Iran’s Sewage Dumping Causes Hepatitis A Outbreak Among Ahwazis

Environmental contamination due to solid waste mismanagement is a major issue in Ahwaz. Most solid waste is found in open dumps, which function as the primary disposal system in marginalised and underdeveloped areas. This includes medical waste, which is visible in abundant quantities. However, this crisis of unprocessed medical waste is not restricted to areas with impoverished communities, but is rapidly becoming widespread in the city centre, particularly around bridges. This is because the Karoon River has become a centre for the collection of medical waste.

Karoon is the largest river in Iran and the only body of water to connect to international waters across the Shatt al-Arab. As such, it provides an important site of geopolitical navigation. However, the river has been impacted by pollution and water shortages since the Iranian regime initiated several projects through constructing non-standard dams in order to divert Karoon river water from its main course to the arid central Persian regions like the provinces of Yazd and Isfahan as well as a sugar cane planting project, which has impacted the quality and quantity of Karoon water.

In fact, like the oil and gas fields, the sugarcane refineries, built on Ahwazi river banks for access to the massive quantities of water used in the refining process, are one of the factors responsible for heavy pollution in the region, with untreated chemical waste from the refining process being dumped back into the rivers, leading to widespread ecological devastation and dangerous diseases among the local people.

On July 22, 2020, Mohammad Reza Izadi, a member of the Ahwaz City Council said that many residents in Ahwaz city have been infected with ‘Hepatitis A’ due to the contamination of drinking water by municipal sewage. Izadi explained, “the money that was supposed to be spent on improving the water and sewage system of Ahwaz has not been paid, and residents of 301 areas in the city are currently facing many problems in accessing safe drinking water.” He added, “In 2018, it was announced that residents of 301 areas in the city were infected with ‘Hepatitis A’ due to the confluence of water and sewage, but the governor of Ahwaz denied the news.”  

 The disposal of sewage in rivers has affected not only the quality of drinking water available to Ahwazis, but also the quality of agricultural water. As such, the regime is responsible for providing facilities to protect the Karoon, as this is an international obligation of every country in accordance with international law. In contravention to its international obligations, however, the Iranian regime continues to pollute the river, causing a surge in disasters that have implications for Ahwaz’s environment, health, agriculture, and livestock, among other things.

Water pollution is caused by pollutants, which occur as a result of contamination generated by human activities such as sewage disposal and industrial waste. Pollution of the Karoon River endangers the health of Ahwazis, in addition to the plants and animals that constitute its biodiversity. Clinical waste is among the most dangerous pollutants posing risks to human health. It is mainly produced by hospitals, clinics, surgical wards, and vets. Examples of medical waste in the Karoon River have even included body fluids, infectious tissues, swabs and dressings, as well as used syringes and needles.

Numerous reports from environmental and human rights activists in Ahwaz have pointed to pollution in Ahwaz’ water supply as one of the most pressing problems Ahwazi citizens face on a daily basis. Pollution, especially ‘infectious waste’, has caused an increase in diseases among Ahwazi communities, particularly children. Most pollution is a consequence of the practices of Iranian medical and infrastructural institutions, as well as the economic activity of agricultural projects based on harvesting sugar cane. National and local reports from Iran claimed that the vast majority of pollution in the Karoon is due to the regime’s ineptness in managing the crisis, but many Ahwazis believe that this policy, like the rest of the regime’s policies, is intended to put pressure on the lives of Ahwazi citizens. Irrespective of the aims, the causing of pollution in the Karoon River nevertheless represents a violation of human rights. In 2011, Mr Calin Georgecu, the Special Rapporteur on the human rights obligations related to environmentally sound management and disposal of hazardous substances and wastes, in his report to the United Nations, pointed out that “improper healthcare waste management leads to a violation of human rights.” 

Karoon River 

For decades, the Karoon River was an important conduit for trade and tourism. Currently, however, it has become a source of disease and deficiency, as the combination of water shortage and pollution impact the health and wellbeing of Ahwazis. The Iranian regime’s policies are destroying Ahwazi ecosystems. According to Iranian sources, industrial and agricultural wastes make up 40% of pollution in the Karoon River. However, discharging of medical waste to the Karoon by official organisations poses a greater danger to local communities because it can transmit diseases among populations. Government authorities are aware of such perils, yet continue to neglect Ahwazi concerns. 

Politicians speaking on behalf of the government routinely promise to rectify the situation, but to no avail. For example, referring to the disposal of infectious waste from a hospital in Ahwaz to the Karoon River, General-Director of Environmental Protection in Ahwaz, Mohammad Jawad Ashrafi, stated: “The judicial authorities will follow up with this violation”. He refused, however, to provide more details on the type of judicial follow-up. In an interview with the IRNA News Agency, Ashrafi noted the following:

The experts of the department visited the third bridge in the city of Ahwaz after receiving a message from citizens regarding medical waste in the city, so the expert confirmed that medical waste comes from the government hospital (Khomeini hospital). 

Ashrafi added that “the volume of this waste is equivalent to about a six-ton truck, including all types of infectious waste and hospital garbage.” 

The Ahwaz Municipal Waste Organisation also confirmed the existence of hospital waste in the Karoon. Director of Ahwaz Municipal Waste Organisation, Mohammad Reza Qanawati, corroborates this statement. Referring to the presence of infectious waste on the shores of the Karoon, Qanawati said that “one of the bags left on the shores of the Karoon River contains infectious waste.” He added: “These wastes were 8 bags belonging to the administrative section of Khomeini Hospital in Ahwaz, one of which contains infectious waste and the rest are other wastes that were collected immediately from the coastal site of the third bridge on the Karoon.”  

 An Ahwazi nurse whose name is withheld for security reasons told DUSC that this waste dumping goes beyond the Khomeini Hospital, adding that other hospitals in Ahwaz are doing the same. “The local authorities mentioned Khomeini Hospital because the residents protested, and the problem was posted on social media”, she said. She explained that “every morning, most hospitals empty their medical waste near the Karoon River or sometimes near marginalised residential areas.” She stressed that this medical waste could and most likely will lead to cancer and other infectious diseases in the lungs, liver, intestines and kidneys.

Sources in Ahwaz confirmed that dumping medical waste occurs in residential areas, as well as near the rivers of the Arabian Gulf and the marshlands. Ahwaz Journal site reported in the Telegram that “wastes, in general, and medical waste, in particular, cause an unpleasant smell as it disturbs the health of citizens, especially if the city suffers from poor sanitation.” Quoting citizens from the city of Abadan, the site noted that “the city suffers from poor sanitation and sewage and that the transferring of waste caused a crisis in 310 residential areas in the city.”

Another resident in the city of Ma’shor noted that the city’s hospital discharges its medical waste either to the Jarrahi River or to an area close to Kharakoun, a residential neighbourhood in the city. This means that medical waste is transferred through sewage to the Arabian Gulf. Consequently, medical waste causes health problems for downstream residents and environments in the Arabian Gulf, as well as causing a negative impact on citizens in the Koura area of Ma’shor and the city of Jarrahi.

Impact on Ahwazi Communities

The impact of solid waste depends on numerous factors including the nature of the waste, the duration of exposure, the levels of the population exposed, and the quality of services available to prevent pollution in residential communities. Due to the demographic organisation of Ahwazi communities and their neglect by the state, all of these factors are likely to exacerbate the adverse risks associated with increased pollution, especially in areas around the Karoon River. ‘Infectious waste’ specifically targets Ahwazi citizens because it carries the potential to contain pathogens that can cause diseases among citizens. Therefore, dumping of waste in the Karoon River and residential areas by any groups is a clear violation of human rights, especially the right to life free of danger. 

Another problem that endangers human and animal health is the presence of animals in medical waste spread in residential areas where these animals transmit diseases to citizens. Therefore, citizens are at risk of transmission of infection through a nauseating and pungent smell, and animals scattered in dumping sites, as occurs in deprived areas of Ahwaz, such as Malalshiyeh, and the rest of the areas such as Pardis. Some experts believe that wastes, especially medical waste, attract all types of vectors, including common household flies, which are highly efficient in transmitting bacterial diseases. Children living in such neighbourhoods are at risk of serious infectious disease, and face injuries and inhalation problems. Water pollution due to waste, in particular medical waste, also leads to the spread of diseases such as cholera, fever, typhoid, tuberculosis and diarrhoea. 

The local authorities in Ahwaz do not provide services for the management of residential areas in Ahwazi cities. This is especially true for the capital, where people face rising levels of municipal waste and disposed material from other state institutions, such as government hospitals carrying material from all cities. As a result, the municipality and other institutions dispose of waste in street corners in residential districts, agricultural lands and rivers, and in unregulated landfills on the outskirts of low-income residential areas.

Dumping of medical waste often occurs not necessarily because the capacity to deal with it does not exist, but because it is often cheaper, and contractors avoid using technology to properly clean and/or dispose of it. However, Ahwazi citizens and activists believe that this reflects the designs of a racist policy that deliberately discriminates against Ahwazis. For example, an Ahwazi living in Abadan criticised the biased reports by official authorities supporting the Iranian regime’s proposed plans to deal with the medical waste crisis in Ahwazi regions. The interviewee indicated that the municipality and medical facilities ignore people’s complaints regarding the impact of medical waste on their daily lives. He pointed out that people have sent documents – both in the form of reports and pictures – detailing the adverse effects of medical waste in their areas to official institutions, representatives of parliament and the local media. However, this has been met with inaction on the part of the municipality. People also urged the hospital not to throw its medical waste into the river and residential areas, but to no avail. International law aside, the hospital routinely ignores adherence even to Iranian domestic laws pertaining to people’s health.

Ahwazi human rights organisations have warned Iranian authorities that the policies of neglecting citizens allow transgressors of proper waste management such as municipalities, companies, government hospitals and other Iranian institutions to expand their policies against the health of citizens. An environmental activist who spoke to me said that leaving medical and other waste is a policy meant to cause the destruction of agricultural soils, marshes, and rivers, in addition to prompting a spike in diseases in residential areas. The activist pointed out that the centres of the city of Ahwaz and Abadan have an unpleasant smell owing to the fact that medical waste is pervasive in the streets, a situation that contributes to the proliferation of serious diseases among locals.

An Ahwazi doctor, speaking on condition of anonymity, corroborates this. He said that “waste causes serious health symptoms in Ahwaz, carrying with it infections, as bacteria, and viruses can be factors in spreading diseases.” He noted that “physical injury may include severe wounds and trauma, such as immediate skin burns, which disproportionately target impoverished citizens and children, as well as long-term effects caused by inhalation of chemical pollutants.” He pointed to the non-communicable diseases that were caused, such as the development of cancer and other diseases among people. He stated that “the emotional and psychological effects, especially among children and pregnant women, are just as serious, and are also widespread in poor areas in Ahwaz.”

A member of Ahwaz City Council said that, while water for many cities of the Ahwaz region is supplied from the Karoon River, “unfortunately, the influx of sewage and pollution of the river has caused people to suffer from gastrointestinal diseases.”  In an interview with ILNA, Seyyed Mohsen Mousavizadeh stated, “in most Ahwazi cities, including Ahwaz city, Abadan, Muhammarah, Khafajiyeh, there are no suitable treatment plants for the Karoon River, which supplies water to the people. The influx of domestic, industrial and hospital waste causes gastrointestinal diseases.” He added: “Although chlorinated water is treated, the same chlorine has many problems and causes side effects for people’s health.”

According to statistics, the incidence of gastrointestinal diseases and cancers is high due to water contamination and dust storms in the Ahwaz region. Some years ago, the International Agency for Research on Cancer announced that air pollution was the main factor behind the high rates of cancer and other diseases in Ahwaz. As ever, the regime has neglected these warnings. In this respect, the former head of the oncology department at Ahwaz’s Shafa Hospital warned of the increasing number of cancer cases. Figures show that the number of cancer cases is rising as the already horrendous pollution worsens, with a 500 per cent increase in cancer rates between 1996 and 2013 due to water and air pollution, as well as food chain contamination. Residents have been warned to expect a “tsunami” of cancer cases in the years to come.


The pollution of the Karoon River is the result of the Iranian Ministry of Energy’s neglect and the regime’s deliberate policies in building dams and diverting the river’s path towards Persian cities, as these policies endanger the lives of Ahwazi citizens. The construction of dams and the pollution of the Karoon River by government institutions has caused a significant drop in the river’s water. If these policies continue, the situation will become more dangerous for Ahwazi residents. Moreover, it will become increasingly difficult to deal with the crisis going forward. 

The Iranian regime must observe the international laws for which it is responsible as a member of the United Nations. In accordance with international laws related to health, medical waste and human rights, the Iranian regime should ensure that its policies do not pose a threat to Ahwazi residents’ ‘rights to life’. This includes dumping medical and other waste anywhere in the region. 

At the very least, Iran should comply with the relevant laws stipulated within its own constitution in order to solve the waste crisis in the Karoon River. Article 50 of the Iranian constitution states “the necessity to protect the environment in which current and future generations should enjoy a growing social life.” According to this principle, “any economic and social activities related to pollution and irreparable environmental damage are prohibited.” Articles 46 and 47 of the Law on “Fair Water Distribution”, adopted on 07/03/1983, with an amendment on 11/05/1985, indicate that the authorities are to prevent pollution of the water. 

The responsibility for preventing the pollution of water resources is assigned to the ‘Environmental Protection Organisation’. Additionally, Article 4 of the ‘Environmental Protection Organisation’ (approved on 07/15/1992) criminalises and prohibits the contamination of drinking water. Article 2 of the Internal Regulations for ‘Preventing Water Pollution’, adopted on 12/15/1984 and revised on 05/08/1994, prohibits any action that causes water pollution. Article 7 states that all units in companies and industrial complexes containing toxic wastewater and heavy metals are not allowed to discharge sewage into the municipal system and must build a private refinery. 

Under the constitution, the Iranian regime is required to “allocate a budget to cover the costs of establishing and maintaining sound health care waste management systems.” Under the constitution, “it must not allow any institution to leave waste in the Karoon River.” The Iranian regime “must implement and monitor sound health care waste management systems, support capacity-building, and ensure the health of workers and society.”

This should be done promptly – as the long-term health, and environmental consequences are yet to be fully understood, and may, in fact, be greater in scope than is currently assumed. In fact, direct evidence of damage caused by improper handling of medical waste in Ahwaz is very limited. No data can be found on the harm caused to citizens as a direct result of improper disposal of medical waste because the authorities do not publish data on the risks to the lives of citizens. 

The World Health Assembly (WHA 2010) called for more actions on medical waste. The preamble of the resolution notes that the Assembly was “aware that wastes, if not properly managed, in a safe environmentally sound manner, may have serious consequences for human health and livelihood; convinced that the lack of environmentally sound management of waste will harm the environment and be detrimental to human health, through polluted air, water, land and food chain. 

The Iranian regime has been violating these rights since it began constructing dams, causing water shortages and damaging the environment and health of the Ahwazi people. The international community must call on Iran to halt its perilous environmental, health, and human rights policies; they must stop depriving citizens access to safe drinking water as well as agricultural water, as these actions present grave violations of human rights. 

By Kamil Alboshoka

Kamil Alboshoka is an Ahwazi researcher and international law specialist. He tweets under

Editing by Rahim Hamid and Penina Sarah. 

Rahim Hamid is an editor and writer based in the USA and Penina Sarah is a New York Attorney, Human Rights Advocate and Commentator on the Middle East and National Security Issues. 


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