By Laure Behar; March 2026
According to the Pan American Health Organization (PAHO), approximately 70 % of waste generated by hospitals and medical facilities in the region is inadequately managed, increasing the risk of disease transmission, environmental pollution, and injury. Medical waste management is often treated as a technical or operational issue. In reality, it is a core public health challenge-one that is particularly acute in the Caribbean, where geographic, environmental, and infrastructural constraints amplify its risks.
Health-care waste isn’t just hospital trash. It includes materials from clinics, labs, home care, and even vaccination campaigns, all of which have increased sharply during COVID-19.
Medical waste, sharps, infectious materials, or items contaminated with bodily fluids, poses serious risks when poorly managed. While World Health Organization estimates that the majority of health-care waste is non-hazardous, the hazardous fraction poses disproportionate risks when poorly managed, particularly in Small Island Developing States (SIDS), where limited treatment infrastructure, constrained disposal options, and reliance on aging equipment increase exposure risks for workers, communities, and the environment.
A Disproportionate Risk in a Constrained Environment
In many Caribbean territories, medical waste does not rank high among waste management priorities, which tend to focus first on household waste. Yet medical waste has a direct and immediate impact on public health.
Limited land, fragile ecosystems, and insufficient treatment capacity create major risks. Poor segregation increases injuries and disease spread, while inadequate treatment can produce toxic emissions or uncontrolled disposal, as highlighted in UN Environment Programme‘s Waste Management Outlook for Latin America and the Caribbean (2020).
The COVID-19 pandemic exposed these vulnerabilities. The volumes of medical waste increased dramatically across the region, while treatment systems, often already under pressure, struggled to cope. According to WHO, a joint UN emergency initiative procured and shipped about 87,000 tonnes of PPE globally between March 2020[1] and November 2021, most of which is expected to have become waste, illustrating the extraordinary scale of the additional waste burden health systems faced. The crisis did not create new weaknesses; it revealed existing structural gaps.
During the development of the National Medical Waste Management Plans focusing on the reduction of unintentionally produced persistent organic pollutants (u-POPs) in selected Caribbean countries-including St. Kitts & Nevis, Suriname, and Antigua & Barbuda, Unite Caribbean experienced firsthand two critical bottlenecks during the COVID-19 period: storage and treatment capacity. In many cases, incinerators existed but were non-operational due to poor maintenance, lack of spare parts, or insufficient technical expertise. In others, outdated technologies generated u-POPs, creating long-term environmental and health concerns.
Persistent Challenges and Systemic Gaps
Despite efforts, medical waste management in the Caribbean continues to face recurring challenges:
- * Limited or uneven regulatory frameworks and enforcement
- * Insufficient monitoring of private health-care facilities
- * Gaps in data on waste generation, storage, and treatment
- * Weak oversight of waste contractors and limited traceability
- * Limited access to appropriate treatment technologies and inadequate maintenance of existing equipment
Even when health-care workers follow proper procedures, they often cannot see what happens once waste leaves their facility. Failures in treatment and disposal compromise the entire system.
Medical waste management follows a defined chain of steps: waste minimization, segregation, internal transport, storage, external transport, treatment, and final disposal. In SIDS, failures frequently occur at the treatment and disposal stages due to infrastructure and equipment limitations. A failure at any point compromises the entire system. These challenges underline the importance of moving beyond isolated technical fixes toward coherent, long-term strategies to improve medical waste management and safeguard public health.
Key Levers for Improvement: Adapting Global Standards to Local Realities
WHO provides clear guidance on safe medical waste management, but effective implementation requires adaptation to local contexts-particularly in SIDS, where country size, income level, and infrastructure vary significantly.
In countries such as Haiti, road conditions, geographic fragmentation, and limited transport infrastructure necessitate intermediate storage solutions and flexible collection systems. Issues such as outdated or expired medicines also remain a concern. Some of the recommendations made by Unite Caribbean during the implementation of the National Medical Waste Management strategy, was to centralize or hub-base treatment facilities, shared across jurisdictions, which can offer more sustainable and cost-effective solutions compared to isolated national systems.
Monitoring and Data: A Foundation for Decision-Making
As part of an integrated waste management system, medical waste management must be underpinned by clear, reliable, and regularly updated data. Waste must be measured, characterized, and, critically, properly segregated at the point of generation to ensure that each waste stream receives the appropriate level of treatment.
According to the World Health Organization, about 85 % of waste generated by health-care activities is general and non-hazardous, while approximately 15 % is hazardous, meaning it may be infectious, chemical or radioactive and therefore poses a direct risk to human health and the environment if not handled and treated appropriately.[2]
Hazardous medical waste, including sharps, infectious waste, used bandages contaminated with bodily fluids, and pathological waste, poses direct risks to human health and the environment and therefore requires specialized treatment technologies. In contrast, non-hazardous health-care waste, such as plastic packaging, paper, and other materials comparable to household waste, does not present the same level of risk. When correctly segregated, this waste can be managed through conventional municipal waste streams, avoiding unnecessary use of high-cost medical waste treatment systems.
Accurate data combined with proper segregation allows medical waste management systems to be designed at the right scale and at the right cost.
Training, Awareness, and Accountability
Effective medical waste management depends on alignment across all stakeholders: governments, health-care personnel, maintenance teams, waste handlers, and solid waste authorities. Too often, each actor understands only one part of the process.
Regular training, clear visual signage near storage areas, proper labeling of bio-hazardous waste, and simple explanatory tools are essential to ensure correct practices at every stage.
During the implementation of the medical waste management strategy in Saint Lucia, Unite Caribbean training workshops revealed significant gaps: solid waste teams were often unaware of sorting challenges faced by medical personnel, while medical staff did not know what happened to waste once it was placed in bins. Maintenance and security staff were exposed to unnecessary risks, particularly from sharps, when waste was not properly handled. These exchanges reinforced the importance of shared understanding, responsibility, and accountability across the entire waste chain.
Training must be complemented by robust monitoring and traceability. Knowing with certainty that medical waste has been properly treated is not optional-it is a public health requirement. Data is also key to adapting systems and ensuring that treatment capacity is appropriately designed and maintained.
Addressing medical waste is not just a regulatory task, it is a strategic investment in the Caribbean’s public health and environmental resilience.
Research and analysis by Unite Caribbean Consulting’s Climate Resilience, Environment Water and Waste (CREW) Department (Laure Behar)
[2] https://www.who.int/news-room/fact-sheets/detail/health-care-waste
