Potential environmental impacts of a hospital wastewater treatment plant in a developing country

Muhammad Tariq KHAN, Riaz AHMAD, Gengyuan LIU, Lixiao ZHANG, Remo SANTAGATA, Massimiliano LEGA, Marco CASAZZA

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1 Citation (Scopus)


Assessing the quality of a hospital wastewater treatment process and plant is essential, especially if the presence of chemical and biological toxic compounds is considered. There is less literature on hospital wastewater treatment in developing countries because of a lack of managerial awareness and stakeholder cooperation, accompanied by the limited capacity of investment meant to upgrade the existing infrastructures. Limited access to data further hampers the reliable analysis of hospital wastewater treatment plants (WWTPs) in developing countries. Thus, based on the possibility of collecting a sufficient amount of primary (i.e., field) data, this study performed an assessment of the potential impacts generated by the WWTP of Quaid-Azam International Hospital in Islamabad (Pakistan) considering its construction and operational phases. The major identified impacts were attributed to the energy mix used to operate the plant. Marine ecotoxicity was the most impactful category (34% of the total potential impacts accounted for), followed by human carcinogenic toxicity (31%), freshwater toxicity (18%), terrestrial ecotoxicity (7%), and human non-carcinogenic toxicity (4%). An analysis of potential impacts was combined with an assessment of potential damage according to an endpoint approach. In particular, the endpoint analysis results indicated that human health damage (quantified as DALY) was mainly dependent on the “fine PM (particulate matter) formation” category (51%), followed by “global warming and human health” (43%). Other categories related to human health impacts were human carcinogenic toxicity (3%), water consumption (2%), and human non-carcinogenic toxicity (1%). The other impact categories recorded a percentage contribution lower than 1%. With respect to ecosystem damage, “global warming and terrestrial ecosystems” played a major role (61%), followed by terrestrial acidification (24%), ozone formation (10%), water consumption (5%), and freshwater eutrophication (1%). This study’s findings support an increase in awareness in the hospital management board while pointing out the need to further implement similar studies to improve the quality of decision-making processes and to mitigate environmental impacts in more vulnerable regions. Finally, this research evidenced the need to overcome the existing general constraints on data availability. Consequently, further field work, supported by hospital managers in developing countries, would help in enhancing managerial procedures; optimizing treatment plant efficiency; and facilitating the implementation of circular options, such as sludge management, that often remain unexplored. Copyright © 2024 by the authors.

Original languageEnglish
Article number2233
Issue number6
Publication statusPublished - Mar 2024


Khan, M. T., Ahmad, R., Liu, G., Zhang, L., Santagata, R., Lega, M., & Casazza, M. (2024). Potential environmental impacts of a hospital wastewater treatment plant in a developing country. Sustainability, 16(6), Article 2233. https://doi.org/10.3390/su16062233


  • Wastewater treatment plant
  • Life cycle impact assessment
  • Developing countries
  • Hospital environment
  • PG student publication


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