Plastic pollution is one of major problems faced by the world at large. Plastic by its composition is not inherently good object as it has significant adverse impacts on the environment in shape of air, water and land pollution effecting ecosystem and aquatic life. The 5^th June 2019 of the world environment day was celebrated as the year of plastic pollution faced by our planet. A vile threat to human health, from plastics causing adversely, is the recycled plastic from the hospital waste. The impacts of this plastic is unprecedented effecting health and life.

Toys manufactured from the recycled hospital waste are not only hazardous1 but injurious to health of the children across most part of the country. The Federal and Provincial governments have not controlled the recycled hospital waste widely used for plastic toys, utensils and alike products which retains toxic impurities, by the plastic manufacturers.

According to a study1A conducted the toxic substances released from various plastic products includes phthalates2,3 brominated flame retardants (BFRs)4, BPA5,6, bisphenol-A dimethacrylate7, lead, tin and cadmium8, formaldehyde and acetaldehyde9 nonylphenol10,

MTBE (methyl tertbutyl ether), benzene11 and many other volatile organic compounds12. In several of these studies the concentrations released are low compared to the guideline/legal limit values, but there are also occasions where they are considerably higher. Notably, the guideline values do not consider the low levels at which endocrine disrupting chemicals may be in effect and also do not consider the toxicity of mixtures.13

Chemical toxicity at a very early stage of life can reprogrammed development and makes the kids more susceptible to diseases later in life. This health hazardous issue is due to inaction on the part of the public functionaries where children are using, highly contaminated recycled plastic made, toys at large and cups, plates, spoons and other articles by the public, in common in a very attractive and fascinating colour scheme, available in the market. Food gets processed on plastic equipment, and packaged and shipped in plastic-lined boxes and cans. At home we store and reheat the leftovers in plastic containers. The users are unaware of contaminants leached from the products made from material effecting human body and tissues which are directly exposed to contaminants and resultantly suffering from chronic diseases.

The risk associated with the use of the recycled plastic has shocking revelation causing cancer, severe illness, endocrine disrupter causing birth defects, irritation in the eye, vision failure, breathing difficulties, respiratory problems, liver dysfunction, skin diseases, lungs problems, dizziness, reproductive, cardiovascular, genotoxic, and gastrointestinal causes for using toxic plastics.14

The toxic effects of the toys and utensils manufactured from the polyethylene products directly penetrate into the human tissues causing cancer, endomic skin sensitization, reproductive toxicity, skin corrosion, sometimes acute toxicity15. The children are more susceptible to those toxic effects of chemicals in toys manufactured from such recycled plastic as they likely to put things in their mouths which increase their exposure to more risk.

The plastic used in making toys both before and after recycling have serious effects on human health. The plastic used in the process of manufacturing toys is not free from pollutants and chemicals. Even, the process of incineration results in emission of dioxins, furans,16,17 and other particulate matters. Incineration is considered to be the safe process to dispose of hospital waste. It is a controlled combustion process for burning solid wastes in

presence of excess air (oxygen) at high temperature of about 1000 oC or above to produce gases and residue containing non-combustible material. According to the study which has revealed the preceding facts  also states that one of the most attractive features of incineration process is that it can be used to reduce the original volume of combustible material by 80– 90%.

The Products used in hospitals for medical procedures contain pathogenic microorganisms and other hazardous substances, meaning that they pose a threat to human health, as well as the natural environment by leaching into soil and waterways. Many medical products are made of polypropylene and polyethylene. Medical waste after recycling are used to convert into pellets and sold online to plastic factories around the world18.

According to the statistical standards of the World Health Organization (WHO), only about 15% of medical waste generated from healthcare activities is toxic and harmful,19 while the rest is  mostly ordinary and harmless waste. The general and hazardous waste and by-products cover a diverse range of materials20 which include Infectious waste contaminated with blood and other bodily fluids (e.g. from discarded diagnostic samples), cultures and stocks of infectious agents from laboratory work, genotoxic or radioactive, the pathological waste, sharps (needles, syringes, scalpels, knives, broken glass etc; Cytotoxic waste containing substances with genotoxic properties such as cytotoxic drugs used in cancer treatment and their metabolites. Presently there is no statistical data on medical waste; however, the estimated quantities of medical waste are extrapolated using bed occupancy and number of beds in health institutions21.

The sources which generate these health-care wastes, as per World Health Organization22, are hospitals and other health facilities, laboratories, research centers, mortuary, autopsy centers, animal research, testing laboratories, blood banks, collection services; and nursing homes for the elderly.

According to WHO the disposal of untreated health care wastes in landfills can lead to the contamination of drinking, surface, and ground waters if those landfills are not properly constructed and similarly the treatment of health care wastes with chemical disinfectants can result in the release of chemical substances into the environment if these substances are not handled, stored and disposed in an environmentally sound manner, so, Incineration of waste has been widely practiced but inadequate incineration or the incineration of unsuitable materials results in the release of pollutants into the air and in the generation of ash residue. Incinerated materials containing or treated with chlorine can generate dioxins and furans, which are human carcinogens and have been associated with a range of adverse health effects. Incineration of heavy metals or materials with high metal content (in particular lead, mercury and cadmium) can lead to the spread of toxic metals in the environment. Only

modern incinerators operating at 850-1100°C 22 and fitted with special gas-cleaning equipment are able to comply with the international emission standards for dioxins and furans. Alternatives to incineration such as autoclaving, microwaving, steam treatment integrated with internal mixing, which minimize the formation and release of chemicals or hazardous emissions should be given consideration in settings where there are sufficient resources to operate and maintain such systems and dispose of the treated waste.22

The research study based on the Hospital waste have shocking revelations which enshrined that the use of hospital waste particularly the recycled plastic waste is serious threat to health and life of people. A mini review23 on Hospital waste management in developing countries states on the cited subject that developing countries are resource-constrained when it comes to safe management of hospital wastes. The article summarizes the main issues faced in hospital waste management in developing countries. A review of the existing literature suggests that regulations and legislations focusing on hospital waste management are recent accomplishments in many of these countries. Implementation of these rules varies from one hospital to another. Moreover, wide variations exist in waste generation rates within as well as across these countries. This is mainly attributable to a lack of an agreement on the definitions and the methodology among the researchers to measure such wastes. Furthermore, hospitals in these countries suffer from poor waste segregation, collection, storage, transportation and disposal practices, which can lead to occupational and environmental risks.

In Belgium, Martin Wagner, a toxicologist at the Norwegian University of Science and Technology, says that it is a misconception to assume bioplastics are safer. Most health concerns about plastics are linked to plastic additives, chemicals added to give polymers desirable properties, like flexibility and durability. “There are very few polymers that come with little added chemicals because they simply don’t work without added chemicals,” Wagner says. “They are needed for bio-based plastics and conventional plastics.” The most well-known plastic additive is Bisphenol A, or “BPA”, an endocrine disrupter that has been linked to developmental and birth defects, and other health issues. Research has shown that these compounds can leach from plastics into the food and drinks that we consume-more so if they are heated to high temperatures, raising additional concerns about the kinds of plastics that are used as containers in microwave ovens24. Low-level exposure to BPA inhibits the release of adiponectin from human adipose (fat) tissue. Adiponectin increases insulin sensitivity and helps regulate glucose metabolism25. The researchers hypothesized that environmental BPA exposure may increase susceptibility to obesity and diabetes. It is found that urinary BPA levels in humans were associated with increased prevalence of diabetes and cardiovascular disease26. BPA is banned in some products, but many other plastic additives

are also endocrine disrupters.  The problem, Wagner explains, is that many different chemicals are added to plastics and we have very limited scientific understanding of their toxicity and effects on human health. According to Wagner very little research has been conducted on additives in bioplastics and their toxicity. “It is an unknown field,” he says.

The Hong Kong had suffered from contaminant effects of plastic items made from the substandard materials. The Legislative Council of Hong Kong has urged for controls on toys containing toxic substance linked to liver and kidney damage after finding high levels of it in over half the toys it tested. The Press clipping appeared in the electronic media clarifies as under:

“The Legislative Council is considering amending the Toys and Children’s Products Safety Ordinance to introduce control over phthalates in toys. “From a scientific perspective, the danger of phthalates to humans is still up for debate … but it is not too late for Hong Kong to enact stricter regulation, “said Professor Michael Hui King-man, chairman of the council’s publicity and community relations committee. The samples tested included bath toys, toys designed for youngsters to ride on and an alphabet puzzle board. Meanwhile, the council also warned consumers of a series of safety hazards in unbranded Christmas lights, saying some were “probably too good a bargain to be true”. A joint test conducted by the council and the Electrical and Mechanical Services Department on 17 Christmas lights – four unbranded and 13 branded – found all four unbranded samples failed safety compliance regulations for electrical products.”

The government of the Hong Kong seriously considered health and safety issues of children and has promulgated “Toys and Children’s Products Safety Ordinance” in 1993 (the “Ordinance 1993”) to provide safety standards for children’s toys and safety standards for specified chattels. In the Ordinance special powers have been conferred to ensure products of children to be safe.27 The Ordinance 1993 has exhaustively reviewed the sub-standards materials used in manufacturing of children products starting from the categorization of products to safety standards which are enumerated in its Schedule 2. The Ordinance has emphasized with procedural lapses by incorporating prohibition clauses, requirements for standards, general and additional safety standards and its laboratory testing, Additional Controls, Penalties and enforcement powers were part of the legislation. The Ordinance 1993 has recommended the International Standards28, European Standards29 and ASTM

Standards30 to be observed as a vital requirement for the products manufactured in the Hong Kong.

The study conducted in India about the harmful effects of incinerated articles, used in different toys, revealed vast degradation effects on society. It states the Infection at doorstep when plastic parts of used syringes are either dumped or burnt in the location where vaccination is being administered, or are sold to local scrap dealers. Hospital solid plastic waste has huge recyclable potential as this is made up of virgin plastic, which has high market value. This was the reason why both earlier and the new Rules refer to disinfection and shredding of infected plastic waste before selling to recyclers. Instead, in most cases hospitals sell the infected plastic waste directly to scrap dealers. The study further shows that burning of any kind of degradable waste should not be encouraged, burning plastics which are non-degradable, release harmful chemicals can aggravate existing health conditions and lead to cancer in the long run. Incinerating plastic is a very serious health hazard, mainly because of two very toxic chemicals that are released on incineration, namely, Dioxene and Furon, which affect human organs. Current research indicates that burning plastic waste can increase the risk of heart disease, asthma, and emphysema,31 therefore the compliance of standard to be maintained while performing processes like segregation, collection, transport, storage, and final disposal of biomedical wastes.

In USA research reveals the effects of use of plastic particularly in toddlers. The study states it’s worth noting that the phthalates32 that were banned in toys continue to be used in many other products that children come in contact with on a regular basis such as children’s back-to-school supplies. Phthalates are also used in wide variety of consumer products, including cosmetics, personal care products, pharmaceutical, medical devices, children’s toys, food packaging, and cleaning and building materials. People may be exposed to phthalates through ingestion, inhalation, absorption through the skin, or parenteral administration. They have been linked to birth defects and are harmful to reproductive system33. An investigation into children’s school supplies found in USA shows that 80% of children’s school supplies tested contained phthalates, and 75% of all children’s school supplies tested contained levels of phthalates so high they would not be allowed in toys. It recommended that safer plastics for toys include those made out of polyethylene polymers, polypropylene and biobased materials. In October 18, 2017 after a decade-long process and a lawsuit brought by the Natural

Resources Defense Council, the Environmental Justice Health Alliance and Breast Cancer Prevention Partners, the Consumer Product Safety Commission voted to ban five more harmful phthalate chemicals from plastic used in children’s toys and child care articles. 34

In Pakistan, more than two decade after Pakistan Environmental Protection Act 1997 have been passed, the country has not yet enacted laws to prohibit use of recycled hospital waste into manufacturing of toys, plastic utensils and other products. Around 250,000 tons of medical waste is annually produced from all sorts of health care facilities in Pakistan. Some hospitals and municipalities burn their waste, which results in the production of large amount of highly toxic gases35. The recycled items, from the plastic available in the markets, show that the adequate steps have not been taken by the authorities to prevent/forbidding use of recycled plastic.

The federal and provincial governments have made legislation to conserve environment, biodiversity, eco-system and health care of the public with safety standards. The Punjab Environment Protection (Amendment) Act 2012 (the “Act 2012”)36 was promulgated to achieve objectives of right to have decent environment and different provisions of the Act regulate process and procedure for adaptation37 and recommend stern action against the violators. Environmental degradation has been addressed by the courts thought its judgments and law38. The definition clause of the Act 2012 include the adverse environmental effects, if caused to human health and safety by impairment of or damage to or to biodiversity or property in shape of hazardous substances from the hospital waste etc. Apart from the Act ibid, although the Hospital Waste Management Rules 2014 (the “Hospital Rules 2014”)39 are there but it neither addresses the toxic effects of recycled hospital waste used in the manufacturing of toys and in other house hold items nor the same impose any restrictions or ban on the use of recycled plastic in toys that seriously risk the human health and life.

The Hospital Rules 2014 are not strict enough to adhere by hospitals. All hospitals don’t have incineration facility which is essential for safe disposal of toxic waste. There are no provisions in these Rules for hospitals to strictly ensure that hospitals should immediately dispose of their toxic waste in safe mode. The Rule 20 (5) of the Rules ibid states about the operation of incinerator by hospitals after securing environmental approval under section 12 of the Act 2012 but said rule is silent about the record to be kept by every hospital of such disposal facility and handling of toxic waste with the capacity of incinerator under use.

Moreover, there is no safe mode to ensure that such hospital waste is not to be sold in the

market to make granules or plastic pallets. The disposal of such waste by hospitals without

proper incineration has contributed in causing hazardous effects to society.

The amazing fact is that there is no comprehensive parliamentary legislation till date to restrict the use of recycled plastic or even some standards for the products of children from plastic. Absence of such legislation has adversely effected human health. The legislature should focus the need of hour for health and safety of our children by making laws to effectively monitor the recycled hospital waste.

The import of hospital waste into the country is too a serious issue and if it is not addressed appropriately shall risk health and safety of the people too. The Basel Convention40 on the Control of Transboundary Movements of Hazardous Wastes and their Disposal is the most important regulatory framework for the management of hazardous waste which also restricts the hazardous waste movements in cross borders. As adaptation, all items made from these recycled plastic material should be banned immediately and there entry into the country should not be allowed except those items manufactured from the virgin plastic as per standards.

*The writer is an environmental lawyer and activist practicing in corporate, commercial and constitutional law. He has worked in the field of environment for more than a decade and has acted as pro bono publico too by filing constitutional petitions on different environmental issues. Apart from this, he is visiting faculty, teaching environmental laws, in the University of the Punjab. The Article published in law journal CLD 2019.