Maldives. What is the first thing that comes to your mind when you hear this word? Relaxation, beaches, resorts, the undersea world... The same thing happened to me when I first heard that I was being invited to an interview for UNDP Maldives. I began to read a lot about this country, it’s culture, way of life, people, the most developed industries of the country, it’s social and environmental problems - there was a lot of information and it had to be put in my head in the right order, not least of them being the white sandy beaches and the clear blue seas. 

Upon arrival, I actively got involved with the technical details of our project - which focused on ‘The Improvement of Infectious Waste Management in Southwest Asia’. It included how different stakeholders interacted and were involved, the timing and magnitude of the changes the project would entail, and the innovation that UNDP plans to bring within this new project. I learned a very interesting and important thing: In general, waste disposal in the Maldives is a very complex process with a large number of participants and stages in the chain. When you are born and live on the mainland (like me, all my life), the issue of waste disposal is usually not a big problem, and you don’t even think about how it works. The biggest surprise about the Maldives for me was the presence of a whole separate ‘garbage island’ - Thilafushi. For me it took a 360-degree absorption of the whole process, to really understand the importance of medical waste disposal here.

Average estimates of waste in the world show that hospitals produce about 0.3-0.5 kg of waste per hospital bed per day. However, this figure and the basic composition of the waste vary greatly depending on local conditions, grade of hospital and other factors. In general, medical waste makes up about 2-3% of the total waste, but it is one of the most hazardous wastes [A1] .

For example, higher income countries generate much more waste and plastic, often accounting for more than half of all medical waste. Because of this huge difference, there is no single best solution for managing medical waste[A2] . Countries have its own staff of specialists who solve the problem in local realities. The COVID-19 pandemic has resulted in a double burden of increased waste plus reduction in the capacity of healthcare workers to manage waste due to increased workload of patients, work with COVID-19 and social restrictions. As a result, the safe handling of medical waste has suffered.

According to the United Nations Development Program (UNDP) in five Asian cities, COVID-19 increased the number of dangerous medical waste by 3.4 kg/bed/day. This is about 10 times more than the average volume of hazardous medical waste[A3] .

It was time to see with my own eyes how everything was arranged on the sites on the local islands. The first trip under the project to improve the management of medical waste was a visit to the Health Center in Raa Atoll Dhuvaafaru island. Upon arrival, I was briefed on the history of the island, which turned out to be a relatively newly developed and inhabited, and big compared to others in terms of the population (Dhuvaafaru has a population of over 5,000). The island was inhabited after the 2004 tsunami. It has been planned with wide streets, developed infrastructure, with houses creating the impression of a single ensemble without tall buildings. I liked the fact that the residential sector is separated from the state entities and infrastructure facilities.