Ardila Syakriah, Jakarta – Indonesia is grappling with what health authorities have described as a "significant increase" in medical waste during the COVID-19 outbreak, with a shortage in processing facilities forcing the government to allow hospitals to burn their waste without license in times of emergency.
Environment and Forestry Ministry Director General for Waste Management Rosa Vivien Ratnawati said the volume of medical waste spiked by between 30 and 50 percent over the course of the epidemic, which was first detected in Indonesia in early March.
As of Oct. 15, the country had produced 1,662.75 tons of waste related to COVID-19, she said. Jakarta alone reported that it has handled 860 kilograms of disposable masks throughout the outbreak.
Indonesia – home to about 3,000 hospitals, as well as community health centers and clinics each totaling more than 10,000 – produced some 295 tons of medical waste daily in 2019, according to the Health Ministry.
Medical waste is considered hazardous and therefore must be processed in specific waste-processing facilities, which were insufficient and unevenly distributed even prior to the COVID-19 epidemic.
It is estimated that every day during the outbreak, 88 tons of medical waste could not be processed. As a result, much of the waste could be found polluting the country's rivers, such as in the Cisadane River in Banten, which separates Tangerang regency from South Tangerang city.
Three weeks after Indonesia reported its first coronavirus cases in March, the environment ministry issued a circular on infectious waste management during the pandemic, detailing mechanisms for central government and regional administrations to prevent a COVID-19 waste buildup.
Rosa said it gave room for hospitals and other health facilities to get rid of their medical waste by using incinerators at a minimum temperature of 800 degrees Celsius, as regulated in a 2015 Environment and Forestry Ministry regulation.
"Certainly, the top priority is for [facilities] with a license. But if hospitals have not yet got a license, then we give them room: the discretion to burn [the waste using] their incinerators," Rosa said in a virtual public discussion held by the Health Ministry on Friday.
"However, the specifications must correspond to the 2015 Environment and Forestry Ministry regulation," she added.
Only 117 hospitals in the country have the permits to run incinerators, according to the environment ministry's October data.
Its earlier data in April, cited by the Health Ministry, revealed that of 110 licensed hospitals at the time, 56 were in Java, 23 in Sumatra, 13 in Sulawesi, 10 in Kalimantan, five each in Bali and Nusa Tenggara and none in Maluku or Papua.
There are only 17 licensed private medical waste-processing facilities in the country with a total capacity of 731.5 tons per day, with more than half of these located in Java.
The lack of medical waste transporters also remains an issue. In Java there are 97 transporters, 28 in Sumatra, 11 in Kalimantan, four in Sulawesi and none in Bali, Nusa Tenggara, Maluku or Papua. This has contributed to the high waste-processing costs outside Java.
Rosa said five incinerator construction projects were expected to wrap up this year in Aceh, West Sumatra, South Kalimantan, West and East Nusa Tenggara (NTT), and by 2024, it was expected that 32 incinerators for medical waste would be available in 32 provinces.
Azhar Jaya, health services directorate general secretary at the Health Ministry, said that the uneven distribution of licensed processing facilities posed a problem for health facilities, especially those outside Java as they would have to spend a lot more money.
"The biggest problem is the issue of space because healthcare facilities have limited available space or are located near residential areas, which makes it harder for them to process hazardous medical waste," Azhar said. "So these health facilities have been required to partner with third parties: medical waste-processing facilities that have permits from the environment ministry."
"The second-biggest problem is that many of the authorized medical waste-processing facilities are located in Java. This certainly made it difficult for healthcare facilities outside Java [....] because of the heavy funding needed to partner with licensed third parties," he added.
A lab manager in Samarinda, East Kalimantan, previously told The Jakarta Post that her lab would have to spend Rp 1.75 million (US$123.76) per week to process the waste.
"Even without the COVID-19 pandemic, medical waste has not been managed well, even more so with the pandemic. The medical waste is becoming a ticking bomb that is ready to explode," environmentalist Prigi Arisandi of the Ecological Observation and Wetlands Conservation (Ecoton) told the Post.
Prigi said there were more environmentally friendly alternatives to incinerators, such as autoclaves, because using the former could result in dioxin and furan air pollutants.
He said that evaluation of incinerators' emissions has not been reported to the public, noting that the government had not even provided a lab to examine dioxins contained in the gaseous emissions. This meant that the examinations had to be done abroad, he added.
"Even with the discretion [that allows hospitals to use their own incinerators to burn COVID-19 waste], the handling of ash from the burning of medical waste must follow hazardous waste-processing procedures and the locations must not intersect with public activities," he said.
Beyond the disparity between waste volume and processing capacity, as well the uneven distribution of facilities, Health Ministry Director General for Public Health Kirana Pritasari said other "big challenges" in tackling the "significant increase" of COVID-19 waste were cross-sectoral coordination, local administrations' commitment and costs. In Indonesia, waste management falls under the responsibility of local administrations.
"Accelerating medical waste management will only be successful when all concerned institutions and stakeholders coordinate and work aligned to their respective authorities," she said.