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Bio-Medical Waste

Any developing country who seek himself to become a developed country his first and foremost attempt is always to grow its economy and one such sector to invest is healthcare sector which gives a multiplier effect that is it not only just boost the economy and do welfare of people but it also increases country's soft power in world. But rapid development in health care sector often leads to conflict between the environment and medical waste generated in this sector.

The data has been collected from various authentic sources like various legislation, international survey and reports. In this paper an attempt has been made to critically analyze the situation on bio medical waste and what all better we can do to curb this menace. At the same time this paper tries to create awareness among the people and without their participation we cannot save this earth.

Introduction
For any country technological advancement is keen to its development and in field of health care facilities it brings a multiplier effect not just to its economy but also in field of demographic change and at the same time increases its soft power by making other countries to look for it at the time of any kind of medical help. But technological advancement has its own repercussion and biggest challenge faced by all the countries is the piling stalk of bio medical waste and its disposal.

Waste is in itself is a big problem for everyone in present time but the most dangerous kind of waste is Bio-Medical waste it directly effect to biotic and A biotic components of society. The indiscriminate and careless dumping of these waste by the health care facilities and research institute have put us into a situation where if we didn't handle this thing on priority basis then the situation will be beyond repairing capacity.

According to the recent study conducted by ASSOCHAM which state that compound annual growth rate (CAGR) would be around 775.5 tons of medical waste by 2022 from the current level of 550.9 tones daily. To grapple with the rising situation, 199 common bio- medical waste treatment facilities (CBWTFs) are in operation and 23 are in process (CPCB, 2017).

According to Dr. Kirti Bhushan the Director General of Health Service of the Delhi government said that the steps should be come from both the sides i.e. from the legal side as well as from the sides of the society. The major challenges in reducing the waste are lack of technical education of the staff and unawareness among the people.[1]

To tackle this problem the MoEF has issued Bio Medical waste Rules 2016. But the result shows that the Rules were not able to meet the present demands, the bio medical waste has kept on increasing in many states, the bigger concerns have raised after the breakdown of the pandemic epidemic COVID-19 which will left a huge chunk of bio medical waste. So this research paper deals with the critical analysis of our measures in this regard.

Evolution for Bio Medical Waste concern

Discussion about BMW was first time reported when a meeting convened by WHO regional office for Europe at Bergen, Norway in year 1983. Seriousness of the issue was highlighted in beach wash-ups, 1983.
However, the first concrete and legislative step for regulating the BMW was taken only after the horrific incident came in front of world, a 30 mile garbage slick composed of major chunk of medical waste emerged at New Jersey and new York beaches the investigation found out that the incident was intentional rather than accidental, USEPA(US Environmental Protection Agency) insisted US congress to come up with the legislation for Medical Waste Tracking Act in 1988. The act required EPA to create a two-year medical waste demonstration program.

The rationale behind the waste demonstration program was:

  1. To define what bio medical waste is
  2. To build a tracking system and its regulation
  3. Imposing required restrictions for disposal of the BMW
  4. Maintaining records and prescribing penalties on defying the conditions[2]
     

Second major step taken by WHO was the classification of the medical waste into different types[3]:

  1. Infectious: (Meaning- material containing micro organisms or their toxins, which survive due to their adaptability to the outside conditions.
    Source- sharp object which may or may not come into contact with a biological product, blood bottles, or any medical instrument/ object containing any blood or bodily fluids)
  2. Sharps: (meaning- it composed of bio medical waste of used sharps, generally used for puncture are dissect the skin.
    Sources- hypodermic needles, disposable scalpels and Blades, contaminated glass etc
  3. Pathological: (Meaning- any waste involve removal of organs, tissues or body parts of human or animal.
    Source- Amputated tissues, organs or body parts, sample collected for analysis or any part used in research.)
  4. Pharmaceuticals: (Meaning- any expired/unused/soiled medicine or drugs which are not fit for used.
    Source- cream medicines, ointment, pills or anti bodies.)
  5. Chemical: (Meaning- waste generated in any chemical procedure .
    Source: old batteries, disinfect, cleaning and washing through chemicals.)
  6. Radioactive: (Meaning- any wate which are produced due to any radioactive process or treatment.
    Source- treatment like Cancer therapies and medical equipment that is uses as nuclear elements.)
  7. Pressurized containers including gas cylinders
  8. Substances with high heavy metal content: broken mercury thermometers, blood pressure gauges.[4]

In India this issue took importance when the ministry of environment and forest, issued a notification on Bio-Medical Waste(management and handling) rules on 27th July 1998. This power were conferred by section 6,8 and 25 of environmental protection act1986. This put it mandatory condition on Health care establishment to follow these rules but these rules have not been able to reach the desire goals and therefore these rules have been amended time to time.
  Criteria 1998 Rules 2016 Rules
Authorization Authorization for only HCFs with more than thousands beds. Every HCFs needs to seek authorization from the authorities.
S.no
1
2 Duties of operator There were no duties put on the operator There are defined listed duties which are mandatory.
3 Division of waste The categorization of waste was divided into 10 categories but they were very vague and tedious. The categories were reduced to only four category but are very specific.
4 Applicable These rules were applicable only to establishment with more than 1000 beds. These rule broadened the jurisdiction and were made applicable to every establishment which are dealing with Bio-Medical Waste.
5 Examination/Review There was absence of annual report which makes review policy difficult. A format for annual report appended with the rules.


According to the statistics on bio Medical Waste, the total waste produced is 484 tons across India from the registered health care facilities(HCF) and 447 tons per day is treated. This clearly shows that, approximately 33 tons of waste is left out every day and which is generally left unattended.[6]

Table- 2 Disposal of waste per day (for 2009-10)[7]
States BMW generated (kg/day) BMW disposal(kg/day)
Kerala 32884 29438
Andhra Pradesh 14500 13018
Karnataka 62241 43971
Bihar 3572 3095
Jharkhand 5415 4763

[8]The Basel Convention:
The convention monitor the transboundary movements of Contaminated and other wastes under the ‘prior informed consent' as per the Municipal legislation to curb and punish illegal traffic in contaminated and other wastes.

The Stockholm Convention:

This convention resulted into a international treaty to protect human and environment from Persistent Organic Pollutants (POPs). POPs are polychlorinated dibenzo-p-dioxins and dibenzofurans which are hazardous to both human and wildlife. This convention talks about reducing and eliminating these substances through best available technologies(BAT) within four years and prepare a guidelines in order to deal with them. The BAT guidelines for BMW incinerators and waste water to achieve emission levels of dioxins and furans not above the level of 0.1 ng. [9]

Aarhus Convention of the United Nations Economic Commission for Europe, 1998

Convention deals with the awareness aspect and talks about the information access and participation of people in policy making for healthy environment and issues related to environmental rights.[10]

WHO guidance

The WHO in his policy research paper gave suggestion to government organizations of various countries to adopt recycling and polyvinyl chloride- free medical equipments, risk assessment reports and sustainable technologies to reduce and deal with the BMW. [11]

Minimata convention

The convention was on mercury and its use, which came into force on august 16, 2017. It was a multilateral environment agreement aims to protect human and environment from anthropogenic substances released form mercury and its compound. Perhaps it is one of the most effective conventions on environment in terms of bio medical waste.[12]

Constitutional mandate

Article 21:

No person shall be deprived of his life or personal liberty except according to procedure established by law[13]

This article is the most vibrant part of our constitution and it has played a vital role in protection of the environment, this was possible ever since when court started interpreting liberally. The significance of this Article lies in the fact that it forms the part of Fundamental Right (Part-III of Indian Constitution) which means that in case of violation of this article person can approach directly to Supreme Court. The judicial activism of court has established that the Right to Clean and healthy environment comes under the umbrella of rights falling under Art.21 of the constitution and will therefore be ensured and protected as a fundamental right.

Article 47:

The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health. [14]

The Art.47 forms a part of the Directive principle of state policy (part IV of the constitution of India) thereby making it a primary duty of the state to ensure that public health is being taken care of and to take proper measures in protecting the same and to formulate its' policies keeping in consideration its duties as laid down by the constitution. This article in particular talks about public health, which shows its importance in the context of biomedical waste because these wastes are detrimental to the human health and thereby thwart several efforts of the government to improve the public health and in absence of such measures can have bad repercussions on human health.

Article 48A:

The State shall endeavor to protect and improve the environment and to safeguard the forests and wild life of the country.[15]

This article was incorporated later on in year 1976 by 42nd amendment act in backdrop of Stockholm conference on environment this article directly puts an obligation upon the state to ensure not just protection but improvement of environment and wildlife. The BMW effect badly the environment and pollute them through various ways like through harmful fumes it increases Air Pollution, dumping of these waste into water leads water pollution this combined leads to depletion of wild life from earth.

Article 51A(g):

To protect and improve the natural environment including forests, lakes, rivers and wild life, and to have compassion for living creatures;[16]

This article as well was originally not part of the constitution and was added through 42nd amendment act of 1976. Since Protection of Environment will be incomplete without the participation of citizen and this article puts a duty on citizen to protect and improve the environment and have compassion for other living creatures.

Why is it a major concern[17].

If we look the waste is in itself a big issue for everyone but it becomes problem when its disposal becomes difficult and the two kinds of waste with such nature are radioactive waste and bio medical waste. Different countries use different methods to deal with them but due lack of technological advancement and economic backwardness they use the most conventional and easy way which is dumping them to the landfills. This made people prone to BMW, according to a report worldwide, 8-16 million hepatitis B, 23-4.7 million hepatits C and 80,000- 160000 HIV infection are estimated to occur yearly from used unsterilized syringes and needle this is prominent particularly in developing countries.

People who are more prone to such diseases are Health care workers, scavangers and people who come for their treatment.

Major diseases caused due to this are as follows18]-

Parasitic infections: the labs that incubate or test specimens and after test they dispose them as medical waste but some parasites survive and cause infection when they come in contact with the host. Example- Covid-19

Lung infection:

when the pathogens released from the bio medical waste make airborne aerosols which leads to respiratory infections like influenza, tuberculosis and pneumonia.

Skin infections:

though issues related to skin is rare due to Bio-Medical waste but it can cause major damage to skin from some of the medical waste such as anthrax if they are not disposed of properly.

HIV and Hepatitis B and C viruses:

due to various equipments that are used in various health care facilities for testing or operating the human and animals. When these equipments are not disposed in sealed and clearly marked containers they seep passage back into our medical facilities and cause deadly viruses like this.

Candida:

This diseases is named after the yeast candida albicans the waste from hospital contain pathogen and they are deadly to the section of society to elderly, pregnant, small children and people who have weak immunity.

Meningitis:

This disease is transmitted through bodily fluids and attack the brain & spinal cord.

Bacteremia the bacteria enters the blood stream and followed by infection in organism this causes bacteremia.

Occupational transmission of HIV in France and USA

France
In 1992, eight cases of HIV infection were recognized as occupational infections. Two of these cases, involving transmission through wounds, occurred in waste- handlers.

USA
In June 1994, 39 cases of HIV infections were recognized by the Centers for Disease Control and Prevention as Occupational infections.

Kinds
  1. Human anatomical waste- any identifiable body part which also includes pathological specimens, biopsy specimens and tissue which is produced during surgery or autopsy. Example- human tissue, organs, body parts.
     
  2. Animal waste
     
  3. Microbial and biotechnology waste- these kinds of waste generated from labrotaries or in various health care facilities. Example- plastic or dead microbes
     
  4. Waste sharps- this kind of waste are mainly sharp object which are generally used either to puncture or dissect the skin. Examples- surgical blades, needle, syringes, glass etc
     
  5. Unwanted medicine and cytotoxic drug, category: they are extremely hazardous waste which effect environment and human health adversely due to mutagenic, teratogenic or carcinogenic properties. Example – expired medicines, left over drugs etc.
     
  6. Soiled waste: these are contaminated waste with body fluids. Example- cotton dressings, soiled plaster casts etc.
     
  7. Solid waste: any kind of infectious material apart from sharp waste in solid from.
     
  8. Liquid waste: the healthcare facilities are responsible for delivering the patient a clean service and in this process many liquid waste are produced due to cleaning, disinfecting process[19]

BIO-Medical rules
Fig-1: Colour codification
  Yellow- Human or animal Anatomical waste, Solid waste, expired or discarded medicines and amicrobial or Bio Technological waste
Non Chlorinated plastic bags or containers
  Red- Red coloured non chlorinated plastic bags or containers
Contaminated waste like tubings, bottles intravenous tubes
  White- Punctured containers
waste shapes including metals needle syringe
  Blue- Puncture Proof Containers
Glass broken or discarded and contaminated glass

the major salient features of BMW management Rules,2016 includes the following[20]:
  • The rules have been expanded to include vaccination camps, blood donation camps surgical camps or any other healthcare activity.
  • Phase out the use of chlorinated plastic bags, gloves and blood bags within two years;
  • Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilization on-site in the manner as prescribed by WHO or NACO;
  • Provide training to all its health care workers and immunize all health workers regularly;
  • Establishing a bar code system for bags or containers containing bio medical waste for disposal;
  • Report major accidents;
  • Existing incinerators to achieve the standards for retention time in secondary chamber and Dioxin and Furans within two years;
  • Bio-medical waste has been classified in to 4 categories instead 10 to improve the segregation of waste at source;
  • Procedure to get authorization simplified. Automatic authorization for bedded hospitals has been announced. The validity of authorization synchronized with validity of consent orders for bedded HCFs. One time authorization for Non-bedded HCFs;
  • The new rules prescribe more stringent standards for incinerator to reduce the emission of pollutants in environment;
  • Inclusion of emissions limits for dioxin and furans;
  • State government to provide land for setting up common bio- medical waste treatment and disposal facility;
  • No occupier shall establishes on-site treatment and disposal facility, if a service of common bio-medical waste treatment facility is available at a distance of seventy-five kilometer; and
  • Operator of a common bio-medical waste treatment and disposal facility to ensure the timely collection of bio-medical waste from the HCFs and assist the HCFs in conduct of training.

Table- 3: State wise waste produced [21]
STATE 2009-10[22] 2016 2017 2018
Andhra Pradesh 14500 9898 10662.27 15144
Bihar 3572 8827.69 33799.97 34812.9
Delhi 9859 24996.44 24667.05 26757.5
Gujarat 16565 30296 29070 33706
J&K 4827 885.94 4618.58 4482.9
Kerala 32884 37773.45 40990 71976.14
U.P 44392 37655 43554 46401
West Bengal 23571 26858.76 29773.84 34123.62


Table- 4: Amount spend on BMW disposal[23]
Countries Waste generated
(kg/ per day)
India 1.5
Spain 3.0
France 2.5
USA 4.5
U.K. 2.5


Table- 5: Health care waste generated according to national income level (Pruss et al., 1999)
National income level Annual waste generation (Kg/ head of population)
High income countries
All health-care waste
Hazardous Health care waste
1.1-12.0
0.4-5.5
Middle income countries
All health-care waste
Hazardous Health care waste
0.8-6.0
0.3-0.4
Low income countries 0.5-3.0


Techniques in use
According to the official gazette notification of 20th July 1988 all those people who are connected to this process from generation to disposal of BMW were made responsible for disposing & handling without affecting the human and environment. It also prescribed methods that are to be adopted by the health care facilities.
Some of them are as follows:
  1. Incineration- it is a process in which the waste is disposed through combustion process where the harmful microorganism are completely destroyed in a controlled environment, which cost around Rs.7 per kg. These kinds of techniques are adopted in a country with scarce land.
     
  2. Autoclaving: the process involved a low heat thermal process where a steam is used on waste for certain duration to disinfect the waste.
     
  3. Microwaving: the thermal electromagnetic radiation is used between specific frequencies between 300-300000 MHz for microbes to become inactive.
     
  4. Shredder: in this process the waste are unformed or cut into smaller pieces this work in two ways first it makes it impossible to be reuse and identifiable that the waste has been disinfect.
     
  5. Deep burial: Any waste which are categorized under category of 1and 2 of Biomedical waste rule 1998 can be disposed of through by burying it very deep but with certain preconditioned which has to be followed
    • The town population should be less than 5 lakhs
    • The permission have to be taken from the concerned authority for the site
    • It should be away from the residential area
    • Area should not be prone to flood and erosion
Emerging technologies
The growing rate of bio medical waste shows that the present techniques are not sufficient and therefore it becomes important to look for new techniques and in this regards many techniques are in process some of them are:
  1. converting the hazardous waste into municipal solid waste: in this the waste first the waste is disposed through process of shredding and grinding through a sharp cutting blades that are installed within the vessels which rotates around 1750 revolutions per minute and the volume is reduced to 80% of its original quantity. The whole process is done in an enclosed manner which can be used at the very stage of its production of this bio medical waste by installing at the site of origin.

    This technology is already been used in Middle Eastern countries like Iraq, Kuwait, Syria, UAE.
     
  2. In USA as well a group of engineers in Idaho National Laboratory invented a technology which is a mobile shredding and chemical disinfecting machine. The mchine shred the waste into smaller pieces and then wetted with disinfectant spray and immersed in a disinfection solution, the wet waste is dried through hot off-gas in a chamber.
Case laws in India
  1. B.L.Wadehra v. Union of India and others.[25]
    In this case the court said that the resident of Delhi have a salutatory right to live in a clean city and hence the Municipal Corporation of Delhi (MCD) and New Delhi Municipal Council (NDMC) are bind by statutory law to maintain and provide a city free from waste generated by the health care facilities.

    The main argument by the defendants were that the Danish company failed to provide them proper logistic for cleaning. The court went to an extend of saying that non availability of funds or insufficient machinery cannot be an excuse for non performance of their statutory obligations.

    Case is also important because it also lays down directives for collection, handling and disposal of bio medical waste. Thirdly it ask the authorities to promote awareness through mass media platform about their civic duties.
     
  2. Almitra H. Patel v. Union of India
    Supreme court compelled environmentalist, administrators and lawyers to come up with a solution to the growing solid waste management as a result of this the central government notified the Municipal Solid Waste (Management and handling ) Rules 2000.
     
  3. C.S. Prakash and others v. the HUDA and others[26]
    In this case a PIL was filed in which the petitioners ask for an issue of Mandamus writ against the respondent for not taking any action as illegal and violative of Andhra Pradesh Urban areas (Development) act and Article 14 & 21and directing other defendant to remove the illegal structure (hospitals) situated in that area.

    The divisional bench of Andhra Pradesh High Court stated that building a big hospitals in residential area is not an issue but the builders have taken proper caution for the benefit of resident of the locality or not is a concern and secondly whether the disposal of bio medical waste from the concerned authority has taken or not.

    There cannot further be any doubt that before construction of a big hospital is permitted not only care has to be taken about the convenience of the residents of the locality but also as to whether permission from the competent authority had been taken for disposal of bio-medical waste. Prevention of ecology and health of the populace come within the purview of Article 21 of the Constitution of India. The A.P. Pollution Control Board must, therefore, strictly apply the laws governing the field, including the rules, regulations and norms issued by it in this behalf.….Adequate protection for disposal of biomedical waste be taken in terms of the Bio-Medical Waste (Management and Handling) Rules, 1998.
     
  4. Haat Supreme Wastech Pvt. Ltd. & Ors. v. State of Haryana &Ors[27]
    the question put forward in this case was that appellant was running units of bio medical waste treatment faculty with all due authorization laid down in the Bio-Medical Waste (Management & Handling) rules, 1998. Later on Respondent ( Harayana State Pollution Control Board) inspected and pointed out certain short comings because of which the appellant was issued a notice and directed to deposit 5 lakhs rupees as a way of bank Guarantee.

    Subsequently CPCB (Central Pollution Control Board) issued another notice and asking the appellant to deposit a sum of Rupees 10 lakhs each and take steps to remove the short comings. This second notice was brought in questioned in front of court.

    The case become very important when the fundamental issues were raised about the structure of the vicinity and the consent that were earlier given by the authorities so before deciding upon the validity of notices the question raised about the by the tribunal was whether they need environment clearance or not. Tribunal issued notices to as many as nine Government run hospital for mishandling of bio-medical Waste.

    The Tribunal observed:
    The purpose of the Application primarily is to achieve the object of environmental protection. We are of the considered view that it may not be fruitful at this stage to direct prosecution of the Director/Medical Superintendent of all the respective hospitals, but we make it clear that remedial measures to remove the shortcomings/deficiencies pointed out by the Committee should be taken without fail at the earliest.
     
  5. Ratlam Municipality case[28]
    The main contention was regarding the section123 M.P. Municipality Act of 1961. These obligations include many thing and sanitary facilities and prevention of street contamination. The residents of the municipality were in problem and combined went to the court against the lack of sanitary facilities under section 133 of Criminal Procedure Code ( Cr.P.C.).

    India is among those countries who took the menace of Biomedical waste seriously at the very beginning and created a concrete legislative structure and tried to curb it. The rules that were formulated in the backdrop of Stockholm conference on Bio medical waste gave the detailed rules considering every aspect according to the resources and technologies which were there in India and the country upgraded in technology advances and looking to the contemporary need they are been amended time and again.

    But we should not forget the policy on paper which appeared to be perfect becomes ineffective if they are not been monitored and checked properly therefore in such circumstance the role of Judicial bodies become important and this have been proved time and again by them in various judgment.

Impact
Impact

The impact of biomedical waste is multidimensional and we can categorized it under the following sub heads:

  1. humans directly the effect of bio medical waste are sometimes seen direct and within a short period of time these are either in form Diseases like , in form radiation or causing damage to body parts.
     
  2. Indirectly to humans in this case the effect of waste is visible after a long period
     
  3. environment these waste not just effect humans but also causes a great damage to environment as well they leads to soil infertility when it seep into soil which leads to ground water pollution and over a period of time it leads to desertification. When animal gets in contact which results in death of these animals, it not only affects the terrestrial animals but aquatic animals as well. In short it disturb the whole ecological cycle.
     
Conclusion:
Having studied about the whole infrastructure for Bio-Medical Waste management, there are few major problems. Firstly the problem in India has never been the absence of law but its implementation.

Secondly the behavioral attitude of the public, people at large need to become more vigilant and become more sensitive towards the quality of the health care facilities meted out to them. This will naturally address the issue of negligence and recklessness of the health care staff. to keep the same in check, penalties must be imposed in case of negligence.

Lastly, even more advanced and efficient technologies as existing in several other countries throughout the world, should be made available in India as well. Furthermore, efforts should be made to come up with our own ways to dispose of such waste and the same should be encouraged by way of research, studies and experiments and so on, backed by sufficient funds.

However, for the immediate measures we need to go for the conventional but yet very crucial to Bio-Medical Waste management that is:
  • Segregation: According to the WHO report not all medical waste is hazardous it's just the 20-25% of total waste[29]. So we just have to identify this portion.
     
  • 3Rs: Re- use/ Reduce/ Recycle: One of the simplest and easy to achieve steps which can be a game changer. This calls for a change in attitude. The society in which we live is where reusing or recycling things is seen as something of a low status. A change of outlook is required and the people doing the real job should be respected and cooperated with.
     
  • CSR (Corporate social responsibility) : we need to follow a carrot and stick policy, When dealing with the corporate sector, we need to incentivize those who are contributing to curb this menace and need to penalize all those who are creating this menace. Regular compliance checks should also be made.
     
  • Proper Disposal: Although not a technique but an essential procedure without which nothing can be changed. We do not have to dispose of this waste temporarily. We need to dispose of this waste in a proper manner, without leaving it for the future generations to suffer with.
All these steps are interlinked and need go hand in hand in terms of implementation in order for us and our generations to come, to be able to see and experience the difference and reap its benefits.
Conventional method of reducing waste
Fig-3: Conventional method of reducing waste

End-Notes:
  1. Press Trust of India (2018) waste management nightmare: India likely to generate 775.5 tonnes of medical waste daily by 2020. (May. 16, 2020, 02:00 PM). From , https://www.hindustantimes.com/health/india-likely-to-generate-775-5-tonnes-of-biomedical-waste-daily-by-2020/story-nAMjclvzkhck1RPc0tr5SK.html.
  2. U.S. Environmental Protection Agency, US Environmental Protection Agency, Medical Waste Tracking Act of 1988, 2010. http://www.epa.gov/wastes/ nonhaz/industrial/ medical/track- ing.htm.
  3. WHO.(2018). Health-care-waste.(May.15,2020, 11:PM)https://www.who.int/news-room/fact-sheets/detail/health-care-waste.
  4. WHO, (The World Health Organization), Waste Man-agreement at Medical Centers, 2010. http://www.who.or.id/eng/contents/aceh/wsh/books/es/ES08CD.pdf
  5. https://dhr.gov.in/hi/document/guidelines/bio-medical-waste-management-rules-2016
  6. New Rules Notified for Management of Bio-Medical Waste The Times Of India, March 27,2016
  7. Press Information Bureau. (2011) Check on Bio-Medical Waste Generated in Country Every year (May 14, 2020), from https://pib.gov.in/newsite/PrintRelease.aspx?relid=75223
  8. Chartier Y, Emmanuel J, Pieper U, Prüss A, Rushbrook P, Stringer R, et al., editors. Safe Management of Wastes from Health-Care Activities. 2nd ed. Geneva, Switzerland: WHO Blue Book; 2014.
  9. WHO. WHO core principles for achieving safe and sustainable management of health-care waste WHO (2007a). Geneva: World Health Organization; 2007. Available from: http://www.who.int/water_sanitation_health/medicalwaste/hcwprinciples/en/index.html. [Last accessed on 2020 May 14].
  10. Chartier Y.n.1
  11. World Health Organization Guidance: WHO. Safe Health Care Waste Management: Policy Paper. Geneva: World Health Organization; 2004. Available from: http://www.who.int/water_sanitation_health/medicalwaste/hcwmpolicy/en/index.html. [Last accessed on 2020 May 14].
  12. https://www.research-collection.ethz.ch/bitstream/handle/20.500.11850/387293/Sharma2019_Article_implementationOfTheMinimataCon.pdf?sequence=3
  13. Indian Constitution. Art.21.
  14. Indian Constitution. Art.47
  15. Indian Constitution. Art48A
  16. Indian Constitution. Art.51A(g)
  17. WHO.(2018).Healthcarewaste.(May.15,2020,11:PM) https://www.who.int/water_sanitation_health/medicalwaste/020to030.pdf.
  18. https://www.medprodisposal.com/medical-waste-disposal/improperly-disposed-of-medical-waste/
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925840/ (1:39- 13/5/2020)
  20. https://dhr.gov.in/hi/document/guidelines/bio-medical-waste-management-rules-2016
  21. https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1602353
  22. https://pib.gov.in/newsite/PrintRelease.aspx?relid=75223
  23. http://isebindia.com/95_99/99-07-2.html
  24. B.L.Wadehra v. Union of India and others, AIR 1996 SC 2969
  25. ILR (2001) AP 323, (328) (DB)
  26. Appeal No. 63 0f 2012, Principal Bench, National Green Tribunal
  27. Ratlam municipality v. Vardichand. AIR 1980 S.C. 1622
  28. https://www.who.int/news-room/fact-sheets/detail/health-care-waste

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