YAHYA AFRIDI, C.J.--Saifullah Muhib Kakakhel, Advocate/petitioner, seeks the Constitutional jurisdiction of this Court praying for; "It is therefore, humbly prayed that on acceptance of this writ petition, an appropriate writ may be issued to respondents to abide by the law enacted by the legislature for disposal/handling of the medical/clinical/hospital waste and save the environment/people from infections and other diseases by taking concrete steps in the best interest of justice.
Any other order deemed appropriate in the circumstances of the case, may also be passed. The petitioner may be allowed to put forward any other argument/ document at the time of hearing of this writ petition."
2. Keeping in view the public importance of the grievance agitated in the instant petition, the official respondents were put to notice along with the management of the public hospitals in Peshawar, and they were asked to respond to the four issues raised in the petition, which were to the effect that; "a. Waste Management Plan, b. Report of expenditure spent on disposal of Hospital/Clinical/ Medical waste. . c. Report of employees working for disposal of waste. d. Report of committees working for Medical waste disposal and salaries and allowances paid to them for this purpose."
3. After institution of the present petition, the petitioner moved C.M No-389-P/2017 for impleadment of the following six added respondents; i. Secretary Health, Civil Secretariat, Khyber Pakhtunkhwa, Peshawar, ii. Director General Health, DG Health Office, Khyber Road, Khyber Pakhtunkhwa, Peshawar, iii. All Executive District Officers of 23 Districts through DG Health Khyber Pakhtunkhwa, Peshawar, iv. All DHQs Hospitals of 23 Districts through D.G Health, Khyber Pakhtunkhwa, Peshawar, v. Chairman, Health Care Commission University Town, Peshawar, vi. All private Hospitals, Clinics and laboratories through Chairman Health Care Commission.
4. This Court vide order dated 30.3.2017 ordered impleadment of respondents-persons stated at serial Nos,i, ii & v of the petitioner's above application and their response was sought to the assertion made in the instant petition, which was not forthcoming, hence vide order dated 4.5.2017, the management heads of the major public and private hospitals in Peshawar were asked to appear in person. Apcordingly, on 18.05.2017, Dr. Kamran Mushtaq, ADMS, RMI, Dr. Iqtidar Ali Bangash, Senior Manager Admn, Northwest Hospital, and Director General Health, Khyber Pakhtunkhwa, appeared in person, and it was ordered that; "The matter was discussed at some length. It was resolved that the Director General EPA shall visit all the hospitals in the 3rd week of June, 2017, and report the hospital waste facilities provided by the said Medical Institutions. The report thereof be placed on file before the next date of hearing and a copy of the said report be also given to the worthy Director General Health."
5. As directed, inspections were carried out and the inspection report of the worthy D.G EPA was placed on record on 6.7.2017, "i. LRH Hospital: The hospital was visited on dated 31.5.2017.
Incinerator had already installed, however, found nonfunctional at the time of visit. The management informed that with the help of International Committee of the Red Cross (ICRC), changes and improvements have been brought in emergency section of the hospital. The waste of the emergency section is collected and disposed off by the ICRC. However, the majority waste of the hospital is disposed off without any incineration which is violation of EPO. The management should properly segregate and incinerate all the waste in incinerator. ii. KTH Hospital: The hospital was visited on dated 13.6.2017. Incinerator had already installed, however, found nonfunctional at the time of visit. The hospital waste was found nearby incinerator and majority of the waste is smuggled outside hospital. The management should properly segregate and incinerate all the waste in incinerator.
It is worth to mention that whenever the incinerator is functional, there is huge black smoke which means that waste is not properly incinerated. The surrounding population is extremely disturbed and in improper incineration, there is a strong chance of Dioxins and Furans gases in stack emission which are carcinogenic in nature and is serious threat to the environment.
Violation of EPO was observed. iii. HMC Hospital: The hospital was visited on dated 7.6.2017. Three chambered Incinerator had already installed for hospital waste incineration and found functional at the time of visit.
However, proper segregation of hospital waste was required. The management of the hospital should train the staff for proper segregation of waste. Compliance of EPO was observed. iv. RMI Hospital: The hospital was visited on dated 8.6.2017. Incinerator installed however found non-functional at the time of visit. The incinerator was out of order and under maintenance work. The EPA team re-visited on dated 12.6.2017 but again found violation. The management of the hospital have non-serious attitude in maintenance and repair of the incinerator. It is worth to mention that whenever the incinerator is functional, there is huge black smoke which means that waste is not properly incinerated and the waste is incinerated in low temperature, hence there is a strong chance of Dioxins and Furans gases in stack emission which. Are carcinogenic in nature and is serious threat to the environment. Violation of EPO was observed. v. North West Hospital: The hospital was visited on dated 12.6.2017. Incinerator instalted and found functional at the time of visit. However, the incinerator is not working properly and violation of stack emissions was observed. The management should install three chambered incinerator for proper incineration of hospital waste. Violation of EPO was observed."
6. Keeping in view the alarming state of affairs, as reflected in the above report, it was but necessary to seek the response of the Provincial Government, in particular Health Department.
Finally, the report of the worthy Additional Director General Health Services was submitted in Court on 5.10.2017. The said report recommended that; "Instruction for the hospital for waste management/disposal.
On the whole it has been observed that most of the hospitals (both public and private) have not been following the principles of waste disposal according to set protocols. Out of the nine public and five private hospitals in the province no one has proper and adequate arrangements for neither waste products nor there been schedule treatment of the wastes. The two latest methods for the hospital waste disposal could be incineration and shedding. In shedding, the 20-25% residue poses further issue in its disposal while during incineration of the 5% residue in the form of cloud be easily disposed of. The best method for the hospital waste disposal and treatment is incineration. This further needs the hospital to abide by;
1. Assign a properly trained persons for the machine and process of incineration.
2. A schedule of collection and treatment of the waste should be kept on regular basis.
3. Timely repairmen of machinery should be carried out to dispose the accumulated waste.
4. Back-up arrangement should be made in case of prolonged disorders.
5. Periodical checkup and monitoring should be carried out to minimize the emission of effluents and other toxins.
6. The hospital administration would be responsible for any untoward mishap.
7. Weekly/monthly reporting of the condition should be given to the environmental protection agency (EPA) with a copy on the Director General Health Services (DGHS), Khyber Pakhtunkhwa.
8. The joint team of EPA and DGHS will also monitor waste management in all hospitals.
9. Any other relevant."
7. Having considered the recommendations of the Director General Health Department, and the Director General Environmental Protection Authority, Khyber Pakhtunkhwa, this Court is of the firm opinion that Medical, Clinical Hospitals Waste in Peshawar, is not being dealt with in accordance with the bare minimum environmental standard and thus warrants urgent corrective attention.
Accordingly, this Court declares and directs that; I. Director General Health Services Government of Khyber Pakhtunkhwa shall deliver with due acknowledgment receipts "Health Care Standards" with the one exclusively for "Infection Control, Hygiene and Waste Management, Safe and Appropriate Environment" to all hospitals of Categories A, B, C, D and RHCs in Peshawar within one month period.
II. Director General Health Services Government of Khyber Pakhtunkhwa shall organize training workshops for waste management teams established at all hospitals according to Hospital Waste Management Rules 2005 over the next three months.
III. All the hospitals of Categories A, B, C, and D in Peshawar are to have proper waste management plan in place. This should include proper segregation, packing and labeling, arrangements of sharpeners and needles and proper storage area. The needful be completed within three months of this order.
IV. All Category A Hospitals, (MTIs and non-MTIs) are to put in place waste treatment through proper double chamber incinerator fully in compliance Environment Quality standards.
V. All Category A hospitals (public and private) are to have waste treatment with proper incineration (three chambered) or other techniques acceptable to EPA and in compliance of Environment Quality Standards is in place within one month.
All such arrangements of proper waste management (segregation, packing and storage and waste treatment by three chambered incinerator) are to be installed in Category B hospitals within 3 months and in category C hospitals within 6 months, respectively.
VI. All liquid waste (including toxic, radioactive and infectious) to be first treated within the vicinity of the hospital before disposal into municipal sewerage.
VII. Provincial Government shall establish at least one proper three chambered waste treatment incinerator fully functional at every District level within 3 months and at Tehsil level within 6 months.
VIII. All category D hospital, RHs and Private clinics should make arrangements with District and Tehsil Public hospitals or private hospital for proper final disposal of their waste. They should keep record of all their waste produced and transferred to the concerned hospital having treatment facility.
IX. Provincial Government to earmark landfill sites in each district for final disposal of toxic waste including toxic ash collected after incineration.
X. Health Department may prepare a feasibility by establishing centralized incineration/treatment facility for the regions like Central, South, Hazara and Malakand regions where all the waste of public sectors and private hospitals (on payment basis) can be treated.
XI The Director General of Health Services Khyber Pakhtunkkwa shall submit monthly progress report during first week of each month to Director Human Rights Cell of this Court and copy of the same be made available to Director General of Environmental Protection Agency.
XII. Director General EPA shall regularly monitor the arrangements made in public and private hospitals of the province. It should provide proper guidance to the Health department and private hospitals and submit monthly progress report to Director Human Rights Cell of the Peshawar High Court during the last week of every month.