At 60, Bilkis Begum has spent more than three decades cleaning hospital waste at Rangamati Langadu Upazila Health Complex, a small healthcare facility in the remote Chittagong Hill Tracts of Bangladesh. Every day, Bilkis cleaned patient wards, carried infectious waste, and handled used syringes, blood-stained bandages, and broken glass. Yet, despite doing one of the hospital’s most dangerous jobs for 33 years, she had never received any formal training on how to manage medical waste safely.

For years, Bilkis carried out the work with almost no protection. She wore ordinary sandals instead of boots and handled all kinds of waste mixed together in the same bins. Needles, blood-soaked gauze, broken glass, saline bags, and food waste were often dumped without separation. Injuries became a regular part of her life. One day, while throwing waste into an open dumping pit behind the hospital, she slipped and broke her leg. But the incident she remembers most clearly was when a used needle pierced her finger while she was collecting waste. “It started bleeding immediately. I was terrified thinking, what if I had been infected with a deadly disease?” she recalled. The fear stayed with her long after the wound healed. At times, the smell of the waste made her nauseous and unable to eat after returning home from work. More than anything, she worried that the risks she faced every day might also endanger her family.

Hospital cleaners like Bilkis are often the unseen frontline workers of healthcare systems, especially in remote areas. While doctors and nurses treat patients, cleaners handle the dangerous aftermath, infectious waste, contaminated materials, and overflowing disposal pits, usually with little recognition and limited protection. In the Chittagong Hill Tracts, where healthcare facilities face logistical and resource challenges, unsafe waste disposal also created risks for surrounding communities and the environment. Medical waste was frequently burned in open spaces or dumped carelessly, exposing workers and residents to harmful pollution and possible infections.

In 2023, that reality began to change. With support from the Government of Japan, the United Nations Development Programme (UNDP), together with the Government of Bangladesh, launched a healthcare infectious waste management initiative across 26 hospitals in the Chittagong Hill Tracts. The project introduced safer systems for collecting, transporting, and treating infectious waste while also focusing on the people handling it every day. Hundreds of healthcare workers, waste handlers, and local authorities received hands-on training on safe waste management and workplace safety.