Virtual Environmental and Humanitarian Adviser Tool – (VEHA Tool) is a tool
to easily integrate environmental considerations in humanitarian response. Field Implementation guidances are useful for the design and execution of humanitarian activities in the field.
Environmental factors such as air pollution or poor water quality may influence health and make the provision of health items necessary. For example, the lack of adequate water for hygiene activities may drive the need for external sources of water or substitutes that can provide the functions needed, such as sanitiser instead of water and soap.
Also, there are environmental factors affecting the way in which health items are provided or distributed. These are environmental factors affecting the transportation of health items (e.g. high levels of humidity or rainfall might make it necessary to wrap items in impermeable packaging or tarpaulins, and how these are ultimately disposed of. This may also include the state of roads, which may be affected by landslides or extreme weather events that make transportation by road impossible. There are also different climatic or environmental factors that might increase the use of health items or accelerate the deterioration of stored essential medical items.
Women and girls are disproportionately affected by the lack of access to basic water, sanitation, and hygiene facilities, due to their needs during periods of increased vulnerability to infection around menstruation and reproduction cycles. Additionally, other groups may have special needs in terms of hygiene practices. For this reason, disaggregate and understand the different groups of people in the community that may have special needs and behaviours when performing hygiene actions. For example, women may be provided with disposable or reusable menstrual pads which will need to be handled after every use. as a consequence, women may need special and additional messages tailored to handle these specific items and the messages need to be created accordingly women’s beliefs. Regarding other groups such as persons with disabilities or HIV/AIDS, create special messages explaining actions that are environmentally sensitive regarding special items they may be using. Regarding sexual health items, messages need to be oriented towards the safe disposal of items such as condoms. Condoms cause problems by clogging sewage drains.
Girls and women in low-resource and emergency contexts without access to adequate menstrual hygiene management facilities and supplies can experience stigma and social exclusion while also foregoing important educational, social, and economic opportunities.
Natural Resource depletion
Procurement of equipment that cannot be locally maintained, or which is old and approaching the end of its serviceable life, leads to the creation of unnecessary solid waste.
Similarly, procurement of medicines that are not needed locally, or are expired or near to expiration date leads to waste and pollution.
Water sources and soil can be affected by the accumulation of waste and leachates from piled wasted items. Also, the accumulation of packaging, containers, and bottles may result in contamination of water sources and end up in rivers, lakes, and the ocean.
The distribution of items can have negative effects on the environment if not well planned or the needs and behaviour of individuals and communities are not appropriately assessed. Good medicine management also prohibits unsafe or expired medicines, which helps avoid immediate waste. Additionally, when delivered items do not match with the cultural particularities of affected communities, items may be unused and may accumulate. Also, when items are used but the resulting waste is not properly managed, accumulation of wastes can occur in places that have limited capacity to gather, transport, and dispose of that waste appropriately. Additionally, the lack of use of health items and the accumulation of waste can cause health problems because improper disposal and management of health wastes can also become a vector for disease to spread within communities and can contaminate the surrounding environment.
Transportation usually uses fossil fuels that impact the environment by reducing air quality and creating air and noise pollution from combustion, mainly due to carbon dioxide (CO2) and water vapor (H2O) products, which contributes to global climate change. In addition, it can also increase respiratory diseases and there is the potential increase in waste from packaging. In some settings that require the use of boats, transportation can also cause water pollution.
Availability of safe essential medicines and medical services includes transport, storage, and the cold chain for vaccines as well as for the collection and storage of blood products. Delivery of items can be affected by the environment as hazards can impact the transportation of essential medicines (e.g.: if roads are flooded medicines cannot be transported by vehicle).
Essential medical products and technologies often include chemicals that if not properly managed can have detrimental effects on the environment. Medicines can contain solvents, acids, alkalis, mixed chemicals, natural gases, methanol, and isopropyl alcohol; all of which cause a health hazard and an aquatic chronic hazard, having acute adverse effects on aquatic organisms. It can also make drinking water more expensive to filter and can spoil the taste or smell of the drinking water.
Additionally, hospitals often have reserves of ethylene oxide. Any quantity has a potential impact on humans and the environment as it may cause carcinogenic mutagenic, reprotoxic mutation.
Hospitals also store, use and dispose of anaesthetics which can be highly polluting and have significantly greater impacts as greenhouse gases than others.
Medical items create organic and solid waste, which is often a biohazard if released into the general environment. Most medical waste is single-use items that need careful disposal depending on their characteristics. For example, needles, used dressings, placentas, blood products, menstrual hygiene, and incontinence items have the potential to pollute the environment and spread disease.
Procurement policies should be changed to require all equipment, devices, and kits to environmentally source; easily able to transport using minimal but effective packaging; locally maintainable where applicable; and re-usable, repurposable, recyclable, or compostable, as applicable. Local people, including local health staff, should be consulted regarding their preferences, and where sustainable items conflict with their preferences, promote the benefits to encourage increased uptake/acceptance.
Strategic selection of items for distribution can reduce resource consumption and waste generation. Consult the national essential medicines list for selection as well as the future need of the items post-crisis, and check whether multi-functional items are an option..
Increase efficiency by procuring products, equipment, or services that consume fewer resources and less energy and are less polluting during their in-use life and at the disposal.
Ensure that communities are sensitized to the need to manage hygiene kit packaging, particularly if they are experiencing flu-like symptoms.
When identifying and selecting items to procure, choose options with safe but low amounts of packaging that protect the items from external contaminants while packaging various components of a set as one unit versus individual units.
Search for biodegradable options that can be safely and easily disposed of after use or that are made from sustainable sources or using sustainable processes. However, whilst biodegradable materials avoid the risk of persistence that plastics present, the industry for effectively handling and composting these materials is not universally available and may not be cost-effective. In addition, biodegradable materials may not meet the health and durability standards required for certain types of assistance.
The procurement and preparation of items can often be designed to reduce packaging or to substitute with packaging that is more environmentally friendly or reusable. Finally, repurpose items that are shipped for the operations, for example, using bags to grow plants and using disappearing ink if branding is an issue. Reusing and repurposing can both reduce waste and create real value for beneficiaries of humanitarian assistance.
Consider providing reusable containers that allow for a safe refill. Design a recycling plan for items that cannot be reused. Also, consider, when feasible, biodegradable packaging.
Consider the environmental conditions, expiration dates, and energy demands of certain essential medical products and technologies. For example, if a medical product requires a refrigerated environment that is powered by energy, try to find an alternate product or use an efficient renewable power generator.
Reducing demand by looking for opportunities to buy and use less, constantly questioning whether procured products are necessary, supporting interventions that reduce demand for products or use them more efficiently, and ensuring that procured products are not wasted.
Procure when possible, health items, essential medical products, and technologies locally where they are of appropriate quality. When doing so, ensure that the environmental impacts of those local items are comparably less than transported/imported items. Assess the sustainability of producing those items, noting that environmental impacts on water, soil, and air can be greater in local industries due to lack of appropriate technologies. Sustainably sourced local materials have reduced environmental impacts associated with transportation and distribution. However, the provisioning and regeneration capacity of local resources must be ensured.
Oversight of quality and sourcing of goods and services can be more challenging with local stakeholders, for instance, there may be less control over the quality, environmental impact during production, and solid waste management. Mechanisms to address these challenges, including raising awareness and capacity of local stakeholders to understand and pursue opportunities to engage throughout the supply chain, must be established.
Ensure not only the most efficient mode of transportation but also the least detrimental for the environment (e.g.: use one big truck instead of several small vehicles – unless local roads cannot support large trucks which would then cause greater soil erosion and environmental damage).
Prioritise low-carbon alternatives in the design and operation of the built environment, procurement and purchasing, energy efficiency, energy sourcing, retrofitting, and equipment.
Minimize the environmental impacts of distributed health products. For example, ensure adequate and safe storage and distribution. Medicines should not be stored directly on the floor. Ensure separate areas for expired items (locked), flammable products (well ventilated, with fire protection), controlled substances (with added security), and products requiring cold chain or temperature control.
Procure products with a minimum amount of solvents and hazardous chemicals, for example, such as avoiding mercury thermometers.
Use environmentally friendly essential medical products technologies such as a solar fridge/freezer for blood banks.
Many surgical items, including masks, gloves, gowns, syringes, and surgical devices are disposable. Whilst this makes sense in terms of reducing the risks of transmitting disease between patients, it is possible to procure re-useable PPE and medical equipment that can be cleaned to prevent disease transmission. This is critical if we are to reduce the substantial amount of pollution caused by medical waste.
The introduction of reusable hygiene kits for menstrual and incontinence management would highly reduce the volume and amount of waste hospitals and communities produce. Reducing waste helps reduce disease spread. However, affected people need to be consulted regarding their adaptability to reusable items and materials.
If reusable items will be distributed, it is important to also provide extra soap and water, and disinfectant in order to allow for proper reuse and avoid early disposal.
It is important to assess and reduce environmental contamination and hazards to people. Comply with national regulations (adapted to emergencies) or international guidance. Ultra-high temperature incineration is costly, and pharmaceutical stockpiling works only in the short term.
In the Covid 19 response in Bangladesh, the MoH, WHO, UNICEF, IFRC, Donors, and NGOs collaborated in procuring medical equipment including PPE, sanitiser, oxygen, and vaccines. They also collaborated in reducing waste vaccines and in health waste management.
# of medical devices or other health service equipment that have been procured to be energy efficient and can be locally maintained.
Number of positive changes made to procurement processes to minimise environmental impact.
Percentage of delivered items that were produced locally
Percentage of health products that do not contain or create by-products that are hazardous for the environment and ecosystems
Percentage of recipients who are satisfied with reusable menstrual or incontinence hygiene items
Prevention of environmental damage