**1. Introduction**

Healthcare waste (HCW), which is defined as all the waste generated within healthcare institutes, research institutes, laboratories related to medical procedures, and healthcare activities in the home [1], contains infectious hazardous waste components and must be properly sorted, collected, and treated to prevent infection [2, 3].

Over the last decades, the need for safety management of HCW has significantly increased due to the rapid population growth and increase in medical institutes, without which potential risks are very high to human health and the environment. Approximately five million people were reported to die every year due to HCWrelated diseases [4]. The risk comes from accidental injuries during the handling of

infectious waste components of HCW, which can cause diseases like hepatitis B, hepatitis C, and HIV infection [5]. Moreover, numerous other diseases can be transmitted by contact with infectious HCW.

The importance of HCW management is once again drawing attention in today's COVID-19 pandemic [6]. As the virus stays longer on plastic, metal, and cardboard materials in HCW generated from the treatment of COVID-19 infected patients can be one of the potential routes for transmission of infection [7, 8].

However, in economically developing countries, which was defined by United Nations [9], HCW management systems are often unestablished or not fully functional, where infectious HCW that are not properly segregated and/or treated turn into new sources of infection and the waste streams become as a path to spread the infection. According to WHO, just over half (58%) of the sampled facilities from 24 countries (as of 2015) had adequate systems in place for the safe disposal of HCW generated [10]. Many papers have been reported that the implementation system and capacity of HCW management are often inadequate [4, 5, 11–18].

What can we do to improve the status of HCW management in developing countries and prevent the spread of infection? Especially in low-income developing countries where funds are insufficient, capacities at organizational, institutional, and societal levels are weak, some technical assistance for enhancing HCW management will be required through international cooperation [10]. In order to make effective use of the limited resources of donor agencies and provide appropriate technical assistance, it is essential to understand the current situation, evaluate risks, diagnose existing systems, and provide necessary technical supports.

The main theme of this chapter is to consider the challenges of international technical assistance for improving the management of hazardous infectious HCW in developing countries. The author first analyzes the trends in medical waste generation around the world and predicts the needs for medical waste management in developing countries in the near future. Next, we will examine the problems of HCW management in developing countries and the risks arising from them, and review the solutions to the problems, the system design, and an effective HCW management plan for avoiding the risks. It also proposes diagnostic methods and necessary supports for implementing effective international technical assistance. Finally, a case study of the international technical assistance on HCW management in Palestine is described.
