Medical waste remains a relevant issue for Tajikistan, as well as for other countries in the region. The authorities claim that medical waste disposal is under their control. However, observations show that waste is disposed of in regular landfills, which poses a threat to public health.
All waste generated by healthcare facilities and laboratories, including syringes, bandages, masks, gloves, and similar items, are considered medical waste, which can potentially be contaminated with viruses and diseases. Therefore, medical waste requires a special management and disposal system, which is not always implemented in Tajikistan.
Medical waste is divided into four classes: “A”, “B”, “C”, “D”.
Class A waste includes stationery, masks and gloves, shoe covers, disposable gowns, towels, papers and documents, food waste (from non-infectious diseases departments), and other personal protective equipment. Class A waste is considered the least hazardous.
Class B waste includes tissue and organ parts after surgeries, contaminated and potentially contaminated waste, food waste from infectious disease departments, medical laboratory waste, organic waste, waste and packages from anatomical pathology departments.
Group C waste is extremely hazardous waste which was in contact with patients having infectious diseases and may spread infection. It includes animals used for experiments, genetically modified organisms, live vaccines not to be used, and some laboratory and pharmaceutical waste.
Class D waste includes expired medicines and disinfectants, chemotherapeutic drugs, items, devices, and equipment containing mercury, pharmaceutical waste, electrical systems waste, etc.
In Tajikistan, medical waste is mostly disposed of by high-temperature incineration.
Official Statements
During a press conference on February 12, 2024, the country’s Health Minister Jamoliddin Abdullozoda said, “About 50% of the country’s medical facilities are equipped with waste disposal units”.
According to him, facilities equipped with such units, dispose of medical waste in them. Facilities that do not have such units sign contracts and send their waste to private enterprises for disposal.
However, the Minister did not name specific enterprises that dispose of medical waste.
During the first six months of 2024, the Sanitary and Epidemiological Service of the Ministry of Health of Tajikistan disposed of more than 82 tons of expired medicines, medical products, cosmetics and hygiene products, and baby food.
More than 152 tons of medical waste were collected and disposed of in 2023.
Ibodullo Mahmadullo, head of the Department of State Control of Land Use and Protection and Waste Management of the Committee for Environmental Protection under the Government of the Republic of Tajikistan, says that there are no specialised enterprises for medical waste disposal in the country.
“Medical waste is incinerated in specialised places. For this purpose, incinerators have been built in medical facilities. There is no special enterprise for medical waste disposal,” Ibodullo Mahmadullo said during a CABAR.asia interview.
According to official information, there are 70 small waste recycling enterprises in Tajikistan. Including:
- plastic and polyethylene waste recycling plants — 25 enterprises;
- paper and cardboard waste recycling — 10 enterprises;
- non-ferrous metal recycling – 2 enterprises;
- petroleum product recycling – 1 enterprise;
- iron waste recycling — 18 enterprises;
- lime waste recycling — 4 enterprises;
- rag recycling — 1 enterprise;
- glass recycling — 2 enterprises;
- mercury-containing energy-saving lamps recycling — 3 enterprises;
- rubber waste recycling — 1 enterprise.
Reality is Different
For three times during July, a CABAR.asia author visited the Shifobakhsh hospital in Dushanbe, known as “Kariyai Bolo”, one of the largest hospitals in Tajikistan.
It has been found that medical waste in this hospital was disposed of along with the general waste. Rustam, a pharmacy owner in Dushanbe who also does injections to patients, disposes of medical waste generated by his medical room into the regular landfill.
He says he does not know of a special place for medical waste disposal.
Said is a medical student who did an internship at a hospital in Dushanbe this summer. He says the hospital generates mainly two types of medical waste; however, the hospital does not have an incinerator and he does not know where waste is taken.
Medical waste, mostly generated by residents, can be found in almost all regular landfills. In addition, most waste collection points do not have special containers for collecting medical waste.
The medical waste problem in Tajikistan remains as sensitive and acute as in other countries in the region.Eco-activist Anisa Abibullaeva talking about the medical waste problem said that there was no medical waste disposal system in the country.
“There are incinerators near some hospitals where medical waste is disposed of,” she noted.
According to Abdullo Davlatov, a Tajik doctor who lives and works in Russia, medical waste contains chemical, biological, and physical hazards that cause several types of diseases.
“Chemicals such as mercury, chlorine, iodine, various medicines, etc. are widely used in healthcare, and if the pace and place of their use are not controlled, and if they are also mixed with any other waste, they pose a serious threat to human health,” Davlatov said in a CABAR.asia interview.
Microorganisms such as viruses, bacteria, and fungi, which are abundant in medical waste, can cause many infections.
“For example, there are Klebsiella, Proteus, and other microorganisms that often exist in hospitals,” Davlatov says.
Due to this, for example, in Russia, doctors try to discharge patients from the hospital as quickly as possible so that they do not ‘catch’ these hospital-acquired infections.
According to this expert, healthcare uses examination and treatment methods with nuclear (radioactive) drugs, different wavelengths of light, special nuclear (radioactive) devices, or heat carriers increasing temperature, etc., which creates radioactive poisoning risks for people.
“Class B, C, and D waste can cause infectious, radioactive, physical diseases and cause serious damage to nature and animals. In addition, such waste can cause cancer, infertility, etc., depending on the class of waste,” Abdullo Davlatov concluded.