medical waste management contribute in keeping the whole
mechanism effective in the long run. Both of these are continuing activities and
appear to be interdependent in nature.
3.
Analysing the Legal Framework of Medical Waste Management and
Processing:
In identifying the best impacts of effective MW management and processing
practices, it is necessary to explore the existing legal framework. Adhering to a
dualist nature of legal system, Bangladesh has to transform or adopt international
legal principles into its municipal laws by the use of appropriate constitutional
machinery.
17
The prevailing practice in Bangladesh suggests that most of the
international treaties that Bangladesh has ratified need to be transformed into
national law before being applicable in our legal system.
18
Indeed there are quite a
few domestic legal provisions that determine the course of action for processing
and management of MWs in Bangladesh which have followed the directions
promulgated in international legal instruments. As a result, the existing legal
framework regulating the MW management and processing practices in
Bangladesh range from international obligations to specific laws enacted through
the Parliament. The discussion on legal framework regulating MWs can therefore
be covered from both international and national perspectives.
Primarily, three basic principles of international environmental laws can be
identified based on which most of the national legal instruments deal with the MW
processing system and ensure its effectiveness. These basic principles have been
described in the ICRC Manual on Medical Waste Management in light of
16
Rules 2(vi) and 2(vii) of the Medical Waste (Management and Processing) Rules, 2008
17
Sheikh Hafizur Rahman Karzon, Abdullah Al Faruque, ‘Status of International Law under the
Constitution of Bangladesh’ (1999) 3:1 BJL < http://www.biliabd.org/article%20law/Vol-03(1)/
Sheikh%20Hafizur%20and%20Abdullah%20Al-Faruque.pdf> accessed on 8 November 2020
18
ibid
Medical Waste Management and Processing System
101
establishing best practices.
19
Firstly, the polluter pays principle implies that any
producer of waste is legally and financially liable for disposing of that waste in a
manner that is safe for people and the environment. Therefore, the health care
institutions remain liable for the wastes produced in their areas. Secondly, the
precautionary principle portrays that when the risk is uncertain it must be
regarded as significant and protective measures must be taken accordingly. This
principle confirms the responsibility of health care institutions in treating the
produced wastes. Finally, under the proximity principle, hazardous wastes must
be treated and disposed of as close as possible to where they are produced. This is
how prevention of the spread of pollution becomes possible through legal
implementation.
Though the issue of hazardous wastes has been under scrutiny for a while, there
is no international convention solely focused on MW. Bangladesh has ratified
thirty international conventions, treaties and protocols (ICTPs) relating to
protection of the environment
20
and a few national laws were influenced by some
of those ICTPs containing provisions regarding waste management. Hence, a brief
look at the international legal provisions will be helpful in describing the
legislation and policies put forward by the Government of Bangladesh (hereinafter
GoB). The major environmental treaties which regulate specific aspects of
management and disposal of MW are: Agenda 21,
21
Basel Convention,
22
and
Stockholm convention.
23
While Agenda 21 aimed to minimise the generation of
waste and introduced guidelines for treatment and disposal of waste products by
safe and environmentally sound methods and promoted placing all residue in
sanitary landfills
24
, Basel Convention was the very first instrument which
introduced “clinical wastes from medical care in hospitals, medical centers and
clinics”, “wastes from the production and preparation of pharmaceutical
products” and “waste pharmaceuticals, drugs and medicines” in the list of
hazardous wastes.
25
Moreover, Basel Convention added “substances or wastes
containing viable micro-organisms or their toxins which are known or suspected
19
ICRC, Medical Waste Management (2011) p. 28-29 available at: < https://www. icrc.org/ en/doc/
assets/files/publications/icrc-002-4032.pdf> accessed on 20 July 2020
20
Md. Iqbal Hossain, International Environmental Law: Bangladesh Perspective, 2004
21
It was adopted by more than 178 Governments at the United Nations Conference on Environment
and Development (UNCED) held in Rio de Janeiro, Brazil, 3 to 14 June 1992, < https://sustainable
development.un.org/content/documents/Agenda21.pdf > accessed on 1 May 2020
22
Basel Convention on the Control of Trans-boundary Movements of Hazardous Wastes and Their
Disposal was adopted on 22 March, 1989 and entered into force on 5 May, 1992, this convention
currently stands to be ratified by 181 States.
23
Stockholm Convention on Persistent Organic Pollutants was adopted on 22 May 2001 and entered
into force on 17 May 2004, available at: < http://www.pops.int/> accessed on 20 March 2020
24
ICRC, Medical Waste Management (2011) p. 28-29 available at: < https://www.icrc.org/en/
doc/assets/ files/publications/icrc-002-4032.pdf> accessed on 20 July 2020
25
UNEP, Annex I, Basel Convention, p. 46 < https://www.basel.int/Portals/4/Basel%20Convention/
docs/text/BaselConventionText-e.pdf> accessed on 20 July 2020
Jahangirnagar University Journal of Law, Vol. VIII, 2020
102
to cause disease in animals or humans” as hazardous which addressed MWs more
directly. On the other hand, Stockholm Convention included MW incinerators in
the list of industrial source categories that can result in significant emissions of
persistent organic pollutants into the environment. In addition, open burning of
waste, including burning of landfill sites, has been included in the list of other
source categories in the Convention that may generate dioxins and furans.
Therefore, it was the adoption of these international instruments that identified
the necessity of a sound MW management and processing system.
Subsequently, in 2005, WHO published a guidance manual
26
describing the
minimum requirements to be contained in any MW regulating legislation, which
included: general provisions of the law, authorities of enforcement, provisions
related to health-care waste producers and operators, provisions related to
management, treatment and disposal procedures, and specific penalties. Later on,
WHO published the Core Principles
27
which demonstrates the importance of
achieving safe and sustainable management of MWs. These principles require that
all associated with financing and supporting health-care activities should provide
for the costs of managing health-care waste amounting to their duty of care. Under
this manual, manufactures also share a responsibility to take waste management
into account in the development and sale of their products and services.
28
As a
member of the WHO, Bangladesh is duty bound to implement these suggestions
put forward by the international organisation. Even though with the advent of
worldwide movement relating to curbing pollution the environmental legal
regime of Bangladesh has transformed widely, due to lack of national chemical
policy and law, management for MW in Bangladesh is fragmented.
29
Among the
legal instruments that discuss necessary steps relating to controlling pollution
caused by MWs, only one legal document fulfills most of the requirements put
forward by the WHO as mentioned above.
Efforts for improvement in managing MW has initiated in this country since the
beginning of 2005.
30
Prior to this era, there was a Medical Practice, Private Clinics
and Laboratories Ordinance, in 1982. This ordinance only described some criteria
26
WHO, Preparation of National Health-Care Waste Management Plans in Sub-Saharan Countries,
available at: <https://www.who.int/water_sanitation_health/publications/healthcare-waste-guida
nce-manual/en/> accessed on 20 July 2020
27
WHO Core Principles for achieving safe and sustainable management of health care waste, during
the International Health Care Waste meeting in Geneva on June 20 - 22, 2007 <https://www.
who.int/water_sanitation_health/publications/hcwprinciples...care.> accessed on 20 July 2020
28
WHO and UNEP, National Health Care Waste Management Plan: Guidance Manual, <https://
www.who.int/water_sanitation_health/medicalwaste...manual1.pdf> accessed on 20 July 2020
29
Akter N, Kazi NM, Chowdhury MR, Medical Waste Disposal in Dhaka City: An Environmental
Evaluation (1999) ICDDR, B
30
Ministry of Health and Family Welfare, Government of the Peoples’ Republic of Bangladesh,
Environmental Assessment and Action Plan: For the Health, Population and Nutrition Sector
Development Program (HPNSDP), (February 2011)
Medical Waste Management and Processing System
103
for obtaining a license to establish a hospital or clinic stating the proper
accommodation with hygienic environment. The hospitals were also mentioned in
the environmental laws of Bangladesh to be categorised with other industries and
to be brought under the restriction of being built only in non-residential areas. As
per the Schedule 1 of the Bangladesh Environment Conservation Rules 1997,
hospitals fall under the ‘Red’ category carrying highest degree of environmental
risks and clinics along with pathological laboratories which fall under the ‘Orange-
B’ category being comparatively less harmful for environment. Later on, the
Department of Environment (hereinafter DoE) had developed a Hospital Waste
Pocket Book in 2010 which included the procedures for effective MW management
for all health care establishments. However, beyond such initiatives, national level
legislative instruments also play an important role in determining the guideline
for best practices in controlling MW. Brief discussions on such instruments are as
follows:
i) National Environmental Policy, 2018: The first national environmental policy of
1992 was not very direct about maintaining a sound management system of
medical wastes. That dearth has been addressed in the latest policy. The national
environmental policy of 2018 puts an exclusive focus on public health and health
services.
31
It advocates for saving public health and the environment from
detrimental impact of ensuing from use and activities of all radioactive materials
including x-ray and MW. For this purpose it empowers the Ministry of Health and
Family Welfare along with the Department of Health as corresponding authorities.
ii) Medical Waste (Management and Processing) Rules 2008: Under the provision
of Section 20 of the Bangladesh Environment Conservation Act 1995, GoB is
empowered to enact subsequent rules in order to achieve the goals of conservation
of environment. Identifying the severe environmental impact caused by
mismanagement of MW, GoB has framed a Rule in 2008 introducing an
administrative framework responsible for MW management and processing. The
primary task this 2008 Rule
32
fulfills is purely administrative. Here, rule 3 sets up
an ‘Authority’ to provide license of MW management to selected persons. This
authority with three members remains responsible for observing the performance
of the licensees. They are also responsible for collecting and publishing
information related to pollution created by MWs. Another Committee established
under rule 16 is termed as the ‘Advisory Committee’ which is held responsible for
examining successful waste management policies and advise GoB about this.
Besides giving directions relating to proper management of MWs, this document
also outlines the penalties for violating the directions. The highest penalty has
been determined to be simple imprisonment for two years or fine of BDT 10,000.
33
31
National Environmental Policy, 2018, p. 10
32
Published in Bangladesh Gazette (Extraordinary), dated November 5, 2008, p. 6679-6705
33
Rule 11 of the Medical Wastes (Management and Processing) Rules, 2008
Jahangirnagar University Journal of Law, Vol. VIII, 2020
104
Such structure of the 2008 Rule adheres to the basic direction provided by WHO
in preparing legislative documents in regulating MWs as mentioned in prior part
of the chapter.
iii) National 3R Strategy for Waste Management: The issue of proper management
of MW has also been brought under a national waste management strategy in
Bangladesh. The DoE has formulated the National 3R (Reduce, Reuse and Recycle)
strategy
34
with an intention to meet the challenges related with the continuous
increase in waste generation and resource demand.
35
The sector responsible for
managing biomedical wastes has been identified as a priority sector within the 3R
strategy along with municipal solid waste, industrial waste, commercial waste and
agricultural waste.
36
Under this strategy, recycling of medical waste has been
discouraged in order to prevent health hazards. Aside from prioritising capacity
building and waste management education programmes, this document also
declares its aim to manage such wastes in an environmentally sound manner. The
major steps in promoting source separation and management of medical waste
under this strategy paper are as follows:
• Producers of bio-medical and other hazardous waste that can threaten public
health will be made primarily responsible for disposing such waste under the
supervision and care of the Ministry of Health and the Ministry of
Environment.
• Biomedical and pathological waste including body parts of humans will be
disposed of through methods that conform to safety standards stipulated by
the government and will be treated by the producer using environment
friendly technology under City Corporations/Pouroshavas supervision. In
some cases regional treatment facility will be established for treating MW.
• The City Corporations/Pouroshavas will insist on placing special containers
at sorting stations, recyclables collecting centers or other public places for the
deposit of hazardous waste.
iv) Additional Environmental Action Plan under Health, Population and Nutrition
Sector Development Programme (HPNSDP): In September 2015, the Directorate
General of Health Services published an action plan focusing specifically on the
current issues relating to MW management and processing in the health care
facilities in Bangladesh.
37
Aiming to improve health services, service provision,
34
Department of Environment, National 3R Strategy for Waste Management, <http://www. doe. gov.
bd/site/publications...National-3R-Strategy-for-Waste-Management> accessed on 4 January 2020
35
ibid
36
ibid
37
Ministry of Health and Family Welfare, Additional Environmental Action Plan under Health,
Population and Nutrition Sector Development Programme (HPNSDP), (2015) <http://www.
mohfw.gov.bd/index.php?option=com_docman&task=doc_download&gid=6927&lang=en>
accessed on 20 July 2020
Medical Waste Management and Processing System
105
and strengthening the health system in Bangladesh, the Ministry of Health and
Family Welfare prioritised the environmental impacts brought upon by MWs. This
document provided an elaborate action plan containing twelve urgent issued and
identified responsible institutions to carry out such actions. In order to adequately
address the environmental issues regarding Civil works-related activities, a
revised checklist for environmental screening was also included. The proposed
timeline for this action plan was completed on 2016 but no follow up to such tasks
carried out by DoE and Directorate General of Health Services could be accessed
in public domain.
Throughout the analysis above, the basic strategy for prioritising MWs in order to
protect the environment is apparent. However, there are some gaps to be covered
in our national medical waste management policy and legislation. None of these
documents provide for solutions linked to emergency situations; such as an
epidemic or a pandemic. There is no existing provision which can be used for
authorising the expedited adoption of short-term and emergency measures
needed for a pandemic. Hence, it can be deduced that, the existing legal structure
in treating and controlling the impact of MWs are falling short under the ongoing
risk factors posed by the COVID-19 pandemic.
4. Practicalities of Medical Waste Management and Processing System
Post-COVID Bangladesh:
Good health is inevitably dependent on a healthy environment. Likely, the core
purpose of health care related institutions is to ensure good health for everyone.
Hence, in the basic course of their action arises a responsibility of addressing
environmental degradation. For instance, an assessment of waste generation rate
data from around the world shows that about 0.5 kg of MW per bed is produced
in hospitals per day.
38
While providing for treatment of illness and other health
care services to ailing people, these health care providing institutions generate
these MWs which pollute the environment in a large scale. Even though there are
very few documented cases of disease transmission from contact with medical
waste,
39
that non-documentation simply reflects the basic negligence regarding
this sector. It cannot be ignored that mismanagement in the MW disposal sector
negates the basic purpose of the medical service. Therefore, the significance of a
sound MW management and processing system is essentially high. On the one
hand it is necessary to reduce the suffering of diseased and unwell population,
and on the other hand it is equally important to ensure clean environment for them
to thrive. However, this circle of activities is not linear. As a result, such
responsibility lies not only upon the health care providers, but also upon the State.
38
UNEP, Compendium of Technologies for Treatment/Destruction of Healthcare Waste (2012)
39
Pollution issues, Medical Waste <http://www.pollutionissues.com/Li-Na/Medical-Waste.html
#ixzz6VjeFCCID> last accessed on: 10
th
August, 2020
Jahangirnagar University Journal of Law, Vol. VIII, 2020
106
With the advancement of medical science, we have come to learn more and more
about the long lasting impacts that MWs cause. It can be easily identified that the
cautious treatment of MWs, by separating them from general wastes, is a relatively
new concept. It took us, the humankind, quite a while to realise why these
substances should be separately treated and disposed of and how the duties of
such disposal can be distributed. Therefore, development of legal directives for
careful management of MW is also a product of modern times. Undoubtedly, the
current situation relating to an ongoing pandemic puts an added impetus on the
authorities worldwide to implement the relevant legal provisions. As Arnold
Kreilhuber
40
explains: in order to ensure that the world population avoids
negative, long-term health and environmental effects relating to COVID-19 waste
management issues, strong laws and institutions are essential.
41
On one hand, it can be agreed upon that the improvement of health care system is
bound to result in increased production of health care wastes. In Bangladesh, back
in 2011, the Ministry of Health and Family Welfare had projected an assumption
about an 8% increase in the number of patients per year.
42
This projection indicated
that, such increase would lead to a 5% increase of MW generation every year and
there would be 3% net increase in generation of MW.
43
This report also mentioned
that in the year 2009, from the total annual generation of MW of 33,221 tons, 8,208
tons were hazardous.
44
These wastes are of such nature that putting an end to its
production is not possible at all. It is a part and parcel of the health care system.
Therefore, the rule is, the more improved any health care system is, it disposes of
healthcare wastes more safely. On the other hand, the discussed risks show us how
serious the effects of mismanagement of medical wastes can be. The descriptions
from previous chapters also confirm that management of healthcare or medical
waste is complex in nature. In the following paragraphs it shall be explained as to
how the significance of legislation controlling MW management and processing
has been on the rise even before the outbreak of COVID-19 pandemic.
Responding to these practicalities, the bar and bench of the Supreme Court of
Bangladesh had also become active concerning proper management of MWs in
Bangladesh. For instance, back in April 2018, after hearing a writ petition filed by
Md. Ahmed Al Amin, a reporter of the daily, Bangladesh Protidin, a bench
consisting of Justice Moyeenul Islam Chowdhury and Justice Md Ashraful Kamal
40
The Acting Director of Law Division, UNEP
41
UNEP, Factsheet 4 - Policy and legislation linked to COVID-19 and pandemics, Covid-19 Waste
Management Factsheet, 2020, available at: <https://wedocs.unep.org/bitstream/handle/
20.500.11822/32777/FS4.pdf?sequence=1&isAllowed=y> accessed on 18
th
June, 2020
42
Ministry of Health and Family Welfare, Government of the Peoples’ Republic of Bangladesh,
Environmental Assessment and Action Plan: For the Health, Population and Nutrition Sector
Development Program (HPNSDP), (February 2011)
43
ibid
44
ibid
Medical Waste Management and Processing System
107
of the High Court Division had issued an important rule.
45
Coming across a
newspaper article, which reported how hospitals and diagnostic centres in
Chattogram were disposing MW in open bins, the petitioner came forward before
the court on February 4, 2018. The newspaper also published that total of 87
hospitals and 180 diagnostic centers were operating in that district while only one
private organisation, named Chattagram Seba Sangstha, was working to dispose
the MWs. The Secretaries to the ministries of environment and forest, health, and
home affairs, DGs of DoE and DGHS, deputy director of the DoE in Chattagram,
and Bangladesh Private Clinic and Diagnostic Owners' Association were made
respondents to this writ petition by the petitioner's lawyer Syed Mohidul Kabir.
The rule imposed by the High Court had ordered those respondents to explain
why they should not be directed to take necessary action to protect the
environment regarding MW disposal, recycling and transportation for the
safeguard of nature and health care of the citizens.
46
It also ordered these
abovementioned authorities to explain why they should not be directed to set up
Effluent Treatment Plant (ETP) in every hospital, diagnostic and other medical
center for the disposal and treatment of MW.
47
Moreover, the health secretary and
the director general of DoE were ordered to submit a report by July 22, 2018 on the
progress over forming the authority in every administrative division by
complying with provisions of the Medical Waste (Management and Processing)
Rules 2008.
48
It is important to note how pragmatic and proactive the judiciary has
been in addressing this urgent issue. In fact, to prioritise a quick solution, the
respondents were given a time frame of 4-weeks to start complying with the
directions given by the Court. However, such follow up steps were never
undertaken by the concerned authorities.
Nowadays, there is a definite increase in the recent trend in generation of MW
because of the pandemic worldwide, which is yet to be officially reported by the
GoB. Even though the GoB has made it mandatory for the public to use masks and
other protective gears, no special disposal mechanism for such wastes has been
45
Star Online Report, ‘HC Rule over medical waste management’ The Daily Star
<https://www.thedailystar.net/country/bangladesh-high-court-hc-rule-over-medical-waste-
management-1559824> accessed 18 November 2020 and ‘Monitor medical waste disposal’ The Daily
Star <https://www.thedailystar.net/backpage/monitor-medical-waste-disposal-1560049 > accessed
18 November 2020
46
Star Online Report, ‘HC Rule over medical waste management’ The Daily Star
<https://www.thedailystar.net/country/bangladesh-high-court-hc-rule-over-medical-waste-
management-1559824> accessed 18 November 2020
47
‘Monitor medical waste disposal’ The Daily Star <https://www.thedailystar.net/backpage/ monitor-
medical-waste-disposal-1560049 > accessed 18 November 2020
48
Star Online Report, ‘HC Rule over medical waste management’ The Daily Star
<https://www.thedailystar.net/country/bangladesh-high-court-hc-rule-over-medical-waste-
management-1559824> accessed 18 November 2020
Jahangirnagar University Journal of Law, Vol. VIII, 2020
108
implemented. In addressing this issue, a public interest litigation was filed
49
this
year seeking a directive for implementation of the Medical Waste (Management
and Processing) Rules, 2008 in the wake of the countrywide littering of used
COVID-19 treatment equipment and protective materials, such as: masks, gloves,
and PPE. Responding to this Public Interest Litigation filed by Ms. Anika Ali and
Mr. Humayun Kabir Pallob, on July 19, 2020 the High Court asked the Secretary
of Ministry of Environment, Forest and Climate Change to submit a report by
August 10, 2020 on what steps the GoB had taken to collect, treat and dispose of
MWs. The rule yet awaits disposal. However, the issue that we cannot take full
precaution from the spread of the pandemic if we neglect the MW disposal system
is quite clear.
Nonetheless, it is not only during a pandemic that MW disposal system becomes
relevant in our lives Keeping the serious effects of MW management and
processing on human rights worldwide, the UN mandated Mr. Calin Gerogescu
as a special rapporteur by Human Rights Council Resolution 9/1 in 2011.
50
In his
report, Mr. Gerogescu rightly focused on sound management and disposal of MW
and recommended specific measures to achieve safe and sustainable management
of such wastes. Based on the recommendations from the report of the special
rapporteur following steps can be considered in improving the current situation:
Firstly, raising awareness among the stakeholders has to be the prime concern.
This single step can deal with a lot of problems in MW disposal system. Awareness
about the harm MWs impose can reduce the percentage of infections and diseases
to a great extent. However, this responsibility does not lie into personal level only.
Therefore, the State has to take all appropriate measures to raise awareness of the
problems, especially among policymakers and communities living in the vicinity
of sites where MW is incinerated or landfilled. Secondly, non-governmental
organisations working in the field of public health or environmental protection
should include the promotion of sound health-care waste management in their
advocacy and conduct programmes and activities that contribute to sound health-
care waste management. Thirdly, professional training is one important tool in the
fight of establishing human rights. MWs are generated because of various
diagnosis, monitoring and curative activities on patients which vary in nature and
therefore the systems of their disposal tend to be separate as well. The relevant
national health authorities have to include such varied systems of waste
management in the curricula of future medical practitioners and nurses, to provide
appropriate information on the occupational risks to which medical and
49
M. Moneruzzaman, ‘High Court Seeks Report on Medical Waste Management’ The New Age
(Dhaka, 20 July 2020) <https://www.newagebd.ne...article/111604> accessed 18 Nov 2020
50
Human Rights Council, Mandate of the Special Rapporteur on the adverse effects of the movement
and dumping of toxic and dangerous products and wastes on the enjoyment of human rights, <
https://ap.ohchr.org/documents/E/HRC/resolutions/A_HRC_RES_9_1.pdf> accessed 18 Nov 2020
Medical Waste Management and Processing System
109
paramedical staff may be exposed, and to organise training opportunities on safe
health-care waste management for staff handling MWs. Finally, without funding
and technical support none of these abovementioned steps can be carried out in
our country. For the period of 2011-2016, cost for MWM of public HCFs of the
country was BDT 508.08 million (about 7.21 million US$).
51
In general, the MW
generation rate is estimated to be 0.8 to 1.67 kg/bed/day, so that the annual MW
generation rate is approximately 93,075 tons per year in Bangladesh.
52
Moreover, in a country where the basics of MW management remain unknown to
the stakeholders, international support can be of real help. States which are
advanced in controlling the hazardous effects of medical wastes shall come
forward. Without sitting idle, our state shall also take all appropriate steps, to the
maximum of its available resources, to allocate adequate financial resources to all
public and private institutions and bodies responsible for the safe and
environmentally sound management of health-care waste. These include health
authorities, the national environmental protection body, managers of health-care
facilities and managers of private or public waste-disposal agencies.
Nonetheless, in context of the ongoing COVID-19 pandemic, it has become
extremely urgent for us to put greater focus on proper management of MW. About
the disposal of MW in home, the situation is worse because people at home are not
aware of health effects of MW.
53
The extent of using all categories of medical
protective equipment is on the rise. Surgical mask and gloves, which were mostly
being used within the area of hospitals, have now dramatically become an
inseparable part of our daily lives. Yet, the type and the origin of waste covered
by the legal measures are excluding all household sources of MW. As already
discussed in prior part of the article, GoB has instructed the patients with mild
symptoms to take treatment from home
54
but failed to provide any emergency
process for segregating the infected MW. Such exclusion of household generation
of MW from the management process can cost us big time. By following all the
urgent directions, we can ensure cleaning our hands and using masks while
maintaining physical distance. Still, the risk of infection that remains hidden
within a used facemask can only be mitigated by a proper waste management
system.
51
Ministry of Health and Family Welfare, Government of the Peoples’ Republic of Bangladesh,
Environmental Assessment and Action Plan: For the Health, Population and Nutrition Sector
Development Program (HPNSDP), (February 2011)
52
Emdadul H. Syed, Mahmuda Mutahara, and Mosiur Rahman, ‘Medical Waste Management
(MWM) in Dhaka, Bangladesh’ (2012) 24(3) HHCP 140–145 <https://www.researchgate.net/
publication/254096670> accessed 3 June, 2020
53
ibid 144
54
Corona Info, Press Release on Coronavirus Prevention <https://corona.gov.bd/storage/press-
releases/June2020/CvOCZobyC4DkDsn1kPes.pdf> accessed 3 June, 2020
Jahangirnagar University Journal of Law, Vol. VIII, 2020
110
While other countries, like Italy
55
have taken up urgent processes in treating such
MWs, Bangladesh is surely lagging behind. In the context of this pandemic, the
national 3R strategy of waste management has become futile. Infectious MWs
cannot be reused nor recycled. Therefore, as an emergency stop gap solution,
adherence to the 3S solution is now needed. This solution implied the following
steps: Sorting, Segregation, and Storage. Following the UNEP Guideline
56
,
COVID-19 waste shall be separated from general medical waste volumes at point
of generation. Such waste shall then be stored to assess waste volumes and allow
the development of an appropriate response/stop-gap solution. The shocking
amount of disposable wastes needs proper disposal methods. As more and more
Covid-19 positive patients are taking treatment from home, the protective
equipment used by them should also be brought under a strict management
system. We are lacking the additional measures to monitor the export/import of
increased quantities of potentially COVID-19-contaminated/hazardous waste as
well. It has now become essential to provide clear mandate through administrative
steps and determine how such used facemasks are categorised. In absence of such
a direction, it is possible for the life threatening virus to spread far and wide even
when the patients are maintaining isolation. As medical wastes are collected
separately from hospitals and clinics, the local government should bring the
residential areas under similar system. It is also important for us to outline the
necessary measures to prevent negative effects on the environment and/or to
restore the environment in case it was damaged by increased volumes of waste
and by the application of the measures.
57
It should also be kept in mind that, the patients do not always visit the hospitals
for treatment. This scenario has become even more relevant since the spread of
COVID-19 pandemic. The guidelines provided by the Government encourage
both the suspected and affected COVID patients to consult doctors through
telephone and provides specific directions avoiding hospital visits.
58
As a result,
the number of patients availing telemedicine services has risen extraordinarily
during the national lockdown declared by the GoB in response to the pandemic.
However, the portions of population who are being treated in home still are
generating MW which is not being processed as required and have not been
categorised under the relevant legislation either. It has been a common practice in
55
Municipal waste management and COVID-19 Summary of observed trends (March 2020), < https://
www.acrplus.org/images/project/Covid-19/ACR_2020_03_Waste_ management_ covid19 _graph.
pdf> accessed 3 June, 2020
56
UNEP, Factsheet 1, available at: <https://www.acrplus.org/images/project/Covid-19/UNEP_1_
Intro_COVID-19_waste.pdf> accessed 5 June, 2020
57
UNEP, Factsheet 4 - Policy and legislation linked to COVID-19 and pandemics, Covid-19 Waste
Management Factsheet, 2020, available at: <https://wedocs.unep.org/bitstream/handle/
20.500.11822/32777/FS4.pdf?sequence=1&isAllowed=y> accessed on 20
th
August, 2020
58
Corona Info, Press Release on Coronavirus Prevention <https://corona.gov.bd/storage/press-
releases/June2020/CvOCZobyC4DkDsn1kPes.pdf> accessed 6 June, 2020
Medical Waste Management and Processing System
111
our country for the caregivers and family members to throw away the used
needles, syringes, and other items in open places.
59
This is how hazardous health-
care waste; also known as health-care risk waste has become highly difficult to
trace in our country. While management of general wastes is also an important
factor in environment protection, such discussion is not intended to be carried out
here. The COVID-19 pandemic is a health emergency and the measures to tackle
such emergency are directly connected to legislative action. When not managed
soundly, infected medical waste could be subject to uncontrolled dumping,
leading to public health risks, and to open burning or uncontrolled incineration,
leading to the release of toxins in the environment and to secondary transmission
of diseases to humans.
60
Therefore, it is an urgent demand of our times that the
State undertakes concrete measures to separate and treat the infectious MWs in an
efficient way.
5. Concluding Remarks:
Management and processing of MW does not mean mere dumping of biomedical
wastes in a specified area. This process goes much further than that as it requires
meticulous planning in order to be executed. That is why MW management is the
most critical environmental issue that is within the remit of the health sector.
61
It
is quite obvious that this issue of MW cannot be handled only through personal
steps. Without organisational awareness, only individual awareness among few
groups of people stands to be insufficient. Even though health care facility
providers are the main actors in this aspect, such institutions’ lone endeavours
cannot ensure completion of the disposal process of wastes. This is where the
contribution of the Government authorities become relevant. Therefore, in facing
this serious challenge combined effort of the State, its general people and the
concerned organisations is indispensable.
It is recommended that GoB focuses on establishing standardised, routine and
homogenised management procedures in all the health care facilities of the
country. The focus should also expand toward identifying hazardous MW streams
inside and outside such facilities; implementing a tracking system that enable to
monitor and control the hazardous MW production and management in the
health-care facilities; reducing occupational risk and control nosocomial infections
59
Emdadul H. Syed, Mahmuda Mutahara, and Mosiur Rahman, ‘Medical Waste Management
(MWM) in Dhaka, Bangladesh’ (2012) 24(3) HHCP 144 <https://www.researchgate.net/
publication/254096670> accessed 3 June, 2020
60
UNEP, Factsheet 1 – Introduction to Covid-19 Waste Management, Covid-19 Waste Management
Factsheet, 2020 available at <https://www.acrplus.org/images/project/Covid-19/UNEP_1_Intro_
COVID-19_waste.pdf> accessed 13 June, 2020
61
Strategic Plan for Health, Population and Nutrition Sector Development Program (HPNSDP),
2011-2016 <http://www.mohfw.gov.bd/index.php?option=com_docman&task=doc_download&
gid=1384&lang=en> accessed 15 June, 2020
Jahangirnagar University Journal of Law, Vol. VIII, 2020
112
as well as protect the environment; and finally, enabling to treat the waste at a
reasonable cost and reducing environmental pollution. However, the biggest
adjustments need to be made in the sector of monitoring, compliance and
enforcement of MW related laws in Bangladesh. The analysis of the given
legislative measures can not specifically point out any reporting obligations of
those responsible for carrying out the waste management process. Economic tools
employed to promote compliance (such as tax incentives and subsidies) are also
absent. Our need to revision of the legislation, to make it more agile to deal with
similar future situations, without compromising the state of the environment has
become urgent.
In conclusion, the MW management and processing system can be compared to a
two edged sword - absence of which results into widespread violation of human
rights and when enforced improperly, it still results in deterioration of public
health and environment. Improper management system poses a great threat not
only to the people directly involved with it but also to the people who are around.
The quantity of MW is increasing day by day due to the variety and ever growing
number of medical services and nursing homes, facilities. Immediate steps should
be taken by the authority to face the defects in managements. We need to prevent
uncontrolled dumping and stop open burning of MW. In order to avoid these
types worst environmental and health effects, there is no alternative to definitive
and effective legal steps. Due to the fatal spread of the novel coronavirus, it has
become imperative
62
to protect ourselves from droplet infection by using
facemasks and other protective gears. Such facemasks used by suspected
coronavirus patients shall immediately be categorised as medical wastes in order
to contain the level of damage caused by the pandemic. It is the only logical way
through which our legal regime can adapt to the emerging crisis and establish
environmental rule of law.
62
Government of Bangladesh, Corona Info, Press Releases <https://corona.gov.bd/storage/press-
releases/May2020/uaq6fknvAlbHczLVE5kF.pdf>,<https://corona.gov.bd/storage/press-releases/
June2020/CvOCZobyC4DkDsn1kPes.pdf>,<https://corona.gov.bd/storage/press-releases/May2020
/809308ee5817d840c7864e062640360a.pdf> accessed 18 June 2020
