Two yellow trucks rumble out of a waste treatment plant on the outskirts of Dhaka in the middle of the night.
It is around 1:30am, 28 November. A team of The Business Standard follows the dump trucks down a 14km road to Islambagh of Old Dhaka, a hub of plastic recycling shops. One truck pulls over in front of a scrap shop, while another stands a few yards away, with its engine roaring.
The back door of the truck with "Dhaka South City Corporation: medical waste" inscribed on it is opened. A man jumps into the vehicle and begins tossing out large plastic sacks one after another.
In the meantime, the journalists have called in police to find out what is inside the sacks. On opening those up come out used syringes, saline bags, face shields and other plastic medical waste.
The waste items were collected from different healthcare facilities across Dhaka and transported to the Matuail Sanitary Land Filling Station, where PRISM Bangladesh operates a waste treatment plant.
Two of the 12 waste collection trucks operated by PRISM's workers made their way out of the plant to deliver plastic items to a vendor in Islambagh.
The problem is the used plastic medical items have not been crushed into shreds, risking repackaging and reusing of those, which might be hazardous to public health.
Md Habibur Rahman, director of the Directorate General of Health Services, said the disposal of syringes and saline bags without crushing them was an unlawful act that might have alarming consequences. "Infectious diseases might spread through reuse of them."
The misconduct was done with the advantage of the darkness, in violation of the Medical Waste Management Rules, 2008 that PRISM is bound to comply with as per its agreements with the city corporations and hospital authorities.
Meanwhile, discovering that there was a camera inside the car following the yellow trucks, the second truck drove away. The first truck was quickly unloaded before it left the scene. The shopkeepers also ran away, with the shutters unlocked.
The Matuail medical waste treatment plant is the only plant in the city or, in fact in the country, equipped with autoclaves, incinerators, ETP and a chemical disinfection unit. More than a thousand government hospitals and major private hospitals, including Covid-19 hospitals, in the capital, Narayanganj and Savar as well, made deals with it for safe waste disposal.
The services are not for free. PRISM charges healthcare facilities depending on the number of beds for in-patients and their capacity.
Evercare Hospital, a 330-bed facility in Dhaka, pays about Tk60,000 a month to PRISM for carrying 24-26 tonnes of medical waste, said Arif Mahmud, head of medical services of Evercare.
The plant was set up in 2004 in collaboration with the then undivided Dhaka city corporation and support from international organisations. PRISM also received approval from the Department of Environment (DoE), on condition that it does not cause any harm to public health or the environment.
Islambagh incident sheds light on how lax monitoring has led to a mishandling of medical waste. The malpractice raises the alarm in the middle of a raging pandemic.
Air Commodore Md Badrul Amin, chief waste management officer of Dhaka South City Corporation, said, "It [PRISM] is using land of Dhaka South City Corporation. But the city corporation as such does not monitor its activities. Since we can see a violation of the health safety rules, we have to strengthen the monitoring."
While speaking over the phone, PRISM Executive Director Khondkar Anisur Rahman said there was no possibility of plastic waste being taken out of PRISM premises without being crushed.
"There are multiple checking points. However, I will look into the matter if that hast happened," he said.
The role of PRISM
PRISM's vehicles deployed for medical waste collection should carry infectious, sharp and recyclable plastic waste in separate containers from healthcare facilities to the treatment plant in Matuail.
The correspondents visited the plant two days before the November 28 incident. A guard opened a metal gate opposite to a mountainous pile of household waste in the landfill to let them in.
Inside the gate, a narrow strip of road passes by a teen-roofed office room and a store room, to an open space. On the left is where waste is sorted out, washed, sterilised and chemically treated. The liquid is drained to an effluent treatment plant that is always engulfed in stench.
On the furthest corner, two chimneys spit out black smoke coming from waste burning chambers. Opposite the chambers are burial pits where amputated body parts are to be disposed of and covered with soil to prevent any contact with air and surrounding environment.
At this site, PRISM workers segregate the waste, said AKM Saiful Alam, plant operation manager, because of mishandling of the waste at the hospitals' end, due to which PRISM often received all waste materials mixed up.
"Sharp and infectious waste materials such as needle and bandage with blood and body fluid are to be incinerated and sterilised before being disposed of. Only plastic items – syringes, saline bags, gloves, etc – are chemically treated to free those of germs and then shredded into flakes before PRISM sells those to a vendor," Saiful said.
At the plant, there was only one shredding unit, with a medium size square-shaped funnel through which plastic items are dropped into a machine to cut those into microplastics.
Saiful avoided repeated questions over the capacity of the machine meant to chew down all the recyclable plastic waste generated in more than a thousand hospitals every day.
According to PRISM, it receives about 500 kg of medical plastics a day of the estimated 4,000 kg waste generated in health facilities in Dhaka.
The remaining plastic items end up in the black market like that in Islambagh from hospitals through the hands of hospital staff and scrap collectors to make money out of the recycling business.
The latest video captured by The Business Standard points to how plastic medical waste from the PRISM plant goes back to the black market too.
Dhaka Medical College Hospital Director Col Nazmul Haque said, "PRISM is a recognised organisation dealing with medical waste for long. We only see if it is taking waste from the hospital properly. But how they are disposing those off outside the hospital should be monitored by regulatory authorities."
"We were rather assured of proper disposal of medical waste by PRISM during the coronavirus pandemic," said Air Commodore Md Badrul Amin, chief waste management officer of Dhaka South City Corporation.
"Since, what we see them doing here [in the video] is unacceptable, we will call the PRISM authority and take action. We will also have to think of alternative means [of waste management] in the future," he added.