Initial Environmental Examination

Project Number: 51107-002 Loan and Grant Numbers: L3727/G0618 April 2020

SRI: Health System Enhancement Project —Construction of a new PCR Laboratory at Colombo East Base Hospital

This Initial Environmental Examination prepared by the Prepared by Project Management Unit (PMU) of Health System Enhancement Project (HSEP), Ministry of Health and Indigenous Medical Services, Colombo for the Asian Development Bank.

This initial environmental examination is a document of the borrower. The views expressed herein do not necessarily represent those of ADB's Board of Directors, Management, or staff, and may be preliminary in nature. Your attention is directed to the “terms of use” section on ADB’s website. In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area

Initial Environmental Examination

April 2020

Sri Lanka: Health system enhancement project

Construction of a new PCR Laboratory at Colombo East Base Hospital

Prepared by Project Management Unit (PMU) of Health System Enhancement Project (HSEP), Ministry of Health and Indigenous Medical Services, Colombo, Sri Lanka for the Asian Development Bank.

CURRENCY EQUIVALENTS (as of 1 April 2020)

Currency unit – Sri Lanka Rupee/s (SLR/SLRs) SLR1.00 = $0.00521 $1.00 = SLR192.08

ABBREVIATIONS

ADB – Asian Development Bank CEA – Central Environmental Authority CEBH – Colombo East Base Hospital DS – Divisional Secretary EA – Executing Agency EHS – Environment, Health & Safety EMP – Environmental Management Plan EMoP – Environmental Monitoring Plan EPL – Environmental Protection License GN – Grama Niladhari GoSL – Government of Sri Lanka GRM – Grievance Redress Mechanism H&SP – Health and Safety Plan HCMW – Health Care Waste Management HSEP – Health System Enhancement Project IEE – Initial Environmental Examination MOHIMS – Ministry of Health and Indigenous Medical Services NEA – National Environmental Act O&M – Operation and Maintenance PD – Project Director PMU – Project Management Unit PPE – Personal Protective Equipment PS – Pradeshiya Sabha RoW – Right of Way SPS – Safeguard Policy Statement SWL – Scheduled Waste License

This initial environmental examination is a document of the borrower. The views expressed herein do not necessarily represent those of ADB's Board of Directors, Management, or staff, and may be preliminary in nature. Your attention is directed to the “terms of use” section on ADB’s website.

In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Bank does not intend to make any judgments as to the legal or other status of any territory or area.

ii Table of content

Executive Summary ...... iv

I. INTRODUCTION ...... 1

A. Project Background ...... 1

B. The objective of the project and the specific objective of the subproject ...... 1

C. Objectives of this initial environmental examination ...... 2

D. Approach, methodology and personnel involved...... 2

II. Policy, Legal, and Administrative Framework...... 3

A. National Environmental Legislation ...... 3

B. Safeguard Requirements of ADB ...... 7

III. Description of the Project ...... 9

A. Location of the subproject ...... 9

IV. Description of the Existing Environment...... 1

A. Methodology Used for the Baseline Study...... 1

B. Description of the physical environment ...... 1

C. Biological environment ...... 12

D. Social and Economic Environment ...... 15

V. Anticipated Environmental Impacts and Mitigation Measures ...... 19

A. Location impacts ...... 19

B. Design and pre-construction impacts ...... 20

C. Impacts during construction ...... 24

D. Impacts during the operational stage of the PCR Laboratory ...... 31

VI. Consultation, Participation and Information Disclosure ...... 34

A. Consultation and participation during project preparation ...... 34

B. Information Disclosure ...... 34

VII. Grievance Redress Mechanism ...... 35

VIII. Institutional Requirements and Environmental Monitoring Plan ...... 36

A. Implementation arrangements ...... 36

B. Environmental Management Plan ...... 36

C. Environmental Monitoring Plan ...... 36

IX. Conclusion and Recommendations...... 37

A. Conclusion ...... 37

B. Recommendations ...... 37

iii Executive Summary

The global public health emergency due to COVID-19 disease, which has now been characterized by the World Health Organization as a pandemic, calls for urgent measures to respond to the control and manage the disease spread in Sri Lanka. As such, the government has requested the ADB to provide financial assistance through the grant G0618-SRI(SF) to support the government’s response to this pandemic. In response to this requirement, the ADB has agreed to assist Ministry of Health and Indigenous Medical Services (MOHIMS) in establishing a new polymerase chain reaction (PCR) laboratory at the Colombo East Base Hospital (CEBH).

The field visits conducted observed that the proposed site for establishment of the PCR Laboratory within the CEBH is not located within or adjacent to areas that are ecologically or environmentally sensitive. The proposed plot is a bare land located towards the north-eastern boundary of the hospital located at the backyards of the Clinic, ETU and the Operating Theatre premises. The site is flat; however, the peripheral area has a mild slope towards the north- easterly direction.

It is evident that most of the environmental issues during the construction phase is related to localized and temporary impacts such as (i) elevated levels of dust, noise, vibration, (ii) pollution due to solid waste disposal including potentially hazardous components such as discarded construction material, construction wastewater and operation of labour camps, (iii) onsite drainage impairment, (iv) soil erosion and potential for alteration of surface drainage patterns, and (v) risk of occupational health and safety for construction workers. All these impacts can be minimized and mitigated with the adequate implementation of the provisions given in the EMP.

As documented in the IEE, the current practice of hazardous health care waste management in the hospital is inadequate and unhygienic. While a good attempt is made at segregating waste according to category at the point of generation, the segregation is not maintained throughout and finally the waste is open burnt. With the increased collection of clinical and infectious waste once the PCR laboratory is established, is bound to increase raising the risks for public health and environment. This shall be the key environmental issue that needs to be addressed during operation of the PCR laboratory.

Findings of the IEE confirm that the positive impacts of the project far outweigh any negative impacts arising out of establishing the proposed PCR Laboratory. None of the environmental impacts identified are irreversible and widespread, rather they are localized, temporary in nature. With good site management and safety practices, these impacts can be effectively managed. Stakeholder consultations reveal that the demand for increased number of testing is needed to combat the COVID-19 pandemic in the country. As such the project will be a positive step towards providing better health services to the country as well as prepare the country to face emerging health sector challenges successfully in the coming decades.

Among the recommendations, health care waste management be given priority and proper strategies to be developed and implemented to manage the issue as well as to build capacity and awareness within hospital staff for HCWM. Also, a proper sewer disposal system by installing a septic tank and a soakage pit is needed. In addition, the proposed PCR laboratory to be supplied by a dedicated electricity connection, water supplies and telecommunication facilities by the CEBH. Additional water storage, and a standby generator as backup power are needed. In conclusion, implementation of the EMP and the EMoP is essential to make sure that any environmental impacts are effectively mitigated.

iv I. INTRODUCTION

A. Project Background

1. The health sector enhancement project (HSEP), financed by ADB through a concessional loan of $37.5 million from ADB’s ordinary capital resources and a $12.5 million grant from ADB’s Special Funds resources, was approved on 23 October 2018. The loan and grant became effective on 5 February 2018 and are to be closed on 31 May 2024.

2. The Government of Sri Lanka (GoSL) identifying the need of facing the challenges in sustaining the country’s health system performance due to rapidly changing demographics and epidemiological transitions, had requested this assistance from the ADB. HSEP will support some of the reforms by renovating and expanding physical infrastructure in about 30% (135) of the primary medical care facilities (especially for better outpatient’s care), equipping for a better point of care services and introducing more efficient disease surveillance and patient information management. Selection of facilities for improvement under the project has been based on several agreed vulnerability criteria and mapping. The investment is aligned with the government’s priorities identified in the Public Investment Program (2017–2020), as well as with the Health Master Plan’s National Strategic Framework for Development of Health Services (2016–2025). The project is also in line with the ADB Sri Lanka Country Partnership Strategy (2018–2022) and reinforces ADB’s inclusive growth agenda in the midterm review of strategy 2020. 3. Ministry of Health and Indigenous Medical Services (MOHIMS) is the project’s executing agency (EA). The project management unit (PMU) established in the MOHIMS, and project implementing units (PIUs) established in each project supported province are responsible for project implementation (including project supervision, coordination and undertaking procurement of civil works).

4. The global public health emergency due to COVID-19 disease, which has now been characterized by the World Health Organization as a pandemic, calls for urgent measures to respond to the control and manage the disease spread in Sri Lanka. The GoSL has given high priority for strict and urgent measures to arrest importation of the disease to the country and spread of the virus within the country. The government has decided to strengthen the capacity and facilities of the Quarantine Unit, Infectious Disease Hospital, National Reference Lab (the Medical Research Institute), and 17 peripheral hospitals. The government requested ADB to provide financial assistance through the grant G0618-SRI(SF) to support the government’s response to this pandemic.1 In response to this requirement, the ADB has agreed to assist MOHIMS in establishing a new polymerase chain reaction (PCR) laboratory at the Colombo East Base Hospital (CEBH).

B. The objective of the project and the specific objective of the subproject

5. The broad objective of the project is to improve services offered by the primary medical care facilities that include primary health care units (PMCUs), divisional hospitals (DHs) and field health centres. To support the project objectives, selected primary medical care facilities and field health centres in the four provinces will be upgraded with the following broad guidelines.

1 Memorandum 24 March 2020 - Grant 0618 SRI(SF): Health System Enhancement Project -Request to Approve a Minor Change of Scope and Reallocation of Grant Proceeds, ADB

1 (i) Improving services of the outpatients’ department by expanding the patient waiting areas to accommodate greater numbers and adding more consultation rooms, dressing rooms, examination rooms and staff/patient restrooms

(ii) Upgrading/renovating drug stores and dispensary

(iii) Constructing/renovating laboratories, dental units and ETUs

6. The specific and immediate objective of the proposed subproject is to construct a new state of art PCR laboratory at CEBH to increase the number and efficiency of laboratory samples analyzed with respect to COVID-19, thereby improve the early detection and management of COVID-19 affected patients. The laboratory shall, in future, be used to analyze samples of other medical needs.

C. Objectives of this initial environmental examination

7. An environmental assessment review framework (EARF) has been developed for HSEP. Overall, the project is categorized as an environmental category B project. The scope change requested by GoSL is considered by ADB with no change in this categorization. Therefore, proposed activities related to the construction and operation of a new PCR laboratory at CEBH shall not create significant adverse impacts triggering a change in scope.1 Thus the proposed project is categorized as an environmental category B project requiring an initial environmental examination (IEE) report with an environmental management plan (EMP) and environmental monitoring plan (EMoP). This IEE report is developed to fulfil the above requirement.

D. Approach, methodology and personnel involved

8. This IEE was carried out based on:

(i) Review of literature pertaining to the baseline environmental conditions of the project area general status/plans about health care waste management in the country.

(ii) Environmental screening of the proposed subproject site at CEBH. A site inspection was carried out on 6 April 2020.

(iii) Discussions with the staff of PMU and potential suppliers of such laboratory facility and related accessories.

2 II. Policy, Legal, and Administrative Framework

A. National Environmental Legislation

9. The National Environment Act, No. 47 of 1980 (NEA) and its amendments provide guidance for sustainable development with the management of natural resources including water, soil, fisheries resources, forest, flora and fauna in Sri Lanka. It is the basic national decree for protection and management of the environment and paved the way for the creation of the Central Environmental Authority (CEA). Several amendments to the NEA were enacted in the past in a bid to continually make improvements and to respond to the challenging needs of the time.

10. There are several main regulatory provisions in the NEA implemented by the CEA through which impacts on the environment from the process of development is assessed, mitigated and managed.

(i) The Environmental Impact Assessment (EIA) procedure for major development projects. Regulations pertaining to this process have been published in 1993 and are available with the CEA.

(ii) The Environmental Protection License (EPL) procedure for the control of pollution. Regulations pertaining to this process have been published in 1990 and are available with the CEA.

(iii) Scheduled Waste License (SWL) procedure for the management and control of hazardous waste disposal.

(iv) Other regulations related to pollution control enacted under the provisions of the NEA

(v) Apart from the regulatory provisions of the NEA, there are Other relevant legislation and o regulatory provisions for pollution control, environmental perseverance and protection, which are enacted by State-sector entities.

(i) Environmental Impact Assessment

11. The GosL recognizes EIA as an effective tool for integrating environmental considerations with development planning. The application of this technique is considered as a means of ensuring that likely effects of development projects on the environment are fully understood and considered at an early stage of the project and throughout the project cycle.

12. The broader legal framework for the EIA process in Sri Lanka was laid down by the amendments made to NEA in 1988 through National Environmental (Amendment) Act, No. 56 of 1988. The provision relating to EIA is contained in Part IV C of the National Environmental Act. The procedure stipulated in the Act for the approval of projects provides for the submission of two types of reports Initial Environmental Examination (IEE) report and Environmental Impact Assessment (EIA) report. Such reports are required in respect of “prescribed projects” included in a Schedule in an Order published by the Minister of Environment in terms of section 23 Z of the act in the Gazette Extra Ordinary No. 772/22 dated 24th June 1993. This amendment made EIA mandatory for the whole of Sri Lanka and transformed the Central Environment Authority (CEA) into enforcement and implementing agency.

13. However, the first legal provision for EIA in Sri Lanka was included in the Coast Conservation Act, No. 57 of 1981.

(ii) Environmental Protection License

14. The Environmental Protection License (EPL) is a regulatory/legal tool that has been introduced to control and prevent pollution from waste discharges through the adoption of

3 appropriate pollution abatement technology. The activities for which Environmental Protection License (EPL) is required are stipulated in the Gazette Notification No. 1533/16 dated 25.01.2008. The NEA specifies categories of ‘prescribed projects’ which would need to comply with these regulations and are supported by gazetted discharge and emission standards depending on the industry type as well as the receiving environment.

15. The EPL regulation classifies industries into three categories, namely, A, B, and C corresponding to the high, medium and low polluting potential of the relevant activity discharging/emitting waste into the environment. While EPL for A and B categories are directly administered by the CEA, issuing EPL for category C is delegated to the local authorities under the powers of the NEA. CEA has published standards for various parameters such as effluent quality, air quality, noise and interim standards for vibration.

(iii) Disposal of Scheduled Waste

16. As stipulated through National Environmental (Protection & Quality) Regulations, Gazette Notification No. 1534/18 (dated 25.01.2008), which deals with waste from specific and nonspecific sources, any effluent discharges and waste discharges (scheduled waste) should conform to the Standards. The notification has three parts and eight schedules of which Part I deals with the issue of environmental protection license for emission/disposal of waste, and Part II deals with the issue of license for the management of scheduled waste (Hazardous Waste) and part III on general matters including definitions and the effectiveness and validity of the license issued under National Environment (protection and quality) regulation No 1 of 1990 published in Extraordinary Gazette No. 595/16 of February 1990. The eight schedules include the tolerance limits, applications, formats for reporting, categorization of non-specific and specific waste etc.

Applicability of the NEA to the subproject

17. The civil works envisaged under the subproject do not fall within prescribed categories of the NEA for environmental impact assessment and as such IEE/EIA is not required. However, discharge of laboratory waste (solid and wastewater) during operation falls within the prescribed category for pollution control, and as such, is required to obtain an EPL and scheduled waste license (SWL).

18. Environmental standards pertaining to effluent quality, air quality, noise and vibration will be applicable to the subproject where the contractor and the HCF are obligated to comply with stipulated levels during construction and operational levels.

Existing health care waste management framework in the country

1. Draft National Policy on health care waste management

19. In 2001, the Government of Sri Lanka drafted a comprehensive national policy on health care waste management (HCWM). It has three main sections covering:

(i) General considerations on HCWM and the institutional mechanism for policy implementation that should be set up at national level.

(ii) Provisions for the safe management of health care waste (HCW) in medical Institutions, including regulations and HCWM plans.

(iii) Provisions for the implementation of and the monitoring of HCWM plans at national and provincial levels including legislation, provision of human and financial resources, training and awareness and participation of the private sector.2

2 Government of Sri Lanka, Ministry of Health. 201. Draft National Policy on Health Care Waste Management. Colombo.

4

20. The institutional mechanism for implementing the national policy was envisaged under three levels of management as: at the central level, at the provincial level and at the local level. The national policy on HCWM to this date remains a draft as all attempts for its formal adoption in the past has not been successful.

2. National Guidelines on health care waste management

21. In 2001, the government drafted national guidelines for healthcare waste management with the aim of (i) providing a better understanding of the fundamentals of HCWM planning and (ii) directing HCFs in setting necessary procedures and standards to comply with policy and legislative requirements. These have been drafted in a form that provides all fundamental elements that should be integrated into future legislation specific to HCW. Although guidelines were reviewed by the national committee on clinical waste management (NCCWM) as well as the Ministry of Health, it did not receive formal endorsement by the government.

22. The draft national guidelines contain both practical and conceptual information on HCWM covering four main sections:

(i) Definition and categorization of HCW, including potential harmful effects that can result from its improper management.

(ii) Procedures for segregation, packaging, labelling, collection, storage, transportation and disposal (including the selection of appropriate treatment and disposal technologies for HCW) that should be applied and followed by all HCFs in the country.

(iii) Instructions for the implementation of health care waste management plans, including detail description of duties and responsibilities of health care provider at various levels.

(iv) Instruction for personnel of Central and Provincial Health Services who oversee HCWM to ensure smooth implementation of the guidelines and to set up regular monitoring mechanisms.

23. In 2007, concise guidelines for HCWM were prepared under the Hospital Efficiency and Quality component of the Sri Lanka Health Sector Development Project based on the detailed draft guidelines prepared in 2001. The concise guidelines which mainly contain sections in waste categorization and health care waste management procedures have been formally adopted and incorporated into the Handbook of Infection Control.

(iv) Other regulations related to pollution control enacted under the provisions of the NEA

24. Other than the provisions of the NEA, the following are also applicable for the proposed project.

Table 1.1: Other provisions of the NEA which are applicable for the proposed project

Laws and Regulations Provisions and Main Content Applicability to the project National Environment (Noise Control) Regulates maximum allowable Noise levels should be strictly Regulations 1996. Gazette noise levels for construction monitored for conformity, especially Notification Number 924/12 dated activities during subproject during excavations and backfilling. 23rd May 1996. activities National Environmental (Vehicle Horns) Regulations, No. 1 of 2011

National Environment (Ambient Air Establishes permissible ambient Ambient air quality should be Quality) Regulation 1994 and air quality standards during established before construction and Amendment of Gazette Notification proposed project activities be monitored during construction, Number 1562/22 dated 15th August especially activities involving 2008. earthwork.

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(v) Other relevant legislation for pollution control, environmental perseverance and protection

25. The present Constitution of Sri Lanka came into operation in 1978 and also provided the basic principles of environmental protection and preservation through Chapter 4, Section 27, and Item 14; “The State shall protect, preserve and improve the environment for the benefit of the community.” Based on the above principles, the Government of Sri Lanka has laid down various Acts including the National Environmental Act, No. 47 of 1980, to ensure environmental perseverance and protection. The relevant Environmental legislation applicable to the industry are listed in Table 1.2:

Table 1.2: Legislation, Regulations and Standards relevant for project activities

Laws and Regulations Provisions and Main Content Applicability to the project Fauna and Flora Protection Provide for the protection and There are no sensitive habitats Ordinance, 1937 (Chapter 469); conservation of the fauna and located, including wetlands and low- Fauna and Flora Protection flora and their habitats; for the lying areas, in the project vicinity. (Amendment) Act, No. 49 of 1993 conservation of the biodiversity Therefore, this is not applicable to and Fauna and Flora Protection and to provide for matters the project. (Amendment) Act, No. 22 of 2009) connected in addition to that or incidental to it.

Felling of Trees Control Act, No. 09 of This Act prohibits and controls No commercially and/or ecologically 1951 as Amended by Act, No. 30 of the felling of specified trees. valuable tree species will be cut. 1953 & as Amendment Act, No. 1 of No tree cutting permits are needed. 2000

Geological Survey and Regulates the exploration for Only small quantities of material will Mines Bureau (GSMB) Act, minerals, mining, transportation, be used. No. 33 of 1992 processing, trading in the export No permits from the GSMB and/or Removal of Sand Regulations, No. 1 of mineral products and usage of CEA (EPL) and Local Authorities are of 2007 quarries and sand mines in the needed. country.

Pradeshiya Sabha Act, No. 15 of These outline the procedures in Approval of the building plans 1987 approval of building plans, and subsequent Certificate of approval of drainage Conformity (COC) is not needed management plans, etc., and as the proposed facility is a semi- regulations for disposal of permanent structure. municipal solid waste. Approvals for drainage Involvement of MOH/PHI in management plans, disposal of matters related to public health. municipal solid waste are not needed as both these aspects will be included in the CEBH’s overall plans.

Approvals of the MOH/PHI in matters related to public health are needed. The Antiquities (Amendment) Act No This requires that an Approval of the Department of 24 of 1998, and regulations published Archaeological Impact Archaeology is not needed as the in Gazette Extraordinary No 1152/14 Assessment (AIA) be conducted project does not involve of 4 October 2000 about every proposed excavations exceeding 500 m in development project with a land length, and the land area is less area of over 0.25 ha. than 0.25 ha.

Pradeshiya Sabha Act, No. 15 of Regulates dumping municipal MSW that arise during the project 1987 solid waste at any place other activities has to be appropriately National Environmental than places designated for such collected, stored, and disposed of. (Municipal Solid Waste) purpose by the relevant local During operations, the generation of Regulations, MSW is not expected.

6 Laws and Regulations Provisions and Main Content Applicability to the project

No. 1 of 2009 authority during proposed project

activities

Labour Laws and Occupational Sri Lankan legislation comprises Compliance required during pre-

Health and Safety some laws, acts, and regulations construction, construction and

designed to prevent the decommissioning stages

Legislation in Sri Lanka relating to exploitation of workers and to The following sources provide

Industrial, Employment and Labour protect their health and safety in further information: Department

relations included in the Labour Code the workplace. The project of Labour; National Institute of

of Sri Lanka proponent and all the Occupational Safety and Health3;

subordinates will be required to and for an international Standards and Best Practices to comply with all such laws and perspective, and IFC’s

operate a health care laboratory provisions that may be Environmental, Health, and applicable. Safety Guidelines

for Health Care Facilities4.

Follow recommendations and

Guidelines of:

▪ ISO 15189 (2003): Medical

laboratories — Particular

requirements for quality and competence

▪ Specific Criteria for

Medical/Clinical Testing

Laboratories: Sri Lanka Accreditation Board (SLAB),

2015

• Guidelines on the

Establishment of Accreditation of Health Laboratories, WHO,

20075

• Laboratory quality standards

and their implementation., WHO, 20116

B. Safeguard Requirements of ADB

26. The safeguard policy statement (SPS) 2009 of ADB is the policy document that relates to compliance with safeguards in projects financed by ADB. The SPS includes operational policies that seek to avoid, minimize, or mitigate adverse environmental and social impacts, including protecting the rights of those likely to be affected or marginalized by the development process. It sets out the policy objectives, scope and triggers, and principles for three key safeguard areas: (i) environmental, (ii) involuntary resettlement, and (iii) indigenous peoples. All three safeguard policies involve a structured process of impact assessment, planning, and mitigation to address the adverse effects of projects throughout the project cycle.

27. The safeguard policies require that impacts are identified and assessed early in the project cycle, plans to avoid, minimize, mitigate, or compensate for the potential adverse impacts are developed and implemented and affected people are informed and consulted during project

3 http://www.niosh.gov.lk/ 4 https://www.ifc.org/wps/wcm/connect/960ef524-1fa5-4696-8db3-82c60edf5367/Final%2B- %2BHealth%2BCare%2BFacilities.pdf?MOD=AJPERES&CVID=jqeCW2Q&id=1323161961169 5 https://www.who.int/ihr/training/laboratory_quality/11_cd_rom_publications_sea_hlm_394.pdf 6 https://apps.who.int/medicinedocs/documents/s22409en/s22409en.pdf?ua=1

7 preparation and implementation. A basic principle of the three existing safeguard policies is that implementation of the provisions of the policies is the responsibility of the borrower/client. Borrowers/clients are required to undertake social and environmental assessments, carry out consultations with affected people and communities, prepare and implement safeguard plans, monitor the implementation of these plans, and prepare and submit monitoring reports.

28. All projects funded by the ADB are first screened and categorized into one of the following categories in the early stages of project preparation. Screening and categorization are undertaken to (i) reflect the significance of potential impacts or risks that a project might present; (ii) identify the level of assessment and institutional resources required for the safeguard measures, and (iii) determine disclosure requirements.

29. The overall HSEP is categorized as an Environmental category B project. Proposed activities related to construction and operation of a new PCR laboratory at CEBH shall not create significant adverse impacts triggering a change in scope. Thus, the proposed project is categorized as an environmental category B project requiring an initial environmental examination (IEE) report with an environmental management plan (EMP) and environmental monitoring plan (EMoP).

8 III. Description of the Project

A. Location of the subproject

30. The CEBH is located within Kolonnawa Divisional Secretary (DS) Division in Colombo District of the Western Province. Within the Kolonnnawa DS Division, the hospital is located within 502C Rajasinghagama Grama Niladhari (GN) Division.7 The project area falls within the Kotikawatta-Mulleriyawa Pradeshiya Sabha8.

31. The CEBH is situated in the heart of Colombo East suburbs with its surrounding residential neighbourhoods of Kolonnawa, Kaduwela, Kelaniya and Kotikawatta. The land area is about 117 acres. The sub-project location and the project footprint is presented in Figures 3.1 and 3.2. The existing layout of CEBH is presented in Annex 2 (with sub-project location and new access road indicated).

Figure 3.1. Location map of the sub-project within Colombo East Base Hospital premises

7 Grama Nildhari Division is the smallest administrative division of the country. 8 Pradeshiya Sabhas in Sri Lanka, which are the legislative bodies that preside over the third tier municipalities in the country

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Figure 3.2. The proposed site for the subproject

The need for the subproject

32. One of the key factors in tackling the spread of COVID-19 across the globe is testing. In South Korea, for example, mass testing has been used to try and quickly identify and isolate those with the disease. Testing is also vital to calculate accurate infection and survival rates – data that is critical for getting public safety measures right. Polymerase chain reaction (PCR) testing is the most commonly used test for diagnosing coronavirus because it’s highly accurate.

33. Some of the key advantages of using PCR testing are considered as valuable for detecting specific pathogens that are difficult to culture in-vitro or require a long cultivation period, significantly more rapid in providing results compared to culturing, enables earlier informed decision making, rapid diagnosis of bacteremia, particularly for low levels of bacteria in specimens, useful in detecting cases in extrapulmonary specimens which may be missed by smear and/or culture. The present condition of COVID-19 pandemic in the country requires an accurate detection method of infected cases in order to manage and control it’s spread. At present only about 100–150 tests are conducted by the laboratories available, though the capacity of the country’s available facilities have a capacity of around 500–700 (exact information is not available). The average time taken to obtain the results for a sample is around 24 hours (the overall turnaround time —from the time the samples are collected to when the report is delivered). Therefore, the need for the establishment of a new state-of-the-art PCR laboratory at CEBH is justified.

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Key activities related to the subproject

1. Establishment of the PCR laboratory – a single storey prefabricated building consisting of sandwich-panelled walls, and a zinc-aluminium roof. The building will have the following four functional spaces:

• Sample reception area

• Reagent Preparation area

• Sample preparation area

• Amplification area

2. The above four areas will be provided with the following as appropriate for the proposed functions:

• Sample storage space

• Storage space for chemicals, reagents, etc.

• Laboratory working space, clean benches

• Sinks and washbasins

• Space for equipment and electrical outlets for equipment

• Space for temporary collection and storage of contaminated/clinical and hazardous waste

• Proper lighting

• Proper air conditioning and air circulation/filtering

• Space for a cloakroom

• Space for record-keeping/filing

3. Two separate changing rooms, washrooms and toilets, for male and female staff use, as detached units constructed outside the proposed PCR Laboratory

4. Collection chambers for contaminated/clinical and hazardous waste

5. Wastewater disposal facility – septic tank and soakage pit for blackwater, catch-pit for disinfection of wastewater (from the washroom and sinks) and baffled channel for aeration of disinfected wastewater before diverting to the soakage pit.

34. There are no office space, resting areas, cafeteria, dining areas or reception areas (other than sample reception) within the laboratory.

Subproject implementation schedule

35. Based on the requirement to combat the spread of COVID-19, the proposed laboratory shall be established and operations within the shortest possible time period. The proposed subproject site is located within the CEBH premises, which is a government land with no encroachments. Therefore, the subproject shall not envisage any acquisition of private land or displacement of persons.

36. The sub-projects involve only erecting a semi-permanent building and provision of associated services. With the urgency of commissioning the facility and due to the fairly simple type of civil works, all construction works shall be completed within 2 to 3 weeks.

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Figure 3.3: Proposed layout for the PCR laboratory at CEBH

12 IV. Description of the Existing Environment

A. Methodology Used for the Baseline Study

37. Data collection. The study was based partly on primary as well as secondary sources of information, reconnaissance and a field visit. As the sub-projects involves only erecting a semi- permanent building and provision of associated services, the environmental impacts are expected to be local and short-term in nature, considering the magnitude and methodology of construction. Baseline monitoring of water quality, noise, and dust levels will not be required by the contractors before the commencement of civil works because the small-scale construction that is limited to a duration as short as 2–3 weeks.

38. A baseline description is presented in this Chapter with the data and information collected during the field visit and published sources on physical condition, biodiversity status (habitat types, fauna and flora species), land use pattern, and socio-economic structure of the project area. Visits to the project were made from April 5 to 7th by the PMU staff and Consultants, to assess the existing environment and gather related information. The data and information collected, as outlined above, are presented in the following paragraphs.

B. Description of the physical environment

B.1 Location and existing land use

39. The location for the proposed PCR is within the CEBH, as shown in Figures 3.1 and 3.2. The coordinates of the location are: 6°55'32.09"N 79°56'40.71"E

40. The land selected to establish the new PCR Laboratory is a bare land located close to the CEBH premises that border the by-road that connects to Staff Quarters, which are located towards the north-eastern side as shown in Figure 3.1. The following are prominent features of the existing land and its periphery:

• The vegetation and topsoil of proposed land area are already removed. The proposed land is bare at present, ready for construction work to commence (See Figure 4.1a, b).

• The buildings of ETU ward and treater and a clinic could be observed towards the west and north-west direction of the proposed site (See Figure 4.1c).

• There is an on-going construction site (for nephrology unit) located towards the south of the site (See Figure 4.1d).

• Presently, a 20-foot road is being constructed to serve as the access road to the proposed nephrology unit (See Figure 4.1e). This road can serve as the access road to the proposed OCR Laboratory.

• The access to the PCR laboratory from outside the CEBH premise can facilitate through the gate located close to the proposed site. This gate is facing the by-road of the road that runs along the north-south border of the CEBH (See Figure 4.1f)

• There are houses located outside the premises of the CEBH across the existing road.

• Some quarters could be observed to the north-east and south-east direction.

1

Figure 4.1a: Proposed site for the PCR Figure 4.1b: Proposed site for the PCR Lab Lab from SE-NW direction from N-S direction

Figure 4.1c: The rear side of the operating Figure 4.1d: The Nephrology Uni under theatre, ETU and the clinic premises construction towards South of the site adjoining the site

Figure 4.1e: The 20-foot access road Figure 4.1f: The gate which serves as the being built, which will serve the PCR lab entry to the site and subsequently to the and the Nephrology unit PCR laboratory

2

Proposed site

Figure 4.2: Zoning Plan proposed for the Kotikawatta-Mulleriyawa PS area Source: Urban Development Authority, Zoning Plan for 2020

41. The proposed site is located within CEBH, which is within the Administration and Institutional Zone of the Zoning Plan developed by the Urban Development Authority (Figure 4.2).

B.2 Topography, geology and soil

B.2.1 Topography

42. The Colombo district, which incorporates the project area falls into the so-called lowest peneplain of Sri Lanka (after P.G. Cooray – Geology of Sri Lanka, 1984). The elevation variation of Colombo and parts of Gampaha District situated in this coastal peneplain ranges to a maximum elevation of 100 m from the seacoast. The terrain in Colombo and suburbs largely consists of gently undulating plains and low-lying flatlands with a high density of drainage paths formulating geography consisting of a mix of land and water.

43. The general topography in Mulleriyawa area is undulating with some areas rising to above 80–90 feet above MSL, and there are extensive areas where the elevations are below +3 m MSL. There are large marshy areas connected with Kolonnawa Marsh, Madinnagoda Marsh, and Mullleriyawa low lying areas (See Figure 4.2 and 4.6). These wetlands, marshes and low lying areas naturally serve as flood retention areas have been utilized as retarding basins for major floods or severe floods.

16. The location of the CEBH and the project area is at highland relative to nearby food plains which are at low elevations and are prone to frequent floods. The proposed land for the PCR laboratory within the CEBH premises has mild slopes towards the north-eastern side (1–1.5%), and again towards the south-eastern side, the latter slope is steeper (about 2–2.5%).

3

Figure 4.3: Elevation maps of the Mulleriyawa area which displays the range of elevation (MSL) with different colours (Source: https://en- gb.topographic-map.com/maps/enb0/Belagama/ – accessed on April 7, 2020)

B.2.2 Geology and Soils

44. The country’s major geological formations are dated back to Precambrian era with metamorphic type formations. These formations are subdivided as Highland complex, Vijayan complex, Wanni complex and Kadugannawa complex. More recent formations of sandstones, shales and siltstones are found in Tabbbowa and Andigama near Puttalam. A sedimentary limestone formation is prominent in Jaffna peninsula and along the north-western coastal belt. Accordingly, the proposed project area is located within the Wanni complex.

45. The project area lies within the Southwestern Group and the Wanni complex in the lowest peneplain of Sri Lanka, which rises to a maximum elevation of less than 500 ft from the seacoast. The Wanni series is composed of meta-sediments and closely associated hornblende gneisses and charnokite gneisses. The meta-sediments comprise quartzites, hornblende-biotite gneisses, granulite with hornblende, marble, and konderite, which is sillimanite-garnet-graphite schist. Both its lithology and metamorphic history differentiate it from the Highland series (Panabokke, 1996). Geologically, the study area consists of hornblende genesis and Alluvial, underlain by the Highland Series of Metamorphic Basement (National Atlas, 2007). A map of the geomorphology in the project area is given in Figure 4.4.

4

Figure 4.4: Geomorphology Map of the Study Area (Source: National Atlas, 2007)

46. Overlying the Pre-Cambrian basement are alluvial and littoral sedimentary deposits of Quaternary age, within the project area. The fluvial deposits here include thick alluvium (20–30 m) in some areas of marshes and water bodies. These alluvial deposits include lean/plastic clays, organic clays/peat, and sand with clay.

47. Field surveys and direct observations carried using recently formed earthen embankments, and excavations have indicated that the local geology in the proposed project areas is characterized by sandy lateritic soils and patches of peaty clay with the bedrock lying at a depth > 20 m. Surface alluvium with sporadic laterite patches, especially on high ground have also been recorded. It is presumed that these site-specific features are the most important ones as the environmental impact is considered.

48. Sandy laterite soils have relatively high permeability in the range of 0.03 ~ 0.08 mm/hour. However, when saturated, this decreases to almost zero. Alluvial soil is known to have very low permeability due to their high peat and fine contents. According to Survey Dept maps (Figure 4.5), the main soil types in the project area is Red Yellow Podzolic soils with soft or hard laterite and undulating terrain.

Figure 4.5: Soil Map of the Study Area (Source: Survey Department, undated)

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B.3 Meteorology

49. Compared to the other months of the year, months of January and February are fairly dry in the project area. Rainfall to the project area is mainly influenced by the south-west monsoon winds (mid-May to September) and second inter-monsoon rains governed by the clouds formed during the shift of the Intertropical convergence zone9. The 75% expectancy-value of annual rainfall is greater than 1,700 mm.

50. Wind direction and wind speeds in the country, including the western region are depending on the pressure gradients developed between Siberian high and Mascarine high. According to the wind roses developed by the Department of Meteorology, the wind directions and speeds within the western region could be described as follows: January - Northerly direction with an average speed of 7.2–9.4 km/h

April - Calm wind with an average speed of 5.4–7.6 km/h

July - south-west direction with an average speed of 7.6–15.5 km/h

October - south-west direction with an average speed of 5.8–9.0 km/h

51. The mean monthly temperatures of the country differ on the seasonal movement of the sun with some influence caused by rainfall. Colombo features a tropical monsoon climate under the Köppen climate classification, falling just short of a tropical rainforest climate.

52. Following facts are relevant with respect to the climatological and meteorological condition of the proposed project area. Firstly, the climate of Colombo district is fairly temperate throughout the year. From March to April the temperature averages around 31 C maximum. The only major change in the Colombo weather occurs during the monsoon seasons from May to August and October to January. Heavy rains are expected during this time of the year. Located within WL3 agro-ecological region Colombo experience little relative diurnal range of temperature, although this is more marked in the drier winter months, where minimum temperatures average 220C. Rainfall in the city averages around 2,400 mm a year. Table 4.1 below summarizes the climatological data of Colombo.

Table 4.1 Climatological data of Colombo city

Month Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Year e

Average 30. 31. 31.7 31.8 31.1 30.4 30.0 30.0 30.2 30.0 30.1 30.3 30.64 high 0C 9 2

Daily mean 26. 26. 27.7 28.2 28.3 27.9 27.6 27.6 27.5 27.0 26.7 26.6 27.38 0C 6 9 Average 22. 22. 23.7 24.6 25.5 25.5 25.2 25.1 24.8 24.0 23.2 22.8 24.11 low 0C 3 6

Precipitatio 58. 72. 128. 245. 392. 184. 121. 119. 245. 365. 414. 175. 2,523. n mm 2 7 0 6 4 9 9 5 4 4 4 3 7

% humidity 69 69 71 75 78 79 78 77 78 78 76 73 75

Source: World Weather Information Centre – Colombo, World Meteorological Organization

9 Inter Tropical Convergence Zone or ITCZ is the terminology used to delineate a zone of separation between the northern and southern hemispheric trade winds usually close to the equator.

6

B.4 Surface and groundwater hydrology

Figure 4.6: Low-lying area located near the CEBH and the Kelani Ganga

53. There are no surface water bodies present within the CEBH premises. However, there are extensive low-lying areas located nearby (Figure 4.6). The surface runoff flows towards the north-eastern direction into the low-lying areas.

54. The surface runoff pattern of the project site area is shown in Figure 4.7. It is noted that the ground elevation is towards the north-east direction and also towards the south-west direction. The surface runoff up to now had been directed toward the site area proposed for the PCR laboratory, as the land had not been used for any productive purpose. The area had functioned as a percolation site for the runoff water. Once these areas have been occupied by the proposed PCR laboratory, its parking areas, and the access road being constructed to serve the PCR laboratory and the Nephrology unit, the area cannot be used as a percolation area. The surface drainage has to be diverted towards the vacant land further towards the north-east part of the hospital (See Section C.8 Chapter V).

7

Figure 4.7: The surface runoff patterns of the project site. !: Proposed site for the PCR Laboratory; 2: The on-going construction site for the Nephrology Unit. The arrows indicate the direction of surface runoff.

55. Within the CEBH premises, the maximum water table is about 3–6 m below ground level.

56. The hospital premises has not experienced flooding in the past. The most recent heavy floods that occurred in May 2018 did not reach the hospital premises (See Figure 4.8).

8

Figure 4.8: Floods that occurred in May 2018 around Kelani Basin where the project area is located (Source: Special Surveys and Quality Control Branch, Survey Dept., 2018)

B.5 Ambient air quality

57. The existing evidence, in general, has shown that the ambient atmospheric environment of Colombo and its suburbs are heavily contaminated with vehicular emissions. Many studies were undertaken by regulatory agencies, and researches clearly indicate that inefficient combustion of petroleum fuels in motor vehicles is the primary cause of growing air pollution in Colombo, the largest metropolitan area with nearly 50% of vehicle population is concentrated and 30% of the nation’s human population dwells (Clean Air 2025, An Action Plan for Air Quality Management, 2016).

58. Based on monitoring conducted by CEA, the ambient air quality in the project area is within the prescribed ambient limits. The Air Quality Index (AQI) for PM2.5 is continuously measured in the Colombo area by the US Embassy in Sri Lanka, which has consistently recorded AQI values of 0–50 (which corresponds to breakpoint value of 0.0–15.4 µm3) or AQI values of 51–100 (which corresponds to breakpoint value of 15.5–40.4 µm3), which indicates an either good or moderate level of health concern. Similar values can be expected in the project area, as the vehicular movement, extent, and nature of paved areas and air-borne dust levels are more or less similar to Colombo.

59. Based on long-term monitoring of air quality by the CEA, annual averages of ambient PM10 level in Colombo over the years had remained relatively within the range of 60 to 82 µg/m3 with a slightly decreasing trend beginning from 1998 to 2011, and a peak in the trend was recorded in 2001. These readings, however, consistently exceeded the WHO latest guideline value of 50 3 µg/m for PM10.

9

Figure 4.9 Air Quality Index for PM2.5 for Colombo on 11th (Tuesday) and 12th (Wednesday) May 2019 (Note: (Green bars: AQI of 0–50 & Yellow bars: AQI of 51–100) Source: The US Embassy in Sri Lanka ( http://aqicn.org/city/sri-lanka/colombo/us-embassy/)

60. However, the air quality within the hospital premises is observed to be not contaminated by the burning of fossil fuels. There are no laundries, or any other emissions seen nearby. However, open burning of waste is practised by the hospital at a location which is about 200 m away from the proposed site.

Figure 4.10: The location where the hospital burn waste in the open air

61. The hospital, though collect waste separately, some of the waste is being open-burnt, which is not a good practice.

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B.6 Existing sources of noise and vibration

62. Existing ambient noise and vibration levels in the areas are consistent with suburban and light industrial areas. There is also moderate levels of traffic noise from adjoining roads. Industrial activities and commercial activities of much of the project area are not very significant to have high levels of noise.

63. Secondary data on noise levels that have been reported elsewhere is reported here. Noise levels have been measured as a one-time measurement on December 27, 2018, in Kolonnawa area (Table 4.3). Two measurements have been taken at each location: during daytime (between 08.00 and 13.00 hrs) and nighttime (between 19.00 and 23.00 hrs). All noise measurements have been carried out within 5 m of the ROW. Moderately high noise levels were predominant due to the vehicular movements along the busy roads. Night-time levels were somewhat lower compared to those of daytime due to the lesser number of vehicles on the road.

Table 4.3: Ambient noise levels in dB(A) measured in the project areas

Location number Coordinates LA,eq in dB(A) measured for 10 minutes Daytime Nighttime

Meetotamulla Road, Vihara Mawatha 6°55'53.28"N 12.20 68 19.10 58 near Railway crossing 79°53'1.68"E Meetotamulla Road, Vihara Mawatha 6°56'5.12"N 12.50 62 19.35 56 Junction 79°53'5.16"E Avissawella Road, Railway line 6°56'37.03"N 06.40 73 20.25 64 overpass 79°53'5.17"E Awissawella Road, Meetotamulla Road 6°56'25.15"N 07.20 68 20.55 61 Junction 79°53'22.20"E Awissawella Road, Kolonnawa Road 6°56'14.05"N 07.50 69 21.10 62 Junction 79°53'46.38"E Kolonnawa Road, near Angoda Road 6°55'58.13"N 08.30 65 21.50 60 Junction 79°53'36.93"E Angoda Road, near Malwatta Road, 6°55'45.79"N 09.20 68 22.20 64 Gothatuwa 79°54'13.05"E Angoda Road, Gothatuwa Junction 6°55'22.71"N 10.00 68 22.55 60 79°54'47.79"E Awissawella Road, Kotikawatta 6°56'9.16"N 10.40 67 23.05 60 Junction 79°54'57.90"E Awissawella Road, Angoda Junction 6°56'9.09"N 11.20 67 19.40 54 79°55'32.89"E Hospital Road, Mulleriyawa, near the 6°55'38.01"N 11.50 68 20.05 55 Hospital 79°55'39.72"E

Source: Draft IEE Report submitted to the ADB for SRI: Integrated Water Supply Investment Project: Sub-projects for Distribution System Improvements in Kotte, Kolonnawa and Kelaniya Areas (2019)

B.7 Existing water sources and incidence of water pollution

64. Water extraction from a couple of shallow wells had been the practice a few decades to fulfil the water supply needs. However, the CEBH now relies entirely on the water supply by the

11 NWSDB, and there are storage tanks to satisfy the demand of 2–3 days. There is no water extraction within the hospital premises at present. However, the wells can be used at any time as a contingency measure, if needed.

65. There is no sewerage system or a central wastewater treatment facility. There are septic tanks and soakage pits for individual buildings. As the maximum water table is about 3–6 m below the ground surface, it can be assumed that there is no groundwater pollution occur due to wastewater discharge. Wash water from janitorial services are dumped over the ground; however, the quantities of water are not large.

C. Biological environment

66. The proposed subproject site is located within a low country (i.e., elevation below 400 m above mean sea level) wet zone of the country. According to agro-ecological classification,10 all locations of these subcomponents falls within WL3 agro-ecological zone. Topographic features, 75% expectancy of annual rainfall, soil and predominant land use of WL3 agro-ecological zone is presented below.

Table 4.4: Characteristics of the WL3 agro-ecological zone

Agro-ecological 75% expectancy-value Description

zone of annual rainfall (mm)

(Land use, Terrain, Soil groups)

WL3 > 1,700 Coconut, Fruit crops, Mixed Home gardens and

Paddy

Rolling and undulating terrain

Red Yellow Podsolic soils with soft and hard

Laterite and Regosol soils

nd Source: The National Atlas of Sri Lanka (2 edition), Survey Department Sri Lanka 67. The CEBH premises, which has an area of 117 acres, has been used as a medical institution for over five decades, and development had been taken place from time to time. There is an extensive road network, and a large playground within the premises, and a large number of staff quarters, dormitories apart from the hospital facilities.

68. The vegetation that is found within the hospital premises is common home garden species, and exotic plants and flowering plants grown for aesthetic and beautification purposes. Home garden species are common in the areas where staff quarters are located, and there are numerous common fruit-bearing trees such as mango, guava, citrus sp., banana, jambu, etc. There are trees such as jackfruit, mara, kenda, kohomba, coconut, etc. on the roadside. Home gardens found in the staff quarters areas, which are a bit congested and confined to small land plots. These home gardens are comprised of exotic foliage, fruits, medicine, spices, and timber. Among them, coconut (Cocos nucifera), jack (Artocarpus heterophylus) and mango (Mangifera indica) were commonly observed. In addition, commercially valuable exotic timber species such as teak, mahogany, Ruk attanana (alstonia) were also found in home gardens.

69. Common fruits and vegetable species, timber species and ornamental plants are the species observed within the area towards the north-eastern part from the project site. Mainly, secondary vegetation can be found in the area including native species; Bowitiya (Osbckia

10 The entire country has been divided in the 46 agro-ecological zones based on terrain (elevation), soil types, land use and 75% expectancy of annual rainfall.

12 parvifolia), Andara (Dichrostachys cinerea), Weralu (Elaeocarpus serratus), Wata-keyiya (Pandanus kaida), Pera (Psidium guajava), Kirilla (Glochidion stellatum), Kenda (Macaranga peltata), Himbutu wel (Salacia chinensis), Wal Habarala (Alocasia macrorrhizos), Hambu pan (Typha angustifolia), Gandapana (Lantana camara), Nidikumba (Mimosa pudika), Balunakuta (Dichapetalum gelonioides), Nuga (Ficus bengalensis), Mango (Mangifera indica), Araliya (Plumeria obtusa), Kesel (Musa x paradisiaca), Suriya (Thespesia populnea), Eth thora (Atylosia trinervia), Kaduru (Sapium insigne), Endaru (Ricinus communis), Coconut (Cocus nusifera), Madan (Syzygium cumini), Pethithora (Cassia tora), Acacia (Acacia melanoxylon) etc.

70. Habitats of the wetland system in the Mulleriyawa area is classified as Annona woodlands, Herb dominant low vegetation, Open water, Highland vegetation associated with wetlands (MCUDP Report No. MCUDP/PHRD/03, 2015). Many invasive species such as Wel atta (Annona glabra), Lantana (Lantana camara), the introduced species of Acacia (Acacia melanoxylon), Alstonia macrophylla, Dillenia suffruticosa, Chromolaena odorata, Clidemia hirta, Eichhornia crassipes, and Salvinia molesta can be commonly seen.

71. Much of the wetland habitats are dominated by the single tree species, Annona glabra, which is an invasive alien plant. The understorey of this habitat contains various herbaceous plant species such as Acrostichum aureum, Monochoria vaginalis (Diya habarala), Ludwigia perennis (Piduruwella), Ludwigia peruviana, Rhynchospora corymbosa, Commelina diffusa (Gira pala), Lasia spinosa (Kohila), Colocasia esculenta (Gahala) and climbers such as Mikania cordata (Wathu palu), Pothos scandens (Pota wel), Lygodium microphyllum (Pamba wel). These aquatic habitats serve as roosting and breeding sites for aquatic birds, daytime resting places for cryptic, nocturnal animals such as fishing cats and porcupines, a major habitat for shade preferring species such as land snails and some species of butterflies.

72. There are a few trees in the site proposed for the PCR laboratory that is commonly found in other home gardens. The following is the list of trees in the proposed site and its near periphery:

Table 4.5: Tree species that are located near the proposed site

Tree species Number DBH Remarks of trees

Kenda (Macaranga 02 450 mm & The larger tree is located in the frontal area of peltata) 200 mm the proposed building, which may need

removal as this tree (being a fast-growing

Figures 4.11a,c week wooded tree) may pose dangers of

falling branches at a later stage.

The smaller tree needs removal for the construction of the access road.

Hik (Lannea 03 450 mm The larger tree is located very close to the coromandelica) proposed site. The tree has two large tree

300 mm x

hollows – one at the bottom and one at about

Figures 4.11a, b, e 2 trees

3 m height, which are apparent signs of tree ageing.

This tree needs removal for the safety of the

building.

The other two trees are located in the frontal

area of the proposed building, which may

13

need removal as these two trees (being a fast-

growing week wooded tree) may pose

dangers of falling branches at a later stage.

Ketakela (Bridelia 01 300 mm This is located about 50–60 m away from the

retusa) proposed site. Figures 4.11a No need for removal.

Jackfruit 01 600 mm This is located between the proposed site and

(Artocarpus the Nephrology building site. heterophyllus)

No need for removal.

Figures 4.11a, d

Mango (Mangifera 01 450 mm; This tree is located away from the proposed indica) 300 mm site.

Figure 4.11d The trees are not affected.

Kottamba Tree 01 200 mm This is located between the proposed site and

(Terminalia the Clinic building site. catappa) -

No need for removal. Figures 4.11d

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D. Social and Economic Environment

D.1 Population Characteristics

73. The proposed subproject site is located within existing hospital premises, which is within 502C Rajasinghagama GN Division of Kolonnawa DS Division. Basic socio-economic information is presented below with respect to above GN, DS Division and Colombo District. The CEBH is located within Kotikawatta-Mulleriyawa Pradeshiya Sabha (Figure 4.12)

15

Figure 4.12: Map of Kotikawatta-Mulleriyawa Pradeshiya Sabha

74. Table 4.6 below compares the land area, population, population density and poverty headcount index for the year 2016 with respect to Sri Lanka and Colombo district.

75. The DS Division occupies an area of 28.82 km2. Thus, the population density per km2 becomes 8,745 persons per km2, showing a higher density of population. As in the case of national population statistics regarding sex ratios, Kolonnawa division also has a female population exceeding the male population, showing a sex ratio of 96 males for 100 females. Kolonnawa DSD has an unemployment rate of around 2.4% against 3.4% unemployment rate at the national level,

16 showing a less unemployment situation. The ‘economically not active’ population (underage and overage persons for working) in Kolonnawa DSD is around 47% showing a great similarity to the national level, which is around 48.4%.

Table 4.6: A summary of land area, population, population density and poverty headcount index

Province District Population Land Population Poverty Total poor Cont. to (Census area Density headcount population total 2012) (km2) (person/ index (%) poverty km2) (%)

Sri Lanka 20,359,439 65,610 325 4.1 843,913 100

Western Colombo 2,324,349 699 3,325 0.9 19,796 2.3

Kolonnawa DSD Colombo 251,454 28.82 8,745

Kotikawatta- Colombo 141,710 29.63 Mulleriyawa PS

Rajasinghegama Colombo 6,582 GN Division

Source: Department of Census and Statistics, 2012

76. The Kotikawatta-Mulleriyawa PS borders the Kelani River towards north, Kaduwela Municipal Council area towards south, Kolonnawa Pradeshiya Sabha towards west. There are 33 GN divisions that belong to the Kotikawatta-Mulleriyawa PS.

Rajasinghagama GN Division (502C) has a total population of 6,582 (Male: 2,971 and Female: 3,611). Out of the total population, there are 6,092 Sinhalese, 58 Sri Lankan Tamils, 13 Indian Tamils, 105 Sri Lankan Moor, 89 Burghers, 30 Malays and seven others.

D.2 Existing Infrastructure facilities

77. Housing: According to Sampath Pethikada, the Kolonnawa DSD has 44,646 housing units spread over in all the GNDs with highest units being registered in Megoda Kolonnawa (2,164) with Meethotamulla having the second largest number of housing units (1,880). In Kolonnawa DSD, 73% of housing units are owned by households, 15.6% are rented housing units belonging to private owners, and 5% are rented housing units belonging to the government. At the national level, nearly 83% of housing units belong to households themselves. It is also reported that 99% (39,997) of housing units in the DSD are permanent with a few (4,304) being categorized as semi-permanent. There are also 341 improvised houses and 41 houses with no classifications. (Makeshift). Most numbers of houses are recorded in Megoda Kolonnawa GND, and the least number of houses are recorded in Veheragoda GND. Kolonnawa GND has 525 houses, and the number of semi- permanent houses is only 4, according to the Population and Census Data (2012). Wadulla GND has about 40% of its houses under the semi-permanent category.

78. Public Institutions: Kolonnawa being located neighbouring Colombo and Sri Jayewardenepura Kotte is well linked to the other regions and Urban centers of the country by a good road network and public transport system. With the growth of Kolonnawa and Kotikawatta Town centers as the main commercial centers in the DS Division, the area is densely populated with light, and heavy industries are being developed at a rapid pace.

79. Educational Institutes. There are many public and private institutions located in the Kolonnawa DS area.

17

80. Medical Facilities. The DSD area hosts the Colombo East Base Hospital, Mental Health Institute and IDH hospital. It serves the population of areas all parts of Sri Lanka. Maternity and childcare clinics are held at Vihara Mawatha, Sedawatta and Orugodawatta areas provided free of charge by the urban council and expectant mothers vaccinated. There are maternity and childcare centres run by the urban council. In addition, free Ayurvedic dispensaries are available at Vihara Mawatha, Sedawatta and Meethotamulla.

81. Recreational Facilities. There are 03 playgrounds and 04 children’s parks maintained by the Kotikawatta-Mulleriyawa PS.

82. Social Service Organizations/ Agencies. There are more than 50 registered Social Service organizations in the DS Division.

83. Commercial Services/Business. On either side along the main roads, RDA and PRDA roads, are the major public receptors such as banks, police, schools, playgrounds, public fairs, boutiques, office buildings, markets, service stations, and small kiosks.

84. Availability of infrastructure facilities in the proposed site premises. The CEBH has electricity supply serviced by Lanka Electricity Company, water supplied by the National Water Supply & Drainage Board and telecommunication services provided by Sri Lanka Telecom and private telecommunication service providers. Also, the hospital has sufficient capacity of backup electricity provided by a number of diesel generators installed at several ward premises.

85. The proposed PCR laboratory will be supplied by a dedicated electricity connection, water supplies and telecommunication facilities by the CEBH.

18 V. Anticipated Environmental Impacts and Mitigation Measures

86. This chapter discusses the impacts that arise from project interventions from site selection to the operational stage of the proposed sub-project with suitable measures to avoid, minimize or mitigate the significant adverse impacts. Impacts and mitigation measures are presented in the following order.

A. Location impacts: Impacts associated with the selection of sites, including effects on the environment, including any resettlement or livelihood impacts on communities.

B. Design and pre-construction impacts: This includes the impacts arising due to designs of the subcomponents, standards and techniques selected for construction.

C. Construction impacts: This includes impacts arising due to activities from site clearing up to completing of construction of each subcomponent, including civil works, mechanical and electrical works where applicable.

D. Operation and maintenance impacts: Impacts associated with operation and maintenance of the PCR laboratory.

A. Location impacts

87. The site selected for implementing the sub-project is owned by the CEBH. This land does not have any encroachments or other socio-economic activities that would be affected by implementing the project. No land acquisition is envisaged; therefore, there will be no physical or economic displacement leading to involuntary resettlement of people.

88. The proposed PCR laboratory will have separate access through the gate located on the north-eastern boundary of the CEBH. The selected land has a dedicated access road branching immediately to the left from the inner lane within the hospital premises, as one enters through the gate (Figure 5.1).

19

Figure 5.1: The entrance to the PCR laboratory. The access is shown in blue arrows, and the red strip shows the access road under construction to the Nephrology unit, which also can be used to access the PCR laboratory.

89. Due to the selection of this isolated location for the proposed PCR laboratory, there will be no impacts due to the movement of vehicles, persons to and from the laboratory.

B. Design and pre-construction impacts

B.1 Impacts due to the removal of trees

90. As mentioned in Table 4.5, one tree needs removal, which is a Hik tree (Lannea coromandelica) – Figure 4.11e. This tree has two large tree hollows – one at the bottom and one at about 3 m height, which are apparent signs of tree ageing. Removal of this tree is needed to ensure the safety of the proposed building. There are three more threes: one Kenda tree (Macaranga peltate) (Figure 4.11b) and two Hik trees (Lannea coromandelica) (Figure 4.11b), which are located in the frontal area of the proposed building and may need removal as these trees (being fast-growing weak wooded trees) may pose dangers of falling branches onto the building at a later stage. There is another Kenda tree (Macaranga peltate) (Figure 4.11c), which is located near the entrance gate, and its removal is needed for construction of the road. However, this tree is small (DBH is about 200 mm)

20

91. All these trees species, three Hik trees and Kenda trees are fast-growing weak wooded trees which are very common in any part of the wet zone of the country. Their removal will not affect the avifauna of the area as there is a large number of trees located nearby.

92. It is recommended to plant at least three trees each to compensate for the loss of each tree. Trees can be planted along the newly built access road and as part of the landscaping of the hospital premises. Trees such as jackfruit, breadfruit, mango, jambu, guava, are some of the species that are preferred. Trees such as teak, mahogany, mee, ehala are also recommended.

B.2 Impacts due to the removal of any existing structure/ part of structures

93. Removal of structures is not needed. The present site is bare land, and removal of topsoil is also not needed. The soil excavated from the foundation trench and septic/soakage pit can be used as a backfill material.

94. There is only a small partially-built security hut made of masonry abandoned near the entrance gate, which needs removal as part of road construction. However, the work will be carried out by the contractor who is responsible for road construction.

B.3 Designing of a proper stormwater drainage system

95. The rainwater drainage from the site can be connected to the drain that will be constructed as part of the access road. The scale of the building is small, and the rainwater draining from the roofs will also be small.

96. However, the hospital has to provide a suitable solution for drainage of the north-eastern part of the hospital premises (see Section C.8 of this Chapter for details).

B.4 Designing of proper clinical waste sorting, storage and disposal facility

Impacts of improper handling and disposal of healthcare waste

97. Health-care waste includes a large component of general waste and a smaller proportion of hazardous and infectious waste. Infectious and anatomic wastes together represent the majority of the hazardous waste, up to 15% of the total waste from healthcare activities. Sharps represent for about 1% of the total waste, but they are a major source of disease transmission if not properly managed. Chemicals and pharmaceuticals account for about 3% of waste from healthcare activities while genotoxic waste, radioactive matter, and heavy metal content account for around 1% of the total healthcare waste, depending on the types of services provided by the facility

98. All individuals exposed to hazardous health-care waste are potentially at risk, including those within health-care establishments that generate hazardous waste, and those outside these sources who either handle such waste or are exposed to it as a consequence of careless management. The main groups at risk are the following:

- Medical doctors, nurses, health-care auxiliaries, and hospital maintenance personnel

- Patients in health-care establishments or receiving home care

- Visitors to health-care establishments

- Workers in support services allied to health-care establishments, such as laundries, waste handling, and transportation

- Workers in waste disposal facilities (such as dumping sites or incinerators), including scavengers.

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.

Figure 5.2: Impacts of improper handling of waste disposal

Mitigation:

99. It is required to have waste segregation facility in each chamber of the laboratory to have a better Health Care Waste Management system. Health-care waste is generated in the lab and should be segregated according to national colour code as shown in Figure 5.3.

Figure 5.3: National colour codes for segregation of waste

100. The storage area should have an impermeable, hard-standing floor with good drainage (away from watercourses). The floor should be easy to clean and disinfect. It is required to include the facility to keep general waste separated from infectious and other hazardous waste, a water supply for cleaning purposes, easy access for staff in charge of handling the waste, lockable are to prevent access by unauthorized persons, easy access corridors for waste-collection vehicles; should be inaccessible to animals, insects and birds; have good lighting and at least passive ventilation; not be situated in the proximity of fresh food stores and food preparation areas; have a supply of cleaning equipment, protective clothing and waste bags or containers located conveniently close to the storage area; and have a washing basin with running tap water.

101. These storage areas should be sized according to the quantities of waste generated and the frequency of collection. The areas must be totally enclosed and separate from supply rooms or food preparation areas. Floors and walls should be sealed or tiled to allow easy disinfection. If

22 present, the storage room should be connected to a special sewage system for infectious hospital wastewater (Figure 5.4).

Figure 5.4: The general layout of the PCR Laboratory for better management of HCW

102. While transporting waste within the hospital premises, it is required to use separate floors, stairways or elevators as far as possible. Waste, especially hazardous waste, should never be transported by hand due to the risk of accident or injury from infectious material or incorrectly disposed sharps that may protrude from a container. Spare trolleys should be available in case of breakdowns and maintenance. The vehicles should be cleaned and disinfected daily. All waste bag seals should be in place and intact at the end of transportation.

103. Grey water should be autoclaved and disinfected before discharge to the septic tank. It is important that such water is disposed of in drains connected to a septic system or sewer or in a soak away pit. If grey water is disposed of in a soak away pit, the pit should be fenced off within the health facility grounds to prevent tampering and to avoid possible exposure in the case of overflow

104. Highly infectious waste, such as diagnostic laboratory samples and waste from infectious patients in isolation, should be collected separately and autoclaved at the point of generation. Once disinfected, the waste would leave a medical area in the infectious health-care waste container.

105. Containers for infectious waste should not be placed in public areas because patients and visitors may use the containers and come into contact with potentially infectious waste items.

106. Waste bins should be located as close as possible to sinks and washing facilities, because this is where most staff will deposit gloves and aprons after treating patients. If the general waste container is closest to the sink or under a towel dispenser, it will encourage staff to place towels

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into the non-infectious receptacle. Containers should be of similar size to overcome the observed tendency for staff to put waste in the largest receptacle.

107. Where possible, hazardous waste generated in medical areas should be stored in utility rooms, which are designated for cleaning equipment, dirty linen and waste. From here, the waste can be kept away from patients before removal,

108. Wastewater from washing hands, cleaning, laundry, bathing, flush toilets and teeth brushing activities should be safely collected and treated with chlorine before being sent to sewer lines or infiltrated into a soak-away pit (providing the water table is at least 1.5 m under the bottom of the pit at any time). The potential of contamination to the sanitation crew, the general community, healthcare workers and environment is of course, of critical concern.

B.5 Designing of a wastewater treatment system

109. Wastewater generated from the laboratory if discharged directly to the environment shall contaminate soil and groundwater. Design of an adequate wastewater treatment system shall reduce such contamination.

110. The wastewater treatment system includes a septic tank and soakage pit, which will be designed and constructed based on the Code of Practice: Sri Lanka Standards 745: Part I and Part II (2004). A soakage pit as the final disposal method is appropriate as the maximum groundwater table is about 4–5 m below the ground surface.

111. Small amounts of blackwater (wastewater generated from toilets will be less than 0.5 m3/day ) will be first sent through a septic tank, and then the settled wastewater will be transferred to the soakage pit. The expected (maximum) wash water discharge (after pre- treatment) will be about 1.5 m3/day, which will be directly sent to the soakage pit.

112. The volume of septic tanks (to receive a volume of 0.5 m3/d) is 1 m3, which is the minimum volume for a septic tank specified by the SLS745.

113. The septic tank/soakage tank as the wastewater collection and disposal method is appropriate for the PCR laboratory, and no negative impacts are expected. Desludging should be done as and when needed, however, given the size of the septic tank and the small amount of blackwater generated at the laboratory, the desludging time is expected to be very long.

B.6 Designing of adequate and uninterrupted electricity, water and telecommunication facilities.

114. Any interruption of electricity, water and telecommunication facilities to the laboratory shall interrupt its operations and even cause damage to equipment.

115. The proposed PCR laboratory will be supplied by a dedicated electricity connection, water supplies and telecommunication facilities by the CEBH. There will be water storage of 1,500 l (which is sufficient for 1½ –2 days), and a standby generator (30 kVA) as backup power. Telecommunication facilities will include wired as well as wireless communication devices and services.

C. Impacts during construction

C.1 Impacts due to site preparation activities

116. Construction activities envisaged under the project can be categorized as small-scale with impacts that are localized, temporary in nature and easily manageable with good construction practices.

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117. The sub-project activities will involve the construction of the foundation and erection of the building (sandwich-panelled single-storied building for the laboratory, and the toilets/washrooms together with septic/soakage tanks. The land has already prepared and levelled. Therefore, there are no site preparation activities other than the mobilization of the work. There are no impacts and mitigation is not needed.

C.2 Impacts due to excavation, transportation and storage of construction material and disposal of packing material

118. Excavation for foundations, stockpiling of excavated material and spoil, stockpiling of construction material and construction debris etc. are all expected to give rise to increased risk of soil erosion from the sites during wet weather, especially during the month of April, when inter- monsoons and convectional rains, which are torrential in nature, are expected. Since the construction area is relatively small and limited to just one particular location, the impact is short- term and not expected to be significant. Moreover, the foundation construction will be over within a couple of days, and surface runoff is not expected to be severe as the project site is flat terrain.

119. Impact on soil could also occur due to construction machinery/vehicles operated at the site premises, as the topsoil is already removed. Soil contamination may also result from the inappropriate storage and disposal of concrete, chemicals such as paints/solvents and other hazardous material. As the nature of construction envisaged is small and the duration to be short (approx. 2–3 weeks), these impacts are not significant as the use of construction machinery and vehicles will be minimal.

120. Disposal of spoil (excess earth from excavations) with fine particles susceptible for washout) can lead to washout of loose soil/particles causing erosion and siltation of drains/waterways. Large scale excavations are not expected under the project, and hence the quantity of earth spoil requiring disposal will be very much less. Since the hospital compound is are large, the excess earth (if any) can be levelled off on-site.

Mitigation measures

(i) Removal of vegetation on-site should be restricted to the bare minimum, and a strip of vegetation (at least 1 m in thickness) should be left around the disturbed area.

(ii) Earth stockpiled on-site should be fully covered on all sides with a suitable material, and weight should be placed at the base to prevent the cover from getting displaced and exposing earth to erosion. They should be stored away from site/road drainage paths.

(iii) Drains bringing in stormwater towards the construction area should be prevented with earthen/sandbag berms during wet weather.

(iv) Construction should be scheduled in a way that earthwork such as excavations are carried out while all the preparations for foundation construction and pipe works, septic tank and soakage pit construction are ready to commence immediately after excavations are over. This will allow the backfills to be completed without delay and minimize the need to stockpile the spoil/soil for a longer duration.

(v) Use of ready mix concrete will avoid the need to bring much of the construction material such as cement, sand, metal etc. be brought to the site (thus minimizing the vehicular movements within the site premises) and providing storage space on-site. This will also avoid the need to have cement mixed on-site, which will prevent further disturbance of the exposed soil surfaces in peripheral areas, as it is now.

(vi) Oil and lubricant waste should not be buried or burnt in the project site but collected and stored in proper oil-cans and disposed for re-use or LA approved designated sites.

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(vii) All other hazardous chemicals such as paint shall be stored in a safe place that is not subjected to floods or accidental spilling. Empty paint cans will be collected and removed to an authorized dumpsite.

(viii) Packing material, polyethene, wooden debris (e.g., used for shuttering work), etc. should be properly collected, stored and the contractor should remove them from the site prior to handing over.

C.3 Impacts due to activities creating noise and vibration

121. Noise and vibration are two key impacts that may result during construction work, which will be a nuisance to hospital staff, patients and neighbourhood. Major sources of noise are the movement of construction vehicles, haulage of material, concrete mixing and other noise-generating activities (operation of cutters, drilling machines, riveting machines, compactors, poker vibrators etc.) at the site which, cumulatively, can possibly produce a noise level exceeding 75 dB.

122. The elevated noise levels will be a localized and temporary impact that will last throughout the construction period (which will be about 2–3 weeks). However, given that the worksite is close to the ETU and the operating theatre, and hospitals being sensitive receptors to impacts of noise and vibration, maximum mitigation will need to be taken to keep it under acceptable limits.

Mitigation measures

(i) Use of noisy machines should be restricted and where possible noise-reducing means for construction machines should be used.

(ii) Construction activity should be between 8.00 am to 6.00 pm daily to avoid discomfort caused by noise and vibration that for in-patients and neighbourhood.

(iii) If certain nighttime construction activities are unavoidable, it should be done using noise-reducing means or low-noise technologies.

(iv) Use of ready mix concrete will avoid the need to have manual mixers operated at the site, ready mix concrete mixer trucks and pumps can generate similar kind of noise; however, the duration will be very much shorter than manual mixing of concrete.

(v) Vehicles and equipment used in construction work should meet CEA standards for noise and vibration in Sri Lanka.

(vi) Noisy construction machines/activities should be scheduled to coincide with non-clinic and non-OPD days/times as much as possible or on days that patient visitation to the facility is minimum.

(vii) Liaising with the hospital authorities of the work schedules is always advisable. Prior notices of noise generating activities will avoid confusions of among hospital authorities and the contractor.

C.4 Impacts due to activities creating emissions and impacts on air quality

123. Air quality within the sites will suffer temporarily due to fugitive dust generation from excavation, construction, stockpiling and transporting activities. The impact will be localized and minor because the proposed site is located at the backyards of the clinics, and the premises are not often visited by hospital staff and/or patients. Small amounts of dust can fall within the clinics which are located on the western direction of the site (about 50–75 m away).

124. The impact on the neighbourhood is also minimal as well because the hospital boundary has a high wall (about 10feet high), and the houses across the adjoining road are well-shielded. Increase in gaseous emissions such as CO2, NOx, and SO2 from construction machinery and vehicles will be minor to make a serious impact on the air quality.

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Mitigation measures

(i) The louvres of the ETU, operating theatre and the clinic can be temporarily covered with polythene sheets until the construction work is over.

(ii) The site should be cleaned daily, especially surfaces that are affected by soil and dust.

(iii) Regular watering (at least twice a day during the mid-morning and mid-evening) should be carried out in the construction site for dust suppression.

(iv) Excavated soil that is temporarily stored on-site should be covered in a tarpaulin or other locally sourced suitable material to prevent from dust particles getting airborne.

(v) Where possible, construction stockpiles and debris piles should be stored away from the functional areas of the hospital.

(vi) During transportation trucks carrying earth, spoil (if any) or construction material to and from the sites should be covered by a tarpaulin. Speed controls must be imposed on construction vehicles from about 500 m away from the site.

C.5 Impacts due to activities that affect surface and groundwater quality and quantity (use of water by workers and disposal of wash/kitchen wastewater)

125. Construction work is commonly known to cause blockages in drains (both natural and man-made) leading to localized flooding and water stagnation. Impedance to drainage is often a result of poor site management and mishandling of construction material/debris. It is important to identify the drain paths within the hospital that discharges storm-water outside and to ensure that these as well as the lead away drains are kept clear of debris for water to flow freely. Stagnant water also carries the risk of mosquito breeding.

126. Construction wastewater from concrete work and equipment washing can potentially pollute water sources, both ground and surface. Any contamination that occurs either directly through over-land surface runoff during rainfall or indirectly through contaminated soil can lead to the washing away of construction waste. Construction wastewater that ends up in the roadside drainage adjacent to the hospital can eventually lead to wetlands, paddy fields or surface streams in both hilly and flat terrain. Given the scale of construction planned, this is not considered a very serious impact, nevertheless requires mitigation.

Mitigation measures

(i) Maintain cross drainage within site always during construction. Hence stockpiles and debris must be safely stored away from these drainage paths.

(ii) Where blockage of drainage is unavoidable, alternative paths must be created to facilitate stormwater flows from the site to outside.

(iii) Lead away drains that collect water from the internal drainage system of the nearby three building (ETU, operating theatre and the clinic – See Figure 5.5) must be kept clean and free from any constrictions to ensure a smooth flow of stormwater.

(iv) The construction ground/s should be checked daily (after wet weather) for any signs of water stagnation and cleaned.

(v) A washing area for construction equipment should be delineated within hospital premises away from the construction area

(vi) Wastewater from the construction site should not be directly discharged into roadside drains. It should be first directed to a pit to allow siltation and percolation before connecting to a lead away drain.

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C.6 Impacts due to migrant labourers and operation of labour camps

127. A large labour force is not expected to be required for project purposes and as such large labour camps having significant impacts are not anticipated. However, basic mitigation measures will be taken in managing labour.

Mitigation measures

(i) Local labour should be recruited as much as possible to minimize social consequences of migrant labour and to provide livelihood opportunities to the local community.

(ii) Labourers/workers should be provided with adequate sanitation facilities and receptacles for garbage collection.

(iii) Domestic solid waste collected should be disposed of daily at a site given to them.

(iv) Burying and burning domestic waste in the project sites should also be strictly avoided

(v) A good supply of drinking water should be provided to the labour camps.

C.7 Impacts due to hazardous working conditions (accidents to workers and the public)

128. Occupational health and safety are one of the key risks of the project to be addressed. The scale of construction is small, and the risks are not significant. There will be no large machinery or equipment needed for construction purposes. Scaffolding will be limited as the building is only a single stories building.

129. Public safety issues concerning the hospital staff and the patients who visit the hospital daily are also not significant. This impact is minor because the proposed site is located at the backyards of the clinics, and the premises are not often visited by hospital staff and/or patients.

Mitigation measures

(i) The construction site should be delineated from the rest of the hospital, preferably using barricading tape or any other suitable material that separates the construction area from the rest of the hospital physically.

(ii) A safe pedestrian pathway to the hospital buildings should be provided if regular access along with the nearby gate and the hospital access road is blocked.

(iii) Concrete mixer trucks or any other trucks/construction vehicles should not be parked outside the hospital premises, as the road is narrow.

(iv) Delineation devices such as cones, lights, tubular markers, barricades tapes, warning signposts, etc. should be erected to inform hospital users about work zones.

(v) Dangerous warning signs should be raised to inform public of dangers and to keep them away from such hazards.

(vi) Appropriate safety equipment, tools and protective clothing should be provided to workers, and the contractor must ensure that safe working methods are applied.

(vii) The constructors should carry out suitable training programs on occupational health and safety for workers

(viii) Machinery and equipment that could easily electrocute should be kept safely within site and always under the supervision of an experienced worker.

C.8 Impacts due to site clearing (at the end of construction) and landscaping

130. Two additional works are needed at the hospital premises, though they are not parts of the sub-project activities or interventions.

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1. Providing proper drainage network to the areas peripheral the PCR laboratory, which will also prevent flooding of the low-elevation areas of the hospital premises, avoid soil erosion in the sloping areas. The suggested intervention is provided in Figure 5.5c.

131. However, it has to be noted that there are sewerage lines and septic tanks located at backyards of the three buildings. There is a 3-phase electricity line running parallel to the back boundaries of the buildings. Any stormwater drain should not damage the septic tanks and should not shift the electricity lines.

Figure 5.5a: Rainwater drainage from the three buildings are directed towards the western part of the hospital premises

Figure 5.5b. The septic tanks and the electricity line should not be disturbed when a rainwater drain is constructed

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Figure 5.5c: Proposed drainage network for the premises

132. As shown in Figure 5.5c, all the six lead away drains (marked as 1) which brings in rainwater from roof gutters and downpipes of the three buildings (clinic, ETU and the operating theatre) should be collected into one canal running parallel to the rear boundaries (marked as 2) of the buildings and should be constructed to intercept all the six drains. This drain (marked as 2) should then be connected to a cascading drain constructed down the slope along the side of the access road (marked as 3). The rainwater gutters of the PCR laboratory (marked as 4) can be connected to the roadside drain (marked as 5) of the access road that is being constructed. The confluence of drain 3 and 5 can be directed to the other side of the hospital ((though a drain marked as 6) premises through a culvert constructed across the access road.

2. Turfing the area, providing permeable pavement surfaces for parking lots, and landscaping with shady trees. This will prevent soil erosion of the peripheral areas of the sub-project.

C.9 Impacts on biological resources

133. The proposed PCR laboratory is not located within an ecologically/biologically sensitive area. The only impact to biological resources will be felling of a few trees to make way for the proposed infrastructure, which has been covered under pre-constructional impacts.

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D. Impacts during the operational stage of the PCR Laboratory

D.1 Generation and disposal of wastewater generated from the PCR laboratory

134. The wastewater treatment system includes a septic tank and a soakage pit. A soakage pit as the final disposal method is appropriate as the maximum groundwater table is about 4–5 m below the ground surface. Small amounts of blackwater will be first sent through a septic tank, and then the settled wastewater will be transferred to the soakage pit. The wash water will be directly sent to the soakage pit.

135. The septic tank/soakage tank as the wastewater collection and disposal method is appropriate for the PCR laboratory, and no negative impacts are expected. Desludging should be done as and when needed, however, given the size of the septic tank and the small amount of blackwater generated at the laboratory, the desludging time is expected to be very long.

D.2 Generation and disposal of HCW

Impacts:

136. Types of waste generated in PCR Labs are as follows:

• Sample container ( Infectious) - Plastic / Mettle / Cardboard • Biological Sample - Infectious • Waste from Extraction kits -Plastic / Cardboard • Before use - Non-infectious • Used - Infectious • Chemical / reagent • Pipette tips - Infectious • PCR plates / Tubes/ PCR products - Infectious

• Personal protective equipment - mask, disposable garments, disposable shoe cover, gloves • Wastewater from wash basins • Used paper towels • Non-infectious clean paper/ cardboard / plastic • Waste from dining room • shape waste - needles/ blades • Waste after cleaning the lab ( floor) • Water waste from washroom

137. As mentioned above, many types of additional medical and hazardous waste are generated, including infected masks, gloves and other protective equipment, together with a higher volume of non-infected items of the same nature.

138. The large component of non-hazardous health-care waste is similar to municipal waste and should not pose any higher risk than waste produced in households. It is the smaller hazardous health-care waste component that needs to be properly managed so that the health risks from exposure to known hazards can be minimized.

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139. Excreted pharmaceuticals from patients do find their way into waterways, which can contribute to potentially serious environmental effects, including toxicity to wildlife and the generation of antibiotic resistance in bacteria

140. Medical and sanitary staff can be at risk of respiratory or dermal diseases caused by exposure to chemicals and pharmaceuticals.

Mitigation:

141. To minimize any kind of occupational risk, less hazardous chemicals should be substituted whenever possible and protective equipment provided to all personnel likely to be exposed. Buildings in which hazardous chemicals are used should be properly ventilated, and personnel handling hazardous materials should be trained in preventive measures and emergency care in case of accident.

142. Hospital and the lab should derive a benefit from introducing and implementing an environmental management systems. These benefits include cost reductions through reduced energy consumption, reduced quantities of waste, increased recycling, and minimized negative impacts on the environment from waste handling and treatment, and an improved public image.

D.3 Possible contamination of infections by laboratory staff

Impacts:

143. Occupational exposures to blood, body fluids, or laboratory specimens containing HIV, and were considered possible cases of occupationally acquired HIV infection. The infections caused by percutaneous exposure occurred through the following pathways:

• hollow-bore needles • broken glass vials • scalpel • other waste generated in the lab

144. The highest rates of occupational injury among all workers exposed to health-care waste are reported by cleaning personnel and waste handlers. The most numerous work-related injuries among health-care workers and waste collectors are sprains and strains caused by lifting and overexertion, and not from the hazardous components of health-care waste.

Mitigation:

145. The following are proposed as mitigation measures:

• Ensure yellow bags are properly closed and tied with an overhand balloon knot so that they are leak proof before being moved. • Yellow bags should be placed in a container with a secure lid.

• All sharps containers should be fully closed and placed in a bag and then in a container. Preferably, single-use disposable sharps containers should be used in place of reusable sharps containers.

• Single-use gloves (nitrile or latex) and gowns should be discarded after each use and not reused

• All who handle health care waste should wear appropriate PPE (boots, apron, long-sleeved gown, thick gloves, mask, and goggles or a face shield) and perform hand hygiene after removing it. Careful and continuous use of the relevant health & safety equipment (gloves, masks etc.) – an important measure here is to make sure that the workers are removing masks and gloves without getting in contact with them, usually this means with

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the help of someone else. Protective equipment for eyes is also very useful for avoiding coronavirus infections. • Frequently touched surfaces throughout the reception area should be cleaned regularly. • Bathrooms should be cleaned and disinfected at least once a day.

• Well trained permanent h are responsible from packaging waste to transport for treatment facilities.

• Each bag must be hand tied by gathering and twisting the neck of the bag and using a tie or hand knot to secure the bag, and each container must be securely closed.

• Closed bags must not be visible once a secondary container (box or reusable tub) is closed.

• Improperly packaged containers or damaged containers will be denied pick up until packed them properly.

• Bins used for disposing infectious waste must be disinfected prior to reuse by any means effective for the infectious substance the container previously contained. • Direct contact (without gloves) with bins or bags should be avoided in any case.

• Uniforms should be daily changed - cleaning of work clothes and shoes is minimizing the possibility of dispersing the virus in the air – make sure not to shake clothes – wash them at a temperature of at least 60 ° C with common detergents, add disinfectants if possible.

• Put a disposable set of gloves, on a daily basis, in direct contact with skin, before wear usual work gloves. • Frequent hand-washing and increased cleaning in workers’ facilities is a must

D.4 Breakdown of power, water and telecommunication facilities

146. The proposed PCR laboratory will be supplied by a dedicated electricity connection, water supplies and telecommunication facilities by the CEBH. There will be water storage of 1,500 l (which is sufficient for 1½ –2 days), and a standby generator (30 kVA) as backup power. Telecommunication facilities will include wired as well as wireless communication devices and services.

147. Therefore, the chances of a breakdown of power, water and telecommunication facilities will be remote. The only concern is the breakdown of power, for which a contingency plan will be devised, secure temporary generators until the power supply is restored. However, if any samples, reagents, cultures, etc. need to be removed due to unavailability of air-conditioning or chilled/cooling, such material will be transferred to suitable locations without delay.

33 VI. Consultation, Participation and Information Disclosure

A. Consultation and participation during project preparation

148. Meaningful stakeholder consultations have been held during project preparation and will continue throughout project implementation. Stakeholders consulted during the preparation of the sub-project include officials of the MOHIMS, provincial health services, key experts on laboratory methods for diagnostics and virologic testing, especially PCR testing. Stakeholder consultations allowed opportunities to incorporate needs/views of the stakeholders in the final sub-project design and mitigation measures, raise implementation issues and enhance the ‘ownership of the project’. Meaningful stakeholder involvement and participation in decision making contributes to project sustainability.

149. Along with field assessments carried in preparation of this IEE, the team carried out individual studies with the objective of (i) understanding the viewpoints of hospital staff and the public on the need for increased need for PCR testing, (ii) regarding current practices of handling and managing hazardous health care waste and wastewater, as well as challenges faced with regard to the availability of infrastructure services, and (ii) respond to their concerns and suggestions during the early stages of the project thereby reducing any objections towards the project, incorporate any valuable suggestions by the public into the design in order to reduce any adverse impacts to the environment

150. The key stakeholders to be consulted during project implementation and subsequent operations include the Director and the staff of the CEBH, the staff of regional and provincial health services, other government bodies. The consultation process carried out so far has solicited views and information from medical and nursing staff of CEBH, the staff of the regional/provincial directorates of health services. The information thus obtained, where relevant, has been incorporated into the IEE.

B. Information Disclosure

151. While stakeholder consultations will be the main source of information disclosure, the PMU will ensure that environmental safeguards documents prepared in support of project implementation such as IEEs, HCWMPs and monitoring reports are disclosed via its website. In addition, the PMU will take necessary steps to make these documents available in appropriate locations, in a manner that is timely and in a language that is understood by local community/affected people for those who do not have access to the internet. The PMU will also send a written endorsement to ADB for disclosing these documents on the ADB website.

34 VII. Grievance Redress Mechanism

152. A project-specific grievance redress mechanism (GRM) will be established to receive, evaluate, and facilitate the resolution of affected person’s (AP’s) concerns, complaints and grievances about the social and environmental performance at the level of the project. It is important that the GRM is established before any site works commence.

153. The objective of the GRM is to provide a timely and transparent mechanism to raise and find a resolution to social and environmental issues arising out of the project. While the following institutional mechanism is recommended for project-specific grievances, it will not replace, override or bypass other GRM systems that exist at the government/community level but provide another route through which concerns of affected parties can be swiftly addressed.

154. The proposed mechanism will have three tiers at different levels linked to the project’s implementation hierarchy.

(i) Tier 1: Director of Colombo East Base Hospital (CEBH) will be the first level to resolve grievances. The Director of the CEBH will be the focal point for grievance redressal.

a) On receiving a grievance, the Director will (i) Enter the grievance in the Complaints Register, (ii) open a grievance file for the specific case and (iii) close the grievance filing a closure sheet that will be signed by the complainant agreeing that the concern has been satisfactorily resolved.

b) Grievances will be attended to within a week based on on-site investigations and consultations with relevant parties. All grievances will be properly recorded with personal details unless otherwise requested.

(ii) Tier 2: Project Management Unit (PMU) of the Health Sector Enhancement Project (HSEP) will be the second level to resolve grievances. The Project Director (PD) or Deputy Project Director (DPD) will be the focal point for grievance redressal. The PD/DPD in consultation with the Environmental Specialist of the PMU will activate the second level for those grievances that are not resolved at tier 1. This tier will consist of a Grievance Redress Committee (GRC), the composition of which will be decided by the PD. The Environmental Specialist of the PMU will be responsible for processing and placing all papers before the GRC.

155. The GRC must be appointed and established before the commencement of site works. The written grievance will be forwarded to the GRC who will call a hearing, if necessary, with the complainant. The process will facilitate resolution through mediation. The GRC will meet as required and direct the field level with clear instructions and responsibilities to attend to the agreed actions within two weeks of the meeting. The contractor will sit in the GRC as an observer.

(iii) Tier 3: If a grievance cannot be resolved directly by the first two tiers, the affected person can seek alternative redress through other means such as the Government’s judicial system.

156. It is important to ensure that the project’s mechanism for grievance redressal is widely disseminated to the public and other affected stakeholders through (i) public consultation meetings (ii) media advertisement (iii) locally erected notices and other means.

35 VIII. Institutional Requirements and Environmental Monitoring Plan

A. Implementation arrangements

157. The MOHIMS will be the implementing agency through the PMU of the Health Sector Enhancement Project (HSEP). A national project steering and coordination committee chaired by the Secretary, MOHNIM will provide policy direction to the project. The PMU, headed by a Project Director (PD), will be responsible for the overall coordination, management, administration, and project implementation and monitoring.

158. Within the above structure planning, implementation and supervision of environmental safeguards will take place at three levels:

(i) Ministry of Health and Indigenous Medical Services (through the PMU) – The overall responsibility of ensuring compliance with the EMP and monitoring plan will be borne by the PMU of the Health Sector Enhancement Project (HSEP). It will be supported by a part-time environmental consultant who will ensure that the EMP is finalized (based on final layouts and designs) and included in the bid documents, provide awareness to the contractor, monitor EMP implementation, coordinate with the Director, CEBH, attend to grievances and prepare monitoring repowers as required.

(ii) Provincial Ministry of Health/Provincial Directorate of Health Services (through local PIUs) - The responsibility of day to day planning, implementation and supervision of environmental safeguards specific to sub- projects will be borne by the PIUs. An engineer will be appointed as the focal point for coordinating with the environmental specialist of the PMU on monitoring and reporting. Specific formats for monitoring and reporting will be prepared by the environmental specialist and shared with the PIUs.

(iii) Contractor – Implementation of EMPs will largely be the contractor’s responsibility (apart from those provisions relating to technical designs and other specified tasks indicated in the EMPs), and for this, the contractor will nominate a site engineer as the focal person who will be directly responsible for ensuring compliance with the EMP during construction.

B. Environmental Management Plan

159. The impacts and mitigation measures discussed in chapter V has been summarized into an environmental management plan, which as presented as Annex 3 of this IEER. This EMP is inline with the requirements as stipulated in paragraph 82 of the EARF (i.e. to include a comprehensive EMP in the IEE report).

C. Environmental Monitoring Plan

160. An environmental monitoring plan has been developed to monitoring the implementation of EMP. This environmental monitoring plan is presented as Annex 4 of this report.

36 IX. Conclusion and Recommendations

A. Conclusion

68. The field visits conducted observed that the proposed site for establishment of the PCR Laboratory within the Colombo East Base Hospital is not located within or adjacent to areas that are ecologically or environmentally sensitive. The proposed plot is a bare land located towards the north-eastern boundary of the hospital located at the backyards of the Clinic, ETU and the Operating Theatre premises. The site is flat; however, the peripheral area has a mild slope towards the north-easterly direction.

69. It is evident that most of the environmental issues during the construction phase is related to localized and temporary impacts such as (i) elevated levels of dust, noise, vibration, (ii) pollution due to solid waste disposal including potentially hazardous components such as discarded construction material, construction wastewater and operation of labour camps, (iii) onsite drainage impairment, (iv) soil erosion and potential for alteration of surface drainage patterns, and (v) risk of occupational health and safety for construction workers. All these impacts can be minimized and mitigated with the adequate implementation of the provisions given in the EMP.

70. As documented in the IEE, the current practice of hazardous health care waste management in the hospitals is inadequate and unhygienic. While a good attempt is made at segregating waste according to category at the point of generation, the segregation is not maintained throughout and finally the waste is open burnt. With the increased collection of clinical and infectious waste once the PCR laboratory is established, is bound to increase raising the risks for public health and environment.

71. Findings of the IEE confirm that the positive impacts of the project far outweigh any negative impacts arising out of establishing the proposed PCR Laboratory. None of the environmental impacts identified are irreversible and widespread, rather they are localized, temporary in nature. With good site management and safety practices, these impacts can be effectively managed. Stakeholder consultations reveal that the demand for increased number of testing is needed to combat the COVID-19 pandemic in the country. As such the project will be a positive step towards providing better health services to the country as well as prepare the country to face emerging health sector challenges successfully in the coming decades.

B. Recommendations

72. Therefore, the IEE recommends that:

(i) Health care waste management be given priority and proper strategies to be developed and implemented to manage the issue as well as to build capacity and awareness within hospital staff for HCWM. The hospital has to implement an appropriate way of waste HCWM without delay.

(ii) It is required to do a detailed waste audit in each and every unit of the hospitals to identify waste quantities generated, characterization, need for management, appropriate equipment/technology and associated costs. Without such basis information, it is difficult to assess the need and introduce sustainable healthcare waste management system.

(iii) Short and long term healthcare waste management plans need to be established at institutional level. There is an urgent need to implement the HCWM action plan, and scale up healthcare waste management, by preparing HCWM plans for each facility, setting up of monitoring procedures, and strengthening capacity at all

37

hospitals.

(iv) It is required to have a financial assistance along with technical guidance for installing sustainable technology for the management and disposal of healthcare waste at the hospital premises.

(v) A proper sewer disposal system by installing a septic tank and a soakage pit is needed.

(vi) The proposed PCR laboratory to be supplied by a dedicated electricity connection, water supplies and telecommunication facilities by the CEBH. Additional water storage, and a standby generator as backup power are needed.

(vii) Implementation of the EMP and the EMoP is essential to make sure that any environmental impacts are effectively mitigated.

38

ANNEX 1: ENVIRONMENTAL CHECKLIST USED FOR THE SCREENING OF EACH SITE

Environmental Screening Checklist

Instructions: Answer the questions assuming the “without mitigation” case. The purpose is to identify potential impacts. Use the “remarks” section to discuss any anticipated mitigation measures.

Name of sub project: Construction of a new PCR laboratory at Colombo East Base Hospital, Mullariyawa

Basic Information on the Health Care Facility (HCF) • Name of the HCF Colombo East Base Hospital • Location • Western Province • Colombo District • Kolonnawa Divisional Secretariat Division • Type of HCF Base Hospital - B • Number of beds and bed occupancy rate Around 400 (Occupancy Rate: 70–100%) • No of outpatients a day 800–1,000 • No of staff 250 • Proposed rehabilitation interventions A new PCR laboratory for an existing Base Hospital • Contact person in the HCF Dr. Priyantha Weerasinghe, Director

PART I B. General construction-related impacts Screening Questions Yes No Remarks C. Project screening Is the project site within or adjacent to any of the following areas: • Densely populated area X The new laboratory shall be constructed • Cultural heritage site X within the existing base hospital. • Protected Area X • Wetland X • Mangrove X • Estuarine X • Buffer zone of protected area X • Special area for protecting biodiversity X D. Potential Environmental Impacts Will the project involve or cause… Encroachment on historical/cultural areas? X Encroachment on precious ecology (e.g. X sensitive or protected areas)? Unsatisfactory raw water supply X The hospital obtains water from the Conflicts in abstraction of water with other X NWSDB. There is no abstraction of water. beneficial water uses of the same sources Over pumping of groundwater X Increase in production of general solid waste X General waste production will be increased once more staff occupied. Increase in production of hazardous waste X Sample container (Infectious), Biological Sample. Waste from Extraction kits, Chemical / reagent, Pipette tips, PCR plats / Tubes/ PCR products, Personal

39 Screening Questions Yes No Remarks protective equipment- mask, disposable garments, disposable shoe cover, gloves, Waste water from wash basins, Used paper towels, shape waste - needles/ blades, Waste after cleaning the lab ( floor) and Water waste from washroom will be increased Increased sewage flow X Depend on the number of staff will be increased Generation of sludge from waste treatment X Sludge will be generated from toilets, plants sinks and floor and other equipment cleanings Use of or dismantling of structures that X contain Asbestos Noise and dust from construction activity? X Dust emissions can occur until the site premises is turfed or paved. Noise generation is not significant due to small- scale construction. Soil erosion and silt runoff from construction X Soil erosion and silt runoff can occur until activity? the ground surface that is exposed to surface runoff is turfed. Accident risks associated with increased X Vehicular movement signage shall be vehicular traffic? provided at the site. All construction vehicles shall not be allowed to move outside of the demarcated construction area. Increased noise and air pollution resulting X Only during construction, the duration from increased traffic volume? which is very short (approx. 2 weeks). A dedicated entrance shall be provided to the new laboratory. Risks and vulnerabilities related to X Due to the nature of small-sale occupational health and safety due to physical construction, risks and vulnerabilities hazards during project construction and related to occupational health and safety operation? due to physical hazards during project construction is minimal. During operations, risks and vulnerabilities related to occupational health and safety are high unless precautions are taken to avoid/mitigate such impacts. Providing proper training and appropriate PPE, establishing strict rules and practices for hazardous and clinical waste management, and maintaining and strict adherence to standard industry practices are needed. Requirements for disposal of fill, excavation, X Filling of the site is not needed. A small and/or spoil materials? amount of spoil will be generated due to excavations for foundations and septic/soakage tanks. This material can be used as backfill, and the rest can be levelled and compacts in the peripheral areas. Loss of large trees (more than 30 cm DBH); There are four trees that need removal. how many? (Three Hik trees and one Kenda Tree).

40 Screening Questions Yes No Remarks One of the Hik trees (DBH: 450 mm) has two large hollows in its trunk and is likely to fall at any time. Removal of these trees is needed to ensure the safety of the building. Long-term impacts on groundwater flows as X result of needing to drain the project site prior to construction? Long-term impacts on local hydrology as a X A stormwater drainage plan shall be result of building hard surfaces in or near the included in the designs, and the building? collected stormwater shall be diverted to the existing drainage network of the hospital. Large population influx during project X As this is small-scale construction work construction and operation that causes involving erection of a pre-fabricated increased burden on social infrastructure and building, the labour required will be 10– services (such as water supply and sanitation 15, and the duration of construction is systems)? very short (approx. two weeks). There will be 8-10 staff those who will be working at the new laboratory facility. Risks to community safety caused by fire, X The new building will be constructed electric shock, or failure of the buildings safety within the hospital premises, as a features during operation? detached unit – about 50 m away from the nearest building. There is no risk to community safety. Risks to community health and safety caused X Mismanagement of waste and ad-hoc by management and disposal of waste? dumping are characterized by the scattered, uncontrolled deposit of wastes at a site. It is a practice that almost always leads to acute pollution problems, fires, higher risks of disease transmission and open access to scavengers and animals. Health-care waste should not be deposited on or around uncontrolled dumps. The risk to people and animals coming into contact with infectious pathogens or hazardous materials is obvious, with the further risk of subsequent disease transmission through direct contact, wounds, inhalation or ingestion, as well as indirectly through the food chain or a pathogenic host species Procurement of x-ray machines or any other X equipment containing radioactive material Procurement of incinerators? X It should be a double chamber incinerator where temperature reach at least 1,200 C Is siting and/or routing of the project (or its X components) likely to be affected by climate conditions including extreme weather-related events such as floods, droughts, storms, landslides?

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Part II

Health care waste assessment (for the proposed PCR laboratory)

Generation

Source Waste type11 General Sharps Infectious Chemical Pathological Pharmaceutical OPD Medical ward Surgical ward Theatre ETU Laboratory 30.7 0.5 Pharmacy/ Drug store Labor room Other kg/day 30.7 0.5

11 Sharps: items that could cause cuts or puncture wounds, including needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws, broken glass, and nails; Pathological waste: consisting of tissues, organs, body parts, human foetus and animal carcasses, blood, and body fluids; Infectious waste: suspected to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts. Chemical waste: consists of discarded solid, liquid, and gaseous chemicals, used for diagnostic and experimental work and for cleaning, housekeeping, and disinfecting procedures; Pharmaceutical waste: expired, unused, spilt, and contaminated pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to be disposed of; Radioactive waste: waste that contains radioactive material.

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Waste Segregation

Questions Yes No Description Is clinical waste segregated from general  No segregation waste? If yes, into which categories are HCW separated?  General waste  General Infectious waste  sharps  Pathological waste  other Where does the segregation take place? Segregation is done within the unit, What type of bags/primary containers Bags are used according to the standard color code, Wheeled, are used in segregating wastes? paddled primary containers with lids are used according to the color code and required sizes What type of labeling/color coding is According to the standard color code used in segregation What types of equipment are used for Different carts are used as per the standard color code internal transport of wastes? Where is the segregated waste stored In different storerooms as per the standard color code until final disposal? Describe the final disposal method Sharps Incineration Infectious waste Incineration Pathological waste Incineration General waste Food Waste – send to piggery farm Recyclable Waste – recyclers Mixed waste – Local Authority Garden Waste – open burning Other: COVID 19 Open burning at the hospital premises patients treated waste

Waste handling and Treatment

Equipment Yes No Description/ Location (within Status (used/ functioning Capacity/ Number hospital or or not) of units nearest facility with approximate distance) Incinerator  It has been shifted to waste park Metamizer  Autoclave Mini autoclaves are Functioning available Lined burial pits  Unlined burial pits  Impossible to get data due to staff’s hectic duty schedules Waste cards Colour coded waste  Unable to get data and bins observe due to COVID 19 pandemic Waste storage space  Four chambers Corner of the Functioning hospital

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Waste handling

Questions Yes No Remarks Is there a designated person (s) responsible for  Infectious Control Nursing Officer is organization and management of waste collection, designated handling, storage, and disposal at the hospital administration level? Does the waste management staff have job  Job description is available descriptions detailing their tasks? Has he/she received any training on hospital waste  During the infectious control training, basic management? waste management also covered. Are there clearly defined procedures for collection  Collection procedures and timetables are and handling of wastes from specified units in the available hospital? Does your hospital have a written Waste  Waste management plan is developed Management Plan? Are waste handlers provided with adequate  PPEs are provided. Sanitary workers are personal protective equipment (PPE) not always following the guidelines.

Water supply and sewerage

Questions Yes No Remarks Does the hospital have a sewer treatment plant? If  It is available 700 m away from the hospital not, is it disposed to on-site soakage pt.? premises. If a sewer treatment is available, when was it built? 1970 Does the HCF have a water supply provided by  National Water board drinking water scheme? Is the water treated?  Is the water supply adequate?  Does the HCF have Reverse Osmosis units for  treating raw water supply?

Screening decision and recommendation

Sub project A B - X C All potentially adverse effects can be classified as general construction related impacts and are mitigatable with known technology. Standard clinical waste management practices shall be adopted for storage and disposal of clinical waste. Public concern does not warrant further assessment. THEREFORE, AN INITIAL ENVIRONMENTAL EXAMINATION WITH EMP WOULD SUFFICE. EIA Any other Recommendations for - Waste segregation should be done at each chamber of the lab. improving health care - Waste audit need to be done in each section of the hospital. waste management - All waste should be disinfected before transport to central storage facility at the hospital premises - All health care waste produced during the care of COVID 19 patients should be collected safely in designated containers and bags, treated, and then safely disposed of or treated, or both, preferably onsite. - Wastewater from washing basins, floor cleanings, toilets need to be disinfected and autoclaved before discharge to pits

44

- Waste generates from COVID 19 patients should not burn in open environment. Waste can be autoclaved and transported to incinerator until an incinerator is established at the hospital premises. - HCWM training need to be provided to each category of staff - Garden waste should not be burn. - It is required to locate a place for parking and cleaning waste collection carts and waste bins - Preparing policy documents or guidelines for purchasing environmental friendly products for day to day activities can help to reduce overall impact on the environment, provide healthier conditions for patients, staff and community by switching to less hazardous materials (e.g. solvents, cleaning fluids, plastic brooms etc), and lower the costs related subsequently to waste disposal - Need to apply and obtain Scheduled Waste License - Wastewater from sinks should not discharge to the open environment. - Pedal-operated waste collection bins with liners should be available at point of use in healthcare facilities as the preferred choice. In the absence of pedal- operated waste bins, bins with swinging lids can be opted as the alternative. Otherwise, open waste containers are better than those which require physical opening/covering by hands. Collection bins need to be provided according to the national color-code for waste segregation. Waste bin coding/labelling is key to identify infectious healthcare waste and home-based materials to prevent infection. Waste bin liners should also be procured. - Waste record keeping is important to understand how much waste is generated per day. - Storage location to cater for large volumes, transport mechanism in decontaminated trucks and final disposal arrangements through incineration and autoclaves should be arranged in advance. - Pit burning with the aid of fuel drops such as kerosene cannot be recommended in the absence of incinerator and autoclave. - Train waste handlers and sanitation crew on donning/doffing PPEs, decontamination, Infection Prevention and Control (IPC) measures - Ensure the safe collection, treatment and final disposal of patient feces and wastewater from screening and treatment HCFs. - Ensure availability of clean and adequate toilets or latrines, dedicated for assigned medical/non-medical staff who are working in the lab • - Use chlorine solution to pre-treat wastewater from washing hands

Details of person conducting screening

Screening checklist completed by Date April 10, 2020 Jagath Manatunge, Environmental Specialist HMCL Jayawardhana, HCWM Specialist Signature Name/ Designation/ Contact information

Screening report reviewed and approved by Date

Name/ Designation/ Contact information Signature

45

Annex 2: Layout of the Colombo East Base Hospital Premises and the location for the proposed PCR laboratory

46

Annex 3: Environmental Management Plan

Implementation Monitoring

No Activity/Env. impact Mitigation measures Costs

responsibility responsibility

Pre-construction stage

1 Clearing of vegetation Clearing of vegetation is not needed. The No cost is N/A N/A

and ground preparation land has already prepared and levelled. involved

Therefore, there are no site preparation

activities other than the mobilization of the

work. Mitigation is not needed.

2 Removal of large trees Plant at least three trees each to compensate SLR 10,000 Director/CEBH PMU

for the loss of each tree. Trees can be planted

along the newly built access road and as part

of the landscaping of the hospital premises.

Trees such as jackfruit, breadfruit, mango,

jambu, guava, are some of the species that

are preferred. Trees such as teak, mahogany,

mee, ehala are also recommended.

Construction stage

3 Impacts due to (i) Earth stockpiled on-site should be fully This item has Contractor PMU

excavation, covered on all sides with a suitable already been

transportation and material, and weight should be placed at absorbed into

storage of construction the base to prevent the cover from the cost of the

material (including getting displaced and exposing earth to project.

containers) and disposal erosion. They should be stored away

of packing material from site/road drainage paths.

(ii) Drains bringing in stormwater towards

the construction area should be

prevented with earthen/sandbag berms

during wet weather.

(iii) Construction should be scheduled in a

way that earthwork such as excavations

are carried out while all the preparations

for foundation construction and pipe

works, septic tank and soakage pit

1

construction are ready to commence immediately after excavations are over. This will allow the backfills to be completed without delay and minimize the need to stockpile the spoil/soil for a longer duration.

(iv) Use of ready mix concrete will avoid the need to bring much of the construction material such as cement, sand, metal etc. be brought to the site (thus minimizing the vehicular movements within the site premises) and providing storage space on-site. This will also avoid the need to have cement mixed on-site, which will prevent further disturbance of the exposed soil surfaces in peripheral areas, as it is now.

(v) Oil and lubricant waste should not be buried or burnt in the project site but collected and stored in proper oil-cans and disposed for re-use or LA approved designated sites.

(vi) All other hazardous chemicals such as paint shall be stored in a safe place that is not subjected to floods or accidental spilling. Empty paint cans will be collected and removed to an authorized dumpsite.

(vii) Packing material, polyethene, wooden debris (e.g., used for shuttering work), etc. should be properly collected, stored and the contractor should remove them from the site prior to handing over.

4 Impacts due to (i) Use of noisy machines should be This item has Contractor PMU activities creating restricted and where possible noise- already been noise and vibration reducing means for construction absorbed into the machines should be used. cost of the project. (ii) Construction activity should be between

2

8.00 am to 6.00 pm daily to avoid discomfort caused by noise and vibration that for in- patients and neighbourhood.

(iii) If certain nighttime construction activities are unavoidable, it should be done using noise-reducing means or low-noise technologies.

(iv) Use of ready mix concrete will avoid the need to have manual mixers operated at the site, ready mix concrete mixer trucks and pumps can generate similar kind of noise; however, the duration will be very much shorter than manual mixing of concrete.

(v) Vehicles and equipment used in construction work should meet CEA standards for noise and vibration in Sri Lanka.

(vi) Noisy construction machines/ activities should be scheduled to coincide with non- clinic and non-OPD days/times as much as possible or on days that patient visitation to the facility is minimum.

(vii) Liaising with the hospital authorities of the work schedules is always advisable. Prior notices of noise generating activities will avoid confusions of among hospital authorities and the contractor

5 Impacts due to activities (i) The louvres of the ETU, operating This item has Contractor PMU creating emissions and theatre and the clinic can be already been impacts on air quality temporarily covered with polythene absorbed into sheets until the construction work is the cost of the over. project. (ii) The site should be cleaned daily, especially surfaces that are affected by soil and dust.

3 (iii) Regular watering (at least twice a day

during the mid-morning and mid-

evening) should be carried out in the

construction site for dust suppression.

(iv) Excavated soil that is temporarily

stored on-site should be covered in a

tarpaulin or other locally sourced

suitable material to prevent from dust

particles getting airborne.

Where possible, construction stockpiles (v) and debris piles should be stored away

from the functional areas of the

hospital.

During transportation trucks carrying (vi) earth, spoil (if any) or construction

material to and from the sites should be

covered by a tarpaulin. Speed controls

must be imposed on construction

vehicles from about 500 m away from

the site.

6 Impacts due to activities Maintain cross drainage within site This item has Contractor PMU (i) that affect surface and always during construction. Hence already been

groundwater quality and stockpiles and debris must be safely absorbed into the

quantity (use of water by stored away from these drainage paths. cost of the project.

workers and disposal of

(ii) Where blockage of drainage is wash/kitchen wastewater)

unavoidable, alternative paths must be

created to facilitate stormwater flows from the site to outside.

Lead away drains that collect water from (iii) the internal drainage system of the

nearby three building (ETU, operating theatre and the clinic – See Figure 5.5)

must be kept clean and free from any constrictions to ensure a smooth flow of

stormwater.

The construction ground/s should be (iv) checked daily (after wet weather) for any

4 signs of water stagnation and cleaned. (v) A washing area for construction equipment should be delineated within hospital premises away from the construction area (vi) Wastewater from the construction site should not be directly discharged into roadside drains. It should be first directed to a pit to allow siltation and percolation before connecting to a lead away drain.

7 Impacts due to migrant (i) Local labour should be recruited as This item has Contractor PMU labourers and operation much as possible to minimize social already been of labour camps consequences of migrant labour and absorbed into to provide livelihood opportunities to the cost of the the local community. project. (ii) Labourers/workers should be provided with adequate sanitation facilities and receptacles for garbage collection. (iii) Domestic solid waste collected should be disposed of daily at a site given to them. (iv) Burying and burning domestic waste in the project sites should also be strictly avoided (v) A good supply of drinking water should be provided to the labour camps.

8 Impacts due to (i) The construction site should be This item has Contractor PMU hazardous working delineated from the rest of the hospital, already been conditions (accidents to preferably using barricading tape or absorbed into the workers and the public) any other suitable material that cost of the project. separates the construction area from the rest of the hospital physically. (ii) A safe pedestrian pathway to the hospital buildings should be provided if

5 regular access along with the nearby gate and the hospital access road is blocked. (iii) Concrete mixer trucks or any other trucks/construction vehicles should not be parked outside the hospital premises, as the road is narrow. (iv) Delineation devices such as cones, lights, tubular markers, barricades tapes, warning signposts, etc. should be erected to inform hospital users about work zones. (v) Dangerous warning signs should be raised to inform public of dangers and to keep them away from such hazards. (vi) Appropriate safety equipment, tools and protective clothing should be provided to workers, and the contractor must ensure that safe working methods are applied. (vii) The constructors should carry out suitable training programs on occupational health and safety for workers (viii) Machinery and equipment that could easily electrocute should be kept safely within site and always under the supervision of an experienced worker.

9 Impacts due to site It has to been noted that there are This item has Contractor PMU clearing (at the end of sewerage lines and septic tanks located at already been construction) and backyards of the three buildings. There is absorbed into landscaping a 3-phase electricity line running parallel the cost of the to the back boundaries of the buildings. project. Any work should not damage the septic tanks and should not shift the electricity lines.

6 10 Impacts on biological No impacts are envisaged other than See Item No. 2 - -

resources removal of three trees. of this Table.

Planting of trees as specified above – See

No. 2 of this Table.

11 Generation and disposal The wastewater treatment system includes This item has Contractor PMU

of wastewater generated a septic tank and a soakage pit. already been PHI of the CEBH to

from the PCR laboratory absorbed into The septic tank/soakage tank as the check

the cost of the wastewater collection and disposal method

project. is appropriate for the PCR laboratory, and

no negative impacts are expected.

Desludging should be done as and when

needed.

13 Increased generation of Infectious waste should be collected This item has Contractor PMU

hazardous health care separately and autoclaved at the point of already been PHI of the CEBH to

waste which is improperly generation. Once disinfected, the waste absorbed into check

disposed can put public would leave a medical area in the infectious the cost of the

health at risk from health-care waste container. project.

accidental infections and Containers for infectious waste should not be

contaminate the natural placed in public areas.

environment.

Waste bins should be located as close as

possible to sinks and washing facilities.

Containers should be of similar size to

overcome the observed tendency for staff to

put waste in the largest receptacle.

Where possible, hazardous waste generated

in medical areas should be stored in utility

rooms, which are designated for cleaning

equipment, dirty linen and waste.

14 Increased generation of A properly designed septic tank and a This item has Contractor PMU

sewage and wastewater soakage pit should be installed. already been PHI of the CEBH to

from the hospital that can The blackwater should be directed to the absorbed into the check

septic tank before soakage. contaminate ground water cost of the project.

with disease causing All wash water shall be disinfected and

pathogens,

aerated first before being sent to the

pharmaceutical

soakage pit. chemicals, endocrine

Wastewater from washing hands, cleaning,

7 disrupting chemicals laundry, bathing, flush toilets and teeth brushing activities should be safely collected and treated with chlorine before being sent to sewer lines or infiltrated into a soak-away pit

15 Impairment of surface Construction of a storm water drainage This item is not N/A N/A drainage management system is needed for the part of the sub- hospital premises. project.

16 Soil erosion The areas peripheral to the PCR This item is not N/A N/A laboratory needs turfing to prevent soil part of the sub- erosion. project.

17 Breakdown of power, The proposed PCR laboratory will be This item has Contractor PMU water and supplied by a dedicated electricity already been telecommunication connection, water supplies and absorbed into facilities telecommunication facilities by the CEBH. the cost of the There will be water storage of 1,500 l project. (which is sufficient for 1½ –2 days), and a standby generator (30 kVA) as backup power. Telecommunication facilities will include wired as well as wireless communication devices and services. The only concern is the breakdown of power, for which a contingency plan will be devised, secure temporary generators until the power supply is restored. However, if any samples, reagents, cultures, etc. need to be removed due to unavailability of air- conditioning or chilled/cooling, such material will be transferred to suitable locations without delay.

8

Annex 4: Environmental Monitoring Plan

Parameters to be

Impact/mitigation Location Measurement Frequency Responsibility

monitored

Pre-construction and Construction Stage

Minimize the need to remove Final layout plan Site premises Number of large trees Once after PMU

large mature trees that need removal designs are

Number of trees completed

that need removal

Soil erosion control during Final layout plan Construction Check design layouts Once after PMU

excavation and construction area Inspection of the site for designs are

the adequacy of soil completed

Material erosion control

stockpiles measures, possibility of

soil erosion

Soil washed away Visual observation Daily Contractor

with surface runoff PMU

Air-borne particulate matter Air-borne particle Construction Visual observation of Daily - Contractor

and air quality deterioration in the air site dust in the air Continuous due to excavation, Dust collected at Nearby

construction work, stockpiling the window sills of buildings Feedback from hospital Weekly PMU

and movement of heavy the three nearby authorities

vehicles buildings

Controlling noise and Noise and Qualitative observation Daily - Contractor

vibration levels due to vibration levels of Continuous

excavation, construction Noise/Vibration level

work and movement of heavy Weekly PMU

vehicles Feedback from hospital

authorities

Containment of Storage of Storage areas Inspection of the site for Daily Contractor

contamination potential the adequacy of

contaminants and contamination control

any spills measures, the possibility

of contamination

9

Proper disposal of Collection, storage Construction Inspection of the site for Daily Contractor construction waste (non- and disposal of site, areas of availability of waste hazardous) non-hazardous waste storage collection bins, records waste of waste removed from the site, an inspection of disposal sites

Events of open burning of waste Control of onsite drainage Surface Runoff Site premises Visual observation and Daily Contractor impairment patterns and the inspection of the site for peripheral areas stagnant water; blocked drains etc. Containment of construction Discharge of Site premises Visual observation and Daily Contractor wastewater discharge construction inspection of the site for wastewater open discharge of wastewater and pollution Pollution from labour camps Waste and Site premises Visual observation and Daily Contractor wastewater inspection of the generated due to activities of labour labour gangs at gangs, feedback from site construction workers Occupational health and Records of Site premises Visual inspection of the Daily Contractor safety issues accidents site, adequacy of signage and delineation barriers, number of accidents and complaints registered in the GRM Complaints registered in the Records of Nature of complaint and Daily PMU GRM complaints providing a proper solution

10

Operational stage

Proper collection and Leaking drains PCR Laboratory Any signs of leaking Daily PHI of the disposal of wastewater and pipelines, drains and pipelines, CEBH overflowing of overflowing of drains drains and septic and septic tank tank Proper collection, storage Method of PCR Laboratory Inappropriate methods Daily PCR and disposal of construction collection, sorting, or lapses in methods Laboratory waste (hazardous) storage and collection, sorting, staff disposal of HCW storage and disposal of PHI of the HCW CEBH Soil erosion control during Soil washed away Peripheral Visual observation Continuous Maintenance excavation and construction with surface runoff areas of the Division of the PCR laboratory Check for the adequacy CEBH of soil erosion control measures, possibility of soil erosion Control of onsite drainage Surface Runoff Site premises Visual observation and Continuous Maintenance impairment patterns and the inspection of the site for Division of the peripheral areas stagnant water, local CEBH flooding, blocked drains etc.

11