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Attachment E:
International NGO Letter to the World Bank on Medical Waste Guidance Note

TEL (202)387-8030; FAX (202)234-5176; EMAIL: [email protected]

April 15, 1999

Ian Johnson
VP for Environmentally Sustainable Development
World Bank
1818 H St. NW
Washington, DC 20043

Dear Mr. Johnson:

We are writing to you regarding the World Bank's upcoming guidelines on medical waste disposal systems in Bank-financed projects. For some time, we have been expressing our concern that the World Bank finances the construction and expansion of medical waste incinerators as part of many of its health sector projects. These incinerators are a polluting, unsafe and uneconomical technology. In the U.S., medical waste incinerators are a principal source of dioxin (a persistent ubiquitous carcinogen with a global impact), mercury, and a number of other toxins. There are many other
technologies that are both less-polluting and more economical. As a result, medical waste incinerators are being phased out of use in most Northern countries. Our concern is that the Bank is aiding the incinerator industry in dumping in Southern countries a technology that is too dangerous to sell in the North.

We understand that the Bank is drafting a guidance note to address the issue of medical waste disposal systems. Given the Bank's commitment to transparency and openness, we had hoped to have early and substantial input into the drafting process. Unfortunately, that has not been the case. NGOs with expertise in medical waste management have repeatedly tried to obtain a draft of this note in order to offer our input and suggestions, and repeatedly been denied. They have also offered on numerous occasions to brief Bank staff on the topic of medical waste disposal, but been denied an opportunity to do so. However, we are aware that Bank staff have hosted briefings by incinerator industry representatives in the same period of time. Given that medical waste disposal is a new issue for the Bank, it is particularly disheartening that the Bank has rejected our efforts to give input into these guidelines. We are concerned that any public consultation in this process will come too late to have any substantial effect. Specifically, we are asking you to 1) make available a draft of the guidance note on medical waste management systems for public comment; 2) establish a 60-day comment period; 3) ensure that the guidance note is not finalized until these comments have been taken into account; and 4) make public the comments received and the Bank's responses to each.


Neil Tangri                                     Ann Leonard
Multinationals Resource Center

cc: Jan Piercy, US Executive Director
        Joanne Salop, Policy Revision Team
        Mark Malloch-Brown, Vice President for External Affairs
        Kris Zedler, External Affairs
        William Reuben, NGO Liaison
        Mary Yee, US Treasury Department
        Victor Bullen, USAID

Kenichi Azuma
Nara, Japan

Clifford T. Honicker
Executive Director
American Environmental Health Studies Project, Inc.
Knoxville TN, USA

Jim Puckett
Asia-Pacific Environmental Exchange
Seattle WA, USA

Lilian Corra, M.D.
Asociación Argentina de Médicos por el Medio Ambiente
Santa Fé, Argentina

Asociación Vecinal Moronense

Rokeya Kabir
Executive Director
Bangladesh Nari Progati Sangha

Basel Action Network
Seattle WA, USA

Debi Goenka
Bombay Environmental Action Group
Mumbai, India

Paul A. Ringo, R.N.
Calcasieu League For Environmental Action Now
Lake Charles LA, USA

Jane Williams
Executive Director
California Communities Against Toxics
California, USA

Cape Environmental Trust
Cape Town, South Africa

Magda Stoczkiewicz
Polish Coordinator
CEE Bankwatch Network
Krakow, Poland

Macrin Desa
National Coordinator for Romania
CEE Bankwatch Network
Bucuresti, Romania

Eva Charkiewicz
CEE Initiave for Sustainable Consumption and Production

Penny Newman
Executive Director
Center for Community Action and Environmental Justice
Riverside, CA USA

Roger Normand
Policy Director
Center for Economic and Social Rights
New York NY, USA

Michael Green
Executive Director
Center for Environmental Health
San Francisco CA, USA

Ryan Hunter
The Center for Environmental Public Advocacy
Ponicka Huta, Slovakia

Dana Clark
Senior Attorney
Center for International Environmental Law
Washington, DC USA

Centro de Tecnologías Apropiadas de la República Argentina

Glenn McRae
Vice President
CGH Environmental Strategies, Inc.
Burlington VT, USA

Jindrich Petrlik
Children of the Earth - Czech Republic
Prague, Czech Republic

Juan Carlos Acuña
Coalición de Ciudadanos y Organizaciones Antiincineración de la República
Salto, Buenos Aires, Argentina

Comisión Permanente de Protección del Medio Ambiente

Jean Halloran
Consumer Policy Institute/Consumers Union
Staten Island NY, USA

Stephen M. Brittle
Don't Waste Arizona, Inc.
Phoenix AZ, USA

Chris Trepal
Executive Director
Earth Day Coaliton, Cleveland
Cleveland OH, USA

Farzana Anwar
EarthRights International

Mark Wakeham
Environment Centre of the Northern Territory
Darwin, Australia

S. (Bobby) Peek
Community Campaigns Coordinator
Environmental Justice Networking Forum
Dorpspruit, South Africa

Monica Wilson
Essential Action
Washington DC, USA

Virginia Vargas
Flora Tristan Center

Dr. Raúl A.Montenegro
FUNAM (Fundación para la defensa del ambiente)
Professor of Evolutionary Biology
National University of Córdoba (UNC)
Córdoba, Argentina

Fundación Proteger

Bradley Angel
Executive Director
Greenaction for Health and Environmental Justice
San Francisco CA, USA

Paula Palmer
Executive Director
Global Response
Boulder CO, USA

Nancy C. Alexander
Globalization Challenge Initiative
Silver Spring MD, USA

Margaret Wooster
Executive Director
Great Lakes United

Dr. Ted Schettler
Greater Boston Physicians for Social Responsibility.
Boston MA, USA

Verónica Odriozola
Greenpeace Argentina
Buenos Aires, Argentina

Lisa Finaldi
Acting Toxics Campaign Coordinator
Greenpeace USA
Washington DC, USA

Gary Cohen
Health Care Without Harm
Boston MA, USA

Jackie Hunt Christensen
Food Safety Project Director
Institute for Agriculture & Trade Policy
Minneapolis MN, USA

Marie-Lou Roux
Executive Officer
Habitat Council
Cape Town, South Africa

Debjani Das
International Human Rights Association
Bremen, Germany

Anabela A. Lemos

Michael Bender
Mercury Policy Project
Vermont, USA

Anne Hedges
Montana Environmental Information Center
Helena MT, USA

Deepika D'Souza
The Mumbai Medwaste Action Group
Mumbai, India

Marcia Ishii-Eiteman, PhD
Senior Program Manager
Pesticide Action Network North America
San Francisco, CA USA

Romeo F. Quijano, M.D.
Pesticide Action Network Philippines
Associate Professor
University of the Philippines College of Medicine
Manila, Philippines

Karen Perry
Associate Director, Environment & Health Program
Physicians for Social Responsibility
Washington DC, USA

Delores Broten
Reach for Unbleached! Foundation
British Columbia, Canada

Reconciliarnos con la Tierra

Fernando Bejarano
Red de Acción sobre Plaguicidas y Alternativas en México
Texcoco, México

Areli Carreon
Red de Comunicación de Morelos
Cuernavaca, México

Heeten Kalan
South African Exchange Program on Environmental Justice
Boston MA USA

Ms. Joy Kistnasamy
Project Co-ordinator
South Durban Community Environmental Alliance
Bluff, Kwazulu-Natal, South Africa

Ravi Agarwal
Executive Director
New Delhi, India

Taller Ecologista

Amit Srivastava
Transnational Resource and Action Center
San Francisco CA, USA

John Blair
Valley Watch, Inc.
Evansville, IN USA

Verde x Gris

Carol Dansereau
Washington Toxics Coalition
Seattle WA, USA

Annabel Hertz
Executive Director
Washington DC USA

(Affiliations for identification only)

Keya Acharya

Brahm Amadi
Youth for Environmental Sanity
Santa Cruz CA, USA

Marc Beck
The Consultative Group on Biological Diversity
San Francisco CA, USA

Agustín Bravo Gaxiola
CEDANEM (Northeast Mexican Center of Environmental Law)
Chihuahua, México

Beryl Brugmans
Darwin, Australia

Vanessa L.Cabanellas

Dr. Eugene Cairncross
Department of Physical Science
Peninsula Technikon
Bellville, Cape, South Africa

Kathryn Caldwell
Macedon NY, USA

Jon Campbell
Acton MA, USA

Anita Celdran
Washington, DC USA

Ellen Ceppetelli, MS, RN
Assistant Profesor/Senior Program Developer
The University of Vermont

Mark Chernaik, Ph.D.
Environmental Scientist
Eugene, Oregon USA

Mark Colvin
Specialist Scientist
Medical Research Council
Congella, South Africa

Daniel De Lemos Ribeiro

Joseph Di Gangi, PhD
Chicago IL, USA

Joyce Hammer
Salt Lake City UT, USA

Naimul Haq
Staff Reporter (health)
The Daily Star
Dhaka, Bangladesh

Dave Hazzan
Hull Quebec, Canada

Von Hernandez
Greenpeace International
Manila, Philippines

Rick Hind
Washington DC, USA

Hironori Mori
Attorney at Law
Nagoya, Japan

Mehzabeen Hoosein
Mumbai Medwaste Action Group
Mumbai, India

Nityanand Jayaraman
Greenpeace International

Jong Lull Yoon M.D.
Department of Family Medicine
Hallym Univ. Hangang Sacred Heart Hospital
Seoul, Korea

Lin Kaatz Chary, M.P.H.
School of Public Health,
University of Illinois at Chicago
Chicago IL, USA

Kate Konschnik
San Francisco, California

Silvia Latrubesse
Attorney at Law
Salto, Buenos Aires, Argentina

Janice A. Lemos

Charles Levenstein, Ph.D., M.Sc.
Professor of Work Environment Policy
University of Massachusetts Lowell
Editor, New Solutions: Journal of Occupational and Environmental Health Policy
Lowell, MA USA

Larry Martin
US EPA Office of Research & Development
Washington DC USA

Max Martin
New Delhi, India

Jennelle Murosky
Allegheny College
Meadville PA, USA

Peter Orris, MD, MPH
Professor of Preventive and Internal Medicine
Rush Medical College
Director of Research
Great Lakes Center for Occupational and Environmental Safety and Health
University of Illinois School of Public Health
Chicago IL, USA

Conan Pereira
Mumbai Medwaste Action Group
Mumbai, India

Romina Picolotti, J.D.
Legal Officer, Latin America
International Human Rights Law Group
Washington DC, USA

Swati Prakash
Harvard School of Public Health
Cambridge MA, USA

Tara Price

Bill Ravanesi MA, MPH
Boston Project Director
Health Care Without Harm
Newton, MA USA

Larry Shapiro
Senior Attorney
New York Public Interest Research Group

Barbara Warren
Consumer Policy Institute/
Consumers Union
Staten Island, NY USA

Daphne Wysham
Institute for Policy Studies
Washington DC, USA


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