A/HRC/18/31 equipment for radiotherapy treatment in Goiânia, Brazil.9 Similar accidents occurred in Algeria (1978), Morocco (1983) and Mexico (1962 and 1983).10 Furthermore, low-level chronic exposure to some hazardous substances contained in medical waste or produced by its incineration may lead to slow-progressing but fatal diseases, including several forms of cancer. 22. All persons exposed to hazardous medical waste are potentially at risk of injuries and/or contamination through accidental exposure. They include persons in health-care establishments, such as medical staff, patients and workers in support services, and persons within and outside health-care establishments who either handle the waste (for example, people involved in waste handling or disposal) or are exposed to it as a consequence of unsound management or disposal (such as people living close to the places where waste is incinerated, used in landfill or illegally dumped). 1. Infectious waste 23. Infectious waste may contain a great variety of pathogenic micro-organisms, which may infect the human body through skin absorption, inhalation, absorption through the mucous membranes or (rarely) by ingestion. Pathological waste is among the most dangerous category of infectious waste owing to its potential of transmitting lifethreatening diseases such as acquired immune deficiency syndrome (AIDS), viral hepatitis, typhoid fever, meningitis and rabies, to mention but a few. 24. Incineration is the method most commonly used in developing countries to dispose of infectious waste, though alternative technologies, such as autoclaving, are increasingly being used. As small-scale incinerators often operate at temperatures below 800° C, the incineration process may lead to the production of dioxins, furans and other toxic pollutants as emissions and/or in bottom/fly ash. Although pathological waste, including anatomical waste, is often incinerated, there are several reports of illegal disposal together with nonhazardous municipal waste or illegal dumping in many regions of the world. 2. Sharps and needles 25. Contaminated sharps are considered the most hazardous category of medical waste for health-care staff and the community at large. They may not only cause cuts and punctures but also infect wounds with agents previously contaminating them. Syringe needles are of particular concern because they constitute an important part of the sharps and are often contaminated with the blood of patients. 26. The lack of sufficient financial resources drives many health-care facilities to reuse objects and materials contaminated by blood or body fluids, such as syringes, needles and catheters. In some cases, these products are simply rinsed in a pot of tepid water between injections. In other cases, used medical products are sold to waste recyclers and then reprocessed and sold back to hospitals without proper sterilization. 27. The reuse of unsterilized syringes and needles exposes millions of people to infections. Worldwide, up to 40 per cent of injections are given with syringes and needles reused without sterilization, and in some countries this proportion is as high as 70 per cent.11 Other unsafe practices, such as poor collection and the dumping of dirty injection 9 10 11 8 International Atomic Energy Agency, The radiological accident in Goiânia (Vienna, 1988). World Health Organization, Wastes from health-care facilities, fact sheet No. 253, 2007. World Health Organization, Injection safety, fact sheet No. 231, October 2006. An assessment of injection practices in India found that nearly two thirds (62.9 per cent) of all injections administered each year in the country were unsafe, and almost one third (31.6 per cent) carried the potential risk of spread of blood-borne viruses. See Indian Clinical Epidemiology Network, “Assessment of injections safety practices in India”, 2004, pp. 22-23.