Report References to occupational exposures associated with the unsafe handling of hazardous medical waste, nor do they receive any training on how to eliminate, or reduce to a minimum, such hazards. Medical personnel often receive limited instructions on the use of personal protective equipment, and are not aware of safety emergency procedures for dealing with spillages (for example, when mercury-containing equipment breaks) and accidents. In some health-care establishments, staff members are not vaccinated against common infectious diseases, such as tetanus and hepatitis. Hospital cleaners and waste handlers are in an even more vulnerable position than the medical staff that produce the waste. An increasing number of them are employed by external contractors rather than being directly employed by the hospital, and may not receive any information on the occupational risks to which they are exposed and on the correct procedures for handling, loading and unloading waste bags and containers. They are often poorly educated, and often do not receive any vaccinations or proper personal protective equipment. Disposable latex gloves may be provided, but they are usually thin and offer little protection. In many health-care establishments, it is not uncommon to see medical waste being transported by hand in bin bags, risking spills of toxic or infectious liquids, or staff injuries from protruding needles or other sharp objects. Challenges faced by workers • Monitoring and enforcement gaps • Informal economy • Disconnected efforts on occupational and environmental health • Inaccessible remedies, justice and accountability Like hospital cleaners and waste handlers, operators of small-scale medical waste incinerators, garbage collectors and people working in municipal waste facilities, where large amounts of medical waste are mixed and disposed of with general household waste, are unlikely to receive proper training on the risks associated with the handling of hazardous medical waste or protective clothing, including gloves against needle-stick injuries. They do not usually receive any vaccinations against common infectious diseases. Untreated medical waste can reach the recycling industry by a number of routes. In many developing countries, where hospitals have no recycling programmes, staff at healthcare facilities often sell medical waste to waste recyclers in order to supplement their incomes. This practice allows for the reuse and recycling of a large amount of non-hazardous hospital materials, such as empty bottles and containers or aluminium from vial caps. Other materials, such as syringes, blood bags or laboratory waste, are, however, extremely hazardous, and the practice puts whoever processes these products at risk. Waste recyclers usually have no formal education and possess very little or no knowledge of the risks associated with the handling of hazardous substances or the precautions to adopt to minimize their adverse health effects. They usually use no protective gear to prevent them from exposure to the hazardous substances contained in medical waste. 33 A/HRC/39/48 Medical waste is also sought out by scavengers, who put themselves at great risk by collecting it. In some countries, scavengers are often seen in hospital grounds, while others collect waste from municipal dumps or at illegal landfills. In December 2007, for instance, a large number of scavengers, mainly children, were suspected to have contracted hepatitis C as a result of needlestick injuries during the collection of used syringes and other clinical waste for recycling. Even in countries where there is less of a recycling industry, the practice of mixing medical waste with ordinary garbage exposes scavengers to a number of infectious diseases, such as hepatitis and tetanus, and to physical risks associated with the handling of infected needles and broken glass.