Healthcare waste in Kiribati: a joint humanitarian, private and public sector response

Kiribati’s limited, fragmented, and low-lying land area creates severe constraints for healthcare waste management. With scarce suitable land available, there are few safe options for the treatment, storage, disposal, or long-term isolation of hazardous medical waste, particularly in ways that keep it separated from communities, water sources, and fragile coastal ecosystems.

With limited disposal options available, most waste that enters Kiribati remains there. Over time, the accumulation and disposal of medical waste, particularly at Tungaru Central Hospital (TCH) in Tarawa, has placed considerable strain on existing systems.

Kiribati is a small island nation in the central Pacific, made up of 33 low-lying coral atolls. Its total land area is just over 800 square kilometres, only slightly larger than Singapore, but with land dispersed across approximately 3.5 million square kilometres of ocean. Much of the country sits only a few metres above sea level, leaving communities and infrastructure exposed to tidal surges, coastal flooding, erosion, and other climate-related pressures.

The Kiribati Health Care Waste Management project represents an integrated, cross-sector approach that brings together government, humanitarian, and private sector technical expertise to address a complex public health and environmental issue. It is designed not only to respond to Kiribati’s immediate needs but also to offer a practical and scalable model for other island nations facing similar challenges.

By strengthening healthcare waste management systems, the initiative aims to reduce risks to human health, protect fragile island environments, and support compliant and sustainable healthcare waste management systems for the people of Kiribati.

This challenge is not unique to Kiribati.

The United Nations Environment Programme has identified that Small Island Developing States (SIDS) across the Pacific face the same constraints: limited land, climate vulnerability, and waste infrastructure that has not kept pace with demand.

The Government of Kiribati, in partnership with MSF and supported by BFS, is now delivering a direct response to this challenge: a comprehensive healthcare waste management project at the country’s national referral hospital.

The initiative aims to establish a sustainable, compliant, and effective system aligned with international standards, including the Basel Convention on hazardous waste.

There are three phases of the project:

• The safe removal of legacy hazardous medical waste through a process called Transfrontier Shipment (TFS), under the Basel Convention, the international treaty governing the movement of hazardous waste across borders, for compliant treatment and disposal abroad.
• Improvements to infrastructure and operational practices at TCH, including enhanced waste segregation, upgraded incineration processes, and training for local healthcare workers with the goal of development of a long-term, circular waste management system.
• The design and implementation of an Extended Producer Responsibility (EPR) system to provide a sustainable financing mechanism for ongoing healthcare waste management.

For more information or to organise an interview please contact: 

Diana Worman on +61 447 348 556 [email protected] AND 

Yash Das Sharma on +49-17668648384 [email protected]

Project note:

Médecins Sans Frontières (MSF), in partnership with international waste management experts Black Forest Solutions (BFS), and the Government of Kiribati, are operating a healthcare waste management project in Kiribati to strengthen safe, sustainable waste practices and protect public health and the environment.

Additionally, MSF operates a climate-sensitive health care project in Kiribati in partnership with the Ministry of Health and Medical Services, addressing non-communicable diseases, particularly in women and children, as well as improving long-term access to safe water to support public health needs.

About BFS:

BlackForest Solutions (BFS) is an international environmental management firm founded in 2016, part of the RainbowForest Solutions Group. With more than 275 projects delivered across 100 countries, BFS specialises in hazardous waste advisory, the compliant cross-border movement of hazardous materials under the Basel Convention and the design of long-term waste management systems for governments, health systems, and industry.

In Kiribati, BFS is responsible for the safe export of legacy medical waste, improvements to the TCH incinerator infrastructure, staff training, and the design of a sustainable financing model for healthcare waste management. BFS operates under the supervision of MSF and in close coordination with the Government of Kiribati. 

For more information visit: https://rainbowforest.org/blackforest-solutions/

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