A/HRC/18/31 and disposal (see paragraphs 75-77 below). While most hospitals and health-care facilities in developed countries comply with these safety procedures, the lack of appropriate information on the risks posed by radioactive materials and waste and on the procedures to minimize these risks may lead to their inappropriate management and disposal in some developing countries. 6. Dioxins and furans 40. Medical waste contains a high proportion of polyvinyl chloride (PVC), a chlorinated plastic that is used in containers for blood, catheters, tubing and numerous other applications. When burned, PVC releases polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (dioxins), a family of 210 persistent organic pollutants that are unintentionally formed and released from a number of industrial and incineration processes, including medical waste incineration, as a result of incomplete combustion or chemical reactions (see paragraph 70 below). 41. Dioxins are a known human carcinogen. Chronic lymphocytic leukaemia, soft-tissue sarcoma, non-Hodgkin’s lymphoma and Hodgkin’s disease have been linked to dioxin exposure. There is further evidence of a possible association with liver, lung, stomach and prostate cancers. Short-term high-level exposure may result in skin lesions and altered liver functions, while low-level exposure to dioxins may lead to impairment of the immune system, the nervous system, the endocrine system and reproductive functions. Foetuses and new-born children are most sensitive to exposure. 42. In the late 1980s, developed countries began to adopt strict regulations to reduce the amount of dioxins released into the atmosphere as a result of combustion and incineration processes.15 The enforcement of stricter emission standards significantly reduced the release of these substances into the environment and their concentration in many types of food (including breast milk). In the European Union, for example, industrial emissions of dioxins and furans were reduced by 80 per cent between 1990 and 2007. 43. The Stockholm Convention on Persistent Organic Pollutants establishes that emission levels of dioxins and furans should not be higher than 0.1ng/m3 (see also paragraph 69 below). The emission standards set out in the Convention require the reduction of atmospheric emissions of dioxins and furans through the use of various air pollution control devices as well as monitoring, inspection and permitting programmes. The majority of small-scale medical waste incinerators used in developing countries do not, however, incorporate any air pollution control devices or other equipment necessary to meet modern emission standards, since this would increase greatly costs for their construction and operation. 44. An assessment of small-scale medical waste incinerators in developing countries showed widespread deficiencies in the design, construction, siting, operation and management of these units. These deficiencies often result in poor incinerator performance, for example, low temperatures, incomplete waste destruction, inappropriate ash disposal and dioxin emissions, which can be even 40,000 times higher than the emission limits established by the Stockholm Convention.16 Small-scale incinerators used in developing countries also release significant amounts of other hazardous pollutants through gaseous emissions, fly and bottom ash, and occasionally through wastewater. Such pollutants 15 16 Dioxin emission limits vary from 0.1ng/m3 for incinerators of all types, in the European Union, to 0.013 and 2.3 ng/m3, depending on the size and construction date of the incinerator, in the United States of America. Stuart Batterman, Assessment of small-scale incinerators for health-care waste (Geneva, World Health Organization, 21 January 2004). Available from www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf. 11