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Medical waste is highly hazardous. There are a multitude of risks involved in storing unsecured containers and of dumping medical waste, including the spread of disease and the contamination of water. The illegal dumping and storage of medical waste in South Africa is verging on a national crisis. South Africa generates 35% more waste than can be handled, and as much as 800 tons of medical waste are believed to be illegally dumped each year in the country. The Health Care Waste Forum (HCWF), under the auspices of the Institute of Waste Management of South Africa, has said that the current situation could lead to a "major disaster". There have already been a number of exposés in recent years of illegally dumped or illegally stored medical waste. Two years ago, a warehouse full of decaying human tissue, blood and pus-soaked bandages, used needles, syringes, and discarded HIV-test kits from about 200 state hospitals was discovered in Springs. Three months ago, piles of used needles, tablets and medicines were found illegally dumped in Queenstown. This is only a tiny fraction of the total number of reports, which surface at regular intervals across the country. The government is well aware of the problem, but has not yet been able to solve it. In the past year there have been eight investigations into major industry players. But all got away with a mere slap on the wrist. Untrained personnel, lax oversight, poor regulation, dodgy tenders and the murky delineation of responsibility are at the root of the problem. The recently passed National Environmental Management: Waste Act, as well as other national laws, call for the proper regulation of health care waste management. But an overriding authority responsible for the oversight of industry players, the punishment of transgressors and the ultimate regulation of HCWM does not exist. Although regulations clearly lay out the correct handling, storage and disposal of medical waste, not all institutions comply with the rules. The lack of segregation of waste into correct containers at the point of waste generation is a major problem, leading to increased volumes of waste that has to be treated and disposed of by incineration or non burn technology, and as a result, increases the costs of treatment. This is a direct result of inadequate personnel training and effort. Increased costs and a resulting lack of resources (or attempts to save on treatment costs), lead to illegal dumping at general waste disposal sites or in fields, rivers, water sources, or burnt in open pits. The lack of uniform standards with regard to medical waste generators further aggravates the problem. Some contractors used by health care facilities do not have their own treatment facilities and have to use a third party to ensure the appropriate treatment of the collected waste. But no control measures exist to ensure that all waste collected is treated at a licensed facility, and there is poor record keeping and reporting. The government insists that anatomical waste must be incinerated; yet there are presently only five incinerators available to treat health care risk waste for South Africa. Incineration is officially banned in KZN. Due to the extreme work load of the incinerators, they do not operate within their permit conditions all of the time. As a result, it sometimes occurs that medical waste from the northern provinces is trucked all the way to the Western Cape when incineration capacity in Gauteng cannot cope with the demand. It is possible that none of the incinerators will meet the new air emission standards which come into imminent effect under the new National Air Quality Management Act. Furthermore, certain provincial health departments, including Limpopo and the Eastern Cape, have a record of awarding tenders to private sector service providers that do not have the expertise, infrastructure or capacity to manage the legal treatment of medical waste. There are few officials in provincial health departments who have the knowledge or expertise to deal with contracts related to hazardous waste, and who have knowledge of how the industry works. To address these problems, the Democratic Alliance (DA) proposes the creation of a specialised Health Care Waste Management Program (HCWMP). Resources need to be allocated to such a programme from the Department of Environmental Affairs, the Department of Health, and the provincial health departments. The HCWMP would take direct responsibility for the regulation of the generation, handling, storage, treatment, and disposal of medical waste. Most importantly, it would enforce the law, create clear guidelines, keep the necessary records, monitor transgressors, educate government officials and work for the introduction of alternative technologies. We believe that this body would go a long way to solving what is a growing but almost completely unaddressed crisis.