A/HRC/18/31 33. Mercury is a hazardous product common in hospitals owing to its prevalent use in a number of laboratory and medical instruments, such as thermometers and blood pressure devices, as well as in other products, such as fluorescent light tubes and batteries. It is a potent neurotoxin that can have several adverse effects on the central nervous system in adults, increase the risk of cardiovascular disease and cause kidney problems, miscarriage, respiratory failure and even death. 34. In the health-care context, elemental mercury may be released as a result of spillage from broken thermometers or leaking equipment. In many developing countries, there is no clean-up protocol for mercury spills. Mercury spills are not properly cleaned, and mercury waste is not segregated and managed properly. Inhalation of mercury vapours may cause damage to the lungs, kidneys and the central nervous system of doctors, nurses, other health-care workers or patients who are exposed to it. 35. In many developing countries, mercury waste is either incinerated with infectious waste or treated as municipal waste. If improperly disposed of, elemental mercury may travel long distances and eventually deposit on land and water, where it reacts with organic materials to form methyl mercury, a highly toxic organic mercury. This type of mercury, which affects the nerves and the brain at very low levels, bio-accumulates and become part of the aquatic food chain. The main source of human exposure to this form of mercury derives from the ingestion of contaminated fish and seafood. Even at very low levels, methyl mercury can cause severe, irreversible damage to the brain and nervous system of foetuses, infants and children. 36. Owing to their adverse effects on human health and the environment, mercurycontaining medical devices are now banned or severely restricted in many developed countries. WHO has issued technical guidance to promote the use of alternatives to mercury-containing thermometers and other medical instruments,14 and a global legally binding instrument to phase out the use of mercury is currently being negotiated under the auspices of the United Nations Environment Programme (UNEP) (see paragraph 59 below). 37. Thermometers and sphygmomanometers containing mercury continue, however, to be widely used in many developing countries. In some cases, when health-care institutions in industrialized countries decommission their old mercury-containing instruments, they donate them to institutions in developing countries. Without health-care management systems that assure the use of mercury-free devices and the proper clean-up and final disposal of mercury-containing ones, the total amount of mercury released into the environment by health-care institutions in developing countries is expected to grow in the future. 5. Radioactive waste 38. Radioactive materials can cause harm through both external radiation (when they are approached or handled) and their intake into the body. The degree of harm depends on the amount of radioactive material present or taken into the body and on the type of material. Exposure to radiation from high-activity sources, such as those used in radiotherapy, can cause severe injuries, ranging from superficial burns to early death. Radioactive waste arising from nuclear medicine is unlikely to cause such harm, but exposure to all levels of radiation is considered to be associated with some risk of carcinogenesis. 39. There are well-established procedures for minimising the hazards arising from handling radioactive materials. The International Atomic Energy Agency (IAEA) has elaborated a number of recommendations and guidelines on the safe handling of radioactive substances produced in health-care establishments and on safe radioactive waste storage 14 10 World Health Organization, Replacement of mercury thermometers and sphygmomanometers in health care: technical guidance, May 2011.