BINGHAMTON, New York, December 29, 1997 (ENS) - Hospitals are supposed to be the places for people to have their wounds mended. Ironically, hospitals that incinerate their wastes are inflicting illnesses on nearby residents and on their own patients. Even with this knowledge, many World Bank officials are still supporting the construction of these incinerators.Despite mounting evidence that medical waste incinerators are primary sources of dioxin and mercury emissions, and that these emissions are harmful to all living things, especially those highest on the food chain - humans - and despite the fact that there is growing pressure in the United States to close existing incinerators because of health concerns, World Bank officials persist in recommending their construction in the countries whose development the Bank is assisting.
The case against incinerators is easily won, however, when the tools of factual knowledge are available. "When you decide to incinerate medical waste, you're turning a biological problem into a chemical problem," points out Paul Connett, professor of chemistry at Saint Lawrence University in Canton, New York.
Medical waste incinerators aim to disinfect wastes, but in the process, all of the materials on which infections may exist are burnt. Given that much hospital material is composed of polyvinyl chloride (PVC), toxic dioxins are created in the fire, particularly if temperatures are kept too low. Even if very expensive cleaners are installed in the stacks, there are still toxic emissions into the nearby ecosystem. Of course, even when pollution control devices capture some of the dioxin, there is no guarantee that the dioxins and other poisons like mercury will later be safely disposed.
According to Connett, Dutch officials, after spending half of the total $600 million dollar construction bill on an Amsterdam incinerator's pollution control devices, are now allowing 33 percent of their collected incinerator ash to serve with asphalt on road surfaces, instead of treating the ash properly as a hazardous waste. Connett says, "This is a prime example of thinking with your wrong end."
Especially pernicious about dioxins is their persistence through the food web. Since dioxins are fat-soluble, they are retained by the body (and by the bodies of everything you eat). Working their way up the food chain, the bioaccumulative dioxin in cattle and fowl carry their highly concentrated poison to humans via "food."
As the toxins magnify toward humans, it is alarming to realize that breast milk is the most concentrated package of dioxin available to most humans. Doubly alarming is the fact that infants and fetuses are especially vulnerable to this chemical attack. Some doctors in Europe are reported to be recommending that mothers limit breastfeeding their children in areas heavily contaminated with dioxin.
Even earlier in the human reproductive cycle, dioxins are also being identified as endocrine disruptors, agents of sterility, and causes of endometriosis, and testicular and ovarian cancer.
Presently a source of both frustration and hope is the fact that alternatives to incineration are readily and cheaply available. Autoclaving (high temperature steam sterilization) and microwaving are able to disinfect materials without burning them, at a cost that even World Bank economists would recognize as cheaper than incinerators.
But don't tell the World Bank's Environment Department about the dangers of incineration - they'll say they're aware of the problem and they're working on it. In fact, at least one part of the Bank is aware of the dangers of incinerators, but the news has not spread to others within the Bank.
Policy recommendations from a World Bank South Asian Regional Office Report in January 1996 include the claim that medical waste should be separated and decontaminated at its source "rather than [using] imported high-technology incinerators that are expensive to purchase and difficult to maintain." But a Staff Appraisal Report on a project in India dated one month later details plans for incinerators in potentially hundreds of hospitals in the states of Karnataka, Punjab, and West Bengal.
When asked why the Bank is pushing forward with plans to build incinerators in spite of the mounting evidence of their dangers, a World Bank Environment Department staffer who requested anonymity pleaded for patience. "It takes lots of time to change the culture of the bank."
Meanwhile, investigation via the World Bank's web site reveals that over two dozen Bank related projects in 19 countries contain provisions for medical waste disposal. Interviews with a number of the World Bank officials responsible for these projects - the task managers - revealed that every one of them was promoting incineration without any knowledge of the dangers involved or the safer alternatives available. Not one task manager was even aware of the link between medical waste incineration and dioxin emissions. People in these regions are already organizing to educate others, protest against these threats, and instill some sense into the development experts to provide environmentally-responsible medical waste management.
Meanwhile, Anwar Bach-Bauab, the task manager for a World Bank Health Sector project in Senegal, has recently attempted to allay concerns about the impacts of incinerators by claiming, "Don't worry. We're using small and locally-made incinerators."
This idea frightens rather than reassures health and environmental advocates monitoring the World Bank's activities. "State of the art" incinerators are extremely complex and expensive technologies, and even the best can't entirely prevent emissions of dioxins and other toxins. For example, most incinerators even in the United States do not have any containment devices for mercury because of the cost. Therefore, it is most unlikely that small and locally-made incinerators will come close to the most efficient incinerators found in Western Europe, which still cause significant health threats.
With a track record of helping people to organize against incinerators all over the world, including in India, Costa Rica, and the Phillipines, Connett has a standing offer to help any anti-incinerator group gratis.
In the United States, the EPA is setting new regulations that will shut down many of the existing incinerators. In fact, a coalition of health, labor, consumer, and environmental groups have organized under "Health Care Without Harm" to call for an environmentally safe health care industry, which includes the global phasing out of incinerators.
Ann Leonard, field director of the Multinationals Resource Center (MRC), has worked with Connett in India trying to catalyze movement to change the Bank's policy.
"It is incredibly frustrating to see the World Bank helping devloping countries make the same technological mistakes we made in the U.S. twenty years ago," Leonard said. "After building incinerators all over this country we learned the hard way that they pollute the environment, poison communities, and don't make economic sense. Now in the U.S. we are developing alternative cleaner technologies. Here is a perfect chance for the World Bank to help India leapfrog over the mistakes we made and go straight to the clean technologies but instead, the World bank is pushing our discredited polluting technologies overseas."
Regarding the World Bank's inconsistent approach to incinerators, Leonard has written to the Bank's former Environmental Director Andrew Steer with concerns about the environmental reviews given to projects with incinerators. Specifically, she wanted to know why, from a sample of eight proposed projects involving medical waste incinerators, there were several that required minimal amounts of environmental impact review. Steer failed to reply for several months, and has recently been transferred to the World Bank's Vietnam Office, leaving the post of Environment Director vacant.
On this issue, at least, the Bank appears rather disorganized.
Connett, co-editor, along with his wife Ellen, of the newsletter Waste Not, charges that the more fundamental problem is "waste." Recognizing that the varied materials of human refuse can often be composted, reused, and recycled, or not used at all, the Connetts think separation of "trash" is essential. "Waste is a verb," says Ellen Connett.
During the first week of July 1997, the refreshingly irreverant Paul Connett told an audience of World Bank officials about one of his visualizations of the future - one that he especially fears. Central in it is a tall, black, monolithic building with no windows in which the autocrats "probably the World Bank" governs everyone else. Connett's lecture was an attempt to remake our fate.
For more information about World Bank funding of medical waste incinerators, contact Ann Leonard 202-387-8030 at the MRC.
To learn more about the incinerator industry, subscribe to Waste Not, 82 Judson St., Canton, NY, 13617 USA. Website: it.stlawu.edu/~wastenot
Kevin Kniffin is a graduate student in anthropology at the State University of New York at Binghamton. Contact him by email at [email protected].