The information contained in the following inventory of World Bank and IFC projects is based on the latest available information provided in the Public Information Documents (PIDs) on the World Bank website (www.worldbank.org). Full copies of the PIDs summarized below are available from the Multinationals Resource Center. Emphasis in quotes added by report authors.

ABBREVIATIONS AND ACRONYMS

EA -- Environmental Assessment CIMA -- Centro Internacional de Medicina GEF -- Global Environment Facility GILS -- Gleneagles International Labs IFC -- International Finance Corporation IO -- Investment Officer (IFC) MRC -- Multinationals Resource Center

PID -- Public Information Document PM -- Portfolio Manager RSSG -- Rumah Sakit Siloam Gleaneagles Hospital TM -- Task Manager (person in charge of the project) WB -- World Bank

INVENTORY CONTENTS

Algeria Argentina Asia (regional project) Brazil Comoros Dominican Republic Egypt India (four projects) Indonesia (two projects) Kenya Lebanon (two projects)

Malawi Mexico Nigeria (two projects) Senegal South Africa (three projects) Sri Lanka Turkey (two projects) Vietnam Western Samoa Zimbabwe (four projects)

ALGERIA

Project Title: Algiers Urban Renewal Project

Project ID Number: DZPA4957 (WORLD BANK PROJECT) Sector: Urban Development

Dates: Initial PID Prepared: 11/96; Projected Appraisal Date: 2/1/99; Project Board Date: 7/13/99

Environmental Classification: Category A

Quote from PID: "It [the project] would supply cans and containers for removal of residential and commercial wastes, and individual incinerators to hospitals in the project area."

World Bank Contact: Ms. Maryse Gautier at (202)458-7132. Email:[email protected]

Project Title: Hospital Privado Centro Medico de Cordoba, S.A.

Project ID Number: 008776 (IFC PROJECT)

Sector: Social Services(Health Care, Education)

Dates: PID Prepared: 3/24/98; Projected Board Date: 4/30/98

Environmental Classification: Category B

Quote from the PID: "This is an environmental review category B project; principal issues involve handling and disposal of solid waste including medical material(bio-hazardous waste), liquid waste treatment, including sewage, . . . incinerators."   "Biological/pathogen waste will be incinerated at the Cordoba Municipal incinerator. The contractor has the appropriate permit to utilize the incinerator."

IFC Contact: Avi Hofman at (202)473-4358   Email:[email protected]

ASIA (Regional Project)

Project Title: Gleneagles International Labs(GILS)

Project ID Number: 007816 (IFC PROJECT)

Sector: Other Population, Health & Nutrition

Dates: Projected Board Date: 1/20/97

Environmental Classification: Category B

Quote from the PID: "The GILS will implement the appropriate mechanisms to handle and dispose of their medical waste. They will install small incinerators, which are appropriate for the types and amounts of wastes generated by diagnostic clinics, and incinerate the wastes on-site or contract the treatment out to appropriately licensed and qualified commercial waste disposal companies."

IFC Contact: Karen Sander(Investment Officer) at (202)473-1484.

Project Title: Laboratorio de An lises e Pesquisas Clinicas Gastao Fleury S/C Ltda. ("Fleury")

Project ID Number: 009587 (IFC PROJECT)

Sector: Health Care

Environmental Classification: Category B

Dates: Projected Board Date: 5/29/99

Quote from PID: "The contaminated residues will be collected in white plastic containers according to ABNT standards and incinerated."

IFC Contact: Currently Unavailable

Project Title: Health Project (previously Second Human Resources Project)

Project ID Number: KMPE52887 (WORLD BANK PROJECT)

Sector: Basic Health

Dates: PID Prepared: 1/15/97; PID Revised: 1/14/98; Appraisal date: 11/ 6/98; Projected Board Date: 2/26/98

Environmental Classification: Category C

Quote from PID: "rehabilitation and equipment of selected health facilities in all three islands . . . "  "All health facilities to be rehabilitated by the project will have incinerators."

World Bank Contact: Eileen Murray at (202)458-5848   Email:[email protected]

Project Title: Red Sanitaria Hospiten

Project ID Number: 009542 (IFC PROJECT)

Sector: Social Services ( Health Care, Education)

Dates: Projected Board Date: 5/29/99

Environmental Classification: Category B

Quote from PID: "Hospiten will either use a private contractor or a municipal incinerator for the treatment and disposal of biological and infectious waste. In the event that the private contractor of the municipal waste incinerator is not in compliance with IFC environmental guidelines, Hospiten is committed to install an on-site incinerator ."

World Bank Contact: Currently unavailable.

Project Title: Orascom Tourism Establishments

Project ID Number: 007790 (IFC PROJECT)

Sector: Tourism

Dates: Projected Board Date: 1/15/97

Environmental Classification: Category B

Quote from PID: "Clinical waste from the medical facility will be incinerated."   "Expected clinical waste from the medical facility is expected to be in the region of 50 kg/day and will be incinerated."

IFC Contact: Mumina Aijazudding at (202)473-8013    Email: [email protected]

Project Title: Duncan-Gleneagles Hospital

Project ID Number: 008084 (IFC PROJECT)

Sector: Pollution Control/Waste Management

Dates: Projected Board Date: 6/9/97

Environmental Classification: Category B

Quote from PID: "All pathogenic, infectious, hazardous and other hospital waste shall be segregated in color-coded containers for treatment and disposal. Human anatomical wastes, blood and fluids, microbiological waste and other bioethical waste are all incinerated following procedures and specifications established by the Central Pollution Control Board. Air emissions from the incinerators will be the only significant air emissions from the hospital, and will meet World Bank guidelines."

IFC Contact: The Investment Officer, Sanjeev Minocha is based in India. Email:[email protected]

Project Title: State Health Systems Development Project II

Project ID Number: INPA35825 (WORLD BANK PROJECT)

Sector: Health

Dates: Appraisal date: 10/5/95; date PID prepared: 2/13/96; Project Board date: 3/19/96

Environmental Classification: Category C

Quote from the Staff Appraisal: Report (2/96):

"For final disposal, the states have proposed to adopt three methods: incinerators for large institutions, purolators for small institutions, and burial methods in wells or pits for primary care facilities.

"Karnataka . . . All hospitals with 50 beds and above will be installed with incinerators.

"Punjab . . . With project assistance incinerators of various capacities would be provided to all hospitals based on their bed strength and the amount of waste likely to be generated at these institutions. 30 to 50 bedded hospitals will be provided with incinerators of . . . type, 100 to 200 bedded hospitals with . . . type, 400 bedded hospitals with . . . and those with more than 500 beds with . . . type.

West Bengal . . . Incinerators will be made available for districts hospitals and some sub-divisional hospitals, where the number of beds is larger than 300."

World Bank Contact: Tawhid Nawaz at (202) 458-03363

Email: [email protected]

Project Title: State Health Systems Development Project III

Project ID Number: INPA10496 (WORLD BANK PROJECT)

Sector: Basic Health

Dates: Appraisal Date: 11/5/97; Projected Board Date: 6/9/98

Environmental Classification: Category B

Quote from the PID: (Annex, Environmental Aspects):

"Environmental Impacts: While the project will not contribute to any sizable increase in hospital waste, it will address the issue of the management of medical waste at the facility level, including collection, storage and final disposal. Due to concern with regard to the use of incineration technology and the expressed concern that incineration of plastics results in emissions of dioxins and furans, alternative disposal technology will be fully evaluated. The state will produce an environmental action plan and the project preparations team will review the plan and incorporate it into project design."

World Bank Contact: Tawhid Nawaz at (202)458-0363.

Email: [email protected]

Project Title: State Health Systems Development Project IV(+)

Project ID: INPE50651 (WORLD BANK PROJECT)

Sector: Basic Health

Dates: Date PID prepared: 11/5/97; Projected board Date: 12/17/98

Environmental Classification: not provided in the PID.

Quote from PID: (Annex, Environmental and Social Aspect):

"Environmental Impact. While the project will not contribute to any sizable increase in hospital waste, it will address the issue of the management of medical waste at the facility level, including the collection, storage and final disposal. Due to concern with regard to the use of incineration technology and the expressed concern that the incineration of plastics results in emissions of dioxins and furans, alterative disposal technology will be fully evaluated."

World Bank Contact: Tawhid Nawaz at (202)458-0363.

Email: [email protected]

INDONESIA

Project Title: Rumah Sakit Siloam Gleaneagles Hospital(RSSG)

Project ID: 007023 (IFC PROJECT)

Sector: Health Care

Dates: Projected Board Date: 8/22/95

Environmental Classification: Category B

Quote from the PID: "RSSG will construct an approved incinerator for the safe disposal of medical waste."

"The hospital site will also include a small incinerator for infectious waste to avoid any off-site transport of these kinds of wastes."

" The hospital will not have any significant air emissions except for combustion gases from the infectious waste incinerator."

IFC Contact: Not available.

Project Title: West Java and Jakarta Environment Project

Project ID: IDPEA40528 (WORLD BANK PROJECT)

Sector: Urban Management/Environment/Solid Waste

Dates: PID Date: 5/11/98; Projected Board Date: 5/99; Tentative Board Date: July/99

Environmental Classification: Category B

Quote from PID: "The focus is on solid waste management and how it is interrelated to other urban environmental issues. If funded, new sanitary landfill sites and waste incinerators will be designed and specified to internationally accepted standards. Compost standards are being established. If new landfills or incinerators are funded, the project’s environmental category will be regarded as "A."

World Bank Contact: Daniel Hoorweg (202)458-4731. Email:[email protected]

Project Title: AAR Health Services

Project ID Number: 008632 (IFC PROJECT)

Sector: Health

Environmental Classification: Category B

Dates: Projected Board Date: 3/31/98

Quote from PID: "Key environmental mitigation measures include incineration of all pathogenic, infectious and hazardous waste . . . "

IFC Contact: Not available.

Project Title: Environment and Solid Waste Management Project

Project ID Number: LBPA5345 (WORLD BANK PROJECT)

Sector: Environment

Environmental Classification: Category A

Dates: PID December 14, 1993, Appraisal Date: 2/95; Board Date: 8/95

Quote from PID: "An environmental impact assessment will be carried out for each major component, including all sanitary landfills, composting plants, incinerators and the Mediterranean coastline."

World Bank Contact: Sherif Arif, (202)473-7315.

Email:[email protected]

LEBANON

Project Title: IBM(The Institute of Behavioral Medicine, SAL)

Project ID Number: 009609 (IFC PROJECT)

Sector: Social Services ( Health Care)

Environmental Classification: Category B

Dates: 6/28/99

Quote from PID: "Medical waste, which are not bio-hazardous, will be sorted in puncture-proof containers and transported by independent authorized contractors to a national waste disposal center to be incinerated. The domestic waste will be collected in plastic bags and transported to the municipal sanitary landfill for final disposal."

IFC Contact: Currently unavailable.

Sector: Health

Project ID: 007534 (IFC PROJECT)

Dates: Projected Board Date: May 31, 1996

Environmental Classification: Category B

Quote from PID: "MRI [Medical Rescue International, a South African company] intends to construct a high temperature incinerator at the facility for the disposal of contaminated sharps, infectious and pathogenic materials, expired pharmaceuticals which cannot be returned to the supplier for disposal, non-toxic spent solvents, used surgical gloves, and all biological wastes. The disposal containers for all of these wastes will be incinerated as well."

IFC Contact: Not available.

Project Title: Centro Internacional de Medicina (CIMA)

Project ID: 008982 (IFC PROJECT)

Sector: Social Services(Health Care)

Dates: Projected Board Date: 6/22/98

Environmental Classification: Category B

Quote from PID: "It is expected that CIMA Puebla will either use the services of a private or municipal incinerator for the treatment and disposal of biological and infectious waste. CIMA will provide IFC prior to disbursement with the incinerators operating procedures(including emission control features), to determine compliance with World Bank guidelines. CIMA is committed to install on-site incinerators in the event that the municipal incinerators or private incinerators are not in compliance with World Bank guidelines."

IFC Contact: Avi Hofman, (202)473-4358.

Email:[email protected]

Project Title: Radmed Diagnostic Center

Project ID Number: 008320 (IFC PROJECT)

Sector: Basic Health

Dates: Project Board Dates 8/28/97

Environmental Classification: Category B

Quote from PID: "The sponsor will treat the waste by autoclaving, discharging it into a sewage treatment plant, and the treated waste (liquid and solid) will be collected by a waste disposal company. The sponsor also plans to use a small incinerator to burn most of its solid waste products."

IFC Contact: Samuel Karori at (202)473-009.

Email:[email protected]

Project Title: Hygeia Nigeria Limited

Project ID Number: 009628 (IFC PROJECT)

Sector: Social Services (Health Care, Education)

Dates: Projected Board Date: 6/25/99

Environmental Classification: Category B

Quote from PID: "At IFC’s request, the sponsor has commissioned a consultant to undertake the development and implementation of a comprehensive waste management plan. Hazardous and biomedical wastes, including laboratory cultures and organic reagents, blood, urine, fecal cultures and expired reagents, as well as bodily fluids on linens, clothing or other absorptive material will be collected separately in color-coded containers and incinerated in situ in a specifically built incinerator that the sponsor has undertaken to install. The Lagos Municipal incinerator represents another facility which could be used if it is adequately licensed to accept these types of waste and deemed adequate after a site visit by IFC environment department. Sharp objects such as needles and blades are currently being secured in refuse cans before being incinerated.

IFC Contact: Currently unavailable.

Project Title: Integrated Health Sector Development(formerly titled Population and Health Services)

Project ID Number: SNPA2369 (WORLD BANK PROJECT)

Sector: Health

Dates: Initial PID: 10/7/95; PID updated: 11/12/96;

Projected Appraisal: 11/15/96; Board Date: 5/20/97

Environmental Classification: Category C

Quote from the initial PID: "The handling and management of medical waste and hazardous materials would be assessed during project preparation and specific recommendations for incinerators, fire protection, and waste disposal will be drawn up for implementation. The project would thus contribute to reducing environmental risks."

PID updated on 11/12/96: "Justification/Rationale for Category C rating: The handling and management of medical waste and hazardous materials would be assessed during project preparation and specific recommendations for waste disposal will be drawn up for implementation. All project-financed construction would include drainage, solid waste disposal and sanitary facilities."

World Bank Contact: Anwar Bach-Baouab at (202)473-5037.

Note: The Multinationals Resource Center spoke with the task manager, Mr. Bach-Baouab, who said the project is in very early stages of design and is far from implementation. He said this and another ongoing health sector project ("Human Resources Development Project") include recommendations for medical waste incinerators and "may include funding for incinerators."

7/97: The Multinationals Resource Center(MRC) spoke with Bach-Baouab, who said: "Whenever we build a health project we make provisions for incinerators." MRC began to tell him concerns exist about incinerators and he interrupted: "Don't worry. The incinerators will all be small and locally made."

Status: April 1999-the updated version of PID for this project shows a change in the project title and a change in the content. The PID does not specify incineration as an option.

Project Title: Lesedi Private Hospital, Gauteng

Sector: Basic Health

Project Number: 008293 (IFC PROJECT)

Dates: Projected Board Date: 7/1/97

Environmental Classification: Category B

Quote from PID: "The Company has a comprehensive manual dealing with medical materials handling and disposal of medical waste. Contaminated linens are bagged in sealed water soluble bags before sending to the laundry or autoclave. Needles are not recapped and are sent for incineration. Contaminated dressings and hazardous waste are bagged in sealed red bags and sent to hospital incinerator for disposal. Fluid waste is absorbed by the municipal sewage system.

"All contaminated sharps are disposed of in special containers . . . when full, these containers are sent to the hospital's high temperature incinerator to be destroyed . . . small items of equipment such as respirators are sealed in a double set of yellow bags . . . and sent to the autoclave for gas sterilization. Non-hazardous solid waste is disposed of in heavy duty plastic bags which are removed by the municipal refuse collection authority on a weekly basis . . . Hazardous or potentially hazardous liquid wastes such as blood or other bodily fluids on linen, clothing or other absorptive materials are placed in red plastic bags, sealed and incinerated on site."

IFC Contact: Not available

Project Title: IHS Technologies (Pty.) Ltd.

Project ID Number: 009402 (IFC PROJECT)

Sector: Health Care

Dates: Not available in the Public Information Document(PID).

Environmental Classification: Not provided in the Public Information Document (PID).

Quote from the PID: "Both Lesedi Clinic and the Dialysis Centre have in place detailed plans for disposing of both hazardous and non-hazardous wastes. All contaminated sharps are disposed of in special containers from which they cannot be removed. When full, these containers are sent to a high temperature incinerator to be destroyed. Contaminated dressing and other potentially hazardous wastes are disposed of in color-coded plastic bags, sealed, and sent to an incinerator for disposal. Non-hazardous solid waste at both facilities is disposed of in heavy duty plastic bags which are collected weekly by the municipal refuse authority."

IFC Contact: Not available

Project Title: The Dialysis Centre

Project ID Number: 009316 (IFC PROJECT)

Sector: Medical Information Services

Dates: Not available in the PID.

Environmental Classification: Category B

Quote from PID: "The Centre has a comprehensive plan for disposing of both hazardous and non-hazardous wastes. Contaminated sharps are disposed of in special containers from which they cannot be removed. Contaminated linen and other potentially hazardous wastes are bagged in color-coded plastic bags and sealed in boxes. The boxes and sharp containers are collected twice weekly by a licensed disposal and taken to a high temperature incinerator to be destroyed."

"Hazardous or potentially hazardous liquid wastes such as blood or other bodily fluids on linens, clothing or other absorptive materials are placed in color-coded plastic bags,

sealed and collected for disposal or incineration."

IFC Contact Person: Not available.

Project Title: Lanka Hospital Corporation

Project ID Number: 007374 (IFC PROJECT)

Sector: Social Services (Health Care, Education

Dates: Not available in the PID.

Environmental Classification: Category B

Quote from PID: "Pathogenic and infectious solid wastes will be separately collected and disposed of in an on-site, electrically-heated medical incinerator. Used needles and syringes and used bandages and vials will be separated and collected in color-coded bins and disposed of at a municipal facility."

IFC Contact: Not available.

Project Title: Turkey-Antalya Solid Waste Management Project

Project ID Number: TRPA40865 (WORLD BANK PROJECT)

Sector: Solid Waste

Dates: PID Prepared: 12/28/95; Appraisal Date: 7/94; Projected Board Date: 2/96

Environmental Classification: Category B

Quote from PID: "The project will: (a) improve solid waste collection, close the existing dump site, develop a sanitary landfill on a new site and provide containers to store domestic and industrial wastes and collect and incinerate medical waste."

World Bank Contact: Bernado Gomez at (202)473-2386

Email: [email protected]

Note: The overall project has been delayed because the municipality has not acquired the land for the landfill site, largely due to community opposition.

Project Title: Bayandir Medical Centers

Project ID Number: 008491 (IFC PROJECT)

Sector: Social Services (Health Care, Education)

Dates: Projected Board Date: 4/23/98

Quote from PID: "Environmental, occupational, health and safety issues associated with this project include: water supply, sewage disposal, air emissions from boilers, incinerators . . . "

"An incinerator with a burning unit temperature of 800C will be used for infectious waste."

Contact Person: Harold Rosen (202)473-8841.

Email:[email protected]

Project Title: Hanoi International Hospital

Project ID Number: 008137 (IFC PROJECT)

Sector: Social Services(Health Care, Education)

Dates: PID Prepared: 12/8/93; Projected Board Date: 3/9/98

Environmental Classification: Category B

Quote from PID: "Solid wastes will be incinerated and liquid wastes will be fully treated on site before release."

IFC Contact Person: Dick Myers at (202)473-3727/Email: [email protected]

Project Title: Medcen Samoa, Ltd.

Project ID Number: 007736 (IFC PROJECT)

Sector: Social Services (Health Care, Education)

Dates: Projected Board Date: 9/30/96

Environmental Classification: Category B

Quote from PID: "The medical wastes will be disposed of in an incinerator which has been designed to meet World Bank guidelines and local standards for stack emissions."

IFC Contact Person: Not available.

Project Title: Yanikai Pharmaceuticals (Pvt.) Ltd.

Project ID Number: 007130 (IFC PROJECT)

Sector: Pharmaceuticals/Health Care

Dates: Projected Approval Date: 3/27/96

Environmental Classification: Category B

Quote from PID: "Containers [of waste] will be disposed of in either municipal landfills . . . or by incineration at high temperature. Yanikai has arranged to use the high temperature incinerator operated at the Ministry of Health's Parirenyatwa Hospital . . . Wherever possible, containers will be returned to the supplier for recycling or re-use. Containers of non-hazardous materials will be thoroughly cleaned prior to reuse . . . Contaminated plastic containers will be crushed or shredded and incinerated."

IFC Contact: Not available.

Project Title: Suburban Medical Centre(Pvt.)Ltd.

Project ID Number: 008807 (IFC PROJECT)

Sector: Social Services(Health Care, Education)

Dates: Projected Board Date: 8/31/98

Environmental Classification: Category B

Quote from the PID: "Disposal of medical and bio-hazardous wastes: contaminated sharps are to be disposed of in special containers fitted with covers that cannot be removed. When full, these containers will be collected by a licensed disposal firm and taken to a high temperature municipal incinerator to be destroyed."

Note: 7/14/98: Updated PID(Environmental Review Summary)

"Medical and bio-hazardous wastes will be collected by a licensed disposal firm and taken to a licensed high temperature municipal incinerator to be destroyed.

IFC Contact: Not available.

Project Title: Belvedere Private Hospital

Project ID Number: 009031 (IFC PROJECT)

Sector: Social Services (Health Care, Education)

Dates: Projected Board Date: 6/30/98

Environmental Classification: Category B

Quote from PID: "medical and bio-hazardous wastes will be collected by a private waste disposal firm for incineration."

IFC Contact: Cesare Calari at (202)473-5330/Email:[email protected]

Project Title: Bell Medical Centres (Pvt.) Ltd.

Project ID Number: 009586

Sector: Health Care

Dates: 5/30/99

Environmental Classification: Category B

Quote from PID: "Waste materials such as gauze and swabs which may be contaminated with blood or other body fluids are collected in lined pedal bins, prior to disposal by Incineration.Each of Bell's two facilities has a high temperature incinerator that reaches a maximum temperature of 1200 C and is licensed by the Ministry of Health for disposal of medical materials and wastes. Contaminated sharps (needles, blades) are collected in specially sealed and labeled containers, and the entire container is then incinerated. Laboratory wastes including cultures, organic reagents, and blood, urine, fecal cultures are collected in lined disposal units and incinerated.

IFC Contact:Not Available.