EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI

ENVIRONMENTAL IMPACT ASSESSMENT REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA HOSPITAL,SESSI LANDHI HOSPITAL @ KARACHI,& SESSI KOTRI HOSPITAL

[Environmental Impact Assessment Report - February, 2020]

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI

Executive Summary The management of SESSI (Sindh Employees Social Security Institution) planned to install the incinerator facility at their following selected hospitals.

1. Kulsum Bai Valika Hospital situated at S.I.T.E, Karachi- ( 250 bedded hospitals ) 2. Landhi Hospital situated at Ladhi Karachi - (300 bedded hospitals) 3. Kotri Hospital situated at Kotri Industrial Area Kotri - (100 bedded hospitals)

SESSI has initiated the process of procurement of Incinerators for the safe disposal of Hospital Waste generated from the said facility. To procure the Incinerators a competitive process has been completed and M/S MEDILAND for the supply, installation, commissioning, and training of staff for operation as per the Specified Quality & Technology was selected. SESSI has selected the most appropriate multiple stage combustion process European technology (ATI Technology) and its brochure and company profile attached as annexure I & II for Incineration with in-built pollution abatement devices for the compliance to any International Environmental Standards for Infectious Waste Treatment & disposal.

In addition to this SESSI has also develop this project with a proper storage and collection system, and a control temperature storage facility (Yellow Room) is also built in the Proposed Incineration Facility. The Incineration Facility acquires an approx. 5000 square foot on composite structure and will be built at the existing premises of all 03 hospitals, for which land is available and after environmental screening qualifies for the installation of the facilities at all three location i.e. Kulsum Bai Valika, SESSI Landhi Hospital and SESSI Kotri Hospital. M/S MEDILAND has engaged the services of M/S NEXUS consulting to prepare a comprehensive EIA report to initiate the process of acquiring NOC from the Sindh Environmental Protection Agency before the installation of the project.

This document presents the findings of an Environmental Impact assessment (EIA) study, carried out by M/s NEXUS consulting. The EIA report conforms to the requirements of Section 17 of the Sindh Environmental Protection Act, 2014, which says; “No proponent of a project shall commence construction or operation un less he has filed with the Agency an initial environmental examination

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI or environmental impact assessment and has obtained from the Agency approval in respect thereof.”

Valika Hospital is 250 bedded and Landhi Hospital is 300 bedded hospitals while the Kotri Hospital is 100 bedded hospital. The all hospitals are located within the Industrial area and serve the labours which fall into the low income group of the society. The proposed facility can treat 50-60Kg/hour, and according to the field survey and estimation of waste generation at hospital is 300 Kg/day at Kulsum Bai and Landhi while only 250Kg/day hospital waste is generated from SESSI Kotri Hospital. The quantum of waste generated at the three location requires only 4-5 hours each of Incineration operation for the safe treatment and disposal of waste.

The only Government owned incineration facility at Karachi is a KMC incineration facility located at Mewa Shah which currently collects waste from 238 Hospitals including Valika and Landhi SESSI hospitals. The KMC facility was also visited by the consultants and found that the facility was installed in 1997 and require upgradation for treating the waste to any acceptable standards. The Hospital Waste generated from SESSI Hospital Kotri, according to the administration of SESSI Kotri Hospital is collected by Kotri Municipality and dispose off with general municipal waste. The current procedures of Hospital Waste Storage, Collection, transportation, treatment and disposal lacks basic infrastructure to comply with the Hospital Waste Management Rules, 2014.

It was observed during the visit that currently waste storage facilities at hospital are not properly established. Currently there is no mechanism adopted to improve the collection of waste storage and collection leading to final disposal. This is the responsibility of Hospital Management and it is already spelled out in the Hospital Waste Management Rules, 2014 but the Rules are neither implemented nor enforced to the Hospital. The waste bins according to the SEPA classification need to be installed there but due to lack of guidance the municipal waste is being dumped into the Yellow and black bins.

Proposed Incinerator having capacity of 50kg/hr will deal with both Hazardous Hospital waste. It consists of three chambers, which are interconnected. The objectives of the proposed incinerator are:

 to incinerate hospital waste

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 to prevent the spread of hospital waste to avoid diseases and injury  to protect the public  to prevent scavenging of hazardous risk waste  Wet Scrubber System to treat the air quality of the whole process.  Waste water treatment system to treat the waste water of incinerator that contain the toxic chemicals

Most of the alternative methods to incineration have one or two disadvantages when compared to incineration. They are more expensive, require additional mechanical equipment such as shredders or have limitations in the type of waste that can be burned e.g. cytotoxic, pathological and chemotherapeutic waste. Guidelines for sensitive and critical areas were reviewed, so that the proposed project is planned and sited in a way that protects the values of sensitive and critical areas. The project site is not located in these sensitive and critical areas.

There is no surface water source near the project area. There is no environmentally sensitive area in the macro environment. No greenery would be removed and no significant impact would occur on the demographic pattern or on the social and cultural values of the settled population.

It was evident from the assessment of impacts that no significant damage to wildlife, vegetation or habitats is anticipated from the proposed project. Similarly no residential property recorded, Cultural/historical or archaeological sites would be affected by the project. Furthermore, no adverse socio-economic impact of the project is envisaged. During construction phase of the project employment opportunities will be provided to local population.

Different methods are used for the impact identification. These include: Assessment through the stages of the Project, Checklists, Matrices and Networks. To minimize the effects of adverse impacts the EIA recommends mitigation measures. These mitigation measures include the use of alternative options, management and physical controls. The proposed mitigation measures are based on the understanding of the sensitivity and behaviour of environmental receptors in the project area, the legislative controls that apply to the project and a review of good industry practices while operating in sensitive environments.

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For the effective implementation and management of the mitigation measures, an Environmental Management Plan (EMP) has been prepared. The EMP satisfies the requirement of the Sindh Environmental Protection Act 2014. The EMP outlines the aims and objectives, defines the responsibilities of the each individual involved in the hierarchy, and lays down the required communication, reporting procedures and mechanism through which the proposed measures will be monitored.

After Screening of the potable environmental impacts it can be concluded that:

 Project activities will cause temporary impacts on local environment all of which are reversible. During operational stage the project will not pollute the environment in normal circumstances except when an incident of spillage occurs. The impact of such incidents will be mitigated by surveillance, proper maintenance, immediate reports, safety and management plan.  No significant damage to wildlife, vegetation or habitats is anticipated from the proposed project  No residential property, cultural/historical or archaeological sites would be affected by the project  No adverse socio-economic impact of the project is envisaged  During construction phase of the project employment opportunities will be provided to local population  By adopting recommended mitigation and safety measures. Little environmental impacts of the project can be eliminated

Environmental Impact Assessment Report concludes that the setting up of Incinerator and the associated activities will lead to minor environmental effects which could be mitigated as illustrated in the report. The project will not add to degradation of the environment at the Project Area. Therefore, the proposed project is considered viable, of enormous potential benefits and environmentally friendly, as supported by this EIA report. Accordingly the EIA in the present form may be approved.

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Contents

Chapter 1 INTRODUCTION ...... 12 1.1Background of the Project ...... 13 1.2 Details of the Project ...... 15 1.2.1Kulsum Bai Valika Hospital, Karachi ...... 16 1.2.2 Landhi SESSI hospital ...... 16 1.2.3 Kotri SESSI Hospital ...... 16 1.2.4 Proposed Incineration Plant Installation, Commissioning & Operation...... 16 1.2.4.1 Introduction of Mediland Pakistan ...... 17 1.3 PROJECT PROPONENTS ...... 17 1.4 CONSULTANT PROFILE ...... 19 CHAPTER 2 PROJECT REQUIREMENT & SITUATION ANALYSES ...... 22 2.1Need of the Project ...... 22 2.2 WASTE STORAGE/WASTE BINS FACILITY AT HOSPITALS ...... 23 2.3 HOSPITAL WASTE COLLECTION SYSTEM ...... 25 2.4 WASTE STORAGE FACILITY AT HOSPITAL FOR STORAGE OR FOR TRANSFER ...... 25 2.5 INCINERATION FACILITYOF KMC AT MEWA SHAH ...... 26 2.6 Findings – Existing situation ...... 27 Chapter 3 LEGAL & INSTITUTIONAL ARRANGEMENTS ...... 29 3.1 Legislative Review ...... 29 3.2 Karachi Municipal Corporation ...... 35 3.3 Sindh Solid Waste Management Board Act, 2014 ...... 35 3.4 Hazardous Substance Rule, 2014 ...... 35 3.5 Sindh Environmental Quality Standards – Emission Standards ...... 36 3.6 Institutional Analysis ...... 36 3.6.1 Health Department, Government of Sindh ...... 36 3.6.2 Safe management of wastes from health-care activities, WHO Handbook(Second edition) ..... 38 3.7.3 Medical Waste Management Guidelines - International Committee of the Red Cross (ICRC) . 40

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3.8 SEPA EIA / IEE Regulations 2014 ...... 40 Chapter 4 ENVIRONMENTAL AND SOCIAL BASELINES ...... 43 4.1THE ENVIRONMENT OF THE PROJECT AREA ...... 43 4.1.1 Topography of Karachi ...... 43 4.1.2 Topography of Kotri ...... 45 4.2 Environmental Setting of the Project ...... 45 4.3 Layout and Land Area Breakup ...... 51 4.4 PHYSICAL ENVIRONMENT OF AREA ...... 52 4.5.GEOLOGY AND SOILS ...... 52 4.5.1 Geology& Soil Texture of Karachi ...... 52 4.5.2 Seismicity ...... 53 4.5.3 Geology and Soil Texture of Kotri ...... 54 4.5.1 DRAINAGE SYSTEM ...... 63 4.5.2 SOLID WASTE MANAGEMENT ...... 64 4.5.3CLIMATE ...... 66 4.6 Road Network of Karachi &Jamshoro ...... 69 4.7Environmental Monitoring ...... 70 4.7.1 Ambient Air ...... 70 4.7.2 Noise Dosimetry ...... 74 4.8 Flora and Fauna in Karachi & Kotri ...... 74 4.9 Socioeconomic Profile of District Jamshoro ...... 75 4.9.1 History ...... 75 4.9.2 Administrative Structure ...... 75 4.9.3 Geography ...... 76 4.9.4 Agriculture ...... 76 4.9.5 Industries ...... 76 4.9.6 Poverty status ...... 77 4.9.7 Irrigation ...... 77 4.9.8 Livestock ...... 77 4.9.9 Health Facilities ...... 77 4.10 Socioeconomic Profile of Karachi ...... 78 4.10.1 History of Karachi ...... 78 4.10.2 Administrative Structure of Karachi ...... 79 4.10.3 Geography ...... 79

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4.10.4 Agriculture ...... 80 4.10.5 Livelihood ...... 80 4.10.5.1 Services Sector ...... 80 4.10.5.2 Industries...... 81 4.10.6 Health Facilities ...... 81 Chapter 5 SELECTION OF TECHNOLOGIES (ATI France) ...... 83 5.1 Activities Associated with Operation ...... 83 5.2 Flow Path of Wastes ...... 83 5.3 Proposed Incinerator ...... 85 5.4 Technical Details ...... 85 5.5 Advantages of Incineration ...... 90 5.6 Ash Management Propose Plan ...... 90 5.7 Project Specifications ...... 91 5.7.1 Yellow Room: ...... 91 Chapter 6 Anticipated Impacts & Mitigation Measure ...... 92 6.1 General ...... 92 6.2 Impacts Assessment Methodology ...... 92 6.2.2.1 Impact Classification ...... 97 6.2.1 Environmental impacts and their mitigation during pre-construction phase ...... 97 6.2.2 Environmental Impacts related to project design ...... 98 6.3 Environmental Impacts during Construction Phase ...... 98 6.3.1 Air emission ...... 98 6.3.2 Noise Pollution ...... 99 6.4.1 Air Emissions ...... 102 Chapter 7 ENVIRONMENTAL MANAGEMENT AND TRAINING PLANS ...... 112 7.1Regulatory requirements and applicable standards ...... 112 7.2 Institutional capacity ...... 112 7.2.1 Institutional Responsibilities ...... 113 7.2.2 Responsibilities of SESSI ...... 113 7.3 Environmental Management and Monitoring Plan ...... 114 Chapter 8 CONCLUSION ...... 130 Annexure I (ATI Brochure of Incinerator) ...... 132 Annexure II (ATI Company Profile) ...... 134 Annexure III (Lab Report) ...... 143

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Annexure IV Pictures ...... 151

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List of Acronyms

KMC Karachi Municipal Corporation

SEPA Sindh Environmental Protection Agency

SESSI Sindh Employees Social Security Institution

EPC Engineering, Procurement and Construction

HCW Health Care Waste

HWM Hospital Waste Management

ICRC International Committee of Red Cross

MHz Mega Hertz db Deci bell

Nox Oxides of Nitrogen

Sox Oxides of Sulphur

HCl Hydrogen Chloride

CO Carbon Monoxide

CO2 Carbon Dioxide

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MCDA Multiple Criteria Decision Analysis

NEQS National Environmental Quality Standards

NOC No Objection Certificate

OHS Occupational Health & Safety

PVC Polyvinyl Chloride

PPE Personnel Protective Equipment

PH Public Health

RFP Request for Proposals

IMC Independent Monitoring Consultant

SEQS Sindh Environmental Quality Standard

PM Particulate Matter

SWM Solid Waste Management

SPPRA Sindh Public Procurement Authority

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Chapter 1 INTRODUCTION According to the experts, 50% the world’s population is under occupational, environmental or public health risk due to absence of the treatment mechanism or poor treatment of the healthcare waste1. The issue is principally more convoluted in developing countries like Pakistan, where improvements in healthcare services are not proportional to the strengthening of the healthcare waste management infrastructure. The existing situation of Health Care Waste (HCW) management is dilapidated in Karachi, Kotri and rest of Sindh due to exponential growth of healthcare facilities generating massive amounts of HCW which lead to adverse health effects. Although the medical waste is much less in volume; however it is not more dangerous than regular household waste. In Karachi, some of the hospitals have installed healthcare waste treatment facilities (Aga Khan University Hospital) which is operational, however, the facilities installed at many other hospitals like Civil Hospital, Secondary Hospital Liaquatabad, Malir and few others are not operational due to technical or administrative issues, as per their requirements. In order to improve the healthcare waste management, treatment and disposal mechanism, The Sindh Employees' Social Security Institution (SESSI), initiate the process for Installation of Incineration Facility at three of its Hospitals which are 1. KULSUM BAI VALIKA – SOCIAL SECURITY SINDH HOSPITAL 2. SINDH EMPLOYEES SOCIAL SECURITY HOSPITAL LANDHI 3. SINDH EMPLOYEES SOCIAL SECURITY HOSPITAL KOTRI

Overall, SESSI provides medical facilities to the secured workers and their dependents. For providing the medical facilities there are currently 39 dispensaries, 5 medical centres and 4 hospitals running under SESSI. In order to get the medical facilities, secured workers and their dependents have to get them registered to any of the 39 dispensaries near their house at their own will. At the first stage of medical treatment, patients have to take medical treatments from the dispensaries they are registered with. The medical facilities that are provided at dispensaries are:

1Harhay, M.O., Halpern, S.D., Harhay, J.S. &Olliaro, P.L.(2009)health care waste management: a neglected and growing public health problem worldwide. Tropical medicine and international health 14(11): 1414‐1417

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 Medical Officer / Lady Medical Officer are available who provide routine medical check-up and treatment.  Pregnant ladies are provided antenatal check-up/ treatment.  The patients who require specialists’ opinion or hospital treatment are referred to nearest SESSI hospital and the treatment advised by hospital is carried out at dispensaries. This Environmental Impact Assessment (EIA) report is prepared to comply with the EIA/IEE Regulations 2014, Sindh Environmental Protection Agency and to professional evaluate the impacts of installation of Incineration Facilities at the 03 hospitals and their mitigation measures through the preparation of Environmental Management Plan.

1.1Background of the Project Hospital waste is a special type of waste produced in small quantities carrying a high potential of infection and injury. Inadequate and improper handling may have serious public health consequences and a significant impact on the environment2. Hospital waste includes hazardous or risk waste and non-risk waste. The different types of risk wastes are: infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste and radioactive waste. The non-risk waste comprises of other types of garbage like foodstuff leftovers, cardboards, packages, etc.3

Meeting the legal and regulatory requirements to generate, use, store, treat and dispose off can be difficult and expensive. Although the regulations are extensive and complex to implement, but complete and documented compliance with the applicable regulations is essential to demonstrate that personnel and environment safety has been assured. 4 The proper management of health-care waste depends on good administration and organization along with adequate legislation, financing and active participation of trained and informed staff. 5 All

2 Fluke C. Handling hazardous waste. J Health Mater Manage 1998;6:70-3

3 Hashmi SK, Shahab S. Hospital and biomedical waste management. In: Iliyas M, Editor, Community medicine and public health. 4th ed. Karachi: Time Publishers,2003, pp. 426-37.

4 Horvath A. Management of waste disposal in medical institutions. RvHetil 1991;132: 919-24.

5Hospital waste management in Pakistan. Case study report. http//www.waste.nl/docpdf/CS_hosp_pak. 1997August

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI individuals exposed to hazardous waste are potentially at risk. The main groups at risk are those belonging to medical profession, patients in the hospital, visitors to the hospital, workers in support allied to hospitals (laundry, waste handlers and transporters) and workers in waste disposal facilities such as landfills or incinerators including scavengers. The diseases which can be transmitted are numerous but the most significant ones are Hepatitis B, Hepatitis C and Acquired Immunodeficiency Syndrome (AIDS).6

Biomedical waste can be threatening to the environment and public health in particular. It requires proper handling and treatment prior to its final disposal. With an increase in the number of hospitals and their inherited Bio Medical Waste (BMW), a large bulk of it is dumped untreated. On the average, a patient generates 1.5-2 kg of waste per day irrespective of the wards. 7 In Pakistan, like other developing countries, prior studies have reported poor hospital waste management (HWM) practices8. Studies conducted in major cities in Pakistan (i.e., Karachi, Lahore, Rawalpindi and Islamabad) have consistently reported mismanagement of hospital waste with respect to following segregation techniques and appropriate disposal procedures9. This is alarming as ~0.8 million tons of waste is produced daily from hospitals in Pakistan10

In Pakistan, hospital waste is collected by sweepers, and then transported to the city’s open waste dumping sites. The team of consultants have visited all the three hospitals of SESSI and found that there is no any formal mechanism of Hospital Waste Storage, Collection, Transportation, Treatment and Disposal. The current mechanism of waste storage and treatment is weak and require strengthening at all levels. Currently the generated waste from Kulsum Bai Valika and Landhi is collected by the KMC Contractor for further incineration at KMC Incineration Plant. Consultants

6 Hospital waste sickening public and environment" Daily Times, 8th July 2004, p. 7

7Pakr k. Hospital waste management. In Parks text book of preventive and social medicine. M/s BanarsidasBhanot Publishers Jabalpur. 2010; pp699-700.

8 Ahmed R (1997). Hospital waste management in Pakistan. Urban wast expertise programe, 11-1100

9Khattak FH. Hospital waste management in Pakistan. Pak J Med Res. 2009 Jan–Mar;48(1):19–23.

10 Khan JA. Hospital waste management issues and steps taken by the Government of Pakistan Oct 2006 (http://www.env.go.jp/ recycle/3r/en/asia/02_03-2/04.pdf, accessed 16 January 2018).

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI have visited the KMC Incineration facility at Mewa Shah and found that the Incineration Facility is very old and lacks with Pollution abatement devices. This report also contains some information of the existing KMC Incineration Facility. In Government hospitals, there are no special techniques for waste handling, and due to lack of awareness, hospital staff normally treat all solid wastes carelessly. Municipal transport is used to collect and dispose of the hospital waste in any open dumping site alongside city garbage11.

The legal and regulatory frameworks for solid waste management are based on the federal and (now) provincial Environment Protection Acts. Apart from constituting the Environmental Protection Agency, the Acts established Environmental Improvement Funds and Environmental Protection Tribunals, listing the relevant functions, powers, penalties and other procedures.

In Pakistan there are about 92,000 beds in public sector hospitals. Pakistan –Population 160 million will rise to 250 million by year 2025. Amount of Hospital Waste generated will increase to alarming rates due to growth of population and healthcare facilities. No well-established segregation system, frequent dumping of hospital waste with municipal waste.

For controlling of nosocomial infections and other environmental as well as public health concerns SESSI department of Sindh Government has decided to install the 3 incinerators in the hospitals which are being operated by the SESSI. With the installation of incinerators the waste should be discarded properly and adaptation of the latest technology along with the waste water treatment facility& scrubbers this waste would not pose any other health impact if operating efficiently. This will also help to reduce the pollution and other contaminated issues.

1.2 Details of the Project SESSI department, government of Sindh, along with the following mention hospitals attempt to implement the health policy related to health to conflict with diseases related to hospital acquired infections. This project has been clearly declares their seriousness towards the health issues and

11 Ahmed R (1997). Hospital waste management in Pakistan. Urban wast expertise programe, 11-1100

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI disease related to hospital wastes. The details of the project describe as under. All the incinerator which are being installed are of the capacity of 50kg/hr.

1.2.1Kulsum Bai Valika Hospital, Karachi Valika hospital is 250 bedded hospital, and around 1000-1200 outpatients visits daily. It can now pompously allege to be the biggest and the best equipped hospital in the vicinity of SITE area, it is under the administration of SESSI. They have employed highly qualified staff in numerous specialties, geared up to deliver quality health care services to the ailing. Valika has almost 12 departments in its fold including labor, Department of Accident & Emergency, , Department of Thoracic Medicine, ICU / CCU, Pathological lab, Radiological lab, specialist OPD’s, ENT, orthopedic.

1.2.2 Landhi SESSI hospital Landhihospital is almost 300 bedded hospital, and around 1200-1500 outpatients come daily. It is located at the industrial area of Landhi and just opposite to the Al-karam Textile. Some of the general departments include; accident and emergency, radio and patho labs, gyanae, Dialysis, these are the specialized services of the hospital,

1.2.3 Kotri SESSI Hospital This hospital is composed of 100 beds with present average of approximately 400-500 patients daily. This hospital is located at the industrial zone of Kotri and the only hospital which provides the first aid in the area for critical patients later those are transferred to Hyderabad for any major issues like cardiac attack and other accidental issues.

1.2.4 Proposed Incineration Plant Installation, Commissioning & Operation. SESSI is acquiring incinerators through a Government set procedures for procurements i.e SPRRA Rules through open tender. M/S Mediland has won the tender by offering lowest price for the specified quality & technology for the desired incinerators. The three of the incinerators having the capacity to treat 50 kg/ hr. The contract signed between the Mediland and SESSI has the following summary;

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 Warranty of the incinerator includes the parts and maintenance starting from the date of commissioning to next 3 years.  Mediland will provide all the technical assistance and consultancy to procurer in order to receive NOC, while respecting SEPA.  The proponent will be responsible for the control of waste and to control the fumes that are being released from the incinerator.  The service manual will be provided by the Mediland to all the sites.  The technical information regarding to the incinerators should be provided by the Mediland.  Mediland will conduct the workshop in the hospitals to train their staff for running the process smoothly after the warranty period.

1.2.4.1 Introduction of Mediland Pakistan Mediland Pakistan Pvt. Ltd. is an Electro-Medical equipment supplier firm in Pakistan along with the provision of after sales services. Established as an enterprise company in Pakistan in 2008 and developed as a Private Limited company in 2011, Mediland Pakistan Pvt. Ltd. always endeavors to differentiate itself from other competitors by providing personalized service focusing on our customer’s requirements. Previously Mediland installed more than 20 incinerators in Punjab and they function efficiently from the prospect of environment.

1.3 PROJECT PROPONENTS In Pakistan, Social Security Scheme was launched on 1st March, 1967, under West Pakistan Employees' Social Security Ordinance No. X of 1965, with the assistance of the International Labor Organization. The Sindh Employees' Social Security Institution (SESSI), however, came into being on 1st July, 1970 when the Scheme was reorganized on provincial basis after the dissolution of One- Unit. Initially, the Scheme was designed for coverage of textile industry workers of Karachi and Hyderabad. On getting encouraging results later on the Scheme was extended to all other industries and commercial units. The main source of income of SESSI is the Social Security Contribution. Employers covered under the Scheme contribute towards the Scheme @ 6% of their wages paid to insurable workers.

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Sindh Labour and Human Resources Ex. Minister Ghulam Murtaza Baloch have said that since March, almost 650,000 workers have been registered with Sindh Employees’ Social Security Institute (SESSI). He added that they were aiming to increase the workers registered to one million in the next fiscal year. SESSI department government of sindh is the main proponent of the project as the Mediland Company won the tender for the installation of incinerator in three different hospitals of SESSI. The two hospitals are located at Karachi and the other is located in the Kotri. As the development of an Incinerator Facility project falls in SEPA EIA/IEE regulations 2014 Schedule-II, Category H ofanEnvironmentImpactAssessment (EIA) of “Incinerator Facility” is required. Mediland has engaged Nexus Consultant to under take Environment Impact Assessment(EIA)studyfor the proposed installation of Incineration Facility at Kulsum Bai Valika Hospital, SESSI Landhi and SESSI Kotri hospitals.

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Figure 1: SESSI Organogram

1.4 CONSULTANT PROFILE The Nexus Consulting has experience with due diligence requirements and knowledge of Pakistan Environmental Protection Act, Environmental Guidelines and Protocols set by the World Bank, Asian Development Bank and other agencies for carrying out Environmental Assessment and Audits in order to assist our client mitigate any negative Environmental Impact during the Planning, Designing, Execution and Operation of Projects. Nexus Consulting has a dedicated team to carryout studies and develop design and projects related to the following Environmental areas;  Preparation of Environmental and Social Management Framework.  Feasibility studies and Design of Landfill Sites, Garbage Transfer Station, Waste to Energy Facilities for Municipal Waste Management including Environmental Studies  Alternate Energy Project Feasibility and Environmental & Social Impact Studies  Planning, Designing and Execution of Water and Wastewater Projects  Feasibility Studies and Design of Health Care Waste Management including installation of Incineration and Waste Sterilization Units  Studies and Design of Industrial Waste Management Systems.  Biogas Studies, Feasibility and Commissioning of Plants.  Environmental Audits of Oil Refineries and Industries (Textile, Pharmaceutical, Tanneries, Sugar, Chemicals, Fertilizers, Food Processing Industries and others).  Climate Change and Sustainable Development Studies.

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Figure 2: PEC Certificate of Nexus Consulting

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI

CHAPTER 2 PROJECT REQUIREMENT & SITUATION ANALYSES

2.1Need of the Project The water commission which is headed by the former justice of Supreme court of Pakistan (retd) Amir Hani Muslim, directed Secretary health Sindh for the installation of Incinerators in several hospitals of Sindh, As due to the improper handling of hospital waste this is the root cause of many nosocomial infections and HAI (hospital acquired infections). In the light of this advisor to the Chief Minister Murtaza Wahab directed public and private hospitals to submit their hospital waste management plans in accordance with the hospital waste management rules 2014. According to WHO (world health organization) the overall quantity of waste generated from the hospital, as regards 85% is general and non-hazardous waste although the remaining is considered as hazardous material which may possibly be infectious, toxic or radioactive. On the other hand, health-care waste is frequently not estranged into hazardous or non-hazardous wastes in low-income countries constructing the real quantity of hazardous waste much higher. M/S. Mediland has to put up a hazardous waste incinerator having the capacity of 50kg/hour at the hospitals of SESSI (Sindh Employment of Social Security Institution) at Kulsum Bai Valika S.I.T.E, Landhi and Kotri.

Currently the mechanism of the Collection, Storage, Transportation, or on-site treatment and final disposal at Karachi is not in place at any level (Hospital Level, District or Provincial level etc). Karachi Municipal Corporation (KMC) has installed two incineration plants with the Capacity of 1 ton per hour at the Mewa Shah to treat the Hazardous and Medical Waste being generated from City of Karachi in 1997. Since the plant commissioned it is being used for the purpose, and from last many years the Operation and Maintenance for Plant along with the Collection, Transportation, Treatment and Disposal of Infectious Waste being generated from 238 Hospitals, this was revealed during our general assessment of the infectious waste current disposal mechanism. The KMC facility is also currently used by the Landhi and Valika Bai Hospitals. Kotri SESSI informed that Municipal Corporation Kotri picks their waste on every second day of the week.

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2.2 WASTE STORAGE/WASTE BINS FACILITY AT HOSPITALS

The 03 SESSI hospitals located at Kulsum Bai Valika, Landhi both at Karachi and Kotri during the field visits it is learnt that the storage facilities at the Hospitals are mostly not properly established. Kotri Municipality is responsible for the collection of waste from Kotri and Municipality also collets the Hospital Waste generated from SESSI Kotri informed by the staff of hospital. It was observed during the visit that waste storage facilities at hospital are not properly established. Currently there is no mechanism adopted to improve the collection of waste storage and collection leading to final disposal. This is the responsibility of Hospital Management and it is already spelled out in the Hospital Waste Management Rules, 2014 but the Rules are neither implemented nor enforced to the Hospital. The waste bins according to the SEPA classification need to be installed there but due to lack of guidance the municipal waste is being dumped into the Yellow and black bins.

Secondly, the infectious waste is mixed with the municipal waste creating the massive amount of infectious waste at the site. This may clear the way for entrance of various hospital acquired infections. Therefore, it is advisable to install the incinerator at the site for the removal of infection waste at the site. Here some pictorial evidences are attached for the reference.

Figure 2.1: Valika, Landhi and Kotri Hospitals pictures

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI

Figure 2.2: Hospital Bins

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In addition to this Waste stream also contains blood, body parts, sharps, chemicals openly disposed off, which provides the information that lack of proper Waste Management Plan at the Hospital level.

2.3 HOSPITAL WASTE COLLECTION SYSTEM Recently the staff collects the waste from various department using rudimentary type of Push Carts/Wheel Barrows etc. The mechanism of collection of waste from various hospital shall also need to be improved at least Bins with Lids must be placed and used for the collection of different Category Hospital Waste as specified in the Hospital Waste Management Rules, 2014.

2.4 WASTE STORAGE FACILITY AT HOSPITAL FOR STORAGE OR FOR TRANSFER At the 03 SESSI hospitals there is lack of storage facility for the storage of Infection waste. The staff collects waste and at the Landhi SESSI Facility there is a Block Masonry Bin where the waste is dumped. During the site visit security officer informed that waste is collected by the KMC vehicle from the bins on regular basis.

The open placement of waste creates environmental nuisance and due to the unavailability of storage facility the following issues were observed. The waste collected from all departments are placed in the open bin which have access to the vermis and rodents.

Currently the SESSI all 03 hospitals does not have the treatment facility (Incineration) for the proper disposal of infectious waste, therefore at SESSI Landhi and SESSI Valika Bai waste is collected by the KMC operator for further treatment at the Mewa Shah Incineration Facility. The waste generated from the SESSI Kotri Hospital is collected by Municipal Corporation Kotri. To prepare the assessment of the entire spectrum of Infectious Waste Generation, collection, storage, treatment and disposal the team of Consultants have visited the Incineration facility of Mewa Shah owned by KMC operated by a private company to observe the mechanism of incineration facility

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2.5 INCINERATION FACILITYOF KMC AT MEWA SHAH It was informed that SESSI Landhi and SESSI Valika Bai Hospitals waste are collected by the KMC operator for the treatment at the incineration facility of KMC at Mewa Shah. The team of consultants visited the facility in October, 2019 and found the following

Two incineration plants are installed in two different sheds available at the Mewa Shah Incineration Facility. Both the sheds are identical in terms of constructed areas, material used for construction and its geometry. Each shed contains one incineration facility equip with the Waste Collection Pit, Chamber, Chimney, Temperature Measuring system, water sprinkler (non-operational at both the incinerators), no any pollution abatement devices installed. The shed also comprised off an operator room. The log book of waste has been maintained at site but the waste classification log book is not maintained. There is no mechanism for preparation of batch as feed stock.

The guidance regarding to storage the feed doesn’t comply on the standard operating procedure. As the plant has the required amount of 1ton per hour but the ground reality is that they feed more than 1 ton in an hour.  This indiscriminate feeding leading toward many problems like, 1.Fly ash 2. Dioxins and Furans 3. High temperature stress

Temperature gauge has the capacity to achieve 1000 degree Celsius only. No water sprinkling system install at the site so the ash is dispersing and problems to the neighborhood. Ash doesn’t collect properly from the site and has no record of the ash monitoring from any lab.

Whatever the infectious waste received at site is being incinerated at the two facilities between 01 to 04 hours it all depends on the type of waste being burnt and quantum of waste. It was informed by

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI the operator that in the absence of storage facility, the staff cannot leave the waste unattended and the quantum of waste batch is increased to finish the day to day job timely. There is a high probability of emitting of fly ash, noxious gases, dioxins and furans from the plant as the temperature does not go above 1250 to 1500 degree centigrade.

ASH DISPOSAL AT KMC AT MEWA SHAH INCINERATION FACILITY It was informed and also observed that almost 70% of the waste volume being reduced after the incineration process. The remaining ash from chamber is taken out with the help of Shovels and transported through wheel barrow to an earthen built ash collection pit.

The ash is being dumped there for 02 days to normalize the temperature only after it is being transported to the landfill site. There is no any safety precautions provided to the workers.

2.6 Findings – Existing situation This EIA report is prepared for the Installation of In-house Incineration facility at the following 03 Hospitals Owned by SESSI 1. KULSUM BAI VALIKA – SOCIAL SECURITY SINDH HOSPITAL 2. SINDH EMPLOYEES SOCIAL SECURITY HOSPITAL LANDHI 3. SINDH EMPLOYEES SOCIAL SECURITY HOSPITAL KOTRI

The team of consultants visited all three hospitals to learn and observe the mechanism of Medical Waste / Infectious Waste storage, collection, transportation, treatment and disposal system and our findings on the existing situation are as under

 The current collection mechanism of infectious waste at all the three SESSI hospitals are not as per the guidelines of Hospital Waste Management Rules, 2014  There is no any storage facility where the segregated waste deposited in lid covered bins for certain period before the collection or treatment of waste at all the three SESSI hospitals.  SESSI Kotri informed that Municipal Corporation Kotri picked the Medical Waste being generated from hospital.

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 SESSI Landhi and SESSI Hospital KulsumBhiaValika informed that the waste is collected by KMC Operator for further treatment of waste at the KMC at Mewa Shah Incineration facility.  From the field visit it is learnt that there is no any mechanism in placed for the storage, collection, transportation, treatment and disposal of waste, and where the mechanism is available the treatment of waste is not up to any satisfactory standards.

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI

Chapter 3 LEGAL & INSTITUTIONAL ARRANGEMENTS

3.1 Legislative Review A legislative review has been conducted for the study and selected all the legislations, guidelines which are relevant to the waste scenario and applicable in conducting this audit and preparation of report. Below is the list of the applicable legislations / guidelines:  Sindh Hospital Waste Management Rules, 2014  Sindh Solid Waste Management Board Act, 2014  Sindh Environmental Protection Act, 2014  Hazardous Substance Rules, 2014  Safe management of wastes from health-care activities – WHO Guidelines  Sindh Hospital Waste Management Rules 2014  SEPA Review of EIA / IEE Regulations 2014  SINDH Environmental Quality Standards 2014

Responsibility for waste management- Every hospital owner, occupier, and operator shall be responsible for the management of the hospital waste generated by it till its final disposal in accordance with the provision of the Act and these rules.

Hospital Waste Management Plan- A Hospital Waste Management Plan shall be based on internationally or nationally recognized environmental management practices, standards, which shall efficiently and effectively address the hospital waste and all hospital shall prepare the plan covering the following aspects;

Waste management points for every ward and department, indicating each point, location on the basis of risk assessment; the categories of waste being generated in accordance with Schedule-I quantity of each waste category; details of the types, numbers of containers, waste bags and trolley required annually; schedule and frequency of waste collection from each ward and department; effective arrangements for onsite and off-site transportation of waste as provided in Schedule-I and II; contingency plans for storage or disposal of risk waste in the event of breakdowns of hospital

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI waste facility, or of maintenance or collection arrangements; training courses and programmes on waste management;

Waste segregation.- Risk waste shall be separated from non-risk waste at the point where the waste is generated by a doctor, nurse, or other person as per Hospital Waste Management Plan and Schedule-I.

Waste collection- Waste shall be collected in accordance with the Schedule-I and II.

Waste storage- A separate central storage facility shall be established within the Hospital with the details provided in Hospital Waste Management Plan

Waste Treatment; On recognition of the type and nature of the waste material and the organisms in the waste, risk waste shall be inactivated or rendered safe before final disposal by a suitable thermal, chemical, irradiation incineration, filtration or other treatment method, or by a combination of such prescribed and effective methods guided by validated and monitoring procedures.

Waste disposal- Risk waste shall be disposed of in accordance to the procedure provided in Schedule-I. The operator, occupier, owner of the Hospital waste disposal and treatment facility shall obtain approval from the Agency under the section 17 of Sindh Environmental Protection Act 2014.

Table 0.1: Categories OF Hospital Waste as per Hospital Waste Management Rules 2014

Category Type of Waste Color Container Treatment Disposal Number Category Coding Type pathological waste Metal or Cremation/ (tissues, organs, body Yellow tough Plastic - Incineration/de parts, fetuses, blood bag ep burial and body fluids)

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Category Type of Waste Color Container Treatment Disposal Number Category Coding Type infectious waste (waste contaminated by any type of pathogens such as bacteria, viruses, parasite or fungi and Disinfected includes cultures container from laboratory High density work, waste from Autoclaving / plastic Incineration/La surgeries and Red micro- container ndfill autopsies, waste from waving. resistant to infected patients, penetration discarded or and leakage disposable materials and equipment which have been in contact with such patients and infected animals from laboratories) Sharp All shall be Disinfected (whether infected or cut or broken container not, needles, syringes, and rendered High density scalpels, infusion sets, non-reusable plastic saws and knives, Red at the point of Landfill container blades, broken glass use; resistant to and any other item disinfection penetration that could cut or by chemical and leakage puncture) treatment

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Category Type of Waste Color Container Treatment Disposal Number Category Coding Type autoclaving/m icrowaving and mutilation/ shredding Pharmaceutical waste (expired or unused pharmaceutical products, spilled contaminated pharmaceutical Metal or products, surplus incineration/lan Yellow tough Plastic destruction drugs, vaccines or dfill bag sera, and discarded items used in handling pharmaceutical such as bottles, boxes, gloves, masks, tubes, or vails) Genotoxic waste (cytotoxic drugs and outdated materials, Return to Incineration vomitus, faeces or Yellow supplier for (>1300oC) urine from patients treatment Landfill treated with cytotoxic drugs or chemicals,

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Category Type of Waste Color Container Treatment Disposal Number Category Coding Type and materials such as syringes and vails contaminated from the preparation and administration of such drugs) Chemical waste (Chemicals from diagnostic and experimental work, cleaning processes, housekeeping and Photo- disinfecting Metal or chemicals procedures, mercury Yellow tough Plastic should be de- Landfill waste such as from bag silvered and broken clinical vaporized. equipment and spillage, and cadmium waste such as from discarded batteries) Radioactive waste (liquid, solid and gaseous waste Metal or Treated in contaminated with Yellow tough Plastic facility with radio nuclides bag lead walls generated from in- vitro analysis of body

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Category Type of Waste Color Container Treatment Disposal Number Category Coding Type tissue and fluid, in- vivo body organ imaging and tumor localization, and investigation and therapeutic procedures. non-risk waste (paper and Black / Recycling cardboard, packaging, Any Suitable Landfill White plant food waste and the like) Incineration Ash Metal or (ash from Yellow tough Plastic - Landfill incineration of any bag bio-medical waste) Liquid Waste (waste generated disinfection Discharge into from laboratory and - - by chemical drains/ sewage washing, cleaning, treatment system. house-keeping and disinfecting activities)

An Authorized officer of SEPA may inspect any Hospital, located within the area of his jurisdiction to check that the provisions of these rules are complied with by the Hospital. If an Authorized Officer found any contravention of any provision of these rules, he shall take legal action as per the sub-section (2) of section 22 of Sindh Environmental Protection Act 2014.

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Each Hospital generating risk waste shall apply to the Agency for issuance of license for handling hazardous substances and the provision of section 13 and 14 shall apply for the purpose of granting such license.

3.2 Karachi Municipal Corporation

Karachi Municipal Corporation (KMC) is the department which take cares the treatment unit and installed two incineration plant each with the capacity of treating 01 tons of hazardous waste per hour back in 1997. Since then the KMC is maintaining the plant and also providing the door to door infectious waste collection and transportation facility from 238 hospitals in Karachi. The entire system is outsourced by the KMC to a private operator from few years. The last contract was made between KMC and M/S Astrotech Company for the period of 03 years on 28-06-2018 which half of the time is already consumed.

The contactor is responsible for the collection, transportation of waste from all 238 enlisted hospitals to the Incineration Facility and the same contractor is maintaining the operation of plants.

3.3 Sindh Solid Waste Management Board Act, 2014 The SSWMB Act, 2014 enacted to establish a board for collection and disposal of all solid waste, to arrange effective delivery of sanitation services, to provide pollution free environment and to deal with other relevant matters. The Board established under the Act headed by the Chief Minister or his nominee and constitutes of thirteen other ex officio members of other relevant departments. The Act was promulgated to establish a board for collection and disposal of all solid waste, to arrange effective delivery of sanitation services, to provide pollution free environment and to deal with other relevant matters. SSWMB will provide necessary infrastructure for disposal of medical waste in Sindh.

3.4 Hazardous Substance Rule, 2014 These Rules were notified to streamline procedures for issuance of licenses to industries / businesses that generate hazardous waste, safety precautions for workers and devices them methods

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI for the removal of hazardous wastes in an environmental friendly manner. The rules also specify procedures to be adopted for import, transport and disposal of hazardous waste; and identify two hundred and forty-three hazardous substances and synthetic chemicals.

3.5 Sindh Environmental Quality Standards – Emission Standards Table 3.2: Emission Standard Legal Emission Standard Pollutant Parameters Atmospheric Pollutants SOx (mg/Nm3) 1700 NOx(mg/Nm3) 1200 (Coal), 600 (Oil) HCl (mg/Nm3) 400 CO (mg/Nm3) 800 Dust (mg/Nm3) 500

Dioxin (ng-TEQ/N㎥) -

Noise Level 55 (near Residential area) (Day Time) (dB) 50 (in 100 m radius of Hospital) 45 (near Residential area) (Night Time) (dB) 45 (in 100 m radius of Hospital) Other Pollutant Smoke opacity not to exceed 2 Materials Smoke Ringleman Scale or equivalent smoke number.

3.6 Institutional Analysis This institutional assessment covers institutional structure of health institutions and waste management institutions and ability to address medical waste management issues as well as other players who will be involve directly or indirectly during project execution.

3.6.1 Health Department, Government of Sindh The Sindh Department of Health currently has more than 14,000 Doctors 2,000 Nurses and over 12,000 paramedics serving all over the province. The province has two medical universities; one

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI each at Karachi and Jamshoro, and three medical colleges; one each in Sukkur, Nawabshah and Larkana, 12 Nursing School, 10 Midwifery Schools and 5 Public Health School for lady health visitors. The huge network of hospitals and health facilities include 6 teaching hospitals, 5 specialized institutions for chest, dermatological and mental illness, 11 district headquarters hospitals, 27 major hospitals located in the major cities, 44 Taluka hospitals, 99 Rural Health Centers in small towns, 738 basic health units in Union Councils, 305 dispensaries in larger Union Councils, 36 MCH Centers 12 maternity Homes and 39 centers for traditional medicine. The rural health centers provide specialist care in the morning hours in addition to minor emergency services and have indoor facilities that are seldom utilized, while the BHUs and dispensaries provide outdoor medication and preventive care till 2 pm.

The Provincial Health Ministry is a standard body for providing Medical Education Training & Employment. The overall vision is based on “Health for All“ the new Health Policy aims to implement this strategy of protecting peoples against Hazardous Diseases, promoting public health, upgrading curative health facilities, enhancing equity, efficiency and effectiveness in health sector.  Beside department facilitates:-  Control of Communicable diseases  Tuberculosis  Vaccine-preventable illnesses and Polio eradication  Malaria and Leishmaniosis  Blood Safety and Control of HIV / AIDS  Hepatitis B and C  Control of Non-communicable diseases  Cardiac disease, diabetes, Cancer, Mental Illness, Genetic disorders, Snake bite and Dog bite  Prevention of Blindness (Vision 2020) Program in Sindh  Take measures to implement Better Maternal and Child Health  To counter Malnutrition  To ensure Road Safety

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There is a marked urban bias for both the health facilities and hospitals of the public and private sectors, with little linkages between the two. Therefore, a cadre of Lady Health Worker (LHWs) was established at the grassroots level in 1994, in order to ensure that health education, reproductive health, vaccination, control of diarrhea and other communicable diseases, promotion of safe water and sanitation and other dimensions of PHC could be made easily accessible to the local community. The LHWs are middle level educated, preferably married and residing in the catchments areas, which they serve. They are subsequently trained enabling them to provide preventive, promotive and simple curative care.

3.6.2 Safe management of wastes from health-care activities, WHO Handbook(Second edition) World Health Organization (WHO) handbook on the safe, sustainable and affordable management of medical waste – commonly known as “the Blue Book”. The Blue is a comprehensive publication used widely in health-care centers and government agencies to assist in the adoption of national guidance. It also provided support to committed medical directors and managers to make improvements and presented practical information on waste-management techniques for medical staff and waste workers. Table3.3 Emission guidelines for medical waste incinerators Pollutant Unit Standard US EPA emission EU emission limits condition a limits Small Medium Large Daily Half- 0.5- b b b ave. hour 8 ave.c hour ave. 20OC,101.3 66 22 18 Particulate kPa,7% O2, dry matter or Total mg/m3 273OK, 101.3 dust kPa, 11% O2, 10 10,30 dry Carbon 20OC,101.3 Ppm(v) 20 18 11 monoxide kPa,7% O2, dry

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273K, 101.3 kPa, mg/m3 50 100d 11% O2, dry ng 20OC,101.3 0.013 0.014 0.035 TEQ/m3 kPa,7% O2, dry Dioxins/furans 273OK, 101.3 ng kPa, 11% O2, 0.1e TEQ/m3 dry Gaseous and 273OK, 101.3 vaporous mg/m3 kPa, 11% O2, 10 10,20 organics as total dry organic carbon 20OC,101.3 ppm(v) 15 7.7 5.1 kPa,7% O2, dry Hydrogen 273OK, 101.3 chloride mg/m3 kPa, 11% O2, 10 10,60 dry 273OK, 101.3 Hydrogen mg/m3 kPa, 11% O2, 1 2,4 fluoride dry 20OC,101.3 ppm(v) 1.4 1.4 8.1 kPa,7% O2, dry Sulfur dioxide 273OK, 101.3 mg/m3 kPa, 11% O2, 50 50,200 dry ave., average; EU, European Union; TEQ, toxic equivalent; US EPA, United States Environmental Protection Agency

Different standard conditions are defined for EPA and EU limits; corrections have to be made to convert between different standard temperatures and percentage oxygen. EPA defines small incinerators as having a waste burning capacity ≤200 lbs/h, medium capacity as >200–500 lbs/h and large capacity as >500 lbs/h.

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At least 97% of half-hourly average concentrations must meet the first value and 100% must meet the second value.

All half-hourly average concentrations taken in any 24-hour period must meet this value. The sampling period for dioxins/furans must be a minimum of 6 hours and a maximum of 8 hours under the EU directive. AP 42 (EPA, 1996) are emission estimates for incinerators without air pollution equipment and are shown for comparison; adapted from Batterman (2004). 12

3.7.3 Medical Waste Management Guidelines - International Committee of the Red Cross (ICRC) This manual is designed for the medical, technical or administrative staff working in medium-sized hospitals (approximately 100-bed capacity) that are managed or supported by the ICRC. It deals with wastes that are created in the course of surgical, medical, laboratory and radiological activities with the exception of specialties such as oncology, nuclear medicine or prosthetic/orthotic workshops. It deals mainly with so-called hazardous or special medical waste except for genotoxic waste such as cytotoxic substances or radioactive material, which are wastes that ICRC health care activities generally do not produce.

3.8 SEPA EIA / IEE Regulations 2014 Sindh Environmental Protection Agency (Review of IEE and EIA Regulations), 2014 (the Regulations) prepared by the Sindh Environmental Protection Agency under the powers conferred upon it by the Act, provide the necessary details on preparation, submission and review of the IEE and the EIA. Categorization of projects for IEE and EIA is one of the main components of the regulations.

Projects have been classified on the basis of the expected degree of adverse environmental impacts. Project types listed in Schedule-I are designated as potentially less damaging to the environment and those listed in Schedule-II as having potentially serious adverse effects. Schedule-I projects require an IEE to be conducted, provided they are not located in environmentally sensitive areas. For the

12Sources: EPA (2011); European Parliament and the Council of the European Union (2000)

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Categories of projects requiring IEE and EIA are issued through two schedules attached to the Regulations.

 A fee, depending on the cost of the project, has been imposed for review of EIA and IEE.  The submittal is to be accompanied by an application in prescribed format included as schedule V of the Regulations.  The EPA Sindh is bound to conduct preliminary scrutiny and reply within 10 days of submittal of the report:  The EPA Sindh is required to make every effort to complete the review process for IEE within 45 days and of the EIA within 90 days, of the issue of confirmation of completeness.

The IEE/EIA approval will be valid for three years from the date of the accord. A monitoring report is required to be submitted to the EPA Sindh after completion of construction, followed by annual / bi-annual / quarterly monitoring reports during operations. The project falls in Schedule-II of the regulations. Hence, this type of project needs an EIA to be conducted.

3.9 SINDH Environmental Quality Standards The proposed project is legally required to comply with the SEQS (Sindh Environmental Quality Standards). In addition to SEQS, the projects environmental performance will also assess compliance with relevant national and international guidelines on emissions & effluent discharge. Section 11 and sub section (1) of the Sindh Environmental Protection Act 2014, “ No person shall allow no person shall discharge or emit or allow the discharge or emission of any effluent, waste, pollutant, noise or any other matter that may cause or likely to cause pollution or adverse environmental effects, as defined in section 2 of this Act, in an amount, concentration or level which is in excess to that specified in Sindh Environmental Quality Standards; or, where applicable, the standards established under Section 6(1)(g)(i); or direction issued under Section 17, 19, 20 and 21 of this Act; or any other direction issued, in general or particular, by the Agency.

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The Sindh EPA has promulgated several standards, which were applicable to the entire province of SIndh, mainly include are:  Ambient Air Quality (9 parameters)  Drinking water (32 Parameters)  Ambient Nose  Industrial Effluent (32 Parameters)  Industrial Gaseous Emissions (16 Parameters)

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI

Chapter 4 ENVIRONMENTAL AND SOCIAL BASELINES

This section describes the environmental and socioeconomic conditions of the project area. Information for this section was collected from a variety of sources, including published literature, reports of other studies conducted in the area by the NEXUS Consulting and archives of the experts, consultations with institutions, and field surveys conducted for this study by the team. Description of the environmental and socioeconomic conditions of SESSI hospitals requires baseline data on the existing resources of its microenvironment and macro environment as well as the following in particular:  Physical Environment  Biological Environment  Road Infrastructure

In order to carry out environmental assessment study, it is first necessary to demarcate the existing environmental feature in and around the proposed project, on the existing environment and section describes the environmental setting of the project area. Baseline data reported here pertain to the physical, biological and socio-economic aspects of the macro-environment as well as the microenvironment of proposed sites. The project is located near the industrial area. Information available from electronic/printed literature relevant to baseline of the area, surroundings and was collected at the outset and reviewed subsequently. This was followed by surveys conducted by experts to investigate and describe the existing status and scenario.

4.1THE ENVIRONMENT OF THE PROJECT AREA

4.1.1 Topography of Karachi Karachi is one of the largest and the most rapidly growing mega cities of Pakistan with a total population of over 1.5 million with the annual growth rate of 5% (Pakistan Economic Survey,). Karachi can be broadly divided into two categories; the hilly areas in the north and west and an undulating plain and coastal area in the southeast. The hills in Karachi i.e. Khasa Hills, Mulri Hills &Mangopir Hills these are the off-shoots of the Kirthar Range. The highest elevation point of these

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI hills in Karachi is about 528 m which lie in the extreme north. All these hills are devoid of vegetation and have wide intervening plains, dry river beds and water channels. Karachi has a long coastline belt in the south. The famous sea beaches include Hawks Bay, Paradise Point, Sands Pit, and Clifton. Chenna Creek and Korangi Creek provide excellent calm water channels for rowing and other water activities. Away from the shoreline, there are small islands including ShamshPir, Baba Bhit, Bunker, Salehabad and Manora.

The project area is located in the Nazimabad Site Area and Landhi industrial area. The most of the area’s infrastructure is and industrial. The project is at an elevation of 114 feet above mean sea level and 107 feet in Nazimabad and Landhi respectively. Land Elevation Map of the project Site is shown in figure.

Figure 4.1: Elevation Map of Valika

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Figure 4.2: Elevation Map of Landhi 4.1.2 Topography of Kotri The study area has distinct physiographic unit namely the hill range of Surjan. The general topography of the area is that of alternate valleys and hills with their long axes in North- South direction. The Surjan Range in the east of Thano Bula Khan comprises of elongated hills located with-in Thano Bula Khan Valley. These hills reach a maximum height of about 393 meters. The eastern slope of Surjan Anticline is steeper as compared as to the western slope.

The project area is located I Kotri Industrial area. The three quarter infrastructure of this area is industrial. The project is an elevation of 162 feet above the sea level.

Figure 4.3: Elevation Map of Kotri 4.2 Environmental Setting of the Project The proposed project is located in the vicinity of SESSI department. The details of the environmental setting of the project are given in as following.

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Table 4.1: Environmental Setting of Kulsum Bai Valika Hospital Nature of the Project Installation of biomedical waste incinerator of 50-60Kg/hr at Valika Hospital Land Ownership Land is owned by the SESSI Land Area 9.5 Acres Latitude & Longitude 24°55'32.26"N 67° 0'55.50"E Nearest Railway Station/ Airport No nearest Railway station is Located in the area Nearest Water body No water body is founded in the radius of 15Kilometer. Nearest Reserved Forests No forest Area is founded. Nearest Highway 9.66 Kilometer M-9 Motorway 8.69 kilometers Regional Co-operation for Development Highway. Water Requirement 200L/H Power Requirement 380V, 3-Phase, 50Hz, 3KW For Natural Gas 22 m3/hour Project Cost 27.6 Million

Table 4.2: Environmental Setting of Landhi Hospital Nature of the Project Installation of biomedical waste incinerator of 50-60Kg/hr at Landhi Hospital Land Ownership SESSI Land Area 9.66 Acres Latitude & Longitude 24°50'14.07"N 67°12'51.95"E Nearest Railway Station/ Airport 1.45 Kilometer Landhi Railway station 7.37 Kilometer Jinnah Terminal Nearest Water body 3.07 Kilometer Korangi&Gharo Creek Nearest Reserved Forests No reserved Forest was found to be in the radius of 10Km.

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Nearest Highway 2.35 Kilometer National Highway Water Requirement 380V, 3-Phase, 50Hz, 3KW Power Requirement 380V, 3-Phase, 50Hz, 3KW For Natural Gas 22 m3/hour Project Cost 27.6 Million

Table 4.3: Environmental Setting of Kotri Hospital Nature of the Project Installation of biomedical waste incinerator of 50-60Kg/hr at Kotri Hospital. Land Ownership SESSI Land Area 2.09 Acres Latitude & Longitude 25°21'6.86"N 68°16'41.78"E Nearest Railway Station/ Airport 2.55 Kilometer Kotri Junction. Nearest Water body 4.14 Km Indus River 1.73 Km KB feeder Nearest Reserved Forests No forest is located in the area of 15KM Nearest Highway M-9 Motorway Water Requirement 200L/H Power Requirement 380V, 3-Phase, 50Hz, 3KW For Natural Gas 22 m3/hour Project Cost 27.6 Million

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Figure 4.4: Location Map of Kulsum Bai Valika

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Figure 4.5: Location Map of Landhi

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Figure 4.6: Location Map of Kotri

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4.3 Layout and Land Area Breakup The layout of the facility is designed to have maximum logistical economy and ease of operations. The capacities of equipment are well balanced to have maximum plant utilization factor. Automation is planned wherever possible and feasible to restrict human intervention and to ensure trouble free high volume operation for long hours. Land usage is also optimized. The layout is presented in the following figure. Planting of proper species has been built in a proper pattern that will help to buffer the emissions.

Figure 4.6: Ground floor Plan

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4.4 PHYSICAL ENVIRONMENT OF AREA The physical environment of proposed project has been described in this study with respect to the airshed, watershed, geology, soil characteristics and seismicity. Baseline data on the airshed describe the climatic conditions and quality of air in the microenvironment and macro-environment and characterize the airshed in terms of level of pollution, viz. unpolluted, polluted or grossly polluted. Similarly baseline data on watershed describe the hydrology and quality of surface and groundwater as well as water availability. Data on Geology, geomorphology, soil characteristics and seismicity are needed to evaluate the terrestrial resources with respect to quality of minerals and soil characteristics particularly stability.

4.5.GEOLOGY AND SOILS 4.5.1 Geology& Soil Texture of Karachi Geology: Karachi is the part of major synclinorium stretching from Ranpathani River in the east to Cape Monze in the west, Mehar and Mole Jabal (Mountains) in the north. Within the synclinorium a number of structures such as Pipri, Gulistan-e-Jauhar, Pir Mango and Cape Monze are exposed. The presence of concealed structures under the Malir River valley, Gadap and Maripur plains can fairly be deduced. Rock aggregates, sand, limestone and clay are some of the potentials for gainful utilization. Gulistan-e-Jauhar member of the Gaj formation offers groundwater potential for limited use. The area is underlain by rocks of sedimentary origin ranging in age from Eocene to Recent. Major structural trends and the basin axis strike generally south but with a “bulge” to the east alsocalled Karachi Arc (Bender and Raza 1995).

Various rock units described above have been folded to form anti-clinal hills and synclinal valleys, with moderate to gentle dips. The fold axes run approximately north-south. Structurally the area may be divided into two zones. First zone is to the east and northeast and it is characterized by relatively more intense folding and faulting. Rocks ranging in age from Paleocene to Oligocene are also exposed in this zone. The second zone is located in the centre and to the west and southwest and comprises the large area, which opens out towards the south and largely consists of horizontal or near horizontal strata which form gentle structural undulations in the form of synclines and anticlines with low dips of 2 to 6 degrees (rarely up to 10 degrees). These folds have a general

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI southward plunge direction. These structural features clearly indicate that the structure of the Gaj basin (Khadeji basin) is more suitable for the accumulation and storage of ground water by virtue of more extensive recharge zones, locations of probable groundwater aquifers at shallower depths and several shallow synclinal structures.

Figure 4.7: Ground floor Plan

4.5.2 Seismicity For the purpose of seismic design of buildings, Pakistan has been divided into five zones. These zones are based on the peak ground acceleration. Karachi lies on Zone 2B while Kotri lies on the Zone 2Aon the seismic zone of Pakistan.

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Figure 4.8: Seismic Zoning Map of Pakistan

4.5.3 Geology and Soil Texture of Kotri Some fine aggregates were established to be sound and good as they fell within the limits of standard specifications while some were found to deviate from limit in certain respect. Quarries complied with the requirements prescribed in BS and ASTM standards and is suitable for concrete construction. It is mostly used in Buildings, Road and Bridge construction and is also recommended by NHA and Building control Authority The Jamshoro area (from Kotri-Bholari&Petaroetc) is full of quality aggregates The petrographic analysis shows the presence of very minute amounts of deleterious contents in limestone aggregates / Bholari Sand which geologically designate it as suitable aggregate source. The values of all engineering parameters are comparable with standard values of AASHTO, ASTM, BS and NHA which infer the Coarse & fine aggregates as excellent aggregate source.13

A. Lithology of the Area Surficial Alluvium Deposits (Holocene): These deposits consist of sand, silt and clayey materials brought by streams.

13Study of Engineering Properties of Bholari Sand Kotri District Jamshoro Sindh Pakistan, http://ijesc.org/

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Manchhar Formation (Pliocene): Manchhar Formation is mainly composed of sandstones, shales, clays with subordinate conglomerates. Sandstones are greenish grey in colour, gritty to fine grained, soft crumbly and cross bedded. Shales and clays are brownish green to bright red in colour containing pebbles of clay and sandstone. Vertebrate and wood fossils are present in these beds. Gaj Formation (Miocene): The formation consists of limestone, sandstone, shale and minor conglomerates. Limestone is yellowish brown to dark brown, cream in colour, fossiliferous, hard and sandy and argillaceous (at places) interbedded with shales and marls. Sandstone is soft fine grain yellowish brown to grey. Shalwe is greenish grey, gypsiferrous interbedded with sandy limestone and calcareous sandstone.

B. Structure The rocks are deformed in the area. Three phases of deformation are seen in the form of the major anticlines, synclines and minor faults which also occur in the study area. Karachi arc forms the southernmost part of the Kirthar mountains and comprises a series of parallel to sub parallel, short, narrow, serrate, arcuate (convex to east) en echelon ridges and wide, dome shape anticlinal hills. It forms a nearly 200 km long and 50 km wide zone between Karachi and Sehwan. The Bhit Range, Bhadra Range, Laki Hills and Lakhra Hills are some of its more prominent components. The altitude of the hills varies from 250 meters in the south to about 1100 meters in the north. The Naing, Baran and Malir Rivers are the main streams draining this region (Kazmi and Jan, 1997).

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Figure 4.9: Geological Map of Sindh

HYDROLOGY OF THE PROJECT AREA A. Freshwater Resource in Karachi There is no natural freshwater source in the project area. The Indus River is about 120km to the east of Karachi city and the Hub River, a perennial stream that originates in Baluchistan and marks the boundary between Karachi Division and Baluchistan are the sources of water in Karachi. Approximately 89% (2.02 million m3/d or 445 MGD) of the total supply to Karachi is from the Kotri Barrage on the Indus River through a system of canals and conduits. Hub River located north of Karachi, which supplies about 0.13 million m3/d (29 mgd) of water to the city. In addition to these surface water sources, an estimated 0.09 million m3/d (20 mgd) is supplied from private and public groundwater wells in and around Karachi. Except for a few Karachi Water and Sewerage Board’s (KWSB) wells, all of which are connected to the piped supply system, the water from the groundwater wells is distributed through water tankers to various parts of the city.

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The Lyari and Malir Rivers that passes through the area (Karachi City) do not have any natural flow, except during the monsoons. Malir River is ephemeral and is constituted from two major tributaries, i.e. Mol and Khadeji as well as some minor tributaries. Khadeji is a perennial stream that origi-nates at Khadeji falls and gains flow as it travels across the Malir Basin. B. Fresh Water Resource in Kotri The main source of water supply in kotri is from the Kotri Water Supply Schemes (surface water dependent) and get the water from the a branch of the Kotri barrage constructed on Indus river. The Water Filtration Supply Scheme is built by Public Health Engineering Department which supply water to the Kotri Residential and Commercial areas including the Kotri SESSI Hopistal. Kotri Barrage is a barrage on the Indus River between Jamshoro and Hyderabad in the Sindh province of Pakistan. The barrage was completed in 1955. Kotri Barrage is used to control water flow in the Indus for irrigation and flood control purposes.

It has a discharge capacity of 24,800 cubic metres per second (875,000 cu ft/s). It is a gate- controlled weir type barrage with a navigation lock. The barrage has 44 bays, each 18 metres (60 ft) wide. The maximum flood level height of Kotri Barrage is 13.1 metres (43.1 ft). It feeds Fulleli, Pinyari, and KalriBaghar Canals.14

C. Groundwater resources Groundwater resources in Karachi area are limited. The aquifers close to the coastal belt are mostly saline and unusable for domestic purposes. The aquifers near the Hub River bed are well developed and are source of water for agriculture and other domestic purposes. The aquifers are estimated to lie at depths of 50-100 m.

The amount of annually renewable groundwater available in Sindh is estimated to be 22 to 27 BCM (18 to 22 MAF); yet only a fraction of this is used—with the groundwater discharge now leading to waterlogging and soil salinity. There is a need to make better use of groundwater in Sindh. One of the reasons for this concerns the challenge of climate change: with more extreme hydrological situations, the buffering role of groundwater becomes important. Another reason is the expected

14https://sindh.gov.pk/dpt/Irrigation/kotri%20barrage.htm

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI reduced availability of surface water due to sedimentation of the current large storage reservoirs. Over the years, three main water reservoirs in Pakistan have been constructed, Tarbela, Mangla and Chashma, with a total live storage of 20 BCM (16.29 MAF). However, as a result of sedimentation, the effective gross capacity of these reservoirs has been reduced by 5.4 BCM (4.37 MAF) (28%) as of 2012. 15Moreover, it is expected that the process of sedimentation will continue and gross surface storage loss would reach 7.18 BCM (5.82 MAF) (37%) by 2025.16 This calls for better management of groundwater reservoirs. At present, the groundwater buffer is not well managed, with waterlogging being the main manifestation. This suppresses farm yields and keeps cropping intensity relatively low. In Sindh, these cropping intensities have increased significantly over the original intensities. They are, however, considerably lower than they are in Punjab, varying from 116.7% in Sindh Cotton Wheat zone (SCWS) to 234.0% in Punjab Sugarcane Wheat zone (PSW).17 The impacts are not only limited to agriculture but also extend beyond.

D. Water Supply Network in Karachi The existing bulk water supply system for Karachi City has a capacity of about 650 MGD as summarized in Table 4.4. The actual water demand in the Karachi city is about 1100 MGD, how- ever actual supply is about 600 MGD only. The existing bulk water supply system conveys water to Karachi from two main sources, namely, Indus River and Hub Dam. Table 4.4: Bulk Water Supply Capacity in Karachi BulkWaterSupplyCapacityinKarachi BulkWaterSystem RatedCapacity(MGD) ActualSupply(MGD) GKsystem* 280 300 Halejisystem 20 30 K-IIsystem 100 120 K-IIIsystem 100 100 DumlotteeWell 20 0 Hubsystem 80 80

15Pakistan Institute of Legislative Development and Transparency (PILDAT). Inter-Provincial Water Issues in Pakistan; PILDAT: Islamabad, Pakistan, 2011. 16. Ahmad, I.; Sufi, A.B.; Hussain, T. Water Resources of Pakistan; Pakistan Engineering Congress: Lahore, Pakistan, 2012. 17 . Mirza, G.M.; Latif, M. Assessment of current agro-economic conditions in Indus Basin of Pakistan. In Proceedings of International Conference on Water, Energy, Environment andFood Nexus: Solutions and Adaptations under Changing Climate, Lahore, Pakistan, 4–5 April 2012.

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Total 600 630

Figure 4.10: Bulk Water Supply Capacity in Karachi

The water distribution network in Karachi covers 18 towns 6 Cantonments and Defense Housing Authority (DHA) Area. These 18 towns are included in 5 administrative water supply zones classified by KW&SB as shown in figure 4.9. Water is supplied through water trunk mains from water filtration plants, reservoirs, pumping stations in the city of Karachi.

Water Distribution System InKotri Since the lands of this district lie at the bottom of Kheerther mountain range having high altitude as compared to Indus River, there is no canal system available in this district and only perennial water is available for cultivation. Besides, katcha area, alongside the Indus River, is irrigated with river water. As the table shows, majority of the mouzas are waterless (barani). Out of the 150 rural mouzas, 76 (51%) are arid, 59 (39%) are irrigated with the help of canals, and 36 (24%) are irrigated through tube wells.

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Table 4.5: Kotri System Mouzas Reporting Sources of Irrigation Administrative Unit Canal River Tubewell Ravine Spring Arid Flooding / Well / Torrent Stream Jamshoro Number 59 34 36 4 4 76 4 District Sehwan Number 41 7 16 - 3 15 1 Taluka Kotri Taluka Number 3 7 3 2 - 15 - Tahno Bula Number 3 1 15 1 1 26 - Khan Taluka Source: Mouza Statistics of Sindh 2008, Agriculture Census Organization

SURFACE AND GROUND WATER QUALITY Due to unsafe and insufficient water supply and low sanitation coverage, as well as people’s poor hygiene habits, around 60 percent of children suffer from diarrhea that is fatal if not treated in time. Concerns have been raised by various quarters about contamination in drinking water supply in the distribution network and possible linkages with water borne diseases in the city. The seriousness of the issue can be rated from the fact that in the year 2002, the Provincial Ombudsman Sindh, Justice Haziqul Khairi in response to a growing number of reports received from all over Sindh province about the supply of contaminated drinking water, instituted a study for investigating the claims of the public and assessing the causes of contamination.

The water that leaks through the distribution mains and smaller pipes, particularly the ones that were laid long time before and in the Third Phase of the Bulk Water Supply scheme for Karachi, creates an underground pool during the supply hours. This serves as a nursery to the micro-organisms, including fecal coliform released by the leaky sewers crisscrossing the water supply pipes. Sewage might enter into the distribution system due to vacuum created during idle hours. This is the reason for the gradual depletion of free-active chlorine in the treated water as it proceeds from the filter plant to the distribution network and in its onward journey to the households. The findings of the

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI analysis of the water samples suggest that the water even though treated gets contaminated in the distribution network and on its way to the consumers.

This finding suggests that the water as received by the residents is not safe for drinking. Assessment of ground water quality in the aforementioned Ombudsman Study Report indicated that ground water has been over exploited in Sindh and the drying of traditional wells in the vegetable and fruit growing areas in the suburbs of Karachi has occurred. The groundwater pollution due to contamination of by nitrates, pesticides, heavy metals and hydrocarbons dis-charged into the environment is not negligible. The salinity of groundwater in Southern Sindh, particularly in the coastal areas has increased since over pumping has induced seawater to flow in, causing what is known as seawater intrusion.

The fact, also acknowledged by KW&SB that 150 mgd (681,900 m3/day) of water supplied to the consumers is chlorinated and bypasses the KW&SB filter plants is an important indicator of the need of addressing this issue on a priority basis. The Ombudsman Study Report says that the water drawn from about 95% of the wells in the city of Karachi is contaminated with sew-age bacteria and also contains total dissolved solids beyond permissible limits. The Ombuds-man Study Report also documents that 90% of the survey sample tests conducted by PCSIR indicate that the water is unfit for drinking purposes referring to the guidelines set by the World Health Organization (WHO). The study on water supply and sewerage system in Karachi by JICA in 2008 records the final analysis on quality of drinking water collected from Landhi and Bin Qasim areas. The analysis for the Landhi samples shows medium level contamination by metallic ions namely Lead (1.89-4.75 mg/l), Arsenic (0.736 mg/l), Copper (4.5-12.63) and by Fecal Coliform (<3-23), while the analysis for the Bin Qasim samples shows Lead (2.07-6.57), Arsenic (3.530), Copper (9.50-22.6) and by Fecal Coliform (<3).

Chemically the groundwater quality in the macro environment varies from palatable to brackish. The former has been found to have TDS from 400 to 1200 ppm, and although it falls in the range of being acceptable because of dilution with leakages from the water supply mains, it does not qualify as such because of serious contamination otherwise.

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The brackish water contains 1200 to 3000 ppm of TDS, which is the usual range of concentration of salts in the groundwater at reasonable depths in the Industrial Areas. Toxic materials discharged by factories outside their working areas, have only slightly impacted the groundwater so far since the quantities of the concerned contaminants such as chromium is in traces, if detected at all. The groundwater quality at much lower depths has high salinity, with the TDS in excess of 2,500 ppm. A recent report of Water Commission Inquiry (2017), constituted by the Supreme Court, points towards the major issues of unfit drinking water for citizens and poor sanitation in Karachi. Ground water of kotri is deteriorating this may be due to the human settlement and in leaching of dissolved impurities of wastewater effluents used by farmers directly without treatment in oxidation ponds, and also from wastewater ditches around the ponds; chemical composition of earth’s crust; and/or geology of the study area. 18

Ground Water of Kotri Ground water of kotri is deteriorating this may be due to the human settlement and in leaching of dissolved impurities of wastewater effluents used by farmers directly without treatment in oxidation ponds, and also from wastewater ditches around the ponds; chemical composition of earth’s crust; and/or geology of the study area.19

18IMPACT OF WASTEWATER EFFLUENTS ON PHYSICO-CHEMICAL PROPERTIES OF GROUNDWATER Sindh Univ. Res. Jour. (Sci. Ser.) Vol. 41 (1) 75-82 (2009)

19 IMPACT OF WASTEWATER EFFLUENTS ON PHYSICO-CHEMICAL PROPERTIES OF GROUNDWATER Sindh Univ. Res. Jour. (Sci. Ser.) Vol. 41 (1) 75-82 (2009)

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4.5.1 DRAINAGE SYSTEM About 60-70% of the water supplied to Karachi City is said to return as sewage. A total quantity of 315 mgd (1,432,000 m3/d) of domestic and toxic industrial wastewater is generated in the city. There are three sewage treatment plants in Karachi. The total design capacity of these treatment plants is 151 mgd(686,000 m3/d). The untreated sewage is disposed of into the sea through nallahs and rivers including the Lyari and Malir Rivers. The total length of sewers is approximately 3,290 km and ranges from 8 inches (200 mm) to 84 inches (2,130 mm) diameter of trunk sewers, secondary sewers and laterals. Both Lyari and Malir rivers carry the bulk of the wastewater from the city and dispose off into the creeks. This situation is expected to continue until sewers are re-conditioned, replaced, existing sewage treatment works and refurbished and new plants constructed.

Sewerage Collection System There are three sewer districts in Karachi City, namely TP-1, TP-2 and TP-3 districts. New Karachi and Orangi Towns both at the right bank side of Lyari River will be included in sewer district of TP- 3 after construction of new sub main sewers to Lyari Interceptor. Korangi and Landhi Towns at the left bank side of Malir River have been isolated from sewer district of TP-2 after pressure main from these towns to TP-2 was destroyed by the flood in 1974. KW&SB has proposed new sewage treatment plant for these towns at the left bank side of Malir River. Table 4.6: Sewerage Collection System Sewer Districts Sewer District Related Town TP-1District SITE,NorthNazimabad,NorthKarachi,Gulberg,Liaquatabad TP-2District Saddar,Jamshed,Faisal TP-3District SITE,Baldia,Lyari,Saddar,Jamshed,Gulshan-e-Iqbal Korangi District Landhi,Korangi Sewer Districts’ Capacity Sewage Treatment Plant Optimum Design Actual Treatment MGD Capacity(MGD) TP-1DistrictSITE 51MGD 20MGD

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TP-2DistrictMehmoodabad 46.5MGD 0 TP-3DistrictMauripur 54MGD 35MGD Total 151.5MGD 55MGD Sewerage System Sewage Generated in the City(70%ofwater 472MGD Supplied) Optimum Design Capacity of Sewerage 151MGD Treatment Plants Quantity of Sewage Treated 55MGD Short falling Sewage Treatment Capacity 321MGD Untreated Sewage 417MGD

4.5.2 SOLID WASTE MANAGEMENT Karachi It is estimated that the average waste generated in Karachi is 0.483 kg/persons/day, the total amount of municipal living waste is about 17000 ton/day, the total amount of industrial waste, construction waste and hospital waste is about 2000/ton/day. However, the existing solid waste collection and transportation management system in Karachi is not perfect. The municipal infrastructure construction has been lagged behind by the economic development, which becomes the bottle‐neck to hinder the faster and better development of the municipal economy. Of the municipal infrastructure construction, the infrastructure of MSW collection, transfer and final disposal is also on the top of the agenda of the important factor to block the economic development.

There are two landfill sites in the outskirts of Karachi. 1) The Jam chakro landfill site having co- ordinates 25o01’640N, & 67o01’980E at the altitude of 285 ft. This site is spread over 500 acres. The garbage/composite consists of silver, metal, glass, bones, polythene shoppers etc. This landfill is in the north west of Umar goth having 1000 houses in deh Bund Murrad, Gaddap, ManghoPir area. About 8‐9 kms of garbage is dumped at the height of 285ft. below the datum. About 2000‐3000 tons of garbage is dumped in the area, 2) Gond Pass Landfill Site is located in between 25o00’634N

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI and 66o55’262E. Gond pass is an old landfill established about 40‐50 years ago and spread over an area of 500 acres. About 1000 tons/day of municipal waste is transferred from various garbage collection points. The landfill is scientifically maintained by placing PVC filtered pipes for the escape of gases.

Guidelines for Solid Waste Management have been drafted by Pakistan Environmental Protection Agency (PEPA) in collaboration with JICA and UNDP in 2005. These guidelines provide for safe and sustainable mechanism for collection, handling, storage and disposal of solid waste including hazardous waste.

Hyderabad Being one of the major cities of Pakistan, Hyderabad city does not possess a well-developed solid waste management system. The visit at various locations of city unfolds the black side of the city in terms of its solid waste collection, transportation, dumping sites, recycling etc. The study investigates various causes of solid waste generation in Hyderabad with the help of several interviews and visits. Interviews were conducted from municipal officers, lower staff, dwellers of different areas of Hyderabad, rag pickers and shop keepers. The level of significance of causes was determined with the help of collecting data among various respondents with a questionnaire survey. The study concludes that, Increase in Population, Non bio degradable material usage, Lack of awareness among the public, poor management are few critical causes of waste generation in the city. The discussion with experts revealed that, population control including urban growth control in the city can reduce major issues. Reduction of non-bio degradable materials (like plastic bags), awareness among public, good management of various organizations can lead to the reduction of waste generation in the city.There is anutter need for an efficient solid waste management systemin Hyderabad. In this regar d, the Local Government needsto put their efforts. The overall system from collection toits safer dis posal requires special attention. The Local Government should not only utilize the public funds on maintenance of entire system properly but also it requires to focus on arranging few programs like public meetings, seminars, workshops etc. On monthly basis. These programs would definitely

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI aware the public, which is an important stakeholder in reduction and proper management of solid waste.20

4.5.3CLIMATE KARACHI The climate of project area in Saddar town area is arid to semi-arid with hot summers and mild win- ter. Scanty and erratic rainfall is received in monsoon season.

TEMPERATURE The air temperature in Karachi Division and its coastal areas are generally moderate throughout the year due to presence of sea. Climate data generated by the meteorological station at Karachi Air Port represents climatic conditions for the region. The mean monthly maximum and minimum temperatures, recorded during the last 16 years in Karachi to describe the weather conditions are shown in Table 4.10 and 4.7 respectively. The Tables indicate that the mean monthly maximum temperature in Karachi ranged between 26.8ºC and 26.78 0C during the 2001-2016 periods, while the mean monthly minimum temperature ranged between 13.6ºC and 15.72 ºC. The annual mean maximum and mean minimum temperature during 2001-16 periods were 32.80ºC and 23.0ºC, which indicates that there has been a slight but significant rise in the mean minimum temperature during the last 16 years.

The district suffers a long hot season, which starts from March and continues till October. The summer season is not too hot due to influence of sea breeze but in May and June due to low pressure in the interior Sindh the north-east winds increase the temperature and it soars up to 43˚C or even higher. By the end of June monsoon winds from Arabian Sea moves towards low-pressure region. These winds carry water moisture in abundance, which in a shape of clouds, passes through the district reducing the temperature considerably. Winters start from November and continue till February. During winter the temperature re-mains up to 15˚C. The Northern wind blows in this period, which reduces the temperature further.

20Solid Waste Management Issues in Hyderabad City Vol. 37, No. 3, 653-662 July 2018 p-ISSN: 0254-7821, e-ISSN: 2413-7219

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In Karachi, the megalopolis at the mouth of the Indus, the average temperature ranges from 18.5 °C (65.5 °F) in January to 31 °C (88 °F) in June. Here, winter is pleasant and sunny (although it can sometimes be cold during the night). In the months preceding the monsoon, there can be scorching hot days, with peaks of 42/44 °C (108/111 °F), but it's more common for the temperature to remain about 35 °C (95 °F), though with a high humidity. Here are the average temperatures.

Table 4.7: Past 3 Years Temperature

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 Max 26 29 32 34 35 36 33 33 32 33 32 29 Avg 22 24 27 29 31 31 30 30 28 28 27 24 Min 19 20 24 25 28 28 29 28 26 25 23 21 2017 Max 25 29 32 35 37 34 32 30 30 35 24 29 Avg 21 24 27 30 32 32 30 29 29 30 26 23 Min 18 21 23 26 28 29 28 27 27 27 23 20 2018 Max 26 28 31 35 37 34 32 30 30 35 24 29 Avg 22 24 27 30 33 31 30 28 27 33 32 26 Min 19 21 24 26 29 29 28 27 26 30 28 23 2019 Max 26 28 32 34 35 35 33 32 33 35 30 27 Avg 18 20 25 28 31 32 30 29 29 28 28 24 Min 10 12 18 22 26 28 27 26 25 21 24 20 Source: (Extract from world weather online & weather-pk) Karachi Average Precipitation

From June to September, the monsoon season, it doesn't rain a lot: about 160 mm (6.3 in), including 80 mm (3.2 in) in July, but here too, this season can be very rainy during certain years. In July and August, the weather is often cloudy and the heat is sweltering, especially in the interior of the city, while coastal districts receive a fairly steady breeze from the sea. Here is the average precipitation.

Table 4.8: Average Rainfall Karachi (mm)

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 2.63 0.0 3.9 0.11 0.09 9.71 10.23 41.09 1.2 0.01 0.00 0.1

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2017 5.61 0.03 0.1 0.01 0.06 3.47 20.4 27.17 16.9 0.0 0.14 0.22 2 2018 0.01 0.0 0.04 0.53 0.0 5.92 11.86 14.31 2.53 0.0 0.0 0.4 2019 6 9.8 11.7 4 0 5.5 85.5 67.4 19.9 1 5.6 3.3

Source: (Extract from world weather online & weather-pk) Table 4.9: Average Humidity of Karachi %

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 48 33 49 54 66 67 72 73 71 63 39 44 2017 37 29 49 52 63 68 74 72 69 55 38 25 2018 42 45 50 51 52 63 73 75 72 47 37 25 2019 42 39 46 55 61 62 65 75 71 53 40 31

Source: (Extract from world weather online & weather-pk)

KOTRI

The climate of the area under study is subtropical and continental type, which consists of hot summers and clement dry winter lasting from December to February. The annual mean rainfall in the northern part is about 100 mm whereas in the south it is 175mm. July and August are the months of rainfall .The temperature in the extreme north (i.e. upstream Sukkur and Shikarpur ) is in between 400 -500 C where as in the south (i.e. downstream Kotri and Thatta ) is up to 35 0C. The humidity in the above regions is 30% and 61 % respectively. The study area is located at longitude 68°16'36.30"E, latitude 25°21'11.51"N. Air temperature ranges between 9.3°C to 40.4°C. There are significant extremes of rainfall in the basin. According to Climatic Normals of Pakistan (1961-90) the mean annual rainfall over the Indus plains at kotri is 178 mm. The rainy months are late June through September and the driest months are November through March, when the average monthly rainfall rarely exceeds 30 mm. The temperature, precipitation and humidity % average of the 3 years respectively has been discussed below Table 4.10: Average Temperature

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 Max 27 30 36 40 42 43 39 38 39 38 34 31 Avg 21 23 30 33 35 36 34 33 32 31 26 24 Min 16 18 25 27 29 30 30 29 27 26 21 19 2017

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Max 25 30 36 42 44 41 37 37 38 38 32 27 Avg 19 23 29 34 36 35 33 33 32 32 26 21 Min 15 18 23 27 30 30 30 29 28 27 21 17 2018 Max 28 31 36 41 44 41 38 36 37 40 35 29 Avg 21 25 30 34 37 35 33 31 31 37 32 26 Min 17 20 24 28 31 30 29 28 26 31 27 20 2019 Max 27 28 34 41 42 43 39 37 38 37 31 27 Avg 24 24 30 38 39 39 36 24 35 35 28 24 Min 18 19 24 30 31 30 29 28 29 28 23 18

Source: (Extract from world weather online & weather-pk)

Table 4.11: Average Rainfall (mm)

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 0 0 2.27 0.38 1.24 0 9.77 9.42 0 0 0 0 2017 1.31 1.23 0.2 1.16 0 0.41 12.5 17.04 9.25 0 0 0.1 2018 0 0 0 0.13 0 0.05 0.27 3.84 0.06 0.1 0 0.01 2019 4.9 3.6 15.6 3 0.5 2 45.5 46.5 26.7 11.8 29.4 0.2

Source: (Extract from world weather online & weather-pk)

Table 4.12: Average Humidity

Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 34 18 30 29 42 45 57 57 54 44 25 28 2017 32 19 25 28 38 51 58 52 50 32 23 21 2018 28 26 27 25 27 49 57 60 54 25 22 26 2019 31 30 30 25 33 46 57 61 53 37 35 24

Source: (Extract from world weather online & weather-pk)

4.6 Road Network of Karachi &Jamshoro Karachi Road network is considered as a vehicle for economic development and social change. Efficient road network not only develops a quick and efficient transportation system but also opens up new

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI area hitherto remained closed. It brings about social integration among rural and urban sectors and greatly assists in providing access to basic needs such as education, health facilities, etc. It brings rural areas in constant touch with urban segment of a society and creates better understanding necessary for social change and political awareness. Karachi district covers an area of 3,527 sq. km and is served by a well-established network of major roads. The main seaport at Karachi i.e., Karachi Port Trust (KPT), is the main point from which all the major roads originate. As a principal seaport of Pakistan, almost all the upcountry commercial traffic is routed through Karachi. In order to control this commercial traffic, a mega project of Lyari Expressway is constructed which ameliorates the traffic burden. The following is the existing road network of Karachi.

Jamshoro Jamshoro district covers an area of 11,517 sq. km yet it has only 179 kilometers of good quality roads, which are inadequate for the area and its population4. A National Highway (Indus Highway, N55) and Express Way (M-9) connect Jamshoro with other major cities of the province. The district headquarter of Jamshoro is linked with its taluka headquarters of Thano Bula Khan, Manjhand and Sehwan through metaled roads.

4.7Environmental Monitoring 4.7.1 Ambient Air Transportation system and indiscriminate burning of garbage are the dominant source of air pollution in Karachi. Operation of defective vehicles, use of low quality fuel, and increase in the number of vehicles beyond the capacity of roads are the main reasons for deterioration of ambient air quality. However, the impact of air pollution emanating from transportation system has been found limited to the roadways and that too at traffic intersections and on the middle of the road. Emissions from stationary sources e.g. residential and business districts associated with fuel combustion for domestic use and power generation are significant but have limited extent. In order to analyze the existing air quality of the project macro environment, ambient air monitoring had been conducted. The results achieved by the monitoring will be taken as baseline air quality of the area.

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Air monitoring setup was installed at the monitoring locations to collect ambient air quality data for 24 Hours. Pollutants being monitored included NOx, SO2, CO, CO2, O3, SPM, PM2.5, PM10 and Lead. Air quality monitoring was conducted at various locations in the macro environment. The criteria of site selection for air quality monitoring in the macro environment was based on representativeness of the location i.e. locations selected for monitoring are representative of the various type of activities (Industrial operations, traffic congestion etc.) in the macro environment. Each sampling location lies within a varying distance from project site. Below is the result of ambient air sampling results based on environmental monitoring conducted by PRD dated: 24/12/2019, The laboratory report is attached with the document as Annexure III. Table 4.13: Air Quality Monitoring

Monitoring at Valika Hospital

Concentratio S.N SEQS Parameters Units n (Average) Remarks o Limits 24/12/2019 1 CO mg/m3 5 Nil Within limit

2 SPM µg/m3 500 Nil Within limit

Exceed the limit Particulate 3 µg/m3 150 450 Due to Road Matter 10 Construction Exceed the limit Particulate 4 µg/m3 75 195 Due to Road Matter 2.5 Construction Nitrogen Within limit 5 µg/m3 40 39 Oxide Nitrogen di Within limit µg/m3 80 39 Oxide Sulphur Within limit 6 µg/m3 120 25 Dioxide

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7 Ozone µg/m3 130 Nil Within limit

8 Lead µg/m3 1.5 Nil Within limit

Monitoring at Landhi Hospital Concentratio S.N SEQS Parameters Units n (Average) Remarks o Limits 24/12/2019 1 CO mg/m3 5 Nil Within limit Exceed the limit due to dust on Road just due to the construction activities. Once the 2 SPM µg/m3 500 780 road completed the SPM will probably be within the limits. Further tests carried out during the execution. Exceed the limit due to dust on Road just due to the construction activities. Once the Particulate 3 µg/m3 150 370 road completed the Matter 10 SPM will probably be within the limits. Further tests carried out during the execution.

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Exceed the limit due to dust on Road just due to the construction activities. Once the Particulate 4 µg/m3 75 150 road completed the Matter 2.5 SPM will probably be within the limits. Further tests carried out during the execution. Nitrogen Within limit 5 µg/m3 40 35 Oxide Nitrogen di Within limit 6 µg/m3 80 35 Oxide Sulphur Within limit 7 µg/m3 120 29 Dioxide 8 Ozone µg/m3 130 Nil Within limit

9 Lead µg/m3 1.5 Nil Within limit

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4.7.2 Noise Dosimetry The noise level data generated from the survey suggest that the noise levels at the project site were well within the permissible limits. Below is the result of noise monitoring results at various locations, based on environmental monitoring conducted by PRD Lab on 24/12/2019, The laboratory report is attached with the document as Annexure. Table 4.14: Noise Monitoring for 12 Hours S.N Source Average dB SEQS Limit Remarks o 1 Valika Hospital 61 85 Within limit 2 Landhi Hospital 54 85 Within limit 3 Kotri Hospital 48 85 Within limit

4.8 Flora and Fauna in Karachi & Kotri The biodiversity of vegetation on the sandy plains and low hills of urban Karachi is characterized by ephemeral species plus trees and shrubs. During the field visit it has been found that flora & fauna of both the cities has been integrated and generalized in the table 4.15. Flora & Fauna in Karachi Flora Common Fauna Common Name Name Calophylluminc Mahogany Eudynamys Scolopacea Koel ophyllum Ficusreligiosa Peepal Tree Vulpesbenglenis Fox Cassia fistula Amaltas Canis Lupus Familaris Dog Acacia nilotica Babul Felis Chaus Cat Azadirachta indica Neem Rana Tigrina Frog Manilkara Zapota Sapodilla Passer domesticus Sparrow Psidium guajava Guava Sciuridae Squirrel Mangifera Indica Mango Musmusculus Mouse Mentha Mint Cnemidophorus spp. White Lizard Coriandrum Sativum Coriander -

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Cinnamomum tamala Cinnamon - Carica Papaya Papaya tree - Lagenaria Siceraria Bottle Gourd - Rosa Rose - Flora & Fauna in Kotri Flora Common Fauna Common Name Name Acacia nilotica Babul tree Canis Lupus Familaris Dog Cordialatifolia Pidar Felis Chaus Cat Zizyphusnumul aria Bush Flower Coturnix coturnix Quail Azadirachta indica Neem Corvus Crow Tamarundus Indica Tamarind Canispalfipes Wolves Ficusreligiosa Peepal Tree Hystrixindica Porcupine Medicago lupulina Hop Clover Elapidaebungaris Elapid Snake Tamarix dioica Jhau Cnemidophorus spp. White Lizard Populuseuphrafica Desert Poplar Musmusculus Mouse Jasminum officinale Jasmine Eudrynamysscolopalae Owl Sorghum vulgare Jawar Elanuscaeruleus Kite

4.9 Socioeconomic Profile of District Jamshoro 4.9.1 History This region has been ruled by di-erent dynasties, including the Soomras (1024-1351), the Summas (1335-1520), the Arghuns (1520-1650), the Kalhoras (1657-1783) and the Talpurs (1783-1843).After the independence of Pakistan, in 1947, district Jamshoro remained a part of district Dadu. This area continued to be neglected by the authorities but the gradual process of development has changed this district significantly.21

4.9.2 Administrative Structure

21 http://reliefweb.int/sites/reliefweb.int/files/resources/PESA-DP-Jamshoro-Sindh.pdfassessed on July 16, 2016

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Jamshoro district was split from Dadu district in December 2004. It is situated on the west bank of River Indus. The district borders with Dadu district in north, Thatta district in south and Karachi in south west. The district comprises four talukas namely Kotri, Manjhand, Thana Bula Khan and Sehwan.

4.9.3 Geography District Jamshoro lies in 670 16” 20’ to 680 27” 37’ east longitudes and 240 58” 14’ to 260 36” 33’ north latitudes. This district shares its boundaries on the north with Dadu district, on the east River Indus separates it from Shaheed Benazirabad, Matiari and Hyderabad districts, on the south lies Thatta district, south west Karachi district and on the west Kherthar Range make its boundary, which separates Sindh and Lasbela district of Baluchistan. The lands of this district are mostly arid with some vegetation. Due to the hilly nature of the land, cultivation is scarce in this district. Irrigated croplands are on the border alongside the Indus River.

4.9.4 Agriculture District Jamshoro is slightly hotter than surrounding areas in summer and has cool winters. The district is rich in minerals like limestone, gravels and marbles. The Kharif crops produced in the district are rice, cotton, sugarcane, bajra and maize. The Rabi crops are wheat, Barley, gram, pulses and oil seeds. 22

4.9.5 Industries Two out of four talukas have industrial estates in this district. The industrial state in Taluka Kotri consists of 160 factories. This industrial estate employs a large number of people from all over the country. Taluka ThanoBula Khan has an industrial state in Nooriabad along superhighway, which consists of 72 industrial units but where only 42 units are functional and providing employment to its inhabitants and outsiders. Mining is also a source of income for the inhabitants of this taluka.

22 Bureau of Statistics Planning and Development Department Government of Sindh 2007-08

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4.9.6 Poverty status According to the report by Multidimensional Poverty in Pakistan23 2014-15 the Multidimensional Poverty Index is 0.297 in Jamshoro. In another report by Naveed and Nazim24 (2012), the intensity of poverty25 0.54, the head count ratio is 0.39, poorest of the poor 0.23, most Vulnerable 0.16.

4.9.7 Irrigation Katcha area alongside the Indus River is the main agriculture production area where vegetables are grown abundantly. Some of the areas in Sehwantaluka are irrigated by Dadu canal.

4.9.8 Livestock The most kept livestock in district Jamshoro are cattle, buffaloes, sheep, goat, camel, horses, mule and domestic poultry26.

4.9.9 Health Facilities The total number of public sector health facilities in district Jamshoro is 4327. There is only one teaching hospital and four tehsil headquarter hospitals with a capacity of 90 beds. These health facilities are sufficient for only 21% of the estimated 2014 population of the district28. Table 4.16 shows the details of these health facilities Type Number Bed Strength Teaching Hospital 1 - District Headquarter Hospital 0 0 Tehsil Head Quarter Hospitals 4 90 Rural Health Centers 5 50 Basic Health Units 16 34

23 Multidimensional Poverty in Pakistan by United Nations Development Programme Pakistan, Planning Commission of Pakistan and Oxford Poverty and Human Development Initiative 2014-15 24 Clustered deprivation: District profile of poverty in Pakistan, by ArifNaveed and Nazim Ali, 2012, SDPI, Islamabad, Pakistan 25 Intensity of poverty’ or ‘average poverty’ is thus the average of the weighted sum of dimensions in which multidimensional poor households are deprived. This measure of poverty captures depth of poverty 26 http://reliefweb.int/sites/reliefweb.int/files/resources/PESA-DP-Jamshoro-Sindh.pdfassessed on July 16, 2016 27 Health Facility Assessment 2012 (HFA) by Technical Resource Facility (TRF) 28 WHO Standard is 2 health facilities and 25 beds per 10,000 people.

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Govt. Rural Dispensaries 14 - MCH Centers 12 - Sub Health Centers 2 - Grand Total 43 174

4.10 Socioeconomic Profile of Karachi 4.10.1 History of Karachi

A glance at the literature suggests that Karachi was setup in 1728 - 29 by Hindu fishermen and merchants at the northern coast of the Arabian Sea. A historical account on Karachi has been reported by Hasan (1999) starting from the year 1728, though factually claims it as a city existing from Neolithic age and pre-historic times. Former names of the city had been ‘Kalachi Jo Goth ’ or ‘Kalachi Jo Kuh’, which later became ‘Kalachi’ (sometimes referred to as Kolachi) until the beginning of the twentieth century. In 1839, the British Army occupied Karachi and its strategic importance was immediately identified as it became the first airport of the undivided India (subcontinent) in 1843 and an important administrative seat for the British Empire. The British developed the irrigation system in the whole province during these years. Later in 1870, it was connected to Punjab with the railway link for mobilizing agricultural products to the port and within the country. So, these three main factors such as: irrigation system, railway link along with air and sea ports became the reasons for the development of Karachi as the main attraction for the people around. In 1869, Karachi became the largest exporter of wheat and cotton to Indian territories. During the first and second world wars, Karachi played an important role for the landing troops and munitions of the British and also as cantonments. In 1947, the independence year of Pakistan, Karachi became the first capital of the newly founded Pakistan (West). From independence till 1951, migrants kept coming and started settling into squatter settlements. Within a span of four years, more than 600,000 refugees moved-in from India and as a result, Karachi became an ecumenical of cultures. During 1958, it was decided that the capital should be shifted to Islamabad, but Karachi remained the capital of Sindh province. Islamabad started and completed functioning as capital from 1961, though Karachi never loses its industrial, business and financial capital character. Predominant urban growth was mainly because of

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI the migrants and refugees. In 1971, a huge number of refugees migrated from East Pakistan (current Bangladesh) and similarly in the 80s from Afghanistan. Census in 1981 revealed a total of 1.72 million refugees in Karachi with more than 2.15 million in 1998. Most of these migrants are settled in the squatter settlements, which is itself a challenge for the authorities. 29

4.10.2 Administrative Structure of Karachi The Karachi Division was abolished in 2000 and five districts of Karachi were merged in City District Karachi. The City District Karachi was divided in 18 Towns and 178 union councils On 11 July 2011, Sindh Government restored again 5 districts of Karachi division and abolished City District Government Karachi. In November 2013, a new district (6th), Korangi was formed by splitting District Karachi East. The proposed project is located at Dist. West & Malir respectively.

4.10.3 Geography Karachi lies in 660 39’ 25” to 670 34’ 55” east longitudes and 240 45’ 33” to 250 38’ 32” north latitudes. This district is bounded by district Jamshoro and district Thatta on the east and north-east, district Lasbela on the west and north-west, and Arabian Sea is spread over the southern part of the district. It is the largest city of Pakistan located in the south-eastern part of the country. Karachi is located on the coast of the Arabian Sea. The city covers an area of approximately 3,527 square kilometers. It can be broadly divided into two parts; the hilly areas in the north and west and a rolling plain and coastal area in the south-east. The hills in Karachi are the off-shoots of the Keerthar Range Mountains. The highest point of these hills in Karachi is about 528 meters in the extreme north. All these hills are devoid of vegetation and have wide intervening plains, dry river beds and water channels. Karachi has a long coastline in the south. The famous sea beaches include Hawks Bay, Paradise Point, Sands Pit, and Clifton. China Creek and Korangi Creek provide excellent calm water channels for rowing and other water activities. Away from the shoreline are small islands including Shamsh Pir, Baba Bhit, Bunker, Salehabad and Manora. Two rivers pass through the city: The River Malir which flows from the east towards the south and the River Lyari, which flows from north to the south-west. Dense mangroves forest and creeks of the Indus delta

29 Journal of Geography and Regional Planning Vol. 3(11), pp. 306-321, November 2010 Available online at http://www.academicjournals.org/JGRP ISSN 2070-1845 ©2010 Academic Journals

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI can be found towards the south-east side of the city. Towards the west and the north is Cape Mount, an area marked with sea cliffs and rocky sandstone promontories.

4.10.4 Agriculture Agriculture production is insignificant in this district and the agriculture sector contributes merely 1% towards the GRDP of Karachi. Total reported area of the district is 353,000 hectares, out of which 62,000 hectares (17%) are cultivated. Within the cultivated area, 6,000 hectares are net sown30 whereas 56,000 hectares are currently fallow lands31. The remaining 83% of the total reported area is un-cultivated; out of which 131,000 hectares are not available for cultivation and 48,000 hectares are culturable waste32.

Though there is no extensive cultivation in the district, yet vegetables and fruits are cultivated in Malir, Bin Qasim and Gadap towns. Karachi zone is basically as arid (barani) area. Irrigation water sources of this area are underground water and rainfalls. The growers of this area are cultivating their lands mostly by tube wells. Main crops of these areas are; tomato, onion, potato, cabbage, cauliflower, turnip, cucumber and carrot. Among fruits; coconut, chikoo, guava, papaya, banana and citrus are produced in this district33.

4.10.5 Livelihood 4.10.5.1 Services Sector The structure of the economy of Karachi is overwhelmingly service-oriented. Services sector may consist of transport, storage, communications, wholesale and retail trade, ownership of dwelling, financial, banking and insurance, public administration, professional, social and community services. The largest sector and the engine of Karachi’s growth is commerce. Finance, insurance and real estate are important components of this city’s economy. Karachi's considerable presence can be

30 Export Processing Zone Authority, (http://www.epza.gov.pk/karachi.html) 10/06/2013 31 Net Area Sown means the area which has been sown at least once in a year. It will include areas under crops, fruits, vegetables etc. 32 Sindh Development Statistics, (2011), Lahore University of Management Sciences (LUMS) 33 Official Website Portal of City District Government Karachi, (http://14.192.147.139/cdgk/Home/Departments/AgricultureDepartment/tabid/240/Default.aspx) accessed on 10/02013

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI portrayed best by showing the city's central role in various sectors of national economic activity. 40% of financial activity, 50% of bank deposits, 20% of federal tax revenue, 40% of Sindh's provincial revenues, 62% percent of income tax collected, and 95% of foreign trade passes through Karachi's two ports and its airport. As compared to the other two sectors, services sector has outnumbered both in relative and absolute terms. The long-term growth rates of services sectors are considerably higher than manufacturing and agriculture. In addition to that, in GRDP, share of services sector has increased over time from 61.2% to 81.7%.

4.10.5.2 Industries Industrial sector is the second largest sector in Karachi after services. This sector produces 25% of the total GRDP of the city. Traditionally, the manufacturing industries of Karachi include: textile, ready-made garments and food processing. Chemicals, electronics, leather, steel, automotive and large engineering products are also major components of the industrial sector of Karachi. Proposed projects are located in the two industrial zone i.e. Site & Landhi. There are seven major industrial areas in Karachi. 1. Korangi Industrial Area 2. Landhi Industrial Area 3. Federal B Industrial Area 4. Bin Qasim Industrial Zone 5. Karachi Export Processing Zone 6. SITE, North Karachi 7. SITE, Mangophir Road

4.10.6 Health Facilities The total number of public sector health facilities in district Karachi is 16034. There are 17 District Headquarter hospital and one teaching hospitals with a capacity of 1616 and 950 beds respectively. These health facilities are sufficient for only 5% of the estimated 2014 population of the district35.

34 Health Facility Assessment 2012 (HFA) by Technical Resource Facility (TRF) http://115.186.137.115/reports/hfa/sindh/HFA-Matiari.pdf 35 WHO Standard is 2 health facilities and 25 beds per 10,000 people

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Table 4.17 shows the details of these health facilities. Type Number Bed Strength Teaching Hospital 1 950 District Headquarter Hospital 17 1616 Tehsil Head Quarter Hospitals 0 0 Rural Health Centers 7 64 Basic Health Units 37 54 Govt. Rural Dispensaries 85 - MCH Centers 13 - Sub Health Centers 0 - Grand Total 160 2684

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Chapter 5 SELECTION OF TECHNOLOGIES (ATI France)

Health care waste (HCW) is a special type of waste that may cause much bigger harm to environment and public health as compared with the municipal waste. It carries much higher risk of contamination when mixed with any other type of waste. Hospital Waste Management requires special attention and processes. It requires active sorting at source, special handling on site and treatment, and transport to the feasible disposal facility.

The management of health-care waste requires increased attention and diligence to avoid the substantial disease burden associated with poor practice, including exposure to infectious agents and toxic substances. A part from appropriate technology, implementation of best practice must be promoted to ensure optimal operation of the system. There are many technologies available in Market for the safe disposal of Infectious Hospital Waste i.e., (Autoclaving, Incineration, Microwave, Hydro-clave, Sterilization (Pre and Post Shredding).

5.1 Activities Associated with Operation

The following general guidelines shall relate to daily activities associated with the operation: A security system shall be maintained to avoid trespassing and hazard to the public. The Weigh Bridge at the main entrance records all movements and weights and receive waste tracking receipt as required by the waste manifest system.

A waste manifest system shall be followed in accordance with the requirement of the regulatory agencies to cover the transportation of the waste to treatment facility and to provide the record of waste manifestation. The manifest system shall include details of the waste generator, waste transporter, quantity of waste, characteristics of waste, physical description, consistency of waste in terms of physical state and waste category number as per Hospital Waste management rules 2014, and amendments thereof.Monitoring and auditing of the facility shall be performed on a periodic basis by the SESSI officials.

5.2 Flow Path of Wastes

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Figure 5.1: Solid Waste Management System

The above Diagram gives the idea about the whole process flow as well as final disposal. Waste should be segregated at source as per the guide lines of Hospital Waste Management Rules, 2014 in different bins which is classified as under. The categories of the waste discussed already in chapter 3. The waste is then transported to the store room by means of trolley. The proper record system should maintain at the store room about the waste type and the area which produced the waste. Due to a smaller area the waste bags is transported to the yellow room which is design to store the waste before the incineration. However the specs of yellow room discussed later in this chapter. Now the composition bags for the waste for each batch will be prepared. This is so important to avoid the chances of smoke from the incinerator. After the cooling down of ash it is then transported to Landfill site.

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5.3 Proposed Incinerator

Modern incineration facilities can generate combustion temperatures of more than 850 degrees Celsius, which is the minimal level necessary for maximum efficiency in the destruction of potentially hazardous organic materials36.

The Medical Waste Incinerator (Waste Treatment System) shall consist of a hospital grade incinerator along with water treatment and allied accessories and operational services for proper disposal of hospital waste materials.

 The high temperature incineration of all hospital waste shall result in the complete destruction of waste consisting of syringes, bandages, cotton, dialysis, anatomical pieces, new virus and bacteria as ESB, Creutzfeld-Jacob diseases, contaminated bloody waste, and medicines  Estimated ash residue: 2 %  Estimated weight reduction: 90%  Secondary chamber operating temperature: 1100°C  Average Lower Calorific Power: 3500 Kcal/Kg

5.4 Technical Details

Manual-Loading, the operator weighs the waste and feeds the waste into primary combustion chamber repeated at every required interval through a feeding door manually with the help of tools. The same door will be used for de-ashing purpose.

Semi-automatic, continuous side feeding system at regular intervals. The person is not exposed to heat. A semi-automatic mechanism controlled by the control panel feeds the waste into the Primary Chamber.

36https://www.brighthubengineering.com/structural-engineering/89810-pros-and-cons-of-incineration-for-landfill- relief/

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Full-Automatic, The control panel, with the help of loading trolley lifts and loads the waste into hopper and feeds it into combustion chamber after every programmed interval automatically. Calorific value of the feeding waste: 3500 – 4000 kcal/kg.

Primary Chamber The first phase of the incineration shall be combustion without air (pyrolytic effect), comparable to gasification. This combustion in a reduced atmosphere must produce a combustion gas rich in CO and not in CO2. This shall be a considerable advantage for the secondary combustion of gases, because CO2 is combustible.

The process then can run in a complete self-combustion and does not need any other combustible.  Number of burners: 1  The combustion chamber shall be thick sheet steel (5 to 15 mm)  The post-combustion chamber shall be lined with refractory bricks and high thermal insulating materials  Each combustion stage shall be equipped with primary air nozzles to assure the perfect combustion.  The air injection shall be done with a high pressure.  The temperature shall be in the rangeof 800-1000°C  Electrically/ Electronically controlled natural gas operated burner  Thermocouple/sensors to monitor the temperature of the primary chamber

Secondary Chamber  The second phase shall be post-combustion of the gases produced by the combustion chamber at high temperature.  The high content of CO in these gases shall permit a re-lighting by simple air injection with the post-combustion burners. This processing is therefore especially well adapted for a treatment on the site.  The post-combustion of gas takes place at a temperature of minimum 1100°C during 2 seconds. The cylindrical form of the secondary combustion chamber, shall assure the achievement of very low hydrocarbon refuse. This contributes also to the limitation of soot in the downstream and of the quantity of solid to be treated in the dust remover.

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 Number of burners: 01  The post-combustion chamber shall be lined with refractory bricks and high thermal insulating materials.

Blower centrifugal fan(s) shall be provided to inject high pressure air to burn the waste and gases in post combustion chamber for ensuring proper burning of gases before exhaust. These fans will have an automatic servo controlled system for proper injection of air according to the requirements.  Electronically controlled automatic air distribution and regulation system.  The temperature shall be: 1100°C  Electrically/ Electronically controlled natural gas operated burners  Thermocouple/sensors to monitor the temperature of the secondary chamber.

Burners

 Regulated automatically for controlling temperature inside the chamber.  Automatic closing of burners with opening of chamber doors.  Electrical safeties to prevent start-up of burner unless its shutter is full opened  Closure of burner’s shutter on its switching off.  Two burners for ensuring proper burning of gases.

Wet Scrubber (Flue Gas Treatment System) Stainless Steel integrated pass through type gas washing system with water showering creating two water films to clean the gas properly.

Chimney  The chimney shall be made of welded and flanged stainless steel tube  The height of chimney shall be 8 meters.  The chimney shall be fitted with sampling port for the collection and measuring of gas samples.

Electrical command and regulation panel with one supervisor by DCS/P.L.C. system  Shall be PLC based control box with sealed door.

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 Pre-installed control circuitry should be rugged enough to withstand the temperature effect of the incinerator.  It shall house the ignition burner timer, feed interval timer, shut down timer, post combustion chamber temperature controller, and controls for burner, blower fans, gas washer  The digital panel shall have the temperature regulators which have digital display  One for regulating the temperature of combustion burners,  One for regulating the temperature of post-combustion burners  The control panel shall be commanded by the P.L.C (Programmable Logic Controller) System. And operators shall be able to control and supervise the operation steps by the computer (PC).

Water Treatment Unit to clean and recirculate water used for gas treatment

Water treatment unit shall be used to treat the water used for gas washing before opening it into the main drain having settling tank (SS), manual Water saving system with re-circulating system

Emission Standards

The flue gases have content according to the National Environmental Quality Standards (NEQS)

Table 5.2: Power Requirements 380V, 3-Phase, 50 Hz Burning Capacity Installed Electric Power 50 kg/h 3 kW

Utilities

Burning Capacity Natural Gas Water 50 kg/h 22 m3/hour 200 liters/hour

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Table 5.3: Summary of C.P50 Medical Waste incinerator Characteristics: Number of Beds Hourly Destruction Capacity Waste destruction capacity 50-60 kg/h Temperature range 850Co in primary combustion chamber and 1100Co in secondary combustion chamber Volume of primary combustion chamber 1.2m3 Ventilation Automatic control of air injection Average calorific power 4KW/Kg Burner Power 250KW Electrical Power 380V, 3-Phase, 50Hz, 3KW Burner type Natural Gas, consumption 22m3/H Gas washing/ Scrubber type Wet scrubber Water consumption 200L/H

Figure 5.2: Schematic Diagram of Incinerator

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5.5 Advantages of Incineration According to the latest calculations, the world is currently producing about 1.3 billion tons of garbage on a yearly basis37. To put that in perspective, if we took all the human beings on the planet and placed them on an impossibly gigantic scale, their combined weight would only be one-quarter of that amount38. Dumping and burying everything in landfills is not a viable solution to our collective garbage disposal problems. There simply isn’t enough usable space, horizontally or vertically, to safely deposit billions of tons of this heavily contaminated material on an annual basis. As an alternative to landfills incineration offers following advantages:

 After the incineration process is complete, the total mass of the remaining garbage can be reduced by up to 85 percent, while its volume may shrink by as much as 95 percent39. In small countries, or in municipalities where landfills are full and additional space is scarce, this type of mass and volume reduction can be a godsend.  Leachate is thick pea-soup-like slurry of liquid garbage, which is formed every time precipitation falls on landfill.  Calculations show that letting organic matter break down in landfills will contribute about 30 percent more to global warming than burning the equivalent matter in an incinerator—which is far from zero emissions, but still a step in the right direction.  Additional advantage is that waste incineration plants can be located near where waste is generated, which decreases the costs, energy and emissions associated with transporting waste.  Absence of moving parts hence low maintenance

5.6 Ash Management Propose Plan

The worldwide production of MSWI bottom ash is expected to increase in the coming years due to more widespread use of incineration practice as a means of managing MSW. In the future an

37https://www.theatlantic.com/business/archive/2012/06/26-trillion-pounds-of-garbage-where-does- the-worlds-trash-go/258234/ 38https://www.huffingtonpost.com/2012/06/18/human-population-earth-weight_n_1605244.html

39https://sciencing.com/advantages-solid-waste-incinerator-8367212.html

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Advancement in Proposed Incinerator: If sintering of the bottom ash is achieved on the grate the leachates of the bottom ash are comparable to molten bottom ash and also to some natural materials. If surplus water is added to the bottom ash the salt content of the bottom ash can be reduced by more than 50 percent.

5.7 Project Specifications

A waste that is generated in a hospital from various point sources is segregated at site and it is the duty of doctors and paramedical staff to put the waste into the desired bins as classified later in this chapter. Now the waste is transferred to the storage area and then transported by the means of trolley.

5.7.1 Yellow Room: The waste is transported by the means of trolley to the specially design and temperature- controlled room. The purpose of this room is to prevent the workers and other population to the infections because of low temperature i.e. 4-10 degree Celsius in this area. Mesophilic and Thermophiles destroyed in this process leaving only psychrophilic microbes in this area. The collected waste is stored for one day before being incinerated.

It is therefore the responsibility of M/S Mediland for the operation to clean the wastage area and restrict trespassing. It is essential to mention that train staff will be employ there for the cleaning and operation of incinerator. This has to be done for the prevention of infections to the staff of incinerator. Proper batch mixing will allow the negligible smoke across the surrounding areas.

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Chapter 6 Anticipated Impacts & Mitigation Measure 6.1 General This section provides the analysis of the potential impacts during construction/rehabilitation and operational phases of the proposed project on the physical, biological and socio-economic Environment of the project area. Environmental sensitivity of the project area is described through the evaluation of significance of impacts is carried out through Environmental Matrices. In addition, it also narrates the measures that will mitigate the project’s potential environmental impacts. Environmental impacts have been considered not only as they pertain to Industrial city or project site, but also to the site associated with the road project.

6.2 Impacts Assessment Methodology Potential impacts from the proposed project activities were identified thorough review of the project activities, study of surrounding environment, review of literature, from previous similar studies and expert judgment.

Evaluation of Identified Impacts Methodology adopted for the identification, evaluation and analysis of environmental impacts by the proposed project is “Matrix Method and Significance Rating of Impacts”.

Environmental Impact Matrices The environmental impacts matrices have been developed to evaluate magnitude of the impacts of various project activities on different environmental settings during rehabilitation and operational phases of the project. These matrices are given in Table 6.1 and 6.2.

The impact assessment tool used for this project was ‘Analogue’. Analogue tool is the comparison of the impacts of a proposed development with a similar existing development or comparing the environmental conditions with those at similar sites elsewhere.

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Table 6.1: Environmental Impacts Evaluation Matrix during Construction & Rehabilitation Phase VECs Activities VECs and and Components Dismantlin Impact VSCs VSCs Transportation Welding Generator Lifting/over HSE g Score Rating hauling Air Quality and 0.5 -1 -2 -4 -2 0 -1 -5.00 Odor Soil Biophysical Erosion/Conta 0.15 -1 0 -1 -1 0 0 -0.45 Environment mination/Settl ement Waste 0.05 -1 0 -1 -1 -1 -2 -0.30 Management HSE issues (workers and 0.4 -3 -3 -1 -3 -2 -1 -5.20 Socio- public) Economic Noise 0.18 -3 -3 -3 -2 0 -3 -2.52 Environment Traffic 0.12 -3 0 0 0 0 -1 -0.48 Management

Legend + positive O no impact 2 minor impact 4 major impact

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moderate severe 1 negligible impact 3 5 - negative impact impact

Note: The above table reveals that in biophysical environment air quality and odor is considered to be significant impact while in socio-economic environment HSE issues (workers and public) is considered to be significant impact during operational phase

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Table 6.2: Environmental Impacts Evaluation Matrix during Operational Phase VECs Activities VECs and and Impact Components Transportation Handling VSCs VSCs Incineration Ash Disposal Score of waste of Waste Rating Air Quality and 0.5 -3 0 -4 -1 -4.00 Odor Water 0.3 0 0 -1 -2 -0.90 Resources Biophysical Soil Environment Erosion/Conta 0.15 -3 0 -1 -3 -1.05 mination/Settl ement Waste 0.05 -1 -4 -4 -2 -0.55 Management HSE issues

Socio- (workers and 0.4 -3 -3 -3 -1 -4.00 Economic public) Environment Economic 0.3 3 2 4 2 6.00 Activity Noise 0.18 -3 0 -3 -1 -1.26

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Traffic 0.12 -3 0 0 -1 -0.48 Management

major O no impact 2 minor impact 4 Legend + positive impact

negligible moderate severe 1 3 5 - negative impact impact impact

Note: The above table reveals that in biophysical environment air quality and odor is considered to be significant impact while in socio-economic environment HSE issues (workers and public) is considered to be significant impact during operational phase

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6.2.2.1 Impact Classification The predicted impacts have been classified through “Matrix Method”. The Matrix method presents a framework approach to impact assessment of a project by listing the effects on the environment that the proposed development may induce, including the estimate of the magnitude of each of the effects and an evaluation of the importance of each of listed effects. The weighted impact assessment matrices has been in this EIA as these can portray potential project impacts by assigning them a numerical value to indicate their magnitude and importance. The higher the value, the higher will be the importance. In addition to assigning the numerical values to each marked box, plus (+) or minus (-) sign were used to show whether an impact is beneficial or adverse.

The weighted impact assessment matrix was applied to the environmental components listed on the y-axis against the activities of the landfill project listed on the x-axis prior to mitigation measures. In this process, numerical values were assigned from 0 to 1 for biophysical environment and socio- economic environment to indicate the significance of the affected environmental and social components. These numerical values were than multiplied with the individual project activity rating/values and all added to get an overall impact score. This impact score gives the relative significance of impacts for a specific component. The highest impact score gives the level of significance of that impact.

Identification of VECs and VSCs Valued Environmental Components (VECs) and Valued Social Components (VSCs) are the basic elements or features of the physical, biological or socio-economic environment that may be affected by the proposed project.

6.2.1 Environmental impacts and their mitigation during pre-construction phase Impacts The project land is within the premises of Industrial area. This land was not use of economic activity. After construction of this incinerator installed at SESSI hospitals, it will run on its optimum capacity and it shall be a mild stone in the Hospital Waste Management System in Karachi. So this has brought a positive change in HWMS (hospital waste management system). In order to assess the

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Mitigation As in the case of project location, there are no negative impacts on the environment, so no mitigation measures will be required.

6.2.2 Environmental Impacts related to project design Impacts There was not be any environmental problems at any stage from design stage to its operational stage. The design of the incinerator has not affected the adjacent areas and its declared will have no negative impacts directly on the population of the nearby community. This was to be designed in a way that it guarantees all out compliance with the Sindh Environmental Quality Standards (SEQS).

Mitigation As in the case of project design, there are no negative impacts on the environment, so no mitigation measures will be required.

6.3 Environmental Impacts during Construction Phase The construction of incinerator facility will be completed after the EIA report submission. The major activities required in the construction phase are followings:  Transportation of dismantles and new parts to be replaced  Welding  Generator used for backup of electricity  Lifting of the parts

6.3.1 Air emission Potential Impacts Air emissions from proposed project-related activities are likely to include:  Dust emissions produced during transportation activities;

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 Combustion products (nitrogen oxides, sulfur dioxide, particulate matter, carbon monoxide, and volatile organic compounds) from diesel generators;  Combustion products from vehicles used for project-related activities;

Assessment of potential impacts The sources of emissions during proposed project construction will not be significantly enough to alter the ambient air quality. The emissions will disperse quickly with the prevalent wind currents. All generators, vehicles, equipment and machinery will be properly maintained during the rehabilitation phase to minimize emissions.

Mitigation Measures The mitigation measures given below will further reduce their impact, and ensure that they remain within acceptable limits. Water will be sprinkled daily or when there is an obvious dust problem on all exposed surfaces to suppress emission of dust. Frequency of sprinkling will be kept such that the dust remains under control, particularly when wind is blowing towards the receptors.

 All equipment, generators, and vehicles used during the project will be properly tuned and maintained in good working condition in order to minimize exhaust emissions;  Construction materials that are susceptible to dust formation will be transported only in securely covered trucks to prevent dust emission during transportation.  All project vehicles will be checked regularly to ensure that engines are in sound working condition and are not emitting smoke;  Implementation of the proposed mitigation measures is likely to leave no long-term residual impact on the ambient air.

6.3.2 Noise Pollution Potential Impacts Potential sources of noise pollution will include operation of generators, machinery, welding equipment, and vehicles during the project activities. The potential noise related issues during

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Assessment of Potential Impacts The potential sources of significant noise during the rehabilitation period include the welding machinery, generators at project site and transportation related traffic. There is no continuous major source of noise. The main exposure of noise pollution will be on crew members. To minimize exposure to noise personal protective equipment (PPE) will be provided to the workers.

Mitigation Measures All on-site personnel will use required personal protective equipment (PPE) in high noise areas that will be clearly marked. Proper engineering control will be applied to noise producing sources like generator. It will be ensured that generators, vehicles and other potentially noisy equipment used are in good condition. Noise from generators, vehicles and other equipment and machinery will be kept to the minimum through regular maintenance.

Before the start of the operations conduct a noise survey of the equipment and prepare a noise control plan

Use noise-abating devices wherever needed and practicable.Blowing of horn will be prohibited on the access road to the proposed site and inside the site. By implementing the above mitigation measures the overall impact will be significantly low. Residual noise impact is expected to be low from the construction activities of the proposed project.

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Assessment of Potential Impacts The nearest community settlementsare located approximately 1 km from all the proposed projects boundary. The road will be used by all the proposed project related traffic and project site is located adjacent to the road, thus ensuring that the community will not be influenced by the transportation vehicle movement.

Mitigation Measures  Transport management plan will be developed;  To the extent possible, peak traffic times will be avoided for project traffic;  Vehicles will remain confined to defined access;  By implementing the above mitigation measures the overall impact will be significantly low, so the residual impact is low.

Safety and Security: There are very less possibility that rehabilitation activities may affect the safety and security of the inhabitants of the areas by arising conflicts between residents because the proposed project is approximately 1 km away from the local community. Community sensitive project planning and implementation as prescribed through the recommended mitigation measures will minimize the occurrence of any serious impacts. Further project vehicles will use the existing road and there will be no road safety issues.

Mobility and Transportation: As the proposed project is already 1 km away from the local residents so mobility of locals will not be affected due to project activities. Project and Community Interface: Inter-cultural differences between the project staff from other areas and the local community could result in frictions. To mitigate these issues locals will preferred for unskilled jobs. Also with proper management of the workforce, it is possible to avoid any complaints.

Mitigation Measures The following mitigation measures will be implemented:  Limit the social interaction between the workforce and the local communities;

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 Safe speed limits for vehicles will be followed;  The rehabilitation crew’s interaction with the local population will be minimized.  The project proponent and the contractor will maintain liaison with the local community. The communities will be informed of the construction activities well in advance.  The IMC will maintain a social complaint register at the site to document all complaints received from local communities. The register will also record the measures taken to mitigate these concerns.  Awareness and cultural inductions to educate the contractor workforce on the requirement of minimizing social interaction with local communities;  Project staff will respect cultural norms.  The non-local project staff will be sensitized to local culture and norms.  Unnecessary interaction of local population with the non-local project staff will be avoided.

Environmental Impacts associated with Operational Phase In this section the environmental and socioeconomic impacts associated with the proposed project operation activities are discussed. In this project there is only incineration of the infectious waste. The impacts that are discussed are as follows:  Air Emissions  Water Resources  Green House Gas Emissions  Wastewater  Waste Management  Occupational Health and Safety

6.4.1 Air Emissions Potential Impacts  Impacts on local air quality may arise from the following project activities:  Air emissions like CO, CO2, NOx, SOx, PCB, Furan, Dioxins from incineration process, vehicles, generators etc;  Exhaust emissions from the vehicles carrying hospital waste ;

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 Carbon monoxide is the most prevalent of the toxic gases. It usually emits from cigarette smoke, generators etc.

 Toxic gases such as, nitrogen oxides, NO and NO2, which are emitted from diesel vehicles.  Assessment of potential impacts  Air emissions from proposed project can have a major impact on the local air quality. The pollutants can impair human health and ecological environment and other materials.  A significant impact will be interpreted if the concentration of pollutants in the ambient air exceeds the PEQS of ambient air quality.

Mitigation The proposed mitigation measures to reduce the impacts on air quality during the proposed operation activities are:  All equipment, incinerator and its allied machinery, generators, and vehicles used during the project will be properly tuned and maintained in good working condition in order to minimize exhaust emissions.  Forklift Maintenance will be done so that they would not be allowed to emit a large amount of exhaust fumes.  Workers will be not allowed to smoke within the unit.  Exhaust fumes will be significantly reduced by the use of Scrubber system.  Air scrubbers will be maintained properly to control the air emissions of incinerator.

 Monitoring of Ambient air parameters (PM 10, SO2, CO and NOx) emissions should be carried out on regular basis to ensure compliance with the SEQS guidelines.  If the mitigation measures are effectively implemented, the residual impact of the proposed activities on the area’s air quality is expected to be low in significance.

Water Resources and Wastewater Management Potential Impacts Proposed activities could affect the area’s water resources in two ways:  Reduction from overuse, and  Contamination

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 Assessment of Potential Impacts  Other than domestic use of water, the wet scrubber and the showering system immediately after secondary chamber will also use exquisite amount of water.It may cause reduction of water level and contamination if not managed properly.

Mitigation measures The mitigation measures described below will ensure that the surface and aquifer resources of project area are not significantly affected by project activities.  A water management plan will be developed. The plan will also include strategies to minimize water use (and therefore volume of discharge) and maintain reserves.  Temperature in the incinerator will be well maintain so enhance the evaporation rate, so less quantity of wastewater will be discharged.  Water conservation practices provided will be followed to minimize the water usage.  Estimation of water consumption will be done on hourly, daily and seasonal variations.  Water use will be monitored periodically to ensure that water is not being wasted;  Direct runoff to the water courses will be prevented.  The nature of impact is direct and its reversibility depends on the rainfall pattern, catchment size and associated aquifer recharge to the project area. Groundwater is available in the majority of the area at, or at less than a depth of 200 feet below the surface level. Proper implementation of the required mitigation and monitoring techniques will prevent any adverse water quality impacts.

Noise Potential Impacts The proposed project will not have any issue regarding the noise. The only source of noise to produce may be from the vehicles that will be used for loading and unloading of the waste/ash but will not pose any significant impact on the nearby community or hospital public as it is inside the premises of Hospital but away from the hospital building about 1Km and community is approximately 1km away from the proposed project.

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Assessment of Potential Impacts Noise sources in the community mostly intermittent in nature including road traffic. It can therefore be concluded that area surrounding the proposed incinerator has low noise pollution.

The World Bank guidelines for noise require that the sound level in residential areas should not exceed 55 dB (A) during the day and 45 dB (A) during the night. The existing daytime noise levels at location show that noise levels are well below guideline value of 55 dB(A) at two sites while on one Valika site the level has been exceeded due to the road construction. The residential area is located approximately 1 Km away from the proposed project site and there will be no significant impact on community.

Mitigation Measures The following mitigation measure will be undertaken in order to further reduce the noise levels.  Proper maintenance of the vehicles, generators and incinerator will be done on regular basis.  Vehicles used for the proposed project will not be allowed to blow horn within the premises of hospital.  All equipment with potential of noise generation will be kept well maintained.  Generator shall be kept in a close canopy to avoid noise.

Solid Waste Management Potential Impacts The solid waste generated during the operational phase of proposed project can pose a health hazard, pollute soil, surface and ground water if not managed properly. Assessment of Potential Impacts A significant impact will be interpreted if the waste management is not carried out properly; which may effect to health of workers, pollution of soil, surface or groundwater. The operation of the proposed project will generate a negligible amount of solid waste per day, so the impact will be of low level.

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All wastes generated from the project (MSW) will be properly managed as currently, KMC is collecting the Municipal Solid Waste (MSW) from the Hospital and disposing it properly.

Mitigation Measures Key elements of the waste management system will be the following:  Separate waste bins will be placed for different type of wastes - plastic, paper, metal, glass, and pathological etc.  No waste will be dumped at any location outside the proposed project boundary.  Ash form Incinerator shall be disposed of in specialized cell of landfill.  Records of all waste generated will be maintained. Quantities of waste disposed, recycled, or reused will be logged on a Waste Tracking Register.  Training will be provided to personnel for identification, segregation, and management of waste.  Proper implementation of the mitigation measures will ensure that the residual impact from waste will be negligible. Occupational Health and Safety Health and Safety Measures Following persons are highly prone to get contact with Hospital waste, thus exposed to its hazards.  Health Care Personnel  Laboratory Workers  Waste Workers  Substance Abuser  General Public

Although general public is not at that risk as are above in the list but in societies where disposal of waste is not very scientifically and methodical, common man may get exposure to Hospital waste and thus it hazardous. Non-accidental injuries result from intentional reuse o syringes and scalpels removed from Hospital Waste.

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This hazardous practice is likely to result from lack of awareness, shortages of supplies or poor waste disposal. However the only way to ensure disposal of syringes and needles not to reused and do not lead to accidental needle stick injuries is efficient, safe and environment friendly sharp Waste Management.

Inhalation Disease Hospital waste, if not properly and timely disposed of, may lead to Generation of aerosol of Microorganism which can spread diseases by air through inhalation. Thus workers must wear masks at the time of carrying and Management of Hospital Waste.

Skin Hazards Lot of chemicals along with microorganisms are presented in the waste generated from labs, radiology department, operation theaters and wards, which may be in liquid form. Thus workers must wear gloves and special dress to avoid exposure to these infected and toxic wastes.

Radioactivity Every department where these radioactive isotopes are used in treatment or in diagnosis must have a policy to keep them for specified period of time, so that decay of radioactivity of these isotopes is ensured before disposal to Hospital waste. Otherwise it has high chances of damage to workers.

Following Health & Safety issue and their solutions are discussed below include:  Electrical hazards  Accidental release  Human Exposure  Slips and trips  Manual handling  Vehicles in and around the unit  Fire and explosion hazards  Lightening

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Electrical Hazards Electrical hazards constitute a major threat to employees. Care will be taken to properly ground and insulate all equipment. Procedures will be developed and implemented to protect workers from exposure to toxic explosive gases as well as other hazards associated with such inspections and maintenance.Written procedures to de-energize circuits that will be impacted by the repair activity will be prepared.

Accidental Release Accidents may occur during the operations of incinerator includes the burn cause by contact with hot surface of furnace, by back-fire while igniting burners, or by flying hot ashes and debris, Fires and explosions caused by flammable or explosive components of refuse, or by fuel (particularly from fuel leaks). Some of accident may cause blast.

Human Exposure During the operations of Incinerator the worker over there may be get exposure from different hazard include: Physical Hazards  Exposure to high levels of noise  Exposure to heat while continuously working near furnaces, esp. when their doors are open  Exposure to abrupt changes from heat to cold and vice versa while entering and exiting the incinerator room in cold weather  Chemical Hazards  Chronic exposure, by inhalation, skin and eye contact and digestion, to hazardous (incl. poisonous) components of refuse prior to incineration, during transportation, loading, spreading, etc.  Chronic exposure, primarily by means of inhalation, to hazardous (incl. poisonous) products of thermal degradation of refuse  Hazards associated with work in confined space Biological Hazards

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Exposure to biologically contaminated refuse containing microorganisms and other toxic products, esp. refuse from medical facilities, laboratories, sewage sludge, etc.  Ergonomic, psychosocial and organizational factors  Cumulative trauma disorders as a result of continuous repetitive movements or over- strenuous efforts  Back pains and other musculoskeletal problems (including lesions of intervertebral discs) resulting from overexertion and awkward postures, during operations of loading, unloading, spreading, agitating, repair of linings, etc.  Exposure to obnoxious (sometimes offensive) odors of refuse and its combustion products  General tiredness as a result of heavy physical work in a hot, noisy and filthy environment  Psychological stress caused by dissatisfaction at work as a result of monotony, low salary, social status, shift work (incl. in night shifts), Etc.

These all hazards are important as these hazards can cause acute and chronic impact. To prevent the worker from these exposure workers shall be trained and Personal Protective Equipment shall be provided.

Slips and trips Slips usually take place when the floor is wet or contaminated. Within proposed project, water, oil, cleaning products, dry powders and foodstuffs can make the floor slippery. Other items, like stretch wrapping, label backing and plastic bags, can also cause slips. In order to make the floor un-slippery, the rough floors will be made because the rougher the floor, the better it will be able to cope up with the water, oil and other contamination and less likely happen that someone slips. And further the right footwear will also be provided to the workers.

Trip hazards include obstructions, waste packaging, holes, change in the surface level etc. The floor and traffic routes will be kept free from obstructions. Proper monitoring will be done to keep the paths free from obstructions like on or near stairs, steps, escalators, moving walkways, emergency routes, in or near doorways etc. Suitable footwear will also be suggested.

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Manual handling People usually doing task related to manual handling will suffer from work related aches and pains including lower back pain and neck pain. Musculoskeletal disorders can be caused by repetitive and heavy lifting, bending and twisting, repeating an action too frequently, uncomfortable working positions, exerting too much force, working too long without breaks, adverse working conditions(e.g. hot, cold) and psychosocial factors (e.g. high workloads, short deadlines etc.). Mechanical handling devices like lift trucks, pallet trucks, trolleys, conveyors, chutes, scissor lifts etc. will be used to avoid or reduce manual handling. Minimum feasible handling temperatures should be maintained.

Vehicles in and around the proposed project Vehicles in and around the proposed project of Incinerator at Hospital involving in the movement of goods and materials may cause accidents. Safe system of the traffic management will be ensured. Proper methods and procedures for arrival, reception, unloading, loading and movement of vehicles within the premises will be formed. Speed limit will also be prescribed.

Fire and Explosion Hazards Poorly designed and constructed electric installations can lead to fire and explosion that may in turn injury and death of a worker. Welding or cutting torch on or near drum (even empty) should never be used because product (even just residue) can ignite explosively Firefighting equipment will be available in the form of ABC fire extinguishers as a minimum, and their locations will be clearly marked. Exits from work places will be well marked and visible in dim light. Fire water will be located throughout the facility in well-marked piping.

Environmental and Social Benefits The project of rehabilitation, repair, maintenance and Operation of Incinerator installed at SESSI hospital shall be beneficent to the environment and community. As if this incinerator operate at its optimum capacity it may cover about 600kg of infectious waste of hospitals per day which may lessen the burden on the environment. As this waste can’t be disposed off like a normal Municipal

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Potential environmental enhancement measures Environmental enhancements are not a major consideration within the operation phase project sites. However it is noted that it is common practice at many such sites to create some local hard and soft landscaping and successful planting of fruit trees and shrubs has been accomplished in many sites. This practice should be encouraged on all sites as far as practicable.

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Chapter 7 ENVIRONMENTAL MANAGEMENT AND TRAINING PLANS

This Chapter provides an overall approach for managing and monitoring the environmental issues and describes the institutional framework and reporting mechanism to implement the Environmental Management Plan (EMP) for said project of Incinerator installed at SESSI hospitals. The EMP has been prepared with the following objectives:

 Provide the details of the project impacts along with the proposed mitigation measures, and a corresponding implementation schedule.  Define the roles and responsibilities of the project proponent & contractor in order to effectively communicate environmental issues among them.  Frame a monitoring mechanism, reporting frequency, auditing mechanism and identifying monitoring parameters to ensure that all the mitigation measures are completely and effectively implemented.  Define the requirements necessary for documenting compliance with EMP and communicating it to all the concerned regulatory agencies.

7.1Regulatory requirements and applicable standards The main law and legislation concerned with the environment in Sindh is Sindh Environmental Protection Act 2014. This Act is a fairly comprehensive legislation and provides for protection, conservation, rehabilitation and improvement of the environment. Sectoral Guidelines for

7.2 Institutional capacity The main institutions involved in environmental management and monitoring program will be as follows:  SESSI and representative of Medilands  Construction Contractor (CC)  Sindh Environmental Protection Agency (Sindh-EPA)  Operational & Maintenance (O&M) team of proposed project as an executor of the EMP during the operational phase of the project.

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7.2.1 Institutional Responsibilities These key organizations will have the following roles and responsibility during the construction and operation stages:

During Construction Phase During the rehabilitation / construction phase, Contractor will be mainly responsible for the execution of the mitigation measures. SESSI management & its contractors will be responsible for the monitoring of the compliance of environmental management plan (EMP) and SEQS defined by SEPA.

During Operational stage During this phase of the project, implementation of recommendations of EMP and its supervision will be the responsibility of monitoring team coordinating with top management.

7.2.2 Responsibilities of SESSI SSESSI will be responsible for the environmental management and supervisory affairs during the Rehabilitation / construction phase of the proposed Project. An Environment personnel designated by the SESSI management will look after the environment related issues during the rehabilitation phase. The responsibilities of Environmental personnel are as follows:  Monitoring progress of the project as per planned schedule of activities;  Exercising oversight over the implementation of environmental mitigation measures by the contractor;  Documenting the experience in the implementation of the environmental process;  Preparing training materials and implementing programs;  Maintaining interfaces with the other lined departments/ stakeholders; and  Reporting to the SEPA on status of EMP implementation.  Responsibilities of Project Rehabilitation Contractor  Rehabilitation Contractor appointed for the rehabilitation and commissioning of the proposed project including the auxiliary facilities is responsible for:

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 Implementation of, or adherence to, all provisions of the EMP and with any environmental and other codes of conduct required by Sindh EPA.  Provision of proper Personal Protective Equipment (PPE) to the workers and train them for their proper use. 7.3 Environmental Management and Monitoring Plan The Environmental Management and Monitoring Plan (EMMP) will be used as a management and monitoring tool for implementation of the mitigation measures identified by the EIA. The EMP matrix lists down:  The required mitigation measures recommended in the EIA;  The person / organization directly responsible for adhering to or executing the required mitigation measures and monitoring adherence to the mitigation measures;  The parameters, which will be monitored to ensure compliance with the mitigation measures;  The timing at which the mitigation or monitoring has to be carried out.  SESSI management will hold primary and overall responsibility for ensuring full implementation of the EMP.  The Environmental Management and Monitoring Plan have been provided separate for rehabilitation and operations phase of the proposed project activities in Table 7.1 respectively.

Environmental Monitoring Environmental monitoring can be categorized into two types;  Compliance Monitoring  Effects Monitoring,  The environmental monitoring will be conducted according to SMART rules and EPA regulation.

Compliance Monitoring

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Compliance Monitoring will be carried out to ensure compliance with the requirements of the EIA and EMP. SESSI, Mediland management and contractors will carry out the inspections on a routine basis. This will also include routine monitoring and assessment of the incinerator.

Effects Monitoring To monitor actual impacts of the project on selected sensitive receptors so that impacts not anticipated in the EIA or impacts which exceed the levels anticipated in the EIA can be identified and appropriate mitigation measures can be adopted in time. This objective will be achieved through Effects Monitoring.

Considering the environmental conditions of the project area and the assessment of potential impacts of the project made in the EIA, the following monitoring Program will be undertaken:

Ambient Air Quality – ambient air monitoring should be carried out to validate the results of air monitoring. The monitoring will be carried out at key locations covering both environmental receptors and workers occupational exposures.

Noise – measurement of noise levels within the incinerator premises and the surroundings (project boundary) will be carried out on regular basis to ensure that the noise levels are within the standards stated in the EIA.

Groundwater –as a good environmental practice, groundwater will be monitored regularly to observe any unlikely change in groundwater properties.

Environmental Trainings Environmental training will form part of the environmental management system. The training will be directed towards all personnel for general environmental awareness. The objective of training Program is to ensure that the requirements of the EIA and EMP are clearly understood and followed throughout the project. The trainings to the staff will help in communicating

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EIA REPORT FOR THE INSTALLATION OF 03 SMALL INCINERATION PLANTS AT SESSI OWNED HOSPITAL AT KULSUM BAI VALIKA, SESSI LANDHI & SESSI KOTRI environmental related restrictions specified in the EIA and EMP. Table presents the training Program.

Training Log A training log will be maintained by Consultant and contractors. The training log will include;  Topic  Date, time and location  Trainer  Participants

Communication and Documentation For effective monitoring, management and documentation of the environmental performance during the operation, environmental matters will be discussed during meetings held on-site. Environmental concerns raised during the meetings will be mitigated after discussions between consultant and the contractors. Any issues that require attention of SESSI higher management will be communicated to them for action. SESSI and its contractors will ensure that the communication and documentation requirements specified in the EMP are fulfilled during the project.

Audits Consultantand its contractor and sub-contractors will carry out periodic audits/inspections of all project activities regarding their effects on the surrounding environment. The contractors will take account of any recommendations relating to the operation arising during the monitoring, with the prior approval of the proponent.

Change Management Plan The EIA recognizes that changes in the operations or the EMP may be required during the operation and therefore a Change Management Plan has been provided to manage such changes.

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The management of changes is discussed under two separate headings, changes to the EMP and changes to the Operation.

Changes to the EMP The EIA and the EMP have been developed based on the best possible information available at the time of the EIA study. However, it is possible that during the rehabilitation and operation phase some aspects of the EMP may need to be changed owing to their non-applicability in a certain area of operation or the need for additional mitigation measures based on the findings of environmental monitoring during the construction and operation phase. In such cases following actions shall be taken. A meeting will be held between Consultant and the concerned contractor. During the meeting the proposed deviation from the EMP, planning and designing will be discussed and agreed upon by all parties.

Based on the discussion during the meeting, a change report will be produced collectively, which will include the original EMP clause/plan or design, the change that has been agreed upon, and the reasons for the change.

The report will be signed by all the parties and will be filled at the site office. A copy of the report will be sent to SEPA and contractor head offices. All relevant project personnel will be informed of the change.

Changes to the Operation The change management system recognizes three orders of changes.

First Order Change A first order change is one that leads to a significant departure from the project described or the impacts assessed in the EIA and consequently require a reassessment of the environmental impacts associated with the change. Examples of such change include change in location of the proposed plant.

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In such an instance, the environmental impacts of the proposed change will be reassessed, and the results sent to the Sindh EPA for approval.

Second Order Change A second-order change is one that entails project activities not significantly different from those described in the EIA, and which may result in project impacts whose overall magnitude would be similar to the assessment made in this report. In case of such changes, the environmental impact of the activity will be reassessed, additional mitigation measures specified if necessary, and the changes reported to the Sindh EPA. Third Order Change A third-order change is one that is of little consequence to the EIA findings. This type of change does not result in impact levels exceeding those already assessed in the EIA; rather these may be made onsite to minimize the impact of an activity. The only action required in this case will be to record the change in the change record register.

Equipment maintenance details In the developmental project the equipment used for construction purpose and some equipment will be used during operational phase. The major equipment used during rehabilitation and operation are listed below:  Welding Machine  Incinerator and its allied machinery  These equipment are maintain to avoid any adverse effect of them, either in the form of any accident or any environmental emission. For the maintenance of these equipment following measure must be taken:  Proper management and utilization will minimize the hazards during rehabilitation.  Proper, adequate and timely maintenance of equipment through lubrication, repair and replacement of parts will go a long way to keep the noise levels within the prescribed limits SEQS.  Equipment cleaning method and frequency to be regulated/controlled.

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 Regular tuning of rehabilitation equipment and vehicles  Equipment and vehicles powered with diesel should be well maintained to minimize particulate emissions. For this purpose the SESSI will generate the vehicle emission report.  Firefighting equipment’s to be installed and proponent shall keep their maintenance record.  A field logbook will be maintained for the documentation. This logbook will additionally serve to document observations, personnel onsite, equipment arrival, and departure times, a truck exit inspection checklist and other project information.  Lists of emergency equipment and materials shall held in stock with quantities and location.

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Table7.1: Environmental Management Plan of Rehabilitation Phase No. Mitigations Measures Responsibility Monitoring Timing 1 SOIL & LAND CONTAMINATION Set speed limits During Rehabilitation 1.1 Vehicle speeds will be regulated and monitored SESSI and check compliance SESSI Monitor During Rehabilitation 1.2 Vehicles will only be washed at designated areas Compliance Daily checking of During Rehabilitation Fuel tanks will be checked daily for leaks and all such leaks 1.3 SESSI fuel tanks for will be plugged immediately. leakages Monitor land Before Land Clearing 1.4 Unnecessary clearing outside work areas will be avoided SESSI clearing activities and During Rehabilitation Waste Management plan will be developed to dispose all kinds SESSI Monitor During Rehabilitation 1.5 of wastes. Implementation 2 REPAIR & MAINTENANCE NOISE Monitor Equipment noise will be reduced at source by proper design, Compliance and 2.1 Mediland During Rehabilitation maintenance and repair of Incinerator & its Allied Machinery Periodic Noise Monitoring

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Monitor Noise from vehicles and power generators will be minimized Compliance and 2.2 RC During Rehabilitation by use of proper silencers and mufflers. Periodic Noise Monitoring 3 DUST EMISSION Water will be sprinkled daily or when there is an obvious dust problem, on all exposed surfaces to suppress emission of dust. Monitor 3.1 Frequency of sprinkling will be kept such that the dust SESSI During Rehabilitation Compliance remains under control, particularly when wind is blowing towards the environmental receptors

Dust emission from soil piles and aggregate storage stockpiles Monitor During Construction 3.2 will be reduced by appropriate measures i.e., Keeping the SESSI Compliance material moist by sprinkling of water at appropriate frequency 4 VEHICLE AND EQUIPMENT EXHAUST All vehicles, generators and other equipment used during SESSI Monitor During Rehabilitation Construction will be properly tuned and maintained in good maintenance 4.1 working condition order to minimize emission of pollutants record of vehicles and equipment 5 HAZARDOUS AND NON-HAZARDOUS WASTE MANAGEMENT A waste management plan will be developed before the start Consultant Monitor Prior to start of 5.1 of the operation Compliance Rehabilitation phase

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Separate bins will be placed for different type of wastes - SESSI Monitor During Rehabilitation 5.2 plastic, paper, metal, glass, can, oils, and containers Compliance

No waste will be dumped at any location outside the project SESSI Monitor During Rehabilitation 5.3 boundary. Compliance Records of all waste generated during the construction period IMC Monitor During Rehabilitation 5.4 will be maintained. Quantities of waste disposed, recycled, or & Compliance reused will be logged on a Waste Tracking Register. SESSI Training will be provided to personnel for identification, IMC & SESSI Monitor During Rehabilitation 5.5 segregation, and management of waste Compliance

6 COMMUNITY AND PROJECT WORKER SAFTEY Rehabilitation area will be properly identified and the access to SESSI Monitor During Rehabilitation 6.1 the area will be limited to only project related personal. Compliance

Strict speed limits will be enforced within the project SESSI Monitor During Rehabilitation 6.1 boundary and where needed, a signal man will be placed to Compliance control traffic. After the completion of construction phase, proper site Consultant Monitor During Rehabilitation restoration will be carried out to eliminate any safety hazards Compliance 6.2 such as any excavation will be leveled to prevent falling injury to worker.

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The equipment and machinery use for Construction of SESSI Monitor During Rehabilitation 6.3 incinerator room will only be operated by properly trained and & Compliance experienced personnel. Consultant

Table 7.2: Monitoring Plan S.no Mitigation Measures Responsibility Monitoring Timing 1 AIR EMISSIONS All equipment, generators, vehicles and incinerator and its allied machinery used during the project will 1.1 be properly tuned and maintained in good working HSE Officer of SESSI condition in order to minimize exhaust emissions. and its operators Monitor Compliance Operational Phase

Imposing speed limits and encouraging more 1.2 efficient journey management will reduce the dust HSE Officer of SESSI emissions produced by vehicular traffic. and its operators Monitor Compliance Operational Phase All project vehicles will be checked regularly to 1.3 ensure that engines are in sound working condition HSE Officer of SESSI and are not emitting smoke. and its operators Monitor Compliance Operational Phase

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Monitoring of air emissions should be carried out HSE Officer of SESSI Records of operational Operational Phase regularly to ensure compliance with the PEQS and and its operators Parameters/periodic IFC/World Bank emission guidelines. monitoring of stack 1.4 emissions from generators, any combustion process. 2 PROJECT NOISE All on-site personnel will use required personal HSE Officer of SESSI 2.1 protective equipment (PPE) in high noise areas. and its operators Monitor Compliance Operational Phase Equipment noise will be reduced at source by HSE Officer of SESSI Periodic noise level Operational Phase 2.2 proper maintenance and repair of vehicles and and its operators Surveys at level Surveys at other equipment. and locations 3 WASTEWATER Water use will be monitored periodically to ensure HSE Officer of SESSI Monitor Compliance Operational Phase 3.1 that water is not being wasted. and its operators HSE Officer of SESSI Monitor Compliance Operational Phase 3.2 Identification of water conservation measures. and its operators Manure from vehicle cleaning should be removed HSE Officer of SESSI Monitor Compliance Operational Phase 3.3 while in solid form; and its operators Take actions to remove solid waste before it enters HSE Officer of SESSI Monitor Compliance Operational Phase 3.4 the wastewater stream: and its operators

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HSE Officer of SESSI Monitor Compliance Operational Phase 3.5 Prevent direct runoff to water courses and its operators Monitoring of effluents should be carried out as HSE Officer of SESSI Monitor Compliance Operational Phase 3.6 per requirement of SMART to ensure compliance and its operators with the NEQS and IFC/World Bank guidelines. 4 HAZARDOUS MATERIALS Storage and handling of hazardous materials will be Check Hazardous material Operational Phase in accordance with national and international HSE Officer of SESSI record and Monitor 4.1 standards which are appropriate to their hazard and its operators Compliance characteristics Labeling will be placed on all storage HSE officer of SESSI Monitor Compliance Operational Phase vessels/containers as appropriate to national and 4.3 international standards. The labeling will clearly identify the stored materials. 4.4 First Aid Facilities will be provided HSE officer of SESSI Monitor Compliance Operational Phase 5 SOLID WASTE Separate waste bins will be placed for different Monitor Compliance Operational Phase HSE Officer of SESSI 5.1 type of wastes -plastic, paper, metal, glass, and its operators detergents etc.

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Non-hazardous non-recyclable wastes such as Monitor Compliance Operational Phase HSE Officer of SESSI 5.2 construction camp kitchen wastes will be disposed and its operators off at designated places. No waste will be dumped at any location outside HSE Officer of SESSI Monitor Compliance Operational Phase 5.3 the unit boundary and its operators All hazardous waste will be separated from other Monitor Compliance Operational Phase wastes. Hazardous wastes will be stored in HSE Officer of SESSI 5.4 designated areas with restricted access and proper and its operators marking. Hazardous wastes will be disposed-off through approved waste contractors.

Surplus materials including partially filled chemical HSE Officer of SESSI Monitor Compliance Operational Phase 5.6 and oil containers will be returned to suppliers. and its operators Training will be provided to personnel for Monitor Compliance Operational Phase HSE Officer of SESSI 5.7 identification, segregation, and management of and its operators waste. 6 WATER SOURCING Strategies to minimize water use (and therefore HSE Officer of SESSI 6.1 Monitor Compliance Operational Phase volume of discharge) and maintain reserves. and its operators 7 SOCIOECONOMIC/ LOCAL COMMUNITY Suitable number of unskilled and semi-skilled jobs SESSI and its Check Compliance Operational Phase 7.1 will be reserved for the local communities. Management

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All community grievances will be recorded and SESSI and its Check Compliance Operational Phase maintained in a Community Complaint’s Register. Management In addition to this close liaison will be maintained 7.2 between the community and the site representatives of Nexus and its operators throughout the project activities. Awareness and cultural introductions to educate Check Compliance Operational Phase the contractor workforce on the requirement of SESSI and its 7.3 minimizing social interaction with local Management communities. Unnecessary interaction of local population with SESSI and its Check Compliance Operational Phase 7.4 the non-local project staff will be avoided. Management

8 OCCUPATIONAL HEALTH & SAFETY

Written procedures to de-energize circuits that will Consultant Monitor Compliance Operational Phase 8.1 be impacted by the repair activity will be prepared.

Procedures will be developed and implemented to Consultant Monitor Compliance Operational Phase 8.2 protect workers from toxic explosive gases and from electrical hazards. Housekeeping will be frequent and thorough to Consultant Monitor Compliance Operational Phase 8.3 prevent slips, trips, and falls.

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Consultant Monitor Compliance Operational Phase 8.4 Mechanical handling devices like fork lifter etc. will be provided to avoid or reduce manual handling. Proper monitoring will be done to keep the paths Consultant Monitor Compliance Operational Phase 8.5 free from obstructions. Slippery shoes will be prohibited. Eye protection Consultant Monitor Compliance Operational Phase 8.6 will be required during all activities involving dust exposure. Inspection of the equipment that work at height Consultant Monitor Compliance Operational Phase 8.7 will be done properly. Proper monitoring and inspection of confined Consultant Monitor Compliance Operational Phase 8.8 spaces will be done.

8.9 Fire water will be located in well-marked piping. Consultant Monitor Compliance Operational Phase

Firefighting equipment will be available in the form Consultant Monitor Compliance Operational Phase 8.10 of ABC fire extinguishers as a minimum, and their locations will be clearly marked. Emergency Exits from work places will be well Consultant Monitor Compliance Operational Phase 8.11 marked and visible in dim light. An emergency response plan will be prepared for Consultant Monitor Compliance Operational Phase 8.12 evacuation of personnel and equipment.

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Proper precautions will be taken to minimize Consultant Monitor Compliance Operational Phase 8.13 employee risk to chemical exposure. Provision will be made for respirator usage in areas Consultant Monitor Compliance Operational Phase 8.14 where chemical exposure concentrations are exceeding the guideline values

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Chapter 8 CONCLUSION The Management of SESSI intends to improve the Hospital Waste Management of their three hospitals s at Kulsum Bai Valika Hospital @ S.I.T.E Karachi, SESSI Hospital Landhi Karachi and SESSI Hospital Kotri. For the installation of an Incineration Facility project falls in SEPA EIA/IEE regulations 2014 Schedule-II, Category H, wherein an Environment Impact Assessment (EIA) study and report for the installation, commissioning and operation of an “Incinerator Facility” is required. SESSI through M/s Mediland has engaged M/s Nexus Consultant to undertake Environment Impact Assessment (EIA) study for the proposed installation of Incineration Facility at Kulsum Bai Valika Hospital, SESSI Landhi and SESSI Kotri hospitals.

The proposed in-house Project “Installation of Incineration Facility” is planned within the premises of Kulsum Bai Valika Hospital @ S.I.T.E, SESSI Hospital Landhi and SESSI Hospital Kotri where space is available and there are no any negative impacts for the installation (50Kg/hour) incineration facility. The facility includes an integrated approach with the improvement of collection, storage, treatment and disposal system. Yellow rooms with control temperatures are also part of the incineration facility for the storage of waste, while proposed incineration facility have built in with all pollution abatement devices so no any noxious gases emitted in the atmosphere along with a comprehensive ash management system.

SESSI through M/s Mediland has procured a French based technology Incinerators with treatment capacity of 50-60Kg/hour with 850Co in primary combustion chamber and 1100Co in secondary combustion chamber along with the Wet Scrubber. The power, gas and water supply requirements at all the three Hospitals are already assured. The area requirement for the installation of Incineration facility along with Yellow Room, Ash pit, staff room & operator room is approximately 5000 square foot. At all the three hospitals the land in available within the premises of hospitals and all measures are adopted to not pollute close by neighborhood airshed.

The installation of the three incinerators at Kulsum Bai Valikaat S.I.T.E Karachi, SESSI Hospital Landhi Karachi and SESSI Hospital Kotri is very much required as current disposal system of all the

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The consultant during the preparation of EIA report has analyzed and assessed the anticipated impacts that are likely to arise due to the identified aspects. Each of the potential impacts identified during the scoping session was evaluated using the environmental, environmental baseline monitoring, socioeconomic, and project information collected and the Incineration Facility Specifications to be installed at Site. A detailed Environmental Impact Assessment Report is prepared by the Consultants (M/s NEXUS Consulting along with an environmental management & monitoring plan (EMMP) is developed to oversee the environmental performance of the project and adoption of proposed mitigation measures for your consideration, review and to accord approval / NOC from Sindh Environmental Protection Agency.

This report is submitted with the request to SEPA office to initiate the process of EIA Submission, Public Hearing, Expert Committee Meeting and issuance of NOC before the installation of Incineration Facility.

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Annexure I (ATI Brochure of Incinerator)

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Annexure II (ATI Company Profile)

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Annexure III (Lab Report)

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Annexure IV Pictures

Date: 4th October, 2019

Valika Hospital

Landhi Hospital

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Site of Valika Hospital

Site at Landhi Hospital

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Date:18th October, 2019

Consultation with MS at Kotri Hospitals

Incinerator Site at Kotri Hospital

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Dispensary of Kotri Hospital

Admin Office of Kotri Hospital

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Date: 26th October 2019

In House Consultation at kotri hospital

In house Consultation at Landhi Hospital

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In house Consultation at Valika Hospital

Date: 11th November 2019

Public Consultation at Valika Hospital

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Public Consultation at Banaras Chorangi

Public Consultation at Kotri

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