Improper management of hospital waste leads to serious health and environmental issues, particularly in the case of developing countries, where, often, applied technologies are obsolete and there is a lack of compliance with respect to international best practices. The present study is designed to assess the environmental impacts of hospital waste management practices in Swath District, Pakistan. For this purpose, a life-cycle assessment (LCA) is applied for the estimation of different impacts of current and alternative hospital solid waste (HSW) treatment practices. Two scenarios are used to describe the current alternative practices (Scenario A and Scenario B), referring either to incineration or to direct landfilling of HSW without any sorting of collected materials. Conversely, Scenario C, which includes the use of pyrolysis and chemical disinfection, are considered as an up-to-date alternative, based on current international recommendations in this field. Prior to the analysis of impacts, due to the lack of available information, data were directly collected from both government and private hospitals in District Swat, involving measurements and a characterization of collected waste. In parallel, interviews were conducted, involving the hospitals’ personnel. With respect to waste generation, government hospitals produce a larger amount of waste (74%) compared to private hospitals (24%). Poor regulatory indications and the absence of clear obligations for collection, disposal and management still represent a first obstacle to implement good practices. After defining the boundary of the system and the functional unit, according to standardized LCA practices, a life--cycle impact assessment (LCIA) was conducted, considering eight impact categories: human toxicity, freshwater eco-toxicity, marine aquatic eco-toxicity, terrestrial eco-toxicity, acidification potential, climate change, eutrophication and photochemical oxidation. The current practices (Scenario A and Scenario B) turned out to be the worst for all categories. In particular, the largest impact of all is recorded for human toxicity generated by incineration. In parallel, it must be considered that, currently, no recycling or reusing practices are implemented. Conversely, Scenario C (alternative up-to-date practices) would generate lower impacts. In detail, the highest value was recorded for marine aquatic ecotoxicity in relation to pyrolysis. Applying Scenario C, it would be possible to recover some materials, such as plastics, paper and sharps. In detail, considering the observed compositional characteristics, it would be possible to recover up to 78% of sharps and recycle 41% of plastic and paper from the general waste stream. Moreover, energy could be recovered from the pyrolysis process, generating a further benefit for the surrounding area. A lack of awareness, knowledge and infrastructures prevents the application of correct management practices, further degrading life and environmental conditions of this remote region of Pakistan. The huge difference in impacts between current practices and alternatives is demonstrated, showing a clear alternative for future management plans in this remote region and supporting future actions for local policymakers and hospital managers.

Assessing the quality of a hospital wastewater treatment process and plant is essential, especially if the presence of chemical and biological toxic compounds is considered. There is less literature on hospital wastewater treatment in developing countries because of a lack of managerial awareness and stakeholder cooperation, accompanied by the limited capacity of investment meant to upgrade the existing infrastructures. Limited access to data further hampers the reliable analysis of hospital wastewater treatment plants (WWTPs) in developing countries. Thus, based on the possibility of collecting a sufficient amount of primary (i.e., field) data, this study performed an assessment of the potential impacts generated by the WWTP of Quaid-Azam International Hospital in Islamabad (Pakistan) considering its construction and operational phases. The major identified impacts were attributed to the energy mix used to operate the plant. Marine ecotoxicity was the most impactful category (34% of the total potential impacts accounted for), followed by human carcinogenic toxicity (31%), freshwater toxicity (18%), terrestrial ecotoxicity (7%), and human non-carcinogenic toxicity (4%). An analysis of potential impacts was combined with an assessment of potential damage according to an endpoint approach. In particular, the endpoint analysis results indicated that human health damage (quantified as DALY) was mainly dependent on the “fine PM (particulate matter) formation” category (51%), followed by “global warming and human health” (43%). Other categories related to human health impacts were human carcinogenic toxicity (3%), water consumption (2%), and human non-carcinogenic toxicity (1%). The other impact categories recorded a percentage contribution lower than 1%. With respect to ecosystem damage, “global warming and terrestrial ecosystems” played a major role (61%), followed by terrestrial acidification (24%), ozone formation (10%), water consumption (5%), and freshwater eutrophication (1%). This study’s findings support an increase in awareness in the hospital management board while pointing out the need to further implement similar studies to improve the quality of decision-making processes and to mitigate environmental impacts in more vulnerable regions. Finally, this research evidenced the need to overcome the existing general constraints on data availability. Consequently, further field work, supported by hospital managers in developing countries, would help in enhancing managerial procedures; optimizing treatment plant efficiency; and facilitating the implementation of circular options, such as sludge management, that often remain unexplored.