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Medical Waste Disposal – International Framework

Despite the risks that medical waste may pose to human health and the environment, the international community has not yet elaborated a comprehensive framework to regulate the sound handling, transport and disposal of hazardous waste generated by hospitals and health-care facilities. 

While not focusing solely on medical waste, a number of international environmental treaties regulate specific aspects of the management and disposal of this particular type of waste; these include the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal and the Stockholm Convention on Persistent Organic Pollutants. In February 2009, the UNEP Governing Council agreed on the need to develop a global legally binding instrument on Mercury. The aim of the instrument is to reduce risks to human health and the environment from the effects of mercury. 

Several international organizations, including WHO and IAEA, have elaborated a number of technical guidance and policy documents to ensure that hazardous waste falling within the scope of their mandate is managed and disposed of in a safe and environmentally sound manner. 

In addition to the above-mentioned evolving body of norms, the Special Rapporteur stresses again that the unsound management and disposal of medical waste may negatively affect the enjoyment of human rights by individuals who either handle this waste or are exposed to it as a consequence of unsound management or disposal. These rights, which have been considered in some detail in the part concerning the human rights impact of medical waste, are set out in the International Bill of Human Rights as well as in other international and regional human rights treaties. 

Basel Convention 

The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal is the first global instrument that aims to protect human health and the environment against the adverse effects resulting from the generation, management, transboundary movement and disposal of hazardous and other wastes. It was adopted on 22 March 1989 and entered into force on 5 May 1992. The Convention had been ratified by 190 States. 

For the purposes of the Basel Convention, “wastes” are defined as “substances or objects which are disposed of or are intended to be disposed of or are required to be disposed of by the provisions of national law” (article. 2.1). Article 1.1 defines “hazardous wastes” as:  

  1. Wastes that belong to any category contained in annex I, unless they do not possess any of the characteristics contained in annex III;  
  2. Wastes that are not covered under paragraph (a) but are defined as, or are considered to be, hazardous wastes by the domestic legislation of the party of export, import or transit. 

Some categories of wastes – such as radioactive wastes – are excluded from the scope of the Basel Convention (articles 1.3 and 1.4). 

The Basel Convention rests on two main pillars:  

  1. First, it establishes a “prior informed consent” procedure for the transboundary movements of wastes between parties (articles. 4.1 and 6), according to which the transboundary movement of hazardous wastes can take place only upon prior written notification to the competent authorities of the States of export, import and transit, and upon consent of these authorities to the movement of the wastes in question. Shipments to and from non-parties are illegal unless there is a special agreement (articles. 4.5 and 11.1); 
  2. Second, the Convention lays down the principle of “environmentally sound management”, which requires the adoption of all practicable steps to prevent or minimize the generation of wastes at source, to treat and dispose of wastes as close as possible to their place of generation and to minimize the quantities that are moved across borders (article 4.2). Strong controls have to be applied from the moment of generation of a hazardous waste to its storage, transport, treatment, reuse, recycling, recovery and final disposal. 

“Clinical wastes from medical care in hospitals, medical centres and clinics”, “wastes from the production and preparation of pharmaceutical products” and “waste pharmaceuticals, drugs and medicines” are included in the list of hazardous wastes covered by annex I to the Basel Convention (categories Y1-Y3). “Infectious substances” (H6.2), defined as “substances or wastes containing viable micro-organisms or their toxins which are known or suspected to cause disease in animals or humans”, are included in the list of hazardous characteristics (annex III). 

In 2002, the sixth Conference of the Parties to the Basel Convention adopted technical guidelines on the environmentally sound management of biomedical and healthcare wastes. The primary objective of the guidelines is to provide guidance on measures to minimize the amount of medical waste generated, ensure their separation and segregation at source and promote their safe handling, storage, transportation inside and outside healthcare establishments, treatment and final disposal. In 2004, the seventh Conference of the Parties adopted a guidance paper on hazard characteristic H6.2 (infectious substances), which is intended to assist in determining whether a given waste displays the characteristic to a degree sufficient to render it hazardous. 

In practice, the Basel Convention is rarely invoked to ensure the sound management and disposal of hazardous medical waste, since this type of waste is mostly treated within the country where it is generated. 

World Health Organization 

WHO has elaborated a number of policy, management and advocacy tools to minimize the risks that the improper management of health-care waste pose to health-care workers, patients, waste handlers, the community at large and the environment, and to facilitate the establishment and sustained maintenance of a sound system of health-care waste management.


These include a policy paper on safe health-care waste management (2004) and core principles for achieving safe and sustainable management of health-care waste (2007). WHO has also developed a handbook on the safe management of health- care waste, a policy document to facilitate the elaboration of a national plan of action on health-care waste management, as well as specific guidelines for the safe management of particular categories of medical waste, such as solid health-care waste, syringes, and mercury-containing equipment. 

WHO has elaborated a number of information tools to raise public awareness of the risks associated with the unsound management and disposal of hazardous medical waste and on the measures to eliminate or mitigate these risks, including fact sheets on health-care waste management, wastes from healthcare activities and injection safety. 

International Atomic Energy Agency 

An important part of the mandate entrusted to IAEA is to elaborate and promote advisory international standards and guidelines on nuclear safety, radiation protection, radioactive waste management, the transport of radioactive materials, the safety of nuclear fuel cycle facilities and quality assurance. 


IAEA safety standards provide a system of fundamental principles, requirements and guides for ensuring safety. They reflect an international consensus on what constitutes a high level of safety for protecting people and the environment from harmful effects of ionizing radiation. A number of safety standards and requirements, such as the Fundamental Safety Principles (2006) and the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (1996), are applicable to all facilities and activities generating radioactive waste. Others, such as the safety guides on the decommissioning of medical, industrial and research facilities (1999) and on the management of waste from the use of radioactive material in medicine, industry, agriculture, research and education (2005), refer to specific activities carried out by nuclear medicine departments in hospitals and research center’s. 

Additionally, IAEA has issued several technical reports that aim to supplement the information offered in safety standards and guides, some of which relate specifically to radioactive medical waste. They include the reports on the management of radioactive waste from the use of radionuclides in medicine (2000) and on the decommissioning of small medical, industrial and research facilities (2003). 

National Regulations 

Only a limited number of countries has developed, or is in the process of developing, a national regulatory framework to respond to the challenges that the management and disposal of hazardous health-care waste pose to human health and the environment. These initiatives include the adoption of specific legislation on the safe and environmentally sound management of health-care waste and the development of national waste management plans, policies and guidelines to facilitate its implementation. 

In most developing countries and economies in transition, the lack of adequate technical resources for the safe and sound management of health-care waste, the limited funding for health-care waste management and the inadequate awareness of the direct and indirect risks posed by health-care waste constitutes the main obstacles to the development of a comprehensive regulatory framework on health-care waste management and to its effective implementation.