Report David da Costa
On a stretch of beach at Lecidere not far from the Government Palace in Dili, Delvio Sequeira walks slowly along the sand, scanning the ground.
He bends down and carefully picks up gloves, discarded water bottles and plastic bags, some of the waste he has collected from public spaces across Dili over the past decade.
The environmental activist says he has spent years trying to clean up the city.
“I do this because of the love I have for the country,” he said.
“But since 2015 it seems like there is more waste,”.
Increasingly, he says, that waste includes hazardous medical materials ending up in public spaces where children and communities can access them.
“The first place where we found medical waste was behind the PSIK Office,” Sequeira said.
“We also found syringes, IV bottles, medicines and gloves in other public places”.
In September 2025, Mr Sequeira made a more alarming discovery: medical waste left inside a disused building next to the Comoro Health Center, a location easily accessible to the community.
“I was shocked and concerned because it was dangerous for people,” he said.
Sequeira said children directed him to the building while he was shopping nearby.
“I saw it with my own eyes,” he said.
“The children played with the medical waste like masks and syringes with needles”
Photographs he later shared on social media showed discarded syringes, masks and other hazardous waste inside the unsecured building near homes and small businesses.
Sequeira warned the waste could put children and community members at risk of infection.
After the images were shared publicly, the building was fenced off.
Just meters from the building, shop owner Mariana Alves remembers seeing children near the discarded waste.
“I saw it with my own eyes,” she said.
“I told them not to play with the syringes because they were dirty and dangerous”.
Alves said while her children never touched the waste, the discovery caused concern for families living nearby.
A Widespread Problem
At Dili’s largest rubbish dump in Tibar, scavengers sort through piles of waste each day searching for recyclable materials they can sell.
Their work often brings them into contact with medical waste.
Lidonia Babo Madeira has worked at the site for 12 years.
“When the truck comes in and if it is from the hospital, we know and most of the time we avoid it,” she said.
“We see many syringes, gloves and waste with blood on it”.
They do what they can to protect themselves from potential injury or infection.
“We often use gloves, masks, and some scarfs or hats to protect our head and face”.
Limited Resources, Ongoing Risks
Following the discovery, the Comoro Health Center fenced off the building and restricted access to the site.
Head of the health center Emelia Ayati de Sousa acknowledged the waste had not been stored securely.
“Because we lack a fixed site for sharps, we used an empty room,” she said.
“The place was indeed not secure because we were just using what we had”.
She said children later accessed discarded syringes that had been moved near the old building.
“Since that previous incident, we have made things better. We secured the building with iron bars and we lock the doors. They have broken our padlocks about three times already,”
“If a sharp needle pricks someone, we don’t know the health status of the previous patient,” she said.
“It is a major risk for infection and disease transmission”.
Ayati de Sousa said the clinic follows Ministry of Health and WHO guidelines, but struggles with limited resources and infrastructure.
“According to medical waste policy, bins should be color-coded,” she said.
“We aren’t operating at 100 percent capacity with this yet”.
She said the clinic does not have a permanent storage facility or its own incinerator, and medical waste must be transported elsewhere for treatment.
“Waste management has been a big problem, and this is what we want to improve in the future”.
Rules Exist, But Enforcement Is Limited
While individual clinics are responsible for managing their own waste, national guidelines outline how hazardous materials should be handled across the healthcare system.
The World Health Organisation (WHO) worked with Timor-Leste’s Ministry of Health and other partners to develop the National Health Care Waste Management Policy for Timor-Leste, strategy, standard operating procedures and guidance documents.
WHO representative Dr Arvind Mathur said, medical waste can be a source of contamination and infection if it is not properly managed, and the policy was developed using global evidence adapted to Timor-Leste’s context.
The guidelines cover the full cycle of waste management from separation, collection to transport and disposal, but WHO says implementation remains a challenge.
“Medical waste Management is not much talked about it’s taken for granted,” the WHO representative said.
“Then the capacity is continued to be low, there is a challenge”.
WHO estimates around 10 to 15 percent of healthcare waste is hazardous and needs to be carefully managed.
“For example, if it is not managed properly, Sharps if it gets fears into the skin can cause a blood transmitted infection like hepatitis,” he said.
The Ministry of Health says it has guidelines, policies and standard operating procedures in place, but acknowledges implementation is not always consistent.
“When we talk about waste management, there are parts we need to look at: waste separation, collection, transportation, and final treatment,” Health care Waste Management Program official Paul da Costa do Rego said.
“Sometimes we cannot guarantee that the management is safe because medical waste is still being mixed with general waste. When it ends up in the general waste, that is a problem”.
Da Costa do Rego said the ministry had provided training and orientation to health facilities, including hospitals, health centers and posts.
But he said the system still relies heavily on staff awareness.
“I want to say that we cannot claim they don’t follow the rules, but while they manage to follow them, it is not yet at a maximum level,” he said.
“In some places it goes well, but sometimes it depends on individual awareness”.
The ministry says it has installed incinerators across 14 municipalities, including Atauro and Oecussi, to treat healthcare waste. It also says monitoring teams visit health facilities and report back to the national level.
but the Health Care Waste Management Program Officer at the Ministry of Health acknowledged that there will be limitations.
“Talking about sanctions, I think we don’t have a law that binds us to give sanctions, but we have the policy and guidelines to teach them how to manage waste safely so it doesn’t impact the environment or our communities,” Costa do Rego said.
“That is what we have, but for medical waste, we don’t yet have a law to regulate it”.
He said the ministry plans to continue training health workers in municipalities with support from UNICEF.
“This year we have a fixed plan with support from UNICEF,” he said.
“We will continue to find ways to orient our health professionals in the municipalities on how to manage waste safely”.
A Safer Future?
Environmental advocate Delvio Sequeira says stronger rules and better facilities are needed to stop medical waste entering public spaces.
“The government should build proper rubbish bin for each hospital and clinic for medical waste,” he said.
“We need a rigorous law to regulate the disposal of medical waste to prevent its impact on the people”.
As healthcare services expand across Timor-Leste, the amount of medical waste generated is expected to grow.
Ensuring that waste is managed safely will be critical to protecting communities, safeguarding the environment and maintaining public trust in the health system.
For residents like Mariana Alves, the concern is simple: medical treatment should never create new risks for the people it is meant to serve.
“I am calling on the health professionals to put the waste in a proper place, to prevent children from playing with it,” she said.
“I am calling on the government to have strong regulations about the medical waste”.