E2960 v1 Chongqing Urban-Rural Integration Project Phase II (CURIP II) Comprehensive EIA Report Feb. 2012 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Contents 1 GENERAL ........................................................................................................................................................ 1 1.1 BACKGROUND OF CURIP II........................................................................................................................ 1 1.1.1 Overview of Chongqing Municipality .................................................................................................... 1 1.1.2 Government Strategies for Urban and Rural Integration Development ................................................ 1 1.1.3 Necessity of CURIP II ............................................................................................................................ 2 1.1.4 EA Classification ................................................................................................................................... 5 1.1.5 EA Report Preparation .......................................................................................................................... 6 1.2 LAWS, REGULATIONS, STANDARDS AND SAFEGUARD POLICIES OF THE WORLD BANK .............................. 6 1.2.1 National Laws, Regulations and Relevant Documents .......................................................................... 6 1.2.2 Assessment Standards .......................................................................................................................... 10 1.2.3 Safeguard Policies of the World Bank.................................................................................................. 11 1.3 SCOPE AND METHODS OF THE ENVIRONMENTAL ASSESSMENT, ENVIRONMENTAL PROTECTION TARGETS AND SENSITIVE AREAS .......................................................................................................................................... 11 1.3.1 Scope of the Environmental Assessment .............................................................................................. 11 1.3.2 Methods of Environmental Assessment ................................................................................................ 12 1.3.3 Environmental Protection Targets........................................................................................................ 12 1.3.4 Environmental Sensitive Areas............................................................................................................. 13 2 PROJECT DESCRIPTION........................................................................................................................... 16 3 ENVIRONMENTAL BASELINE ................................................................................................................. 22 3.1 NATURAL ENVIRONMENT ......................................................................................................................... 22 3.1.1 Project geographic location................................................................................................................. 22 3.1.2 Landform, Geomorphic, Meteorology, River and Hydrology............................................................... 25 3.1.3 Ecological Function Division and Biological Resources..................................................................... 30 3.1.4 Soil Erosion.......................................................................................................................................... 33 3.1.5 Current Environmental Quality............................................................................................................ 33 3.2 SOCIO-ECONOMIC ENVIRONMENT ............................................................................................................ 43 3.3 CURRENT MEDICAL AND HEALTH SERVICE .............................................................................................. 45 3.4 MEDICAL AND HEALTH SERVICE PLANNING ............................................................................................. 49 3.5 DUE DILIGENCE REVIEW AND PLANNING FOR MANAGEMENT OF MEDICAL WASTES AND MEDICAL WASTEWATER ....................................................................................................................................................... 50 3.5.1 Due Diligence Review of Current Management of Medical Wastes and Medical Wastewater in Project Hospitals........................................................................................................................................................... 50 3.5.2 Due Diligence Review and Planning for Management of Medical Wastewater and Solid Waste in Project Districts/Counties ................................................................................................................................ 52 4 ENVIRONMENTAL IMPACTS AND MITIGATION MEASURES......................................................... 56 4.1 ENVIRONMENTAL IMPACTS AND MITIGATION MEASURES DURING CONSTRUCTION PERIOD .................... 60 4.1.1 Social Impacts and Mitigation Measures............................................................................................. 60 4.1.2 Acoustic Environmental Impacts and Mitigation Measures................................................................. 65 4.1.3 Ambient Air Impacts and Mitigation Measures.................................................................................... 68 4.1.4 Impact of Construction Camp and Mitigation Measures ..................................................................... 70 4.1.5 Traffic Impacts during Construction and Mitigation Measures ........................................................... 72 4.1.6 Impacts to Surface Water Environmental and Mitigation Measures.................................................... 75 4.1.7 Impact of Solid Waste and the Mitigation Measures ........................................................................... 76 4.1.8 Ecological Environment Impact and Mitigation Measures ................................................................. 85 4.1.9 Impact on Physical Cultural Resources and Mitigation Measures...................................................... 88 4.2 ENVIRONMENTAL IMPACT AND MITIGATION MEASURES DURING OPERATION STAGE .............................. 88 4.2.1 Environmental Impact on Traffic and Mitigation Measures ................................................................ 88 4.2.2 Medical Wastewater Impact and Mitigation Measures ........................................................................ 91 4.2.3 Environmental Impact on Surface Water and Mitigation Measures................................................... 108 4.2.4 Medical Solid Waste Impact and Mitigation Measures...................................................................... 110 4.2.5 Mitigation Measures on Radiation Environment ............................................................................... 121 4.2.6 Impact on Air Environment and Mitigation Measures ....................................................................... 125 4.2.7 Impact on Acoustic Environment and Mitigation Measures .............................................................. 126 1 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 4.2.8 Analysis on Environmental Risk......................................................................................................... 128 4.2.9 Social Environment Impact ................................................................................................................ 131 5 ALTERNATIVE COMPARISON ............................................................................................................... 132 5.1 WITH AND WITHOUT PROJECT COMPARISON .......................................................................................... 132 5.2 ALTERNATIVE COMPARISON ................................................................................................................... 134 5.2.1 Comparison of Site Locations ............................................................................................................ 134 5.2.2 Medical Wastewater Treatment Technical Options ............................................................................ 136 6 ENVIRONMENT MANAGEMENT PLAN EMP ............................................................................. 138 6.1 PURPOSE OF EMP ................................................................................................................................... 138 6.2 ENVIRONMENT MANAGEMENT ORGANIZATION AND ITS DUTIES ............................................................ 139 6.2.1 Management Organization................................................................................................................. 141 6.2.2 Supervising Organization................................................................................................................... 142 6.2.3 Agencies Responsible of Implementation, Execution and Monitoring ............................................... 143 6.3 CODE OF GOOD PRACTICE FOR ENVIRONMENTAL MANAGEMENT .......................................................... 143 6.4 ENVIRONMENT MONITORING PLAN ........................................................................................................ 166 6.5 CAPACITY BUILDING .............................................................................................................................. 171 6.5.1 Training Program .............................................................................................................................. 171 6.5.2 Equipment (Material) Procurement Plan........................................................................................... 174 6.6 PUBLIC COMPLAINT AND FEEDBACK MECHANISM ................................................................................. 175 6.6.1 Public Complaint ............................................................................................................................... 175 6.6.2 Feedback Mechanism......................................................................................................................... 175 6.7 REPORT MECHANISM .............................................................................................................................. 175 6.8 EMERGENCY PROCEDURE FOR MAJOR ENVIRONMENT IMPACT DURING CONSTRUCTION PERIOD ........... 176 6.9 EMP COST ESTIMATE ............................................................................................................................. 176 6.10 MEDICAL WASTE MANAGEMENT PLAN .................................................................................................. 187 6.10.1 Implement the Provisions of Medical Waste Management in Chongqing .......................................... 187 6.10.2 Development of Medical Wastes Management Plan .......................................................................... 188 6.10.3 Implementation of Mitigation Measures for Disposal of Medical Solid Wastes............................ 193 6.11 EMP PERFORMANCE INDICATORS FOR CURIP II ................................................................................... 196 7 PUBLIC CONSULTATION AND INFORMATION DISCLOSURE ...................................................... 200 7.1 PUBLIC CONSULTATION .......................................................................................................................... 200 7.1.1 The Purpose of Public Consultation .................................................................................................. 200 7.1.2 Methodology of Public Consultation ................................................................................................. 200 7.1.3 Record and Feedback of Public Consultation.................................................................................... 200 7.2 INFORMATION DISCLOSURE .................................................................................................................... 208 8 CONCLUSION AND SUGGESTION ........................................................................................................ 209 8.1 THE PROFILE AND NECESSITY OF CRUIP II PROJECT ............................................................................. 209 8.1.1 PROJECT PROFILE ................................................................................................................................... 209 8.1.2 NECESSITY OF THE PROJECT..................................................................................................................... 209 8.2 ENVIRONMENTAL ASSESSMENT CONCLUSION ........................................................................................ 210 8.2.1 AMBIENT ATMOSPHERE ............................................................................................................................ 210 8.2.2 SURFACE WATER...................................................................................................................................... 210 8.2.3 ACOUSTIC ENVIRONMENT ......................................................................................................................... 210 8.3 CRUIP II PROJECT IS IN CONSISTENCY WITH CHINA'S SECTORAL POLICY AND CHONGQING CITY AND DISTRICT/COUNTY PLANNING ............................................................................................................................. 210 8.4 CONCLUSIONS OF THE ENVIRONMENTAL IMPACT ASSESSMENT AND THE MITIGATION MEASURES ........ 211 8.4.1 Environmental Impact Assessment and Mitigation Measures during Construction........................... 211 8.4.2 Mitigation and Resettlement Impact Analysis .................................................................................... 211 8.4.3 Environmental Impact in Operation Period....................................................................................... 211 8.5 PUBLIC CONSULTATION AND INFORMATION DISCLOSURE ...................................................................... 212 8.6 ENVIRONMENTAL MANAGEMENT AND MONITORING PLAN .................................................................... 212 8.7 CONCLUSIONS IN SUMMARY ................................................................................................................... 213 8.8 SUGGESTIONS ......................................................................................................................................... 213 9 MAIN CONCLUSIONS AND SUGGESTIONS........................................................................................ 215 2 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 9.1 MAIN CONCLUSION............................................................................................................................. 215 9.2 MAIN SUGGESTIONS ........................................................................................................................... 215 APPENDIX A: ENVIRONMENTAL ASSESSMENT STANDARD AND METHOD .................................... 217 APPENDIX B GEOGRAPHICAL LOCATION AND LAYOUT DIAGRAM APPENDIX C PUBLIC CONSULTATION FORUM AND THE APPENDED PUBLIC INFORMATION DRAWINGS APPENDIX D CONFIRMATION LETTERS OF CULTURAL RELICS ADMINISTRATION OF PROJECT COUNTIES APPENDIX E SUMMARY OF PUBLIC CONSULTATION RESULTS AND FEEDBACK 3 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 1 General 1.1 Background of CURIP II According to the Circular of National Development and Reform Commission on Approval of Establishing Pilot Area for National Urban-rural Integration Reform in Chongqing and Chengdu issued on June 7, 2007, Chongqing was approved as the pilot area for national urban-rural integration reform. On January 26, 2009, the General Office of the State Council issued the Opinions of the State Council on Promoting Chongqing Urban-rural Integration Reform and Development (GF [2009] No. 3). Since the implementing of The World Bank Loan Chongqing Urban-Rural Interaction Project Phase I (CURIP I) which was started from June, 2009, great progresses have been made. However the CURIP I placed particular emphasis on the infrastructure facility improvements, migrant workers training and the basically medical and health service projects are only limited to the equipment procurement for Community Health Care System Development in Yubei District and Basic Capacity Building of Village Clinics and Medical Institutions in parts of counties. As the gradual deepening of the health care reform in Chongqing, the World Bank loan were actively required by the counties/ districts to improve medical and health service system and medical service conditions, so as to alleviate "the high cost of and difficult access to the medical service" and provide the best quality medical services for counties/ districts and township residents. In view of this, a World Bank project identification mission for candidate components identification to Chongqing for Chongqing Urban and Rural Integration Project Phase II (CURIP II) during July 10-19, 2011 and completed the site visits to all eight proposed physical components; The Bank’s project preparation mission was on a inspection for the preparation work of CURIP II during October 31, 2011 to November 4, 2011. CURIP II is an extension of CURIP I and focuses on the improvement of medical service system in district/county level. 1.1.1 Overview of Chongqing Municipality Chongqing Municipality covers an area of 82,400 km² and has 38 administrative districts and counties (autonomous counties), including 19 districts of Wanzhou, Fuling, Yuzhong, Dadukou, Jiangbei, Shapingba, Jiulongpo, Nan’an, Beibei, Yubei, Banan, Qianjiang, Changshou, Jiangjin, Hechuan, Yongchuan and Nanchuan, Qijiang and Dazu, and 19 counties (autonomous counties) of Tongnan, Tongliang, Rongchang, Bishan, Liangping, Chengkou, Fengdu, Dianjiang, Wulong, Zhongxian, Kaixian, Yunyang, Fengjie, Wushan, Wuxi, Shizu Tujia Autonomous County, Xiushan Miao and Tujia Autonomous County, Youyang Tujia Autonomous County and Pengshui Miao and Tujia Autonomous County. Chongqing, taking the city proper as the core which is surrounded by the districts and counties (autonomous counties), forms an modern urban network with organic combination of large, medium and small sized cities. It is now the largest metropolis in China with most population and administration units. Chongqing has a registered population of 33,034,500 (by the end of 2010). Most population is of Han Nationality. There are also 54 minority nationalities like Tujia Nationality and Miao Nationality with the population 21,964,500 in total. 1.1.2 Government Strategies for Urban and Rural Integration Development The Municipal Party Committee and Municipal Government of Chongqing put forward the development strategy of “One Circle and Two Wings� at 2007 economic work meeting, aiming at developing a economic circle centered on Chongqing’s city proper with a radius of one-hour 1 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report commuting distance (one circle), and accelerating the construction of the North East Chongqing centered on Wanzhou with the main body of the area of Three Gorges Reservoir and the poorer South East Chongqing centered on Qianjiang with ethnic minorities concentrating (two wings), in order to form a new pattern in which areas could realize balanced development and have complementary advantages. This strategy will help promote Chongqing to transfer from the pattern of “Large urban area leading large rural area� to “Urban-rural integration development and reform�, facilitate the establishment of economic growth pole in Western China in cooperation with Chengdu-Chongqing Economic Zone and narrow the gap between the rural and urban residents in terms of public goods such as education, culture, social security, health care and infrastructure etc. In 2008, Chongqing Municipal Party Committee brought forward the idea of construction of “Five Chongqing� including Livable Chongqing, Green Chongqing, Smooth Chongqing, Healthy Chongqing and Safe Chongqing, which is a practical and new road for characteristic scientific development of Chongqing. One of the objectives of "The 12th Five Year Planning� is to gradually narrow the three gaps between “rich and poor, rural and urban, and regional disparity�, aiming to reduce the income gap between rural and urban residents to 2.5:1, and GDP per capita between “One Circle and Two Wings� to around 2:1, and step by step to achieve the fairness of basic public service including medical treatment and public health. 1.1.3 Necessity of CURIP II Following by the Chongqing Urban-rural Integration project I (CURIP I), the CURIP II Project mainly focuses on the improvement of county level medical service system of Chongqing, of which the key points are: to improve the facilities ability of medical institutions of eight poor districts in Chongqing, to improve service ability and medical level of the medical personnel, the hospital information system construction and remote diagnosis and treatment, institutional capacity strengthening and project management, etc. Please see Fig. 1-1 for distribution of project hospitals in districts and counties. 2 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Chengkou County Wushan County Wanzhou District Dianjiang County Tongnan County Fuling District Qianjiang District Youyang County Project hospital Fig. 1-1 Distribution of proposed hospitals under CURIP II Since Chongqing became municipality city, although many achievements of the social economic development have been obtained, Chongqing is still facing huge challenges. Due to the combination of big city, big rural area, big reservoir area, big mountain area and minority area, about 21 million rural people live mainly in rural areas, of which 16 counties each holds a population of over 800 thousand, and health resources excessive concentration in the downtown area, medical and health resources distribution and the masses demand is not harmonious, and the hospital facilities and ability in district/county is difficult to undertake its key role in three level health service network, the standardized hospital construction and ability together with performance requires to be improved. Although financial expenditure of Chongqing increases year by year with increasing GDP, health spending in the share of fiscal expenditure has been falling with each passing year as it is shown in Figure 1-2. Financial input to medical and health care in district/county is seriously insufficient, and a large number of the limited medical resources (medical facilities, medical personnel) flown to the 3 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report municipal level-3 hospitals and hospitals in district/county are hard to develop. For more details, refer to Figure 1-3. The patients had to seek far to diagnosis in the big hospital because of the worry about the condition of wards and disease cure, which cause the problem of “high cost of and difficult access to the medical service�. Percentage of health care Fig. 1-2 The percentage of spending for health care in financial expenditure of Chongqing. Municipal Level District/County TCM hospital Township hospital Hospital level hospital Fig. 1-3 The financial subsidies on health in Chongqing (Unit: RMB 100 million) Women and children take two-thirds of the total population, to improve maternity and child care career is the important guarantee of people's living level development. As a part of public health, due to the weak infrastructure of women and children care center (station), human resources shortage in 4 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report quantity, unreasonable structure, low quality of professional qualities, government's input insufficient and limited compensation, maternity and child care unit hold a heavy self compensation proportion, prompted the expansion of paid service items, compressed free service items, thus appeared the situation of "small care, big clinical", "easy care, complicate clinical", which seriously deviated from the maternal and child health care working policy “care in center, reproductive health in purpose, combine with health care and clinical practice, and prevention first facing the basic-level crowd". The main objective of the proposed project is to improve medical service system of the district/county level of Chongqing. Compared with the other public service sector, the district/county level medical service system is still a very weak link in Chongqing. Since the district/county level medical treatment institutions are key points in three level health service network (including rural health service agencies and township community medical service centre) and will play a leading role in the improvement of medical service, so the implementation of CURIP II is conducive to shorten the gap between urban and rural areas in Chongqing, improve the accessibility of public service ability and public service resources in district/county level. To reflect the basic medical insurance and social justice, the people's hospital of district/county level, traditional Chinese medicine hospital and maternity and child health care hospitals are the key point of construction. At present, the State Health Department, Chongqing Municipal Government has decided to construct standardized people's hospital in district/county level. One of the goals of the national 12th Five Year Plan for economic and social development in Chongqing is: " Gradually narrowing three gaps (rich and poor, urban and rural, regional gap)", basically completed "Five Chongqing". Among them, the "Health Chongqing" goal means "public health indicator is higher than the national average level; health resources indicator reaches the national average level". One measure of the planning is to: complete medical and health service system, optimize the medical and health facilities system layout and carry out 3A-grade hospital construction. And one of the key projects for Health Chongqing of "12-5" plan is to construct "13 3A- grade hospitals in districts/counties, complete the task to reconstruct and upgrade the district/county level hospitals�. Therefore, the implementation of the CURIP is very necessary and timely. 1.1.4 EA Classification Because the project are scattered in the big region, according to the field survey of the Bank’ EIA experts and CPMO together with EIA team, the project is generally located in urban built-up areas or planning zones for urban development, where the environment vulnerable areas, such as ecological sensitive impact that require special protection and social concern are not existent. In addition, the impact in terms of scale and range caused by medical waste water and medical waste, if they are well managed is not serious, and can be minimized or mitigated to an acceptable level. At the same time, the treated effluent from the proposed medical wastewater treatment stations and the medical waste to be generated from the project hospitals can be further treated or disposed by local facilities. The project has been classified into Category B of the World Bank. Table 1-1 The Constituents of CURIP II 1 The construction of Hospital main part Construction site Hospital Project type Fuling Fuling District People’s Hospital Inpatient Comprehensive expansion in the original site Building Tongnan Tongnan M&C Health Care Hospital New construction in new site 5 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 1 The construction of Hospital main part Construction site Hospital Project type Wanzhou Wanzhou District People’s Hospital Economic New construction in new site Development Area Branch Outpatient & Inpatient Comprehensive Building Dianjiang Dianjiang County TCM Hospital Internal Medicine New construction in new site Comprehensive Building Wushan Wushan County TCM Hospital Jiangdong Branch New construction in new site Chengkou Chengkou County People’s Hospital Inpatient expansion in the original site Comprehensive Building Qianjiang Qianjiang District Central Hospital Zhengyang Branch New construction in new site Inpatient Comprehensive Building Youyang Youyang County People’s Hospital Outpatient & expansion in the original site Emergency Department Comprehensive Building 2 Capacity building of medical personnel 3 Hospital information system and long-distance treatment 4 Policy reform and project support 1.1.5 EA Report Preparation The EIA documents for this project shall meet the domestic EIA approval requirements and comply with the safeguard policies and relevant requirements of the WB. The EIA experts of the WB and the CPMO have organized trainings for the PIUs, design institutes and consultants, so as to make them be familiar with policies and requirements of the WB, take the WB safeguard policies into consideration and reflect in the EA document. 1.2 Laws, Regulations, Standards and Safeguard Policies of the World Bank 1.2.1 National Laws, Regulations and Relevant Documents 1.2.1.1 National Laws and Regulations 1) Environmental Protection Law of the PRC (1989); 2) Law of the PRC on Environmental Impact Assessment (2002); 3) Law of the PRC on the Prevention and Control of Atmospheric Pollution (29 April 2000); 4) Law of the PRC on Prevention and Control of Water Pollution (Feb.2008); 5) Law of the PRC on the Prevention and Control of Pollution by Solid Waste (2005); 6 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 6) Law of the PRC on the Prevention and Control of Environmental Noise Pollution (1997); 7) Law of the PRC on Soil Conservation (25 Dec. 2010); 8) Law of the PRC on the Land Management (28 Aug. 2004) 9) Law of the PRC on Urban Planning; 10) Law of the PRC on the Infectious Diseases (Revised on 28 Aug. 2004) 11) Opinions of the State Council on Promoting Chongqing Urban-rural Integration Reform and Development (GF [2009] No.3); 12) Law of the People’s Republic of China on the Prevention and Control of Atmospheric Pollution (8 May 1991); 13) Law of the People's Republic of China on Prevention and Control of Water Pollution (20 Mar. 2000); 14) Decree of the State Council of the PRC [1998] No. 253: Regulations on the Administration of Construction Project Environmental Protection; 15) Regulations on the Protection of Basic Farmland; 16) Regulations on the Hospital Waste Management (2003) 17) Regulations on the Environmental Protection and Inspection Management for the Construction Project (27 Dec. 2001) 18) Environmental Protection Classification Management List for the Construction Project (2 Sep. 2008) 19) Provisions of Strengthening EIA Management of Construction Projects Financed by International Financial Organizations ([1993] No. 324issued by the State Environmental Protection Administration of the PRC) 20) Decisions on Some Issues about the Environmental Protection of the Sate Council (16 Aug. 1996) 21) Decisions on Strengthening the Environment Protection with the Scientifically Views of the State Council (GF [2005] No.39) 22) Regulations on the Hospital Waste (GF 2003-380) 1.2.1.2 Sector Policies 1) National Inventory of Hazardous Waste (Decree of the Ministry of Environmental Protection of the PRC and National Development and Reform Commission [2008] No. 1); 2) Policies on the Prevention Technology for the Hazardous Waste (HF2001 No. 199) 3) Classification List for the Medical Waste (WYF2003 No.287) 7 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 4) Technical Requirements on the Transferring Vehicles for the Medical Waste (Trial) ( GB 19217—2003) 5) Hospital Waste Management Regulations for the Health and Medical Care Institutions (Decree of the Health Department 2003 No. 36) 6) Design Standards of the Hospital Wastewater Treatment( CECS 07-2004) 7) Guidelines on the Hospital Wastewater Treatment Technology (HF 2003 No.197) 8) Discharging Standards for the Water Pollutant from the Hospital Institutions(GB 18466—2005) 9) Notice of Technical Requirements on the Establishment of the Automatical Monitoring System for the Residual Chlorine in the Discharged Hospital Wastewater (Temporary, HB letter 2003 No. 283) 10) Technical Codes of Hospital Waste Centralized Disposal (HF [2003] No. 206) 11) Measures on the Management of Duplicated Form for Transfer of Hazardous Waste (Decree of the State Environmental Protection Administration of the PRC [1999] No. 5); 12) Standard of Packaging Bags, Containers and Warning Symbols Specific to Medical Waste (HJ/T 421-2008); 13) Technical Standards for Medical Waste Incinerator (GB19218-2003); 14) Standards for Pollution Control on Hazardous Waste Storage (GB18597-2001) 15) Notice to Strengthen the Management of the Medical Solid Waste by Law issued by the Health Department in June 2004 1.2.1.3 Guidelines and Regulations on the EIA Technology 1) Technical Guidelines for Environmental Impact Assessment - General Principals (HJ/T 2.1-2011); 2) Technical Guidelines for Environmental Impact Assessment - Atmospheric Environment (HJ/T 2.2-2008); 3) Technical Guidelines for Environmental Impact Assessment- Ground Water Environment (HJ/T 2.3-93); 4) Notice on the Quality Assessment Methods for the Ground Water Environment Issued by the Environmental Protection Department (Trial 9 Mar. 2011) 5) Technical Guidelines for Environmental Impact Assessment - Acoustical Environment (HJ/T 2.4-2009); 6) Technical Guidelines for Environmental Impact Assessment - Ecological Environment (HJ19 -2011); 7) Technical Guidelines for Environmental Impact Assessment - Underground Water Environment (HJ610 -2011); 8 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 8) Technical Guidelines for Project Environmental Risk Assessment (HJ/T 169-2004). 9) Temporary Methods on the Public Participation in the EIA (HF2006 No. 28) 10) Technical Standards on the Water and Soil Conservation for the Construction Project ( GB50433� 2008) 11) Technical Standards on the Applicable Area Classification of the Environmental Noise in the Urban Areas GB/T 15190 94 12) Letter from the State’s Environmental Protection Head Bureau (HB Letter 2005 No. 713) 1.2.1.4 Local Regulations and Documents 1) Environmental Protection Regulations of Chongqing Municipality (1 Sept 2007) 2) Regulations on the Water Pollutant in the Yangtze Three Gorges Water Reservoir Areas and Valleys (29 July 2011) 3) Improvement Programmes on the Standardization of the Discharging Outfall (YHF2001 No.556) 4) Chongqing Environmental Noise Pollution Prevention Methods (Chongqing Gov. Decree No. 126) 5) Methods to Implement the State’s Water and Soil Preservation Law in Chongqing (28 Nov. 1997) 6) Regulations on the Functional Zone Classification of the Chongqing Environmental Air Quality (YFF 2008 No.135) 7) Regulations on the Applicable Function Category Classification of the Ground Water Area in Chongqing (YFF 1998 No. 89) 8) Notice to Adjust the Functional Category of the Ground Water Area Issued by the Chongqing Environmental Protection Bureau (YHF 2009 No.110) 9) Notice about the Adjustment Programme of the Applicable Area Classification for the Noise Environmental Quality Standard Issued by the Chongqing Environmental Protection Bureau (YHF 2007 No. 39) 10) Notice to Modify the Adjustment Programme of the Applicable Area Classification for the Noise Environmental Quality Standard Issued by the Chongqing Environmental Protection Bureau (YHF 2007 No. 78) 11) Modification on the Chongqing Ecology Functional Zone Classification 2008 12) Notice about the Collective Treatment of the Medical Solid Waste in the Urban Areas (YH2004 No. 88) 13) Notice to Further Strengthen the Medical Solid Waste Management Issued by the Chongqing Municipal Gov. (YFF2007 No.71) 9 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 14) Opinions to Speed up the Key Works for the Health Improvement in 2011 Issued by the Chongqing Municipal Government (YFF No.16 2011) 15) Programmes to Implement the Chongqing Urban and Rural Integration Environmental Protection Works issued by the Chongqing Municipal Government (YFF2009 No. 45) 1.2.1.5 Main Planning Documents 1) Planning on the Water Pollution Prevention in Three Gorges Reservoir Areas and the Up- stream Areas of (Revision) (YHF2008 No.16) 2) General Planning on the Chongqing Urban and Rural Integration (2007- 2020) 3) The 12th Five-year Planning about the National Economical and Social Development in Chongqing 4) Health Action Plan for the “Health Chongqing� (2008-2012) 5) The 12th Five-year Planning about the County and District Health Industry Development Planning in the Chongqing Ecological Functional Zone Classification (Revision) 1.2.1.6 Safeguard Policies of the World Bank and EHS Guidelines 1) World Bank OP4.01: Environmental Impact Assessment 2) World Bank OP4.12: Involuntary Resettlement 3) General Guidelines of the International Financing Company for the Environment, Health and Safety 4) Guidelines of the International Financing Company for the Environment, Health and Safety of the Health Service Institutions 1.2.1.7 Project Relevant Documents 1) FSR of the project 2) Social Assessment Reports of the Project 3) Memo of the World Bank Project Identification Mission for the CURIP II (10 to 19 July 2011) 4) Memo (final version) of the World Bank Preparation Mission for the CURIP II in China (4 Nov. to 31 Oct. 2011) 1.2.2 Assessment Standards The assessment standards include the environmental quality standards and the discharging standards for the pollutant according to the safeguard policies of the World Bank and the environmentally functional classifications for the proposed projects issued by the Chongqing Environmental Protection Bureau and the relevant county / district-level environmental protection bureaus. 10 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report The environmental quality standards and the discharging standards are shown in Appendix A. 1.2.3 Safeguard Policies of the World Bank Among the safeguard policies of the World Bank, the OP4.01 is the basic requirement and is one of the main basis for the environmental assessment document for the project. Through the data collection about the environmental assessment for the hospitals and site investigation, the Table 1-2 shows the items relating to the safeguards policies and procedures of the World Bank. No physical cultural heritages have been found or recorded in the locations of the proposed hospitals and nearby areas (the Cultural Heritage Protection Management Bureaus of the project counties and districts have issued the confirmation letters, see Attachment D). Table 1-2 Items of the CURIP II relating the WB’s safeguard policies and procedures WB’s safeguard policies and procedures CURIP OP 4.01 Environmental Assessment triggered OP 4.12 Involuntary Resettlement triggered 1.3 Scope and Methods of the Environmental Assessment, Environmental Protection Targets and Sensitive Areas 1.3.1 Scope of the Environmental Assessment Table 1-3 shows the scope of the environmental assessment of the project Table 1 3 Assessment Scope Assessment Assessment scope Areas near the construction work and the affected areas along the transporting Social roads during construction. Service areas, collection areas, the affected areas Environment along the transporting roads and treatment areas for the medical waste during operation of project Construction areas, earth & stone dumping and taking areas during construction. service areas, collection areas, the affected areas along the Ecological transporting roads and treatment areas for the medical waste during operation, Environment relevant ground water affected areas where the medical waste water is discharged Areas within 100m of the construction sites and 100m on the 2 sides of the Acoustical transporting roads during construction. Areas 100mm around the operating Environment facilities during operation. Areas within 200m of the construction sites and 100m on the 2 sides of the Surrounding transporting roads during construction. Areas 100mm around the operating Air facilities during operation. Ground water Construction wastewater discharging orifice and the 100m up-stream and 200m 11 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report environment down-stream of the ground water to receive wastewater during construction, wastewater and medical waste collection and transporting affected areas and treatment areas during operation. Heritage Heritage sites and nearby areas investigation 1.3.2 Methods of Environmental Assessment The single assessment index method is adopted for the environmental quality assessment based on the data collection, current situations investigation and project analysis. The formula is as follows: General assessment factors Pi,j=Ci,j/Csi Where: Pi,j- the assessment index of the assessment factor i at j assessment point to the standard value. Ci,j—the actual tested concentration value of the assessment factor i at j point Csi—the standard value of the assessment factor i The PH assessment index PpH,j=(7.0 pHj)/(7.0 pHsd) pHj≤7.0 PpH,j=(pHj 7.0)/(pHsu 7.0) pHj 7.0 Where: PpH,j - PH assessment index pHj—pH actual tested value pHsd—the PH down limit regulated in the standard of the ground water quality The PH upper limit regulated in the standards of the ground water quality Through the assessment analysis on the assessment factors and combining the safety guard policies of the State and the World Bank, the measures to avoid and mitigate the disadvantageous impact on the environment are raised and the plans of the environmental management and monitoring are compiled so as to effectively implement it during the construction and operation stage, protect the environment and improve the service capability at the county and district level hospitals and ensure their sustainability. 1.3.3 Environmental Protection Targets The environment protection targets are identified according to the Chongqing environment functional zone classification There is no natural protection zone and precious wild animal and plants under the State’s protection, scenic spot and heritage in the proposed CURIP II project sites, after site visiting and current surrounding situation investigation about the social and ecologic environment of the proposed project have been conducted by the environmental assessment team. 12 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report According to the features of project and the surrounding environment, it is decided that the environment protection targets are as follows: (1) Trying to reduce the impact of the noise, emission, dust, wastewater and traffic accessibility on such environmentally sensitive areas as the resident areas, schools, hospitals as well as the water source areas during the construction. Taking measures to reduce the impact on the ecological environment such as the water and soil loss, vegetation destroying and the impact on the ground and underground water during construction. (2) After the construction is completed, the vegetation and municipal facilities shall be recovered, the water and soil conservation shall be maintained and the area ecological system shall be improved. The quality of the ground water, air and acoustic environment shall not be obviously worse than the current situation, i.e. The quality of the ground water shall reach the Water Standard Category III of the GB3838-2002 and the ambient air meet Class II Standard of the GB3095-1996 and acoustic environment shall reach the Class II Standard of the GB3096-2008. The health and social environment in the service area of the project hospitals and nearby area shall be improved obviously. 1.3.4 Environmental Sensitive Areas The environmental sensitive areas of the CURIP II are shown in the following Table 1-4 according to the results of the site investigation and current situation monitoring. 4 Table 1� Main environmental sensitive areas of the CURIP II Sensitive areas Distance/High Hospital Impact factor Character Impact size Direction Attitude No. location Inpatient 1 Outpatient building Hospital 72 ward beds SW 33/32 Building of Fuling District Inpatient Hospital S People’s 2 155 ward beds 7/17 building(demolished) Hospital 3 hospital resident Living area NW-W 3 About 370people 9-23 living buildings Resident living Living area SW 4 buildings of Gas 616 people 32/15 Company Noise, dust, emission during construction, noise and Resident living emission during operation Living area N 5 building of Transport 294 people 26/-12 Committee Resident living Living area E 6 building of Nursery 168 people 25/1 School Resident Living Living area SE 7 building on the Abort 322 people 21/10 Liming Road 13 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Sensitive areas Distance/High Hospital Impact factor Character Impact size Direction Attitude No. location Yangtze Fuling Road Medical waste, medical Ground 8 wastewater water Resident area Noise� emission� construction Living area 4households/12 E 1 200 dust people Tongnan section of Medical waste, medical Ground 2 2000 Tongnan M&C Fujiang wastewater water Health Care Hospital Tongnan M&C Traffic noise from Nianhua Hospital N 3 27 Health Care Hospital East Road during operation Tongnan M&C Traffic noise from Wuchai Hospital E 4 27 Health Care Hospital Road during operation Living area 30 households/ W 1 Rural residents 90-200 120people Noise, emission, dust during Living area 6 households/ N 2 Rural residents 120-200 construction, noise and 20people emission during operation 3 Rural residents Living area 1household/4 people EN 140 Inpatient and 4 Rural residents Living area 3households/12people SE 190 out patient Comprehensive Areas nearby Vegetation destroying, water Ecology 5 building of the and soil loss branch hospital of Wanzhou Inpatient and Traffic noise from the Hospital N� W People’s 6 60-140 outpatient building Wanzhou to Zhongxian Road Hospital Inpatient and Hospital S� SE 7 Traffic noise 100-200 outpatient building Gaofeng Reservoir Hospital waste, hospital Water Capacity: 2.80million SW 8 1200 wastewater source area m3 Gaofeng town in Hospital waste, hospital Ground SE 9 2500 Wanzhou wastewater water Resident house Commercial N 1 Air, noise & Living 64people 28 Dianjiang areas County TCM Hospital 2 Guangdian Xingyuan Air, noise Living area 90people S 14/0.5 Internal Medicine Comprehensive 3 Kekai Baibuwan Air, noise Living area 120people N 6 Building Guixi River Ground N 4 Wastewater � 4500 water 14 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Sensitive areas Distance/High Hospital Impact factor Character Impact size Direction Attitude No. location Yangtze Medical waste, medical Ground S 1 2500 wastewater water Daning River Medical waste, medical Ground W 2 1000 wastewater water Resident Emission, dust and noise Living area 17households/ S 3 10~40 during construction 70people Wushan County TCM Resident Emission, dust and noise Living area E Hospital 4 6households/25people 20~40 during construction Jiangdong Branch Resident Emission, dust and noise Living area E 5 5households/20people 40~150 during construction Resident Emission, dust and noise Living area N 6 3households/12people 150 during construction Proposed hospital Traffic noise from the nearby Hospital 7 roads on the east, west and south 1 Elementary school School Teacher and student W 125/20 Noice, emission and dust Chengkou during construction, noice and Chengkou Middle emission during operation School E County 2 Teacher and student 150/- School People’s Hospital Inpatient Medical waste, medical Ground S 3 Renhe River 160/-12 Comprehensive wastewater water Building Chengkou People’s Impact on the sick people Hospital 4 184 2-5/0 Hospital during construction Qianjiang 1 Farmer Living area 1household/4 people E 50 District Central Noice, emission and dust Hospital 2 Farmer during construction, noice and Living area 2households/7 people S 30 Zhengyang emission during operation Branch 3 Farmer Living area 5households/17people SW 60 Inpatient Comprehensive Apeng River Medical waste, medical Ground Building 4 wastewater water Comprehensive 1 Resident building Living area household/people N 10 Youyang County Residents opposite to Noise, emission, dust during Living area W People’s 2 household/people 50 the Shizi Street construction, noise and Hospital emission during operation Outpatient & shops opposite to the Commercial E Emergency 3 40 Heping Street area Department Comprehensive Medical waste, medical Ground Building 4 Youyang River wastewater water 15 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Sensitive areas Distance/High Hospital Impact factor Character Impact size Direction Attitude No. location Youyang People’s Impact on the sick people Hospital 5 588 25-150 Hospital during construction 2 Project Description The general objectives of CURIP are: within the principal framework of Chongqing urban and rural integration development and reform, according to “Health Chongqing� strategic objective, the 12th Five Year Plan of health service and allocation standard of health resources, through necessary investment and other inputs, to improve the condition of district / county level health service institutions and the service ability of related health service staff, promote the reform of public hospitals, strengthen the capacity of district / county level health service institutions to better fulfill their key function in the three level rural health service network, promote the reasonable regional allocation of health resources, improve urban and rural health service system, upgrade the possibility and convenience of health service for people in remote areas and rural villagers, and decrease their health expense burden. The project consists of 8 hospitals and several non-physical components, the details are shown in Table 2-1. The site location and layout of each project hospital is illustrated in Appendix B. 16 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 1 Table 2� Project Summary of CURIP SN / District or Size Infectious Main Construction Contents Target Construction Site Location and PIU / Construction County / project Disease Service Investment Floor Area Period hospital Department People RMB 10,000 Building area 22,583m2, None Construct main building with increase of 273 beds, ground -7F~10F, underground - 1.1566 PIU: Fuling District relocate of 227 beds from 8F, water, power, air million in People’s Hospital original inpatient building to conditional and other public Fuling Expected Construction the new one, with 500 beds utilities; removal of existing District Period: 12 months in total; no additional medical wastewater treatment The original inpatient departments founded, while facilities with capacity of building and office Expansion within allocation of the rooms for 250m3/d in the north-east part 10162 building in the hospital 1 Fuling District the original each department in the new of the site, and construct a new (including will be demolished for People’s Hospital hospital site, No.6 building; increase of 60 wastewater treatment station environment the construction of Inpatient Minkang Street, staffs beside existing 365 with capacity of 270m3/d protection central plaza; while the Comprehensive Fuling District; staffs (enhanced primary treatment) investment of original dead house, Building floor area 6,317 in the north-east part of the new 204) outpatient building, m2. building; arrange 30m2 administrative building, temporary medical solid waste boiler house, staff storage site in -2F, stop the canteen, boiled water service of the existing one; house, laundry room and construct central air conditional staff apartment will be system, 115 parking spaces kept. (ground park 47, underground park 68) Total building area With individual Construct main building with 0.9352 Construction in a 15000m2, 150 beds, design fever outpatient ground 5F, underground -1F, million in new land, Located outpatient capacity 250 department water, power, air conditional Tongnan 6750 in D6-4 Land, person-time/d, with 150 and other public utilities; County PIU: Tongnan M&C (including 2 Tongnan M&C Jiangbei New fixed staffs. construct medical wastewater Health Care Hospital environment Health Care Development Area, treatment station with capacity Relocation Project protection Hospital Tongnan County; of 130m3/d (secondary Expected Construction investment of land area 13,333 anaerobic treatment) in the Period: 16 months 158) m2. south-west part of the site; arrange temporary medical solid waste storage sites in 17 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report SN / District or Size Infectious Main Construction Contents Target Construction Site Location and PIU / Construction County / project Disease Service Investment Floor Area Period hospital Department People RMB 10,000 north-west part of 2F skirt building and east part of 5F tower building respectively. Total building area 30,000 With individual Construct outpatient & m2, 300 beds, designed fever outpatient inpatient comprehensive 1.7332 outpatient and emergency department building with ground 15F, million in capacity 1450 person- underground -2F, including Wanzhou New construction time/d, with 1000 fixed outpatient and emergency District in new land, staffs (average 500 department, medical & Located in the 2nd persons/d in the hospital) technical department, inpatient 3 Economic community, department, as well as water, Development Area Xinglong Village, power, air conditional system, 13500 Branch Outpatient Gaofeng Town, oxygen supply, heating supply (including PIU: Wanzhou District & Inpatient Wanzhou District and other public utilities; environment People’s Hospital Comprehensive (Gaofeng construct underground parking protection Expected Construction Building of expanding area of garage with 200 paring site in - investment of Period: 18 months Wanzhou District Wanzhou 1F and -2F; construct medical 523) People’s Hospital Economic wastewater treatment station Development with capacity of 500m3/d in the Area); land area south-east part of the hospital; 66,667 m2. arrange temporary medical solid waste storage site in south-east of the hospital, close to the wastewater treatment station. New construction Total building area None Construct one internal in new land, 26,000m2, increase of 240 medicine building and 0.9637 4 Dianjiang 11700 Located in the beds, outpatient capacity supporting facilities (parking million in County TCM (including PIU: Dianjiang TCM middle between can reach 600 person- site and canteen) with ground Dianjiang Hospital Internal environment Hospital north side of time/d. 11F (underground -2F), County Medicine protection Expected Construction Dianjiang TCM including outpatient and Comprehensive investment of Period: 22 months Hospital and emergency department, Building 129) Dianjiang Health inpatient department, 111 School; land area ground parks; construct 18 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report SN / District or Size Infectious Main Construction Contents Target Construction Site Location and PIU / Construction County / project Disease Service Investment Floor Area Period hospital Department People RMB 10,000 6,215 m2. medical wastewater treatment station with capacity of 120 m3/d and oil removal tank for canteen domestic wastewater; arrange 4 m2 temporary medical solid waste storage site in the south-west corner outside the building. Total building area 20,000 None Construct in 2 phases: PIU: Wushan County m2, 200 beds, with 304 The first phase includes the 0.6317 TCM Hospital fixed staffs, outpatient construction of outpatient million in The first phase: capacity 500 person-time/d. building, emergency Wushan construction of 1# department building, medical & County medical wastewater technical building, inpatient and treatment station with building and service building. tourists capacity of 200m3/d and Outpatient building is 200m3 emergency framework structure with discharge tank; arrange New construction ground 5F and building area medical solid waste in new land. 8,490.7 m2; emergency 9900 dustbins in inpatient Located in the department building is (including building, medical & 5 Wushan County Jiangdong New framework structure with environment technical building and TCM Hospital Development Area ground 2F and building area protection outpatient building, Jiangdong Branch of Wushan County; 1,577.3 m2; medical & investment of arrange temporary land area 27,129 technical building, including 280) medical solid waste m2 front part and rear part, is storage site in -1F of framework structure with inpatient building; ground 3F & underground -1F Expected Construction and building area 2,796.1 m2; Period: 12 months inpatient building is framework (The second phase: structure with ground 5F and construction of 2# building area 6,691 m2; service domestic wastewater building is framework structure treatment station with with ground 2F & underground capacity of 100 m3/d and -3F and building area 1,961.2 100m3 emergency 19 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report SN / District or Size Infectious Main Construction Contents Target Construction Site Location and PIU / Construction County / project Disease Service Investment Floor Area Period hospital Department People RMB 10,000 m2. discharge tank) The second phase includes the construction of staff living area and administration & logistic building, with ground 2F and total building area of 1,099.28 m2, which is not included in the WB project. Expansion in Building area about None Construct inpatient original hospital 27,000m2, 300 beds, comprehensive building with 0.2465 6 12150 PIU: Chengkou County site, 1630m2. outpatient capacity about ground 20F, underground -2F, million in Chengkou County (including People’s Hospital Located at No.14 420 person-time/d, with 350 water, power, air conditional Chengkou People’s Hospital environment Expansion in the original Wenhua Road, fixed staffs and other public utilities County Inpatient protection site Gecheng Street construct medical wastewater Comprehensive investment of Expected Construction Office, Chengkou treatment station with capacity Building 130) Period: 20 months County; land area of 300m3/d, arrange temporary 1,630 m2. solid waste storage site in -2F. Total building area 32,000 None Construct main building with m2, 350 beds, with 500 ground 16F, water, power, air 0.536 New construction medical care and service conditional and other public million in 7 Qianjiang in new land. staffs for all-time service. utilities; construct medical Qianjing 14400 District Central Located in PIU: Qianjiang District wastewater treatment station District (including Hospital Tongping Central Hospital with capacity of 200 m3/d environment Zhengyang Branch Community, New Construction (secondary treatment) in the protection Inpatient Zhengyang Street Expected Construction north outside of the building; investment of Comprehensive Office, Qianjiang Period: 24 months arrange temporary medical 200) Building District; land area solid waste storage site in 3F, 6.719 m2. close to parking garage; ground park 36. 8 Expansion in Total building area about With individual Construct main building with 9000 PIU: Youyang County Youyang County original hospital 20,000 m2, increase of 60 fever outpatient 13F, including underground - 0.8359 (including People’s Hospital; People’s Hospital site. Located at No. beds, with 638 beds in total, department 2F, water, power, air million in environment Removal of original Outpatient & 117 Middle with 558 fixed medical care conditional and other public Youyang protection medical wastewater 20 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report SN / District or Size Infectious Main Construction Contents Target Construction Site Location and PIU / Construction County / project Disease Service Investment Floor Area Period hospital Department People RMB 10,000 Emergency Taohuayuan Road, and service staffs utilities; construct medical County investment of treatment station with Department Zhongduo Town, wastewater treatment station 242) capacity of 400 m3/d; Comprehensive Youyang County; with capacity of 400 m3/d Expected Construction Building land area 5,200 m2. (secondary treatment) Period: 18 months underground the fire fighting access outside of north side of the building; arrange temporary medical solid waste storage site 168.7 m2 in -1F north side of the outpatient & emergency department comprehensive building. Total 87562 21 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 3 Environmental Baseline 3.1 Natural Environment 3.1.1 Project geographic location Located in the southwest of China, on the upper reaches of Yangtze River and at the eastern border of Sichuan Basin, Chongqing sits at the transition areas bordering Qinghai-Tibetan Plateau and the Middle and Lower Yangtze Basin Plain within the range of 105°11'E- 110°11'E and 28°10'N-32°13'N. Chongqing, extending 470km in the east to west and 450km in the north to south, borders on Hubei and Hunan Provinces in the east, Guizhou Province in the south, Sichuan Province in the west and Shaanxi Province in the north, with total areas of 82,400 km2, including 647.78 km2 of urban areas. Please see Table 3-1 for the districts and counties where the project is located. Table 3-1 Geographic Locations and Surrounding Geographic Environment of CRUIP II District Name of Surrounding Geographic No. Geographic Location component Environment /County 4 buildings (original elixir room) and pavilion in this land will be removed, once the construction of inpatient comprehensive building completed and put into operation, the original inpatient building will be demolished and the hospital Fuling District People’s center square will be Hospital is located in No. 6 constructed. West Renming People’s Hospital Minkang Lane, Liming Road is on the North side of Fuling Inpatient Road, Fuling District, the Fuling People’s Hospital and 1 District Comprehensive construction site of Inpatient East Liming Road is on the Building Comprehensive Building is south side, the hospital internal located in the Hospital, land road is on next to the East, use area of about 87m long South and North side of in north -south, about 73m inpatient building construction long in east-west. site. Besides the municipal road surrounding the subcomponent, nearby several residential buildings, which are staff’s living building of gas company apart from 30 m ~ 35 m, staff’s living building of communications committee 22 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District Name of Surrounding Geographic No. Geographic Location component Environment /County and staff’s living building of healthy school. The proposed project is located in the North side of planning medical and health enterprise Tongnan County M&C site of Tongnan county, the Health Care Hospital was planning 8.0 m wide city road established in 1951, located is in the East and North of in No.2 Jianshe Road, construction site, namely Zitong Street office, Wucai Road and Lotus East Tongnan County. Road, in the east of Wucai Road and north of East Lotus Tongnan M&C Health The new hospital was Road are the planning 2 County Care Hospital proposed to be located in the residential land. The west of place of No.6-4, Jiangbei site has been got by a real New District, Tongnan estate development company county, the construction unit for real estate development and has gone through the land construction, now the field acquisition procedures flatting work has been according to the relevant completed. Currently the land provisions. to be used for this component is farmland, grass, heath land, no industrial enterprises and residential buildings involved. The West and North side of the component is nearby existing The proposed component is Wanzhou - Zhong County People’s Hospital located in No.2 Community, road, the planning municipal Economic Xinglong Village, Gaofeng road is surrounded, the site is Development Town, Wanzhou District, in rural area, the citrus Wanzhou Area Branch located in the land scope of production forest land and the 3 District Outpatient & Economic Development residents of Gaofeng village are Inpatient area for medical and health surrounded. The project site is Comprehensive service in planning about 600m apart from Building Wanzhou Economic Wanzhou Chunyang School, Development Area. Gaofeng Town, 1.2km from Gaofeng reservoir, 2.5km from Yangtze River. This area is flat; the whole Dianjiang County is located district topography height in the Northeast of difference is ±1m, not a big TCM Hospital Chongqing, this component rugged topography. The water Dianjiang Internal Medicine is located in Chaoyang system of project area is Guixi 4 County Comprehensive industrial area, the west of river basin of Gaotan river Building Dianjiang County, about 1 secondary branch of Yangtze km apart from the center of river branch. Business the county. buildings are adjacent to the north and south of The 23 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District Name of Surrounding Geographic No. Geographic Location component Environment /County component According to the overall development planning of Jiangdong New Area, the east, south, and west side of proposed component is nearby the municipal planning road in new area. The north of The proposed component is construction site is the TCM Hospital located in Jiangdong New Wushan residential land and 5 Jiangdong Area of Wushan County, County commercial finance land, west Branch located in Longjing village side of site is the planning of Longjing Township. garden green land and hospital land, east of site is the planning residential land, east of site is the planning commercial finance and work land, as well as public parking area and residential land, green land. The east side of proposed component is Chengkou Middle School across municipal road, nearby municipal road in the west side, About 125m apart from the site People’s Hospital is Chengkou County Chengkou Inpatient The proposed component is Experimental Elementary 6 expanded in the south of County Comprehensive School, south of site is the Building people’s hospital (No.14, southern gateway of Gecheng Wenhua Road, and Gecheng Town, about 120m apart from Street). the site is the main river Ren river in Chengkou County, north of site is the existing Chengkou County People's Hospital. In the west of component is Zhengyang street office is Zhengzhou road (Qianjiang located in southeast about section of national highway 319 4km away from Qianjiang line), about 3.5km apart from urban area, one of the three Qianjiang district ZhouBai Central Hospital great groups in Qianjiang. airport straight-line distance, Zhengyang Qianjiang The proposed component is 2.0km from Qianjiang distance 7 Branch Inpatient District located in Tongping Zhengyang train station. At Comprehensive neighborhood committee of present the main land of site is Building Zhengyang street office, still the wasteland, and a few construction site is the mountain forest land there. planning medical and health Presenting the typical facilities land. Chongqing hills morphological characteristics, the biggest 24 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District Name of Surrounding Geographic No. Geographic Location component Environment /County height difference is 33 m. There is a dumped isolation area in the east which was built in the SARS period, but already abandoned, now in idle state; eight farmers’ households are scattered nearby. The north of Youyang County The current Youyang People’s Hospital is near the County People’s Hospital residential building, west side is located in No.177, is residential area and Youyang Taohuayuan Middle-road, river across Cross street, on the Zhongduo Town, Youyang east side are stores across People’s County. The proposed Heping street. West side of the Hospital component will construct a proposed component is the Outpatient & Youyang new Outpatient & existing medical building, next 8 Emergency County Emergency Department to the hospital square in the Department Comprehensive Building south, the existing surgery Comprehensive in the existing medical building is on the side of the Building technology building and square, which will be outpatient building; the comprehensive buildings land has been approved by together with hospital medical Youyang Planning building and surgery building Bureau. after the completion of the project. 3.1.2 Landform, Geomorphic, Meteorology, River and Hydrology The subtropical monsoon humid climate is dominant in Chongqing, presenting a moderate climate, where annual temperature in average remains at 18 and lowest temperature in the winter sits at 6-8 . Typically, it is pretty hot in Chongqing in the summer, with daytime max. temperature more than 35 over July and August and total hours of sunshine of 1000-1200hr. It is warm in winter and hot in summer. There is a long frost-free season, and the annual precipitation is as high as 1000-1450 mm. Situated in the east of Sichuan Basin, Chongqing is surrounded respectively by Daba Mountain, Wushan Mountain, Wuling Mountain and Dalou Mountain in the north, east and south, where hills and mountains are the dominating geomorphic plus large areas of hillside fields. Chongqing is thus renowned as Mountain City. The regions where the project hospitals are built exhibit simple geological structure and no fault under the sites. There is no fault, landslide, deformation crack or collapse identified within the range of project sites, thus constituting an acceptable overall stability, where seismic intensity VI degree is defined. The rivers running through Chongqing include the Yangtze River, Jialing River, Wujiang River, Fujiang River, Qijiang River and Daning River etc. The Yangtze River main stream 25 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report travels through Chongqing from west to east with a total distance of 665 km. Please see Table 3-2 for natural conditions of landform, geomorphology, meteorology, river, hydrology in the area of the project. Table 3-2 Regional Natural Conditions District/ Name of Related Landform, Geomorphic, Meteorology, River and components Hydrology County It is constructed in original site; the proposed inpatient comprehensive building is located in the north spare plot of hospital land scope, the site is flat. The site and its surrounding area has no bad geological effect, there are no geological hazards, such as landslide and collapse, the site seismic intensity of degree. The subtropical humid climate is dominant in Fuling District, four distinct seasons, annual temperature in average remains at 17.68 . The average annual rainfall of 919.7 mm, much static People’s wind in the area, the perennial average wind speed of Hospital 1.0 m/s, the predominant wind direction in the whole Fuling District Inpatient year is northeast with frequency of 7%. The water Comprehensive resource in Fuling District is very rich, belonging to Building Yangtze river system. The Yangtze river travels through north of municipal from west to east, and Wujiang river travels through east of Fuling district from south to north into the Yangtze river. There are many branches of the two rivers, of which, 35 branches directly flow into level 1 branch of the Yangtze river (including Wujiang river), 10 branches are directly into level 1 branch of Wujiang river. The soil erosion is mainly caused by water erosion (showed in the types of surface and gully erosion) , gravity erosion is lighter. It is in the D6-4 plot in Jiangbei New District, Tongnan County, the landform of project site is about approximately lower in the west and higher in the east trend, the original elevation is between 297 m and 314 m, the site is a shallow hill landscape; According the site investigation, There is no Tongnan M&C Health fault, landslide, dangerous rock, mud-rock flow or ground County Care Hospital collapse identified within the range of the component sites. The subtropical humid climate is dominant in Tongnan County, presenting a moderate climate, annual temperature in average remains at 17.9 , the average annual rainfall of 974.8mm, the perennial average wind speed of 1.2 m/s, the predominant wind direction is NNW with frequency of 13%. 26 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/ Name of Related Landform, Geomorphic, Meteorology, River and components Hydrology County Due to the uneven distribution of rainfall, cause some difficulties of develop agricultural climate resource advantages. The main rivers, namely Fujiang river and Qianjiang river, parallel flows through the county from northwest to southeast. The surface erosion and gully erosion are the main soil erosion types, then gravity erosion as the secondary type. It is located in No. 2 community, Xinglong village, Gaofeng Town in Wanzhou County, a hilly landform, the landform of site land is high in the east and low in the west, high in the north and low in the south at an altitude of 417 to 480m, with maximum height difference of 63 m, land status of agricultural land, now mainly for citrus fruit forest and dry land, with a few common cypress, bamboo, grass and small piece of hill land scattered. There are no geological People’s disasters identified such as ground collapse, ground Hospital fissure, or surface subsidence etc. within the range of Economic the component sites, where seismic intensity VI Development degree is defined. The subtropical monsoon humid Wanzhou Area Branch climate is dominant in Wanzhou District, four District Outpatient & distinct seasons, presenting an abundant rainfall, Inpatient where temperature in average remains at 17.7 and Comprehensive average rainfalls of 1243 mm in many years. All the Building rivers in Wanzhou District belong to the Yangtze river system, there are 8 rivers with drainage area of more than 100 km2, no surface water body such as rivers, lakes and reservoirs etc. around 500 m from project site, there are 2 small pools in the northwest of planning land with function of agricultural irrigation, a seasonal gully in the southwest is 1300 m apart from site and downstream of 1 km enter into the Yangtze river, the site is 1.2 km apart from Gaofeng reservoir. It is located in Chaoyang Industrial Park, Dianjiang County, TCM Hospital this area is flat and the whole district topography height difference is ±1m, not a big difference. The water system in Internal the project area is Guixi river basin, the main secondary Dianjiang County Medicine branch of Gaotan river (branch of Yangtze river), with Comprehensive average annual flow capability of 3.94 m3/s and average flow Building rate of 0.75m/s,. The subtropical monsoon humid climate is dominant in Dianjiang County, where the average temperature remains at 17.6 , average annual rainfall of 27 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/ Name of Related Landform, Geomorphic, Meteorology, River and components Hydrology County 1121.7 mm, and average annual wind speed of 2.2 m/s. The mountain area in Wushan County has accounted for 96% of the total area; only 4% of hills area, the landform is high in the north and south, low and a little flat in the center the whole county, with the characteristics of steep topography, karst development, valleys and deep gorges, big mountains. The land of Wushan is distributed with two wings in South and North by the Yangtze river. The farther distant from the shaft, the higher altitude. The maximum height difference within the territory is over 2000m to form high mountain and low valley landscape. The two wings of the limestone lavas gradually excess to the Yangtze river valley and the lowlands, a little flat valley spread. The construction TCM Hospital land of the component is presenting irregular quadrilateral, Wushan County Jiangdong with a slope of higher landform in the northeastern and the Branch lowest in the southwestern. The current height difference in the north and south is about 41 m in the site, about 21 m height difference in the east and west, overlooking the Daning river and the Yangtze river. It is an ideal location to construct medical institution. The subtropical monsoon humid climate is dominant in Wushan County, with abundant rainfalls, with the annual average rainfalls of 1049.3 mm, where annual relative humidity is 77%, and annual temperature in average remains at 18.40 for many years. The predominant wind direction in the whole year is on the northeast with average wind speed of 2.87 m/s. The main rivers are Daning river and the Yangtze river related to this component and Wushan County. Chengkou County is located in the south of Daba mountain; the terrain is high in the southeast and low in the northwest. The topography is divided into the Chengkou People’s Hospital mountains, low mountains and hills three categories. County Inpatient The construction site is located in Gecheng Town, Comprehensive expanded in the original site of Chengkou County Building People's Hospital. Ren river is located in the south of site and flows from west to east, which is a seasonal river with an average annual flow capacity of 63.4 m3/s. The construction site has a typical characteristic of Central Hospital mountain and hilly area in Chongqing, and the Qianjiang Zhengyang maximum height difference is 33m. There is no District Branch landslide, karst, mud-rock flow, fault, goaf and Inpatient dangerous rock etc. identified within the range of Comprehensive component sites and surrounding. The Building 28 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/ Name of Related Landform, Geomorphic, Meteorology, River and components Hydrology County Building hydrogeological condition is simple; it is good for construction of proposed component with a stability of rock mass. Apengjiang river is the biggest tributary of Wujiang river. There are hydroelectric power stations and reservoir, 6 km downstream from the related section of Apengjiang river in component site. The reservoir is a river type reservoir with a small water surface width, and the widest surface is only about 200 m. It is a medium-sized hydrogeological project with power as the main purpose, incorporated with water supply, flood protection, tourism and other functions. The subtropical humid climate is dominant in Qianjiang District, mild climate, four distinct seasons, abundant precipitation, annual temperature in average remains at 13.7~15.4 , the average annual rainfall of 1197.5 mm, much static wind in the area with the frequency of 57 m/s, the predominant wind direction in the whole year is on the north with average wind speed of 1.0 m/s. Youyang County is located in the southeast of Chongqing, Wuling mountain, where hills and mountains are the dominating geomorphic, thus the structure in construction region is stability, where the basic seismic intensity VI degree is defined. Except for the mature karst surrounded, there are no geological disasters identified such as ground People’s collapse, ground fissure, or frequent large landslides Hospital etc. within the range of the hospital. The proposed Outpatient & component is located on a flat place in No.117, Emergency Taohuayuan Middle Road, Zhongduo Town, and Youyang County Department Youyang County within people's hospital. There are Comprehensive 119 rivers in the County, and Youyang River belongs Building to the Wujiang River in the range of component, originated from Changgangling Quankong 3 km away from the north of county with a length of 11.8 km. It travels through the whole County from the north to the south, with average flow of 4.6 m3 / s, the most withered flow of 0.4 m3 / s, natural fall of 231.6 m, an average slope of 19.6 ‰, and the average Bank width of 20 m. The subtropical humid climate is dominant in Youyang County, four distinct seasons, presenting a moderate climate and large temperature 29 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/ Name of Related Landform, Geomorphic, Meteorology, River and components Hydrology County difference, abundant rainfalls but not distributed well, vertical climate significantly with annual temperature in average remains at 14.9 . The annual precipitation remains between 1150-1600 mm, the predominant wind direction in the whole year is northeast with annual average wind speed of 1.8m/s. 3.1.3 Ecological Function Division and Biological Resources Please see Table 3-3 for current ecological function division and biological resources in regions related to the project. Table 3-3 Current Ecological Function Division and Biological Resources in Regions related to the Project Name of Current Ecological Function Division and Biological Resources in District/County Components Related Regions Fuling District is the agriculture and forestry ecological region and water protection with low hills and mountains - nutrients keep ecological function region; For the benefit of climate environment, evergreen plants are the dominating plants in the area, the crops can be year-round cultivated, and the food crops can be harvested twice within a year and five times within two years. Because of the complex of natural geography, the environment and varieties of plants, there are lots of People’s plant types obviously vertically distributed and the saved many Hospital ancient rare plants because of the geography environment relation, Fuling District Inpatient such as Tushan, gingko, eucommia, EZhangQiu, red bean tree and Comprehensive some ferns. The subtropical plants are the dominating plants in the Building district, representative species are mandarin, orange, tung, solution, palm, litchi, longan, HuangJueShu, distributed at the hills and mountain valley region with an altitude lower than 1000 meters, also have temperate birch, Yang, Liu, maple and other plants distributed in areas with an altitude lower than 1000 meters. The fish from Yangtze river and Wujiang river and animals in the farmland are the dominating animals in this district and other few animals living in the cave and bat in the rock. According to the investigation and analysis of data collection, except for the ornamental plants and green plant in the hospital area, there are no natural forest land and rare animals and plants distributed in the construction site. Tongnan County is an agro-ecological region with hills and Tongnan M&C Health mountains in the west of Chongqing with forest coverage of 36%. County Care Hospital 30 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Name of Current Ecological Function Division and Biological Resources in District/County Components Related Regions County Care Hospital Rice is its main crop, and its output accounts for about half of annual food crop production. Besides, other crops include wheat, sweet potato, corn, peas, gourd beans, soybeans, sorghum, mung beans, rice, beans, etc. The economic crops are mulberry, fruit, oil plants, of which, there are more than 700 varieties of the economy trees, such as mulberry trees, fruit trees. The short-term economic crops are canola, peanut, sesame, sugar cane, hemp, vegetables, herbs, etc.. The proposed project site is currently located in Jiangbei New District D6-4 plot of land in Tongnan County and agricultural land to be acquired, currently with fruit trees and other vegetations. The project site is urban eco-city suburbs system, within small density of building and population surrounded in the construction site, According to the site investigation, data collection and visits to Forestry Bureau, Water Conservancy Bureau, other departments and local residents, that in the proposed component site and adjacent areas there are no rare plants and animals which should be protected. Wanzhou County is a water ecological function zone of soil and water conservation in Three Gorges Reservoir area (hinterland), with the forest coverage of 26.9%, dominating arbors and shrubs. People’s There are varieties of natural pasture in Wanzhou District. The Hospital construction site of project land is an agricultural land for a long Economic historical time, now it is the citrus and dry land, with a few of Development normal cypress, bamboo, and grass scattered in small slopes, fields Wanzhou Area Branch where grass could be grew, connection with farmland. The color of District Outpatient & soil is mainly purple with neutral or slightly acidic. The wild animals Inpatient in Wanzhou District are mammals, birds, reptiles, amphibians, fish Comprehensive and other invertebrates in the region, but few animals in evaluation Building area, mainly are few mice, birds and other outdoor animals. According to the site investigation, visits and analysis of data collection indicate that in the evaluation region there are no rare plants and animals to be protected. TCM Hospital Dianjiang County is an agricultural ecological region and nutrients Internal reservation ecological function zone, with the county forest area of Dianjiang Medicine 34,134 ha, forest coverage of 17.3%. This project area is adjacent to County Comprehensive the industrial park of Dianjiang, and is a typical artificial ecosystem, Building without mineral deposits, no natural resources protection objects. Wushan County is a water protection system - water resources conservation ecological zone, within a high forest coverage which are divided into four kinds of forests as material, economical, protection and new coal, such as Masson pine, Pinus armandi cedarwood China fir tung tree Chinese tallow tree, TCM Hospital citrus, lacquer tree; rare plants of kiwi fruit, wild soybean, tri- Wushan County Jiangdong leaflet, orange, mulberry, Ti essien, camphors java bishopwood, Branch ginkgo, red bean, davidia involucrata, cephalotaxus fortunei, Eucommia ulmoides etc. There are 100 kinds of wild birds, 50 kinds of beasts, such as jackal, wolf, bear, wild boar and deer etc.. The construction land of proposed component is the acquisition land and farmland in Jiangdong new District of Wushan County, the current plants are fruit trees, woodland etc. It belongs to suburb ecological 31 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Name of Current Ecological Function Division and Biological Resources in District/County Components Related Regions system with a small density of surrounding buildings and population, without rare plants and animals to be protected, and no ecological restricting factors exist such as protection of biological diversity and species, etc. Chengkou County is water resources- biological diversity protection Chengkou People’s ecological function zone in the Daba mountain, the project site is the County Hospital urban ecological environment, without centralized forest land Inpatient vegetation and rare animals and plants. Comprehensive Building Qianjiang District is a karst rock grass ecological zone in the southeast of Chongqing, with varieties of plants and animals and other biological types, featured in obvious vertical distribution. The trees there consist of wet forest vegetation area, evergreen broad- leaved forest vegetation belt, subtropical forest green composition, Central Hospital and distribution of ginkgo, taxus chinensis and other rare tree Zhengyang species. In addition to corn, rice and crops, the economic crops are Branch tobacco, rape, peanut, mulberry, cotton, hemp etc., and varieties of Inpatient fruit and forage crop, medicinal herbal and various wild weeds. Qianjiang Comprehensive Wild animal species are as much as 147 kinds. The construction site District Building of component is located in Tongping community Zhengyang street office with a big agricultural development intensity, crops are the main vegetation, the natural vegetation are herbs and thickets, without ecological protection and other ecological sensitive objects. According to the site investigation, the location of proposed project belongs to the ecological system of agriculture; there are no rare plants, famous trees and animal to be protected and other biological diversity and species protection problems in the site and surrounded area. Youyang County is the karst rock grass ecological zone in the southeast of Chongqing, with a rich forest resource in this area and large area of forest with the forest coverage of 31% in the whole county, stocking volume of 9.61 million m3, which is a big forest People’s resources county in the whole city. The Chinese traditional medicine Hospital is very rich in Youyang county with more than 1200 kinds of Outpatient & Youyang Chinese traditional medicine resources, 18 kinds of rare Chinese Emergency County herbal medicine, among them, the scrophula-riacede is the world Department first, the second large-headed atractylodes, is the national famous Comprehensive medicine production site of eucommia, cortex magnoliae officinalis, Building cortex phellodendri "mark" medicinal herbs production base. The component site is presenting an urban ecological environment, without integrated forest land vegetation and rare animals and plants. 32 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 3.1.4 Soil Erosion According to “Soil Erosion Classification and Grading Standards "(SL190-2007) issued by Ministry of Water Resources, CURIP is I5 category in Yunnan-Guizhou Plateau Mountain area of southwest earth-rock mountains. The rocks are mainly carbonate rocks and sand shale, and soils are mainly yellow soil, red soil and yellow brown soil, thin soil, exposed bedrock, Pingba for rendzinas, erosion-based. According to the national water and soil conservation monitoring network data, the soil erosion of districts/counties related to CURIP is a moderate and below water erosion area with the erosion modulus in 5000 t/(km2a) below, the loss of thickness remains at 3.7mm/a below, the allowed amount of soil loss remains at 500t/km2•a. Except that the construction sites of Chengkou County, Youyang County and Fuling District hospitals and its surrounding environment are the urban ecosystem environment, other hospitals basically are the agro-ecological system environment. According to the on-site survey conducted by EIA unit and consultation with the county environmental departments, there are no natural preservation area, landscape and famous scenery, and national protected wildlife identified among assessment scope. The ecological environment keeps good quality in the assessment region, with a strong anti-disturbance ability and recovery ability, the impact caused by the construction of CURIP II on the ecological functions and biological resources is limited. 3.1.5 Current Environmental Quality 3.1.5.1 Investigation and Assessment of Current Water Environmental Quality Please see Table 3-4 for investigation and assessment of water environment in main rivers in project area. 33 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 3-4 Assessment on Current Water Quality in Main Rivers and Reservoirs Related to the Project (unit: mg/L, except pH) District/County and Names of River Monitoring Fecal Monitoring Name of pH COD BOD5 NH3-N TP Petroleum and Reservoir Factors Coliforms Report Components The Yangtze Monitoring 7000 (Fuling 7.90 14 2.9 0.172 0.095 <0.01 river cross value Environment Fuling District section of (Inspection) [2011] People’s Hospital Duckbill stone, 0.45 No. 10-002) Pi 0.70 0.725 0.172 0.475 <0.2 0.70 Inpatient Qingxi field Comprehensive Building 10000/L, Class III water Standard value 20 4 1.0 0.2 0.05 area standard 6~9 Same below Monitoring 7900 Monitoring report Piaoeryan cross 7.81 18.4 2.25 0.093 / / value (2011.10.9) of section of Tongnan county Tongnan M&C Fujiang river Pi 0.405 0.92 0.563 0.093 / / 0.79 environmental Health Care Hospital monitoring station Class III water 6~9 10000/L Standard value 20 4 1.0 0.2 0.05 area standard Wanzhou District Shaiwangba Monitoring 6.74 / Guokong cross 10 2.0 0.233 0.149 <0.01 People’s Hospital cross section of value section Monitoring Economic the Yangtze report (2011.9) of Development Area river Pi 0.26 0.50 0.50 0.233 0.745 <0.2 / Wanzhou District Branch Outpatient & Environmental Inpatient 6~9 10000 Monitoring Station Comprehensive Class III water Standard value 20 4 1.0 0.2 0.05 Building area standard 34 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County and Names of River Monitoring Fecal Monitoring Name of pH COD BOD5 NH3-N TP Petroleum and Reservoir Factors Coliforms Report Components Routine Monitoring Monitoring report 8.17 17.7 4.3 2.72 / 0.134 11000 Dianjiang County monitoring value (2011.2) of TCM Hospital cross section of Dianjiang county Internal Medicine Guixi river Pi 0.85 0.59 0.72 1.8 / 0.27 0.55 Environmental Comprehensive Monitoring Station Building Class water 6~9 20000 Standard value 30 6 1.5 0.3 0.5 area standard Longmen, Monitoring 8.33 4900 Monitoring report 13.3 1.56 0.147 / / Peishi cross value (2011.8) of Wushan Wushan County section of County TCM Hospital Yangtze river Pi 0.665 0.665 0.39 0.147 / / 0.49 Environmental Jiangdong Branch Monitoring Station Class III water 6~9 10000 Standard value 20 4 1.0 0.2 0.05 area standard Monitoring 7.56 2700 Monitoring report Bridge two 12.4 2.3 0.12 / 0.04 Chengkou County value (2011.5) of Wuxi cross section of People’s Hospital County Ren river Inpatient Pi 0.28 0.62 0.58 0.12 / 0.8 0.27 Environmental Comprehensive Monitoring Station Building Class III water 6~9 10000 Standard value 20 4 1.0 0.2 0.05 area standard Qianjiang District Guanhe Bridge Monitoring 7.95 1200 Monitoring report 7.6 2.0 0.62 / / Central Hospital and Fengjia value (2008.6-11) of Zhengyang Branch bridge cross Qianjiang District 35 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County and Names of River Monitoring Fecal Monitoring Name of pH COD BOD5 NH3-N TP Petroleum and Reservoir Factors Coliforms Report Components Zhengyang Branch bridge cross Qianjiang District Inpatient section of 0.475 0.12 Environmental Comprehensive Apengjiang Pi 0.38 0.50 0.62 / / Monitoring Station Building river Class III water 6~9 10000 Standard value 20 4 1.0 0.2 0.05 area standard Youyang County Monitoring 8.4 / Monitoring report Youcheng cross 14.1 2.2 0.11 / / People’s Hospital value (2010.9) of section of Outpatient & Youyang County Youyang river Emergency Pi 0.70 0.705 0.55 0.11 / / / Environmental Department Monitoring Station Comprehensive Class III water 6~9 10000 Building Standard value 20 4 1.0 0.2 0.05 area standard Note: Pi in the Table means monitoring value/standard value, same below. Table 3-4 indicates that the current environment quality for surface water in the project area is good; all the main evaluation indicators meet the requirements of Class III Water Quality Standard of Environmental Quality Standard for Surface Water (GB3838-2002). 3.1.5.2 Investigation and Assessment of Current Air Environment Please see Table 3-5 for investigation and assessment of current air environment in project region. Table 3-5 Investigation and Assessment of Current Air Environment 36 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/county and Name and No. of ( mg/m3) Concentration Components Monitoring site Range GB3095-1996 Class II Pollutants Pi value Monitoring Report Standard 3 (mg/m ) SO2 0.046 Daily average 0.15 0.307 Yingbin Avenue NO2 0.037 Daily average 0.12 0.308 (Fuling Environment Fuling District People’s PM10 0.071 Daily average 0.15 0.473 (Inspection) [2011] No. Hospital Inpatient 10-002 monitoring Comprehensive Building SO2 0.071 Daily average 0.15 0.473 report Xinghua Middle NO2 0.050 Daily average 0.12 0.417 Road PM10 0.063 Daily average 0.15 0.42 SO2 0.010-0.015 Daily average 0.15 0.10 North field boundary Monitoring report Tongnan M&C Health of D6-4 plot of (2011.10) of Tongnan NO2 0.013-0.025 Daily average 0.12 0.21 Care Hospital Jiangbei New county environmental District monitoring station PM10 0.024-0.102 Daily average 0.15 0.68 Wanzhou District People’s SO2 0.008~0.029 Daily average 0.15 0.193 Monitoring report Hospital Economic West of residents (2011.10) of Wanzhou Development Area Branch NO2 0.008~0.055 Daily average 0.12 0.458 house District Environmental Outpatient & Inpatient Monitoring Station Comprehensive Building PM10 0.031~0.15 Daily average 0.15 1.0 Dianjiang County TCM Proposed SO2 0.021~0.053 Daily average 0.15 0.35 Monitoring report Hospital Internal Medicine construction site of (2011.2) of Dianjiang Comprehensive Building TCM Internal NO2 0.032~0.059 Daily average 0.12 0.49 County Environmental Building Monitoring Station 37 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/county and Name and No. of ( mg/m3) Concentration Components Monitoring site Range GB3095-1996 Class II Pollutants Pi value Monitoring Report Standard 3 (mg/m ) Building Monitoring Station TSP 0.053~0.144 Daily average 0.30 0.48 SO2 0.021~0.057 Daily average 0.15 0.38 Upwind (NE) NO2 0.021~0.062 Daily average 0.12 0.52 500m TSP 0.055~0.145 Daily average 0.30 0.48 SO2 0.026~0.057 Daily average 0.15 0.38 Downwind (SW) NO2 0.021~0.062 Daily average 0.12 0.52 500m TSP 0.050~0.142 Daily average 0.30 0.47 SO2 0.011-0.021 Daily average 0.15 0.14 Monitoring report Jingtan Er Road Wushan County TCM (2011.10) of Wushan beside construction NO2 0.020-0.027 Daily average 0.12 0.225 Hospital Jiangdong Branch County Environmental site Monitoring Station PM10 0.041-0.105 Daily average 0.15 0.70 SO2 0.008 Daily average 0.15 0.05 Monitoring report Chengkou County People’s Ren River No. 2 (2011.5) of Wuxi Hospital Inpatient NO2 0.007 Daily average 0.12 0.06 Bridge County Environmental Comprehensive Building Monitoring Station TSP 0.13 Daily average 0.30 0.43 Qianjiang District Central South of field SO2 0.012~0.038 Daily average 0.15 0.253 Current Monitoring Hospital Zhengyang boundary and report of 2010.12 38 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/county and Name and No. of ( mg/m3) Concentration Components Monitoring site Range GB3095-1996 Class II Pollutants Pi value Monitoring Report Standard 3 (mg/m ) Hospital Zhengyang boundary and report of 2010.12 Branch Inpatient adjacent area NO2 0.0025 Daily average 0.12 0.021 Comprehensive Building The nearby area has got pM10 0.072~0.088 Daily average 0.15 0.587 the approved environmental TSP 0.046~0.13 Daily average 0.30 0.433 assessment report SO2 0.014 Daily average 0.15 0.093 Monitoring report Youyang County People’s (2009) of Youyang Hospital Outpatient & NO2 0.027 Daily average 0.12 0.225 County Environmental Youyang County Emergency Department Monitoring Station Comprehensive Building pM10 0.032 Daily average 0.15 0.213 Note: Evaluation indicator Pi=Monitoring Value/Standard Value in the Table The above Table indicates that there are no large industrial enterprises located in the vicinity of each project hospital except traffic road. Daily average concentration of SO2, NO2, TSP as included in the environmental air quality monitoring are all within the limits of Class II standard of Environmental Air Quality Standard (GB3095-96). 3.1.5.3 Investigation and Assessment of Current Acoustic Environment Please see Table 3-6 for monitoring of current acoustic environment for the project area: Table 3-6 Monitoring of Current Acoustic Environments 39 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Monitoring Result District/County and No. and Name of Distance from the project Assessment Result Monitoring Report components Monitoring Site Boundary Day Night Front of Outpatient Meet class II (Fuling 1# Building in Liming Road 57.5 47.8 standard Environment Fuling District People’s Hospital Inpatient 2# (Inspection) [2011] Front of Inpatient Building 53.3 45.2 Same as above Comprehensive Building No. 10-002 4th Tower of Hospital 54.0 3# Staff’s Living Building 46.0 Same as above 50.9-56.5 Meet class II 1# East Field Boundary 36.1 standard Monitoring report Tongnan M&C Health 2# South Field Boundary 49.4-56.0 33.2-38.3 Same as above (2011.10) of Tongnan Care Hospital county environmental 3# West Field Boundary 51.2-58.2 40.6-41.6 Same as above monitoring station 4# North Field Boundary 51.3-53.5 37.0-37.4 Same as above Wanzhou District Residents House in the Side 1#: North Field Meet class II People’s Hospital of Wanzhong-Zhong 57.4~57.8 52.6~52.8 standard Monitoring report Boundary County Road Economic Development (2011.10) of Wanzhou Area Branch Outpatient District Environmental & Inpatient 2#: West Field 45.8~46.4 Meet class II Monitoring Station Residents House 40.9~41.6 Comprehensive Building Boundary standard Dianjiang County TCM 1# East Field Boundary 58.0 49.6 Meet class II Monitoring report Hospital Internal standard (2011.2) of Dianjiang Medicine Comprehensive 2# South Field Boundary 50.5 46.0 County Environmental Building Monitoring Station 40 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Building Monitoring Station 3# Southwest Field Boundary 51.0 46.4 4# Northwest Field Boundary 52.5 48.1 5# North Field Boundary 55.4 47.8 48.5~51.5 Meet class II 1# East Field Boundary 43.8 standard Monitoring report Wushan County TCM 2# South Field Boundary 50.7 43.7~44.1 same as above (2011.10) of Wushan Hospital Jiangdong County Environmental Branch 3# West Field Boundary 52.5~52.9 43.8~44.6 same as above Monitoring Station 4# North Field Boundary 51.3~51.7 43.7~45.8 Same as above Ren River No. 2 Close to Wenhua Road, the 58.8 Chengkou County 47.1 Monitoring report Bridge 1# main line of Meet class II People’s Hospital (2011.5) of Wuxi communication, (non- standard (traffic Inpatient Comprehensive County Environmental Ren River No. 2 sensitive area, executive of 59.2 noise influence) Building 47.2 Monitoring Station Bridge 2# Class 4a standard) West Field Boundary (The Close to Zhengzhou Road, Qianjiang District Central Monitoring report the main line of 53.5 Hospital Zhengyang hospital is a Meet class II (2010.12) of Qianjiang communication, (non- 45.4 Branch Inpatient sensitive area, standard District Environmental sensitive area, executive of Comprehensive Building executive of Class Monitoring Station Class 4a standard) 2 standard) 41 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Meet class II East Hillside 43.2 standard 47.7 53.2 Meet class II 1# Outpatient department 44.1 standard Youyang County People’s 2# Internal medicine building 53.7 43.9 Same as above Monitoring report Hospital Outpatient & (2011.8) of Youyang Emergency Department 3# Internal medicine building 52.6 44.8 Same as above County Environmental Comprehensive Building Monitoring Station 4# Internal medicine building 52.8 44.7 Same as above 5# Dining hall of hospital 54.2 43.5 Same as above “Acoustic Environmental Quality Standard� (GB3096-2008) Class II 60 50 standard “Acoustic Environmental Quality Standard� (GB3096-2008) Class 4a 70 55 standard Although the sites were influenced by traffic noise, the site boundary or surrounding acoustic environment can still meet the Class II standard of Acoustic Environmental Quality Standard’ (GB3096-2008), the noise range in the daytime remains at 45.8-59.2 dB (A), the noise range at night remains at 33.2-52.8 dB (A), and acoustic environmental quality is good. 42 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 3.2 Socio-Economic Environment During the ‘11th Five Year Plan’ period, the economic society development in Chongqing has got a great progress, totally stepping in the track of scientific, healthy and rapid development, featured in : Economic Strength Achieve Significant Progress Economic output in Chongqing was doubled in five years, nearly 800 billion Yuan, the growth for economic keeps in national top three in three consecutive years, 17.1% increased in 2010, ranking second national wide and first in Midwest; the GDP per capita increases to USD 4,000, while five years ago it was only equal to 78% of countywide level, but now it has caught up with the national average. The function of national central city strengthened The Chongqing government has invested 650 billion Yuan in the past two years. The construction of "Five Chongqing" has been all-around spread up in urban city, districts/counties, center towns and vast rural areas. The gaps between urban and rural, regions, rich and poor was narrowed gradually In order to narrow the urban-rural gap, efforts should be mainly paid to promoting the "five integrations" in terms of urban and rural infrastructure, basic public services, social security, resources elements and employment. To narrow the gap between regions, it is essential to do a good job on "five links" in terms of transport network, the county's economy, industrial parks, optimum distribution of resources and capital intermediation so as to form a relatively clear path and obtain certain results. The "two wings" economic growth has exceeded the municipal average level for four consecutive years. Achievement of medical and health reform In 2008 the number of health institution reached 2258 in whole city, of which, 1396 of hospital and health center, 40 of M&C hospital (clinic, station), 13 of specialized hospital of disease prevention and treatment institutions (clinic, station), 43 of disease prevention and control center, 42 of health supervision institutions. The proportion of standardized health care center in rural and towns reaches 51.9%. There were 77,900 beds in hospital and health care center. 88,700 health technical personnel, of which, 39,400 were chartered doctor and assistant chartered doctor, 26,800 were certified nurse and 21.75 million of farmers joined the rural new cooperative medical service. For the current situation of population and health care institution and medical technical personnel in projects Districts/Counties in 2010, please see Table 3-7 43 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 3-7 Statistical Charts of Population and Health Care Institution and Medical Technical Personnel in Project Districts/Counties Registered Number of Number of Hospitals Number of Beds Medical Technical Number of Registered Population, Health and Health Centers in Health Care Personnel Physician in Nurses in Medical Districts/Counties (10,000 person) institutions in Health Care Institutions (bed) (person) Medical Technical Technical (unit) Institutions (bed) Personnel Personnel (person) (person) Fuling 115.66 240 56 4206 4294 1875 1412 Tongnan 93.52 135 29 1521 1516 730 492 Wanzhou 173.32 712 69 5694 7236 2984 2815 Chengkou 24.65 58 26 669 549 217 77 Dianjiang 96.37 109 29 2529 2134 960 657 Wushan 63.17 68 27 1021 1201 450 369 Qianjiang 53.60 75 31 2132 2024 773 761 Youyang 83.59 85 41 1492 1096 495 254 (Data from Chongqing Statistical Yearbook 2011) 44 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Please see Table 3-8 for the calculated numbers of beds per thousand persons of project districts/counties in 2010 according to the Chongqing Statistical Yearbook 2011. The Table indicates that the numbers of beds per thousand persons in each district/county are less than 4 in varying degrees. Except for the three districts of Fuling, Wanzhou and Qianjiang, the other five counties have a figure even lower than health action indicator of Healthy Chongqing (2008-2012) (three beds per one thousand people). Table 3-8 Statistical information of numbers of beds per thousand persons in Project Districts/Counties Districts/Counties Fuling Tongnan Wanzhou Chengkou Dianjiang Wushan Qianjiang Youyang District County District County County County District County Beds/Thousand 3.64 1.63 3.29 2.71 2.62 1.62 3.98 1.78 Persons 3.3 Current Medical and Health Service Most of the hospitals in districts/counties of Chongqing were constructed in 1990’s. Although the beds and medical facilities were improved, the overall level of equipments or professional skills of medical care personnel are still low. With the improvement of people's living standard, living quality requirements and deepening of medical system reform, the scale of current districts/counties hospitals could not meet the local people’s requirements on health care. Some new equipments and new technology projects can not be carried out due to the original architectural design of the old house, severely limiting the improvement of medical service conditions for local people and restricting the improvement of local medical service level and health care business development. Taking Dianjiang County People's Hospital as an example, Beiwaijie with less than 10m width is the only access for vehicle entering into the County People's Hospital, but there are many peddlers on the street, causing the ambulances often being blocked. Although the houses are messy and old in the hospital, the use rate of beds is still over 140% in a long time, and the patients are staying everywhere along corridor. According to the statistics data, every year there is a funding gap amounting to RMB 1.7million for Dianjiang County People's Hospital to pay the pensions for the retirees, so that it is financially unable to take into account the reconstruction of infrastructure, update the medical equipments and the introduction of medical personnel. The difficulties of Dianjiang County People's Hospital are also an epitome of that in other district/county hospitals in Chongqing. Please see Table 3-9 for the current hospital status introduction for the project. 45 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 3-9 Current Hospital Introduction for the Project Name of District/Counties Established Land Covered and Main Medical Facilities Service Medical Hospital Beds and Hospital time of Care Hospital Population Person (bed) (thousand person) 1958 The hospital is located in Liming road, Fuling District, covers an area 115.66 227 1 Fuling District People’s of 40 acres and a building area of 33,500 m2, including 21,165 m2 of Hospital Inpatient medical treatment housing for business. Opening 227 Comprehensive Building Beds 1951 Now the hospital is located in No.2 Jianshe Road, Zitong Street 93.52 73 Opening Office, Tongnan County, with 4400m2 of hospital room, of which the Hospital Beds business houses about 3800m2. Equipped with hysteroscopy, vaginal 108 mirror, 3D color doppler ultrasound meter, anesthesia machine, breathing machine, infrared mammary gland through as meter, 2 Tongnan M&C Health Care automatic blood analyzer, pa, TCT detector, automatic biochemistry Hospital analyzer, focused ultrasound treat instrument, the sword, and trace elements doppler fetal monitoring devices such as detector, medical equipment. Open 48 beds gynecology and obstetrics, pediatric 60 beds, server for 80000 outpatients in the year of 2010, about 7000 people were hospitalized patients. 3 Wanzhou District People’s 1977 The hospital covers an area of about 40000m2, existing large- 173.32 433 Opening Beds Hospital Economic medium sized hospital medical equipments, such as linear 300 in Hospital Development Area Branch accelerator, the CT for whole body, CR, color doppler ultrasound Outpatient & Inpatient diagnostic instrument, automatic biochemistry analyzer, a briefcase- Comprehensive Building sized dialysis machine, blood, vats laparoscopic etc. 4 Dianjiang County TCM 1983 Covers an area of 33.6 hectares, 45000 m2 of business house, 96.37 Staff 456 designated Hospital Internal Medicine existing many medical equipments, such as color doppler ultrasound hospital beds Comprehensive Building diagnostic instrument (pa), spiral CT, nuclear magnetic resonance capacity of 400 (NMR), remote control screen of 1000 ma X-ray machine, CR, DR 46 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Name of District/Counties Established Land Covered and Main Medical Facilities Service Medical Hospital Beds and Hospital time of Care Hospital Population Person (bed) (thousand person) (NMR), remote control screen of 1000 ma X-ray machine, CR, DR digital imaging system, mobile C arm, automatic biochemistry analyzer, electronic gastroscope etc. 1992 Now there are many medical equipments existing in the hospital, 63.17 13 persons 200 opening such as the whole body CT, automatic biochemistry analyzer, C arm, of vice- beds 5 Wushan County TCM CR system, import digital color dopplar ultrasound, mobile TV high title, Hospital Jiangdong Branch remote control X-ray machine, TV laparoscopic, Olympus color 26 persons electronic gastroscope, camera people and the sword. of middle title 1947 There are many advanced equipments existing in the hospital, such as 24.65 Staff 130 Opening beds 6 Chengkou County People’s 500 milliampere of X light TV enhancing system, spiral CT, color of 100 Hospital Inpatient doppler ultrasound system, Olympus electronic gastroscope, and Comprehensive Building automatic counting ball machine. 1998 Covering an area of 80000 m2, construction area of business houses 53.60 400 Opening beds is more than 48000 m2, there are many medical equipments in the of 463 hospital, such as 1.5 T nuclear magnetic resonance (NMR) machine (MRI), GE four row helical CT, GE flat digital X-ray subtraction 7 Qianjiang District Central machine (DSA), digital gastrointestinal X-ray machine, island tianjin Hospital Zhengyang Branch C arm X-ray machine, computer X-ray camera system (CR), GE four Inpatient Comprehensive dimensional colour to exceed, electricity physiological system high- Building grade, blood dialysis machines, automatic biochemistry analyzer, bacteria to be automatic train analysis system, blood gas analyzer, TV laparoscopic vats, fiber, laryngeal mirror, hysteroscopy, fiberoptic bronchoscopy, electronic gastroscope, electronic colonoscopy, electronic vaginal glasses. 47 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Name of District/Counties Established Land Covered and Main Medical Facilities Service Medical Hospital Beds and Hospital time of Care Hospital Population Person (bed) (thousand person) 1940 The hospital covers an area of 22000 m2, with business housing area 83.59 Staff 251 designated of 12218 m2, there are more than 110 kinds of advanced medical hospital beds equipments existing in the hospital, such as philips color doppler, GE capacity of 250 body CT, Hitachi automatic biochemistry analyzer, electronic 8 Youyang County People’s computer X-ray photography (CR), automatic blood count meter, Hospital Outpatient & orin buss electronic gastroscope, electronic laparoscopic, electronic Emergency Department colonoscopy, vaginal mirror, blood wash machine, filling Hotell and Comprehensive Building ecg workstation, rue DE anesthesia machine, anesthesia gas monitor, C arm X-ray machine, ophthalmology operation microscope, A/type- b ultrasonic diagnosis and treatment of advanced medical equipment more than 110 sets. 48 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 3.4 Medical and Health Service Planning The aim of Chongqing health service '12th Five' planning is to establish the basic medical and health service system covering urban and rural areas firstly in the western region, and come into being the regional medical center in the upper reaches of Yangtze river. It is also the objective of this planning to realize that the health indicator of residents in the whole city is higher than the national average level, and health resources indicator is close to the national average level. The main indicators of Chongqing health professionals development are also proposed in “Chongqing Municipal Health Professional Team Construction planning "(2010- 2020), see Table 3-10. Table 3-10 Main indicators of Chongqing Health Professionals Development Category Indicator Unit 2009 2015 2020 ten thousand Sum of health Personnel person 11.96 15.13 18.54 ten thousand Professionals Professional technical personnel person 9.88 12.41 15.21 scale Licensed (assistant) doctor per 1, 000 people person 1.28 1.58 1.88 Registered Nurses per 1, 000 people person 0.97 1.41 1.88 National high level talent person 15 20 30 Academic and technical leader person 120 500 1000 Professional Ratio of high title, middle title quality and primary title 7: 18: 75 10:35:55 10:40:50 Doctor degree person 350 600 1000 Master degree person 1266 2000 4000 Professional In the health expenditure of government budget, the financial input of special fund for input health personnel construction every year should not be less than 37.2 million Yuan. Each district/county has prepared health sector development planning. Taking Fuling District as an example, the target tasks of Health ‘12th Five’ Development Planning in Fuling District are to solve service ability and service level issues, adjust and strengthen health resources, strengthen public health service ability, emphasize hospital and medical characteristics construction, accelerate regional medical center construction, make clear the indicator system to meet localization of target. The health service development indicator should be specific, so as to solve the masses’ problem of “high cost of and difficult access to medical service�. The district / county level hospitals under CRUIP II are in full compliance with Chongqing and districts/counties health service development planning. 49 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 3.5 Due Diligence Review and Planning for Management of Medical Wastes and Medical Wastewater 3.5.1 Due Diligence Review of Current Management of Medical Wastes and Medical Wastewater in Project Hospitals In the operation of the project hospitals, the relevant laws, regulations and requirements for medical wastewater and solid waste management in China has been followed, including the establishment of institutional responsibilities, and assignment of full-time staff for operation of medical wastewater treatment station, and collection and storage of medical solid waste. Regular training program and inspection of performance has been conducted under the internal system of the hospitals. In the EA process, due diligence review was conducted for the current operation of medical wastewater and solid waste management, and proposed remedial measures for correction and improvement of the problems revealed in the review, so as to ensure that the management of medical solid waste and wastewater is in compliance with Chinese domestic requirements. For details of current situation of management of medical wastes and medical wastewater in project districts / counties, refer to Tables 3-11 and 3-12. As the hospitals in Wushan County and Qianjiang District are identified as new construction in new sites, there is no information regarding the two hospitals in the following table. Table 3-11 Current Management of Medical Wastewater in Project Hospitals Wastewater Capacity Main treatment Meeting Problems treatment m3/d process standards station in district / county level hospitals Fuling 250 Embedded Meet pre- Odor not collected, odor District secondary bio- treatment from wastewater People’s chemical standard treatment disseminated, Hospital treatment + ClO2 causing certain impact disinfection on the surrounding environment. To be replaced by the new WW treatment station under this project, and the old one will be demolished. Tongnan 40 Embedded simple Meet pre- Odor treated, having County M&C bio-chemical treatment certain impact on the Health Care treatment tank standard surrounding Hospital environment. To be demolished after Tongnan M&C Health Care Hospital is relocated. Wanzhou 500 New construction NA None District in new site People’s Hospital Dianjiang about 150 Simple bio- Basically Number of fecal coliform County TCM chemical meet pre- in wastewater exceeding Hospital treatment tank treatment standard. Sludge from 50 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report standard hospital wastewater not was disposed as hazardous solid waste. After the component is completed, the sludge from the existing hospital will be disposed of as dangerous waste. Chengkou about150 Embedded bio- Meet pre- Main pollutants in odor County chemical treatment are H2S� NH3 , etc. People’s treatment tank standard Odor not be treated, Hospital with dosing having certain impact on disinfector the surrounding environment. The station will be demolished after the new station is operational. Youyang 400 Hydrolyzed Meet pre- Special person County acidification, treatment responsible for operation People’s contact oxidation, standard of hospital wastewater Hospital flocculating treatment station, timely sedimentation, dosing of chemicals each contact day, residual chlorine disinfection monitored. Wastewater treatment station is stably running 24 hours each day, no public complaints and pollution event occurred. Table 3-12 Current Management of Medical Wastes in Project Hospitals in Project Hospitals Disposal of Medical Solid Waste Fuling In Fuling District People’s Hospital the medical solid waste was bagged and District temporally stored in a special place, and regularly delivered to Fuling Solid People’s Waste Disposal Center for centralized disposal. Active carbon residue with no Hospital mercury from stomatology department was delivered to supplier for recycling. Through such disposal mentioned above, the medical solid waste has minor impact on the surrounding environment. Tongnan A temporary place to store medical solid waste was provided in the first floor County of the hospital. The medical solid wastes (including infectious waste, drug- M&C related waste and chemical waste) was collected in a special barrel and taken Health away by Chongqing Zhongming Environment Treatment Company Ltd. for Care treatment each day. The pathological waste was separately collected and was Hospital delivered to Tongnan County Funeral Home for disposal after disinfection. The sludge from bio-chemical treatment tank was cleaned out by public sanitation department and taken away by Chongqing Zhongming Environment Treatment Company Ltd. for treatment after disinfection. The domestic solid waste was collected by Tongnan County Public Sanitation Department and delivered to a county landfill site for disposal. No separate room was provided to temperately store the medical wastes, no eye-catching sign was provided in the medical wastes storage place, so some safety risks exist. After implementation of CURIP II, the medical solid wastes 51 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report will be safely temporarily stored in the new Tongnan M&C hospital. Wanzhou The hospital engaged Wanzhou Shenhao Pollutants Disposal Company to District collect, store and disposal of the medical solid wastes by signing a contract People’s with it. The medical wastes from the hospital were collected in a Hospital comprehensive and effective way. Dianjiang Each year about 8 tons of medical solid waste was produced. 2 full time staff County have been specially assigned to collect medical wastes and store it in a special TCM medical wastes tank. The wall and ground was sprayed with 0.2-0.5% Hospital peroxyacetic acid after daily cleaning. The system for handling and taking over medical wastes has been established. The hospital has authorized Fuling Solid Waste Disposal Center to treat the medical solid waste. Chengkou Medical solid waste is about 62.58t/a, and sludge (water content 30%) is about County 3.18 t/a. People’s Hospital Youyang The tentative place to store medical solid waste is located in a space between County medical technology building and internal medicine building, occupying an People’s area of about 12m2. Hospital It can be seen form the Tables above that the treatment of medical wastewater from hospitals in the relevant project districts and counties can basically meet the standard for pre-treatment (GB18466-2005). Except for Youyang county, exhaust emission from most of medical wastewater treatment stations in hospitals in most of project districts/counties has some impact on the surrounding environment. The sludge from the wastewater treatment station in Dianjiang County TCM Hospital is not disposed of as hazardous solid waste, definitely causing certain potential impact on the environment. The current existing problems will be solved or alleviated through implementing CURIP II. 3.5.2 Due Diligence Review and Planning for Management of Medical Wastewater and Solid Waste in Project Districts/Counties 3.5.2.1 Planning for Management of Medical Wastewater in Project Districts/Counties Domestic wastewater treatment plants have been set up in all districts and counties under CRUIP II. Before CURIP II, the medical wastewater from various hospitals was collected and treated in their own wastewater treatment stations, and after meeting the pre-treatment standard (GB18466-2005) was discharged through municipal sewer network into the municipal wastewater treatment plants, where the wastewater was further treated and discharged after meeting the discharge standard. After CURIP II is implemented, the expanded hospitals in existing sites in Fuling District, Chengkou County and Youyang County as well as the hospital structures to be constructed in new sites in Tongnan County and Dianjiang County are still in the service area of the existing wastewater treatment plants, so the mode of medical wastewater treatment will not be changed, that is, the medical wastewater will first be treated in the new wastewater treatment stations, and after meeting the pre-treatment discharge standard, discharged through municipal sewer network into the municipal wastewater treatment plants, where it will be further treated and discharged after meeting the discharge standard. The Outpatient & Inpatient Comprehensive Building of Wanzhou District People’s Hospital, Economic Development Area Branch, the Inpatient Comprehensive Building of Qianjiang 52 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District Central Hospital, Zhengyang Branch and Wushan County TCM Hospital Jiangdong Branch are located in their new areas respectively, which are out of the service areas of the existing wastewater treatment plants in the as-built downtown area. The wastewater from Wanzhou District People’s Hospital, Economic Development Area Branch will be treated by the Wanzhou District Gaofeng Township Wastewater Treatment Plant which is now under construction, the wastewater from Qianjiang District Central Hospital, Zhengyang Branch will be treated by Xincheng Wastewater Treatment Plant which is now also under construction, and the wastewater from Wushan County TCM Hospital Jiangdong Branch will be treated by the planned Jiangdong Wastewater Treatment Plant. The on-going Wanzhou District Gaofeng Township Wastewater Treatment Plant is located in Villager Group II, Xinrong Village, Gaofeng Township, about 1 km away from the site of this project. Automatic aeration plus improved quick penetration wastewater treatment process will be adopted in this plant which is expected to be put into operation in 2013. Wanzhou District People’s Hospital, Economic Development Area Branch is also planned to be constructed and opened to public in 2013. However, according to the introduction by Wanzhou District Environmental Protection Bureau, the design treatment capacity of Gaofeng Township Wastewater Treatment Plant is only 1200 t/d, hard to accept the effluent from the wastewater treatment station under this project. Meanwhile, the planned 20,000 t/d WWTP in Wanzhou District is only in planning stage. So the biological contact oxidation + disinfection treatment process is planned for Wanzhou District People’s Hospital, Economic Development Area Branch to treat the medical wastewater from this hospital, so as to meet the requirements of Discharge Standard of Water Pollutants from Medical Units (GB18466 – 2005), and the effluent from this station could be finally discharge into Changjiang River through a channel. of about 1 km in length. Wushan County TCM Hospital Jiangdong Branch will be located in Jiangdong New Area, with Wushan County WWTP on each side of Daning River respectively, and the Jiangdong WWTP in the new area is only in planning stage, so it is planned that the medical wastewater from this hospital will be treated by the hospital itself before Jiangdong WWTP being put into operation. The proposed treatment process for the medical wastewater will be the biological contact oxidation + disinfection, and the effluent from the hospital wastewater treatment station will be discharged through pipeline into the Daning River when complying with the requirements of Discharge Standard of Water Pollutants from Medical Units (GB18466 – 2005). In the near future, the domestic wastewater will be treated with the process of the biological contact oxidation + disinfection, and the effluent will be discharged through pipeline into the Daning River when complying with the requirements of Class A of Integrated Wastewater Discharge Standard (GB8978-1996). When the Jiangdong New Area WWTP is built and put into operation, the medical wastewater from this project will be treated with the process of secondary anaerobic bio-chemical + disinfection, and the effluent will comply with the pre-treatment standard as specified in the Discharge Standard of Water Pollutants from Medical Units (GB18466 – 2005) . Anaerobic biological process will be adopted to treat the domestic wastewater of this project and its effluent can meet the Class C of Integrated Wastewater Discharge Standard (GB8978-1996). Both the treated medical wastewater and domestic wastewater will be mixed and conveyed through municipal sewer network to Jiangdong New Area WWTP for deep treatment, and effluent from Jiangdong WWTP will be discharged into Daning River through channel after complying with the standard of Class B of Discharge Standard. Qianjiang Xincheng WWTP is located in Tuanjie Group 1, Zhengyang Neighborhood, Qianjiang District, 96.75 Mu of land will be acquired for it and the total investment will be near 110 million RMB. 4.7 km of wastewater collection sewers will be constructed. The whole project will be implemented in two phases, operated in BOT mode and constructed by 53 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Chengtou Construction Group. The design capacity of Phase I is 30,000 t/d and C-JECH treatment process will be adopted. The effluent can comply with the Class B of Discharge Standard. 1,300 tons of COD and 310 tons of NH3 could be reduce annually. The Phase II project will be constructed after the normal operation of Phase I project, and the service area of Phase II project will cover Xincheng Administration Committee, Zhengyang Industrial Park, Qianyong Industrial Park with a service population of about 200,000. According to the relevant documents, this WWTP was put into operation at the end of 2010, while the Inpatient Comprehensive Building of Qianjiang District Central Hospital Zhengyang Branch will start its construction in 2012 and will be put into operation in 2014. The wastewater from this project will first be treated by the its own wastewater treatment station, and after complying with the pre-treatment standard, be delivered to Qianjiang Xincheng WWTP for further treatment, and the effluent from Xincheng WWTP will be finally discharged into the Apeng River after meeting the discharge standard. 3.5.2.2 Due Diligence Review of Existing Medical Waste Disposal Facilities and the Planning In the EA process, due diligence review was made for the operating medical waste disposal facilities to receive the water from the project. In Chongqing, the medical solid waste is managed with a mode of separate collection, temporary storage and centralized transportation and disposal. The project related sites to dispose of the medical wastes are located in Fuling District, Yongchuan District, Wanzhou District and Qianjiang District respectively. ( 1) Medical Solid Waste Disposal Facility in Fuling District The medical solid waste from Fuling District People’s Hospital is collected, transported and disposed by Chongqing Fuling District Solid Waste Disposal Center, and its medical solid waste disposal site is located in Haozhiba Group 3, Lizhi Neighborhood, Fuling District, where a medical solid waste incineration facility with a capacity of 3 t/d and its related counterpart equipment is constructed with an annual disposal capacity of 1,080 tons. Chongqing Municipal Environment Protection Bureau issued to it on 8th September 2011 the “Operation Permit for Hazardous Solid Waste Disposal Facility� (the approved category of hazardous solid waste to be disposed of is medical solid waste <851-001-01>). Currently Fuling District Government is implementing the project to expand the Fuling medical solid waste disposal center located in Haozhiba Group 3, Lizhi Neighborhood, and Fuling District. The investment of this project is 18,316,800 RMB, occupying an area of 4,388 m2. A set of high temperature steam sterilization facility for medical solid waste disposal and its related collection and transportation facilities will be equipped. The disposal capacity of this project is 5 t/d and its service area covers six districts / counties, including Fuling District, Changshou District, Dianjiang County, Wulong County, Fengdu County and Shizhu County. When this project is put into operation, the capacity of medical solid waste disposal and disposal technology in Fuling District will be greatly improved. This expansion project is expected to operate at the end of 2012. ( 2) Medical Solid Waste Disposal Facility in Yongchuan District Tongnan M&C Health Care Hospital will be moved to a new place in the urban built area. The medical solid waste from this hospital will be separately collected according to their categories and temporarily stored in the hospital solid waste temporary store room. The infectious waste, injury waste, drug-related waste, chemical waste, etc. will be separately collected according to their categories and then taken away by Chongqing Zhongming Environment Treatment Company Ltd. for disposal. The sludge from wastewater treatment station will be delivered to Chongqing Zhongming Environment Treatment Company Ltd. for disposal after dewatering and disinfection. The pathological waste will be separately 54 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report collected and delivered to Tongnan County Funeral Home for disposal. The current practice shows this option is practicable. Chongqing Zhongming Environment Treatment Company Ltd. is located in Shuangshi Industrial Park in Yongchuan District. Chongqing. According to the layout requirement of Chongqing Master Plan for Hazardous Solid Wastes Disposal issued by the National Environment Protection Bureau, this company invested 40 million RMB to build a comprehensive solid waste disposal site with an area of 17,000 m2. The incineration process is adopted for medical wastes disposal and its design capacity is 15 t/d. On 20th February 2009 the company obtained “Operation Permit for Hazardous Wastes Disposal facility in Chongqing�, and in April 2009 obtained “License for Safety Production�. Now all the required licenses have been obtained, and this company has been listed as one of the key enterprises to be monitored with emphasized efforts by the municipality. After Tongnan M&C Health Care Hospital is moved to the new place, the medical wastes from this hospital will be collected and transported by Chongqing Zhongming Environment Treatment Company Ltd. Now Tongnan M&C Health Care Hospital has signed the contract for medical wastes collection and disposal with this company. ( 3) Medical Solid Waste Disposal Facility in Wanzhou District The original medical wastes disposal site of Wanzhou District is located in Villager Group 5, Qiaojia Village, Changling Township, Wanzhou District, just next to Changling domestic solid waste landfill site. The medical solid waste is disposed of with incineration and its capacity is 5t/d. The Wanzhou Shenhao Pollutants Disposal Company is the only company in Wanzhou District with the qualification to collect, store and disposal of the medical solid waste. This company has accumulatively disposed of 2,170 tons of the medical solid waste from areas such Wanzhou, Yunyang, etc. Wanzhou Shenhao Pollutants Disposal Company has newly acquired 2.6 mu of land in the original Wanzhou Medical wastes Disposal Site located in Villager Group 5, Qiaojia Village, Changling Township, just next to Changling Domestic Solid Waste Landfill Site. The new steaming and boiling workshop, comprehensive building, vehicle parking area and related sewer network have been constructed. The disposal capacity of this project is 8 t/d. The project started its construction on 6th October 2010 and was successfully put into commissioning on 29th September 2011. Three records were created by this project: 1) the total investment of this project amounts to 12.45 million RMB, being the biggest investment in such kind of project in districts/counties in Chongqing; 2) the internationally advanced high temperature steam sterilization disposal process was adopted, so the rate of harmless treatment of medical solid waste can reach as high as 99.99%; 3) its disposal capacity is as high as 8 t/d and its service area can completely cover the northeast area of Chongqing. The basic rationale of this high temperature steam sterilization disposal process is to use the 121 ~ 134 0 C high temperature steam to heat the medical wastes, so as to let pathogenic microorganism containing protein lose active under high temperature. The medical wastes are firstly stored in an airtight container, and operations of vacuation and high temperature steaming are alternatively carried out. Then high temperature is kept for a certain time to kill the germina possibly existing in the medical solid waste. The condensate from this process will be discharged into a waste liquid treatment can for further treatment and the extracted gas will be harmlessly emitted after going through a high efficient filter and a high efficient absorber. The main equipment of this high temperature steam sterilization process includes: solid waste crushing system, sterilization system, unloading system, exhaust gas treatment system, waste 55 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report liquid treatment system, high temperature steam supply system, residue treatment system and automatic control system (See Figure 3-1). The non-toxic,, harmless and sterilized residue of medical wastes from this medical disposal plant will be bagged in plastic bags and transported by vehicle to the municipal solid waste landfill site for landfill. Fig. 3-1 High Temperature Steam Sterilization Workshop and Control System in Wanzhou District Medical Wastes Disposal Site ( 4) Medical Solid Waste Disposal Facility in Qianjiang District The project of Qianjiang medical solid waste centralized disposal was initiated on 9th December 2008, and is now being constructed. The process of high temperature steam sterilization and crushing is adopted for disposal. Its daily disposal capacity is 3 t/d, and its service area covers Qianjiang district, Pengshui county, Xiushan county and Youyang county. It is expected that this project will be put into operation in December 2011. This facility is expected to operate at the end of 2012. The medical solid waste from the proposed project of Inpatient Comprehensive Building of Qianjiang District Central Hospital Zhengyang Branch will be transported on Zhengzhou Road with a transportation distance of 15 km. Qianjiang Medical Solid Waste Centralized Disposal Site will send a vehicle to this hospital to collect the medical wastes one time each day. The due diligence review of the medical waste disposal facilities receiving the waste from the project found that no environmental pollution accidents occurred and no public complaints raised during the operation of the above 4 facilities. 4 Environmental Impacts and Mitigation Measures Analysis of major environmental impacts of CURIP are listed in Table 4-1. 56 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 4-1 Analysis of environmental impacts of CURIP Location of Period Impact factors Source and process of impacts Main pollution factors Level of impact Features impact source Ecological Low impact for Small scale environment Earthwork ,construction Proposed hospital expanded hospital, Construction ,land acquisition vegetation damage solid waste, soil erosion site high impact for new and soil erosion hospital Along the Low and scattered earthwork and Low impact for new Transportation vehicle, impact for new Traffic noise and material hospital, high AcousticEnvironment construction equipment ,blasting hospital, high impact mechanic noise transportation line impact for expanded works for expanded and construction hospital. hospital, site Construction Peirod Surface source , Transportation , stored materials, Along TSP� PM10� NO2� Small sphere of exhaust of construction transportation line Ambient air Heavy TSP influence equipment, construction of and construction And CO structure of hospital site Domestic wastewater, garbage Construction Water environment SS� COD Low A Little dispersed and construction solid waste camp Relocation and resettlement of affected people, land and Along resource use, occupation of road, traffic jam and medical transportation line Short-term, partial Social environment Significant services of the expanded hospital will be influenced within and construction impact short time , site 57 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Location of Period Impact factors Source and process of impacts Main pollution factors Level of impact Features impact source Due to the increase of the number of beds and outpatient, Operation Sound Vehicle entrance the traffic volume will be Low impact and Period Vehicle noise and out area of the Long-term impact increased, so the traffic noise within small scope environment hospital will be increased on a certain basis. Medical Peculiar smell from medical Peculiar smell of ammonia, Slight impact and Air Environment wastewater Long-term impact wastewater treatment station hydrogen sulfide, odor etc. within small scope treatment station Surface water Number of fecal coliform Medical Slight impact and Medical wastewater wastewater Long-term impact within small scope � COD� BOD5� SS� NH3N treatment station Guided discharge of surface Reduce soil erosion, Ecological runoff of the hospital, Long-term beneficial restore the damaged environment enhancement of flood control Surrounding area effects Soil erosion and vegetation vegetation measures in the surrounding of the hospital area, slope protection and ecological restoration Improvement of the resettled people’s life; improvement of medical services in the project area, ease the problem of “difficult and expensive to see a doctor," be conducive to Direct and indirect Long-term Social Environment achieving "Healthy Chongqing" objective in the project Significant impacted area bbeneficial effects districts/counties. Building of green hospital will help to improve doctor-patient relationship and the social environment will be stable and harmonious. 58 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Location of Period Impact factors Source and process of impacts Main pollution factors Level of impact Features impact source As the quality of medical services improved, the number of The hospital Implicative impact of outpatient and hospital bed utilization rate will be increased , entrance and the transportation Significant in a the people hospitalized and accompanying person will result in adjacent road beneficial effects Environment certain time the increase of the traffic volume, therefore , road traffic near the hospital may be pro-resistance Construction of hospitals of district and county-level and the Long-term beneficial improvement of medical service capability will be good to the Areas covered by Resident health in effects development of hospitals at district and county-level, the health three-level Significant districts and counties of residents in districts/counties will be secured; the situation of medical system medical waste management will be improved. Small probability events, preventive Some accidents may occur in The place where measures and Social and ecological medical wastes collection, Medical wastes High accident occurred emergency plans storage or transportation. 59 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 4.1 Environmental Impacts and Mitigation Measures during Construction Period The main working content during construction period includes site building demolition, foundation excavation, structure construction, landscape engineering, and supporting facilities construction. Project construction methods are roughly: foundation piles and circle beam, backfilling, cast-in-place concrete and precast and pre-fabrication and installation of fittings and decoration etc. Construction machinery includes: excavator, bulldozer, trucks, vibrators, etc. The construction methods for construction of drainage ditch, retaining wall, and road leveling are: artificial excavation, artificial rock, earth-moving by machinery, mechanical excavation, transportation of construction materials and taking away surplus soil and earth and surplus backfill material. The main machineries used for construction are excavators, trucks and so on. The general environment management measures during construction period mainly include: The effective measures to prevent environmental pollutions such as flying dust, noise, solid waste and wastewater should be included in the construction organization design and be strictly implemented during construction. The environmental protection management system should be established in the construction site and ensured to be effectively implemented. The supervisions on site environmental protection should be carried out regularly. The trainings on regulations of environmental protection should be provided to the staff, and the performance check should be regularly conducted. 4.1.1 Social Impacts and Mitigation Measures The main social impacts during construction period are the impacts to the people whose land will be used for hospital construction and who need to be resettled due to the hospital construction. For Fuling, Youyang and Chengkou hospital which will be expanded on their original site, it will have influence on the hospital patients and accompanying crowd of people, as well as the working doctors and nurses. In addition, road traffic impact during the construction phase is also a major social impact. it will be analyzed in Section 4.1.5. 4.1.1.1 Impacts to the People to be Resettled and Mitigation Measures Only Wanzhou and Wushan hospitals under CURIP II will involve land acquisition and resettlement. Wushan county hospital will permanently occupy 59.24 mu of rural collective land from Longshui Village 1 and 2, Longjing Town,Wushan County, of which, 45 mu of arable land, 14.24 mu of non-arable land. A total of 27 households with 115 people are affected. Wanzhou district hospital will permanently requisition rural 100 mu of collective land from Xinglong Village and Villager Group No.4 and No.8, (of which, 55.7 mu of farm land , 47.55 mu of forest land changed from cultivated land), construction land 44.3 mu. A total of 132 households with 529 people are affected. Both Wanzhou District and Wushan County hospitals are located in the District and County Economic Development Zone. Since the land acquisition of development zone will be done by Wanzhou District and Wushan County Government. The temporary land for project construction is within the permanently acquired land, so no temporary land occupation are involved in these two components. 60 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report According to the World Bank’s Safeguard Policy for Involuntary Resettlement (OP4.12), Where it is not feasible to avoid involuntary resettlement, displaced persons should be assisted with due efforts to improve their livelihoods and standards of living or at least to restore them, in real terms, to pre-displacement levels or to levels prevailing prior to the beginning of project implementation, whichever is higher Main measures to be taken: ( 1) Improve the land acquisition compensation strategies Local People’s Governments above the district and county level shall take effective measures to improve the land acquisition compensation strategies according to domestic compensation policy and the World Bank policy, in order to avoid their livelihoods and standards of living decreasing because of land acquisition ( 2) Proper arrangements for displaced persons Land compensation fees will be paid directly to the farmers according to the quantity of land acquired, for demolished houses, it will be paid by cash or purchase of preferential house. Taking Wushan project as example, for a household with 5 persons, this household can get 150 m2 house in average. ( 3) Provide training to the displaced farmers and provide social assurance Effective measures should be taken to implement the employment training and seek for social security fund, to promote the displaced farmers to be employed and integrated into urban society, to ensure the living standards of the displaced farmers are not decreased due to land acquisition and have a long term good livelihoods. For rural workers changed to non-rural workers, pension insurance policy will be adopted, at least they can get 6,000 Yuan of social pension each year, and the pension income is far higher than their past agricultural income. ( 4) Restore the affected vulnerable groups There are 3 vulnerable households (total 9 persons) are effected by land acquisition under Wushan components, of which, one household will be changed to non-rural household, for the other 2 households, their income are mainly from working outside, and the land acquisition has little impact on them. The hospital will provide employment assistance to their labor force, such as providing long-term stable jobs as hospital cleaner and etc. In addition, they can get subsidies from the local civil affairs departments. It is understood after the house demolition, they will choose to build their houses. The house demolition compensation is enough for their housing reconstruction. ( 5) Promote the employment of displaced farmers The project Districts and Counties adhere to market-oriented employment mechanism, co- ordination of rural and urban employment, multi-channel development jobs, so as to improve the employment environment, encourage and guide all kinds of enterprises, institutions, communities to absorb the displaced farmers, and support self-employment and private business. 61 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Wanzhou hospital project affects a private enterprise - Youcheng Agriculture Company. The company leased 40 mu of collective land. When his rented land is acquired, the owner will choose to continue to plant oranges and citrus elsewhere after he gets the compensation and under the support of self-business Policy. The 10 permanent staff of the enterprise will move with the company, so the project has little effect on these workers. After taking the measures of improving the land compensation strategies, proper resettlement of displaced farmers, providing employment training and social securities support, restoring the livelihood of the affected vulnerable groups and promoting the job opportunities to displaced farmers, the quality of life of displaced farmers will soon be improved and enhanced. 4.1.1.2 Impacts on the Routine Operation of the Hospitals to be Renovated/expanded and Mitigation Measures Fuling, Youyang and Chengkou hospitals are to be renovated or expanded on their original sites. It will have negative impact not only on municipal traffic but also on the patient populations; treatments groups and accompany people during construction. Patient groups have been on a bad mood, accompanying relatives and friends’ crowd is mainly concerned with the health. The construction environment and jammed traffic environment will form a larger contrast for a quiet, comfortable environment for a hospital, easily induced the generation of a bad mood. And health care workers during the construction period will be affected by construction noise or dust emissions, and the medical equipment maintenance and repair needs to be strengthened, the above factors will lead to boredom and depression, affecting the quality of medical services. In addition, the operation of hoisting materials and construction equipment would cause impact of safety of people near the site. Proposed mitigation measures: Project owners should prepare the medical service plan during construction period in advance and implement it by the various departments, sections, and people in charge. Project owners and the contractors should attach importance to the safety of doctor and patient. The contractor should separate the construction area from the hospital medical services, set aside or build new secure channel for medical services and patients, specially assign people to ensure the clear access to the ambulance; The hospital should set up the flowers or fish tank in the hospital outpatient waiting area for viewing , to adjust the waiting crowd psychology, in particular, to strengthen the setting of fixed and mobile medical advisory services; Construction in night is prohibited. Optimization of medical care processes, shorten the waiting time for the type-B ultrasonic, endoscope and other examinations. During the noon, operation of equipment with high noise should be banned. Hospital inpatient building adjacent to the construction site side, the windows and balconies should be closed properly, to reduce the construction noise and dust emissions impact. Contact the urban management department, to rectify unlicensed vendors and people occupied the road or places to do business in front of the hospital. 62 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report The construction sites should be fenced with steel plates or wall with height more than 2.5 m and more than 3 m in sensitive sections. Open space should be established between the construction sites and the hospital buildings with warning signs set up near the site. Full-time staff should be signed by contractor to guide people avoid the construction sites. Safety nets should be installed at site to protect the people near the site. Separate entrance and exit should be established exclusively for construction vehicles and workers. 4.1.1.3 Impacts on the Surrounding Area of the Hospitals and Mitigation Measures As the hospitals to be renovated or expanded are located in urban built-up areas, construction activities will have impact on the residential area and traffic. 1) Mitigation to Social Impacts Preparation should be done before the commencement of construction covering survey of local roads, power supply and communication. The contractor should develop construction plan with relevant authorities; emergency plan should be included in the construction plan to ensure the normal activities of the residents. Contractor should cooperate with traffic department and police bureau in guiding the traffic flow where necessary, and information on traffic management near the hospitals should be disseminated to the public via radio, TV or newspaper. Bulletin board should be set up at the construction site informing the construction schedule and the hotline number for complaints. As the demand for water and power is huge in the construction, the contractor should contact the relevant departments for development of water supply and water supply. In the area where the power capacity is low, the power supply line should be established for the construction site prior to the commencement of the construction. Access roads should be provided for pedestrians on the sensitive sections where hospitals, schools, residential blocks and commercial areas are located. Construction in night should be banned; where construction in night is necessary, permit should be obtained from local environmental department and the construction plan for night construction should be disseminated to the public near the construction site. Traffic flow of pedestrians and the construction fleet should be separated; Local me trials are preferred for procurement so as to reduce the transportation distance. Bus should be used for workers to travel between the camp and the construction sites. The construction sites should be fenced with steel plates or wall with height more than 2.5 m and more than 3 m in sensitive sections. Open space should be established between the construction sites and the hospital buildings with warning signs set up near the site. Full-time staff should be signed by contractor to guide people avoid the construction sites. Safety nets should be installed at site to protect the people near the site. 63 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 2) Mitigation to noise impact Noise control measures should be used and the location of equipment should be far from sensitive areas. Equipment with low noise level should be used and well maintained. Construction should be carefully scheduled on the section near sensitive areas. Travel speed of construction vehicles should be reduced when entering the area sensitive to noise. Construction in night should be banned; where construction in night is necessary, permit should be obtained from local environmental department and the construction plan for night construction should be disseminated to the public near the construction site. Equipment should be well maintained to reduce noise. Operation staff of equipment should be shifted to reduce the exposure to the noise; the worker near the noise source should be equipped with ear plugs. Transportation route of materials should be far from noise sensitive areas, i.e. schools. Equipment with strong noise and vibration should be banned from operating on noon. 3) Dust control The road sections near the construction sites should be frequently sprayed with water. Before the construction, the site should be enclosed, the ground for construction and entrance should be hardened, and vehicle washing devices should be provided on site. Construction site should be sprayed with water in excavation work; during the backfilling the site should also be spayed with water. Stockpile yard for materials should be covered or sprayed with water. Spoil and construction waste should be collected and cleaned in timely manner. Overloading of vehicles should be avoided and the transportation vehicles should be covered. The transportation route for materials should be planned to avoid the area where traffic is intense. On the sections where traffic control is implemented, transportation in night should be carefully planned; the dust leaked during transportation should be cleaned. 4) Management of solid waste Before construction is started, the contractor should develop earth balance plan; spoil should be reused where possible, if not, the spoil should be transported to the deposit sites or landfill sites designated by municipal department. The solid waste should be collected and transported on daily basis to the landfill sites designated by municipal sanitation department. The earth and spoil should be piled and compacted, the pile should be covered. 64 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report The area beside the roads should be prohibited from stockpiling of materials. Permit should be obtained for transportation of construction solid waste; Burning of construction solid waste should be banned. 5) Management of wastewater The wastewater from construction sites should be treated in settling tanks before discharging into municipal sewers. Direct discharge of construction wastewater into surface waters should be banned. Education on surface water protection should be provided to the contractors. Full-time staff should be assigned by contractors to supervise the collection and transportation of spoil. Direct dumping of spoil into surface streams should be banned. 4.1.2 Acoustic Environmental Impacts and Mitigation Measures 4.1.2.1 Acoustic Environmental Impact During Construction Period For the in-situ expansion work in hospitals of Fuling district, Youyang county and Chengkou county, when a number of equipment are running at the same time during construction period, the noise impacts on the acoustic environment may be significant. The impact of noise on the noise sensitive points are estimated and shown in Table 4-2. The remaining five new hospitals, when the equipment running at the same time during construction period, the noise impacts on the acoustic environment noise sensitive points are shown in Table 4-3. Table 4-2 The maximum impacts to the environment sensitive points in the in-situ expansion hospital by construction noise Name of Sensitive points Noise Excessive Excessive Sensitive components level daytime at night features Name of sensitive Nearest No. (dB) (dB) (dB) points distance(m) Fuling OriginalOutpatient 1 33 61.6 1.6 11.6 Hospital Building District The original 2 7 75.1 15.1 25.1 Hospital inpatient building No.3 Resident Resident 3 11 71.2 11.2 22.2 building in Hospital area No.4 Resident Resident 4 23 64.7 4.7 14.7 building in Hospital area No.5 Resident Resident 5 9 72.9 12.9 22.9 building in Hospital area Resident Building of Resident 6 32 61.9 1.9 11.9 Gas Company area 65 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Resident Building Resident 7 of Transportation 26 63.7 3.7 13.7 area Commission Resident Building Resident 8 25 64.0 4.0 14.0 of medical school area Resident area in Resident 9 21 65.5 5.5 15.5 Liming Road area Youyang Medicine Building 1 25 70.64 10.64 20.64 Hospital of the Hospital Resident 2 Resident Buildings 10 78.6 18.6 28.6 area Resident area of Resident 3 opposite side of the 50 64.62 4.62 14.62 area Shizhi Street Shops of opposite Combined 4 side of the Shizhi 40 66.56 6.56 16.56 area Street Chengkou Shiyan Primary 1 125 51.7 / 1.7 School School Chengkou Middle 2 150 50.1 / 0.1 School School Inside of the 3 2-5 70.0 10.0 20.0 Hospital original hospital Table 4-3 Construction noise prediction of proposed new hospital in Tongnan and Wanzhou etc. Unit: dB(A) Distance (m) Sound level 5 10 20 40 60 80 100 Peak value 90 76 70 64 58 54 52 50 General 81 67 61 55 49 45 / / Noise impact prediction results analysis: The standard distance for construction noise is daytime 40m, night 100m. Noise during the construction will have a certain impact on the external environment, slight during daytime and heavy during night time. It will have a certain influence on the residents’ living; The construction site of Tongnan County M&C Health Care Hospital is located in the northern city, according to site investigation, there are no residential and other sensitive buildings within the proposed project peripheral 100m range, thus the proposed project has very low construction impact on the surrounding environment. There is a higher density of rural residents to the west of the construction site of Wanzhou Jingkai hospital, about five households just 90-100m away from the construction area, and will be effected by construction noise at night, but the effect is low (1dB over Evening Standard) The construction noise of construction site in Dianjiang TCM Hospital on these 3 acoustic environment sensitive points: residential, Guangdian Xinyuan and Kekai Baibuwan are 50, 55 and 57dB ( A ) respectively, They can meet environmental standards on daytime, but will exceed the standard at night time for Guangdian Xinyuan and 66 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Kekai Baibuwan The construction site of Wushan TCM Hospital is located in Jiangdong new area, according to the field survey, approximately 26 households are living within 100 m in the east and south side., of which 23 households are within 40m, therefore the construction noise will have a certain impact on the residents during day and night time. The construction noise of Zhengyan Branch of Qianjiang District Central Hospital can meet the standard outside 80m, but the noise impact will exceed the standard to the 8 farmer households within 20-50m during daytime and night time., of which, exceed the standard by 4.9dB (A) for 7 households, and to the nearest 1 household exceed the standard by 18.6dB (A) day and night. It can be seen from the above two tables, in-situ hospital expansion has significant impact and a big number of population will be effected as compared with the new hospital construction .A new hospital can only have impact of noise exceeding over the standard to only a small number of households living near the construction site, therefore, it will be the focus of noise control for in site hospital expansion and the new hospital close to the household. 4.1.2.2 Mitigation Measures of AcousticEnvironmental Impact During Construction To alleviate the noise impact during construction, construction noise should be controlled as much as possible. According to the characteristics of the noise pollution, construction program should be developed taking into account the control of noise pollution. First, to strengthen management, strictly control the simultaneous operation of high-noise equipment, optimize the implementation arrangements, reduce the high noise equipment operating time, and reasonably arrange the operation time of high-noise equipment, to prevent artificially high noise activities. Strictly enforce the "Chongqing Municipal Environmental Noise Pollution Control Regulations" (CQ Government Order [2002] 126) and Chongqing "Quiet action" Implementation Regulation, and the details are as follows (1) Construction contractor should take measures to reduce noise pollution actively. The contractor must take measures to reduce the noise during construction. The contractors at night (22:00 ~ 06:00) are prohibited to use pile diver. When the contractor uses bulldozers, excavators, loaders, hammers, concrete mixer, vibrator, electric saws, cranes, lifts and other machinery, the noise produced by these equipment and tools should meet noise limits specified in GB12523-90. The use of advanced low-noise construction machinery, equipment and processes are actively promoted. The construction machinery and equipment in construction site should be reasonably arranged and noise barriers should by used. And for the electrical saws, planer, large air compressors and other equipment which have high noise should be in a closed environment and set as far as possible from the sensitive areas to reduce the adverse effects of construction noise. Ready-mixed concrete should be used. Concrete mixer and other equipment which will produce a continuous and hitting noise are strictly prohibited. The contractor should reasonably arrange its working time, for the construction work which will produce strong noise should be put in daytime (06:00 ~ 22:00) to avoid noise nuisance. Due to special working process needs or emergency circumstances requiring continuous work during night time, the contractor must be within 24 hours report to the local Environmental Protection Bureau for their record and publicize in advance to obtain approval of local residents. Where the contractor needs to extend their working time because of temporary emergency cases such as material supply and continuous casting, etc, the contractor should 67 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report write an urgent report to local Environmental Protection Agency. The night working time may be extended after getting the approval of the local Environmental Protection Agency, in principle, not more than 12:00 p.m. (2) Taking the construction noise control into the content of the EIA Report and Pollutants Discharge Declaration To strengthen source control, measures must be taken in all construction projects to control noise pollution according to comments given in environmental impact assessment report. Discharge declaration and registration must be done 15 days before the start of the project and the noise pollution control programs must be sent to the Environmental Protection Agency 15 days before the start of the project. (3) Implementation of permit management for construction project Strict implementation of the temporary construction night work permit system. Construction work is prohibited between 22:00 to 06:00 the next day. Due to the production process needs or special needs (except for emergency repairs), it have to work continuously during night time, the contractor together with the project owner shall apply for permission from the administrative department of environmental protection. Only after obtaining "Chongqing Temporary Permit of Pollutants Discharge� certificates issued by approved department, the contractor then can start the construction. The contractor must publicize the night-time construction permit. Strengthen the permit management during high school entrance examination and college entrance examination. 15 days before the high school entrance examination and college entrance examination, no nighttime construction work which producing noise pollution are allowed. During the examination period, within 24 hours, within the region of 100 m around the examination room, no noise pollution construction work is allowed. 4.1.3 Ambient Air Impacts and Mitigation Measures 4.1.3.1 Dust Impacts and Mitigation Measures in Construction Period During construction, excavated soil is usually stacked in construction site, as short as a few weeks or as long as several months. Bare soil and surplus soil left at the construction site result in suspended particulate matter concentration sharply increased by the disturbance of the rolling vehicles and construction machinery, causing the buildings, plants, bay windows, balconies being covered with a layer of soil near the hospital under construction. For the rainy days, because of rain and vehicle rolling, the road becomes muddy, pedestrians walk with difficulty. After the weather turned fine, mud and dust change into dust; have adverse effect to the hospital and surrounding, seriously affecting people's moving and urban landscape improvements. To control the impact of the construction dust to nearby buildings and the residents, the following measures are to be taken. Reduce the construction activities when wind speed is high, Reduce the construction work of land leveling, piling, excavation, backfilling, road pouring, building materials transportation, open dumps, delivering and mixing, etc. in dry and windy weather which easily produce the dust. Where the surface structure is destroyed by earthwork, leading to long-term surface exposed and causing dust pollution of the ground area, attention should be paid to dust-proof 68 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report cover. Speed should be limited within the construction site. Measures of watering site will be strictly implemented throughout the construction period to reduce dust impact to a minimum. A domestic construction site watering dust comparison survey data shows that the construction dust generated mainly by the transport vehicles, accounting for 60% of total dust. Road dust is related to the vehicle speed and road surface. Under normal circumstances, daily watering 4 to 5 times can reduce the dust by 70% and the hour-concentration of total suspended particulate pollution TSP will be reduced to 20 ~ 50m range, and the closer the more obvious of the level of reducing. Refer to Table 4-4. Table 4-4 Test results of watering reduction dust during construction mg/m3 mg/m3 Before Location of Monitoring points watering After watering 10m 1.75 0.44 Hourly 20m 1.30 0.35 concentration value of TSP 30m 0.78 0.31 from different distance to the 40m 0.37 0.27 construction site 50m 0.35 0.25 100m 0.33 0.24 Take in-situ expansion of Fuling District Hospital as an example, hour-concentration value of TSP of the surrounding sensitive points is decreasing after site watering. The main affected area is just the building within 40 m around the construction site. Therefore, the affects are mainly focused on the existing hospital buildings. The impacts for the surrounding residential area and other sensitive points are relatively small, see Table 4-5. Table 4-5 Impacts comparison for the air environment of sensitive points with or without watering Sensitive points Without With watering watering site site Sensitive Nearest features No. Name of Sensitive points TSP(mg/m3 ) TSP(mg/m3 ) distance(m) OriginalOutpatient 1 33 0.68 0.30 Hospital Building The original inpatient 2 7 1.96 0.57 Hospital building No.3 Resident building in Resident 3 11 1.75 0.43 Hospital area No.4 Resident building in Resident 4 23 1.13 0.36 Hospital area 5 No.5 Resident building in 9 1.87 0.54 Resident Hospital area 69 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Hospital area Resident Building of Gas Resident 6 32 0.70 0.31 Company area Resident Building of Resident 7 Transportation 26 1.07 0.33 area Commission Resident Building of Resident 8 25 1.10 0.34 medical school area Resident area in Liming Resident 9 21 1.31 0.38 Road area The above Table shows, TSP-hour concentration reduction rate reaches 56% to 75%. Although the current standard lacks control limit for TSP-hour concentration., but refer to the limit requirement of Grade II standards 1.0mg/m3 on total suspended particulate concentration as specified in the "Air Quality Standard" (GB3095-82) , the effect of watering is acceptable for human health. That means watering the site is the simple, effective and feasible way to control the pollution source under the dry and windy weather which easily cause the dust during the construction period. 4.1.3.2 The Impact of Exhaust Emissions of Construction Transportation Machinery during Construction Period and Mitigation Measures All kinds of power machinery are doing excavation, transportation and construction works during the construction period of proposed project The gas discharged includes CO and NOx and other pollutants. Because the machinery is working discontinuous, and mainly focus in earthwork stage, combined with a small amount of pollutant emissions, the adverse effects to ambient air is very small. However, equipment maintenance of transportation machinery should be strengthened to keep it in a good working condition and minimize unnecessary energy consumption and gas emissions. The living of the construction workers rely on the existing public utilities and use of clean energy such as liquified gas or natural gas, so the exhaust emission only has little effect on the environment. 4.1.4 Impact of Construction Camp and Mitigation Measures 4.1.4.1 Impact of Wastewater of Construction Camp and Mitigation Measures There are two kinds of wastewater to be discharge at construction camp: one is domestic wastewater of construction workers, the main pollution factors are BOD5, COD, NH3-N, fecal coliform, etc.. The other one is the site runoff of rainfall containing a small amount of silt etc., basically has no adverse impact on the environment. The major impact of the construction camp wastewater is that domestic wastewater directly discharged may cause the surface water pollution. In particular, it will have relatively large impact to the small rivers which have limited environmental capacity, such as the Guixi River in Dianjiang County, Renhe River in Chengkou County and Youcheng River in Youyang County. For Wushan County which is based on tourism economy, great importance should be 70 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report attached to the control of sewage from Jiangdong Branch construction camps of Wushan County Hospital. As the construction sites of proposed hospital projects are located in urban areas or suburbs, construction camp will not be built separatly. The construction worker will rent the farmer’s house or go home directly. The small quantity of wastewater will be collected and conveyed through the existing municipal sewer network to wastewater treatment plant for further treatment; basically this will have no obvious effect on the water environment. 4.1.4.2 Impact of Domestic Solid Waste from Construction Site and Mitigation Measures A small amount of domestic solid waste will be produced at construction site. The site construction workers of the hospital construction are about 40 to 100 people a day. The amount of garbage generated by 0.5kg one person one day, the total amount of garbage produced are about 20 ~ 50kg per day. Waste bins should be put at construction site and should spray lime or disinfectant in spring and summer time. The bagged garbage will be collected by the local sanitation department and be sent to solid waste disposal plant for decontamination and disposal. The health environment of the construction workers and surrounding area are protected. It can effectively control the incidence of infectious diseases induced by domestic solid waste of the construction workers and the surrounding environment. By taking these above-mentioned pollution prevention measures, the environmental impact of waste during the construction period can be reduced to a minimum and the environment is acceptable. 4.1.4.3 The Diet and Drinking Water Supply of Construction Site of and Mitigation Measures No separate canteens will be built in construction sites. The construction workers may go to the canteen of the original hospital to eat or go to the restaurant of nearest commercial town to eat, or eat at their nearby rented house or go back home to eat. They may use the drinking water of the nearest hospital canteen or to purchase bottle drinking water from the food and beverage department, some construction workers may bring drinking water from home or rented room. There should be a specific person responsible for the concentration supply of drinking water at construction site. The water storage containers should be cleaned and disinfected every day. It must be covered when using and shall not be placed in a place where easily affected by the dust, waste gas or wastewater. Strengthen safety and health education on construction workers for eating and drinking water. They must wash their hands before meals to prevent disease from what they eat. 4.1.4.4 Disease Control at Construction Site A fulltime or part-time sanitation workers should be in place at construction site, to put the solid waste bin at construction site properly. The trash bins should be promptly cleaned and disinfected (sprinkle lime powder, spray disinfectant, etc.), Overflow of trash bin is strictly prohibited. Not allowed to store garbage anywhere inside the construction site. There should be a specific person responsible for the concentration supply of drinking water at construction site. The water storage containers should be cleaned and disinfected every day. 71 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report It must be covered when use and shall not be placed in a place where easily affected by the dust, waste gas or waste water. For the small traders and places of entertainment mainly for the construction workers, they should get the approval of local industrial and commercial administrative departments to prevent and control infectious diseases. The construction contractor should prepare all kinds of emergency medicine and strictly control the supply channel, periodically check the inventory to prevent the use of counterfeit and expired drugs. Abandoned medical waste should be given to the project owners for disposal and fill out the reservation "medical waste disposal records." All used detergent and disinfectants must meet national health standards or requirements. Detergent and disinfectants must have a fixed storage location (cabinet) and clearly marked. 4.1.5 Traffic Impacts during Construction and Mitigation Measures 4.1.5.1 Traffic Impact During Construction During the construction period of all hospitals under CURIP , due to a large number of construction activities started such as a large number of machinery and building materials mobilization, demolishing the buildings in original site and transporting out the construction solid waste of new structures and the moving of the construction working staff, all these will cause the traffic volume increased significantly mainly for hospital adjacent roads. It will put pressure on the urban transport and cause the traffic volume and the flow of people increased, mainly for the hospital adjacent roads and junctions. It will have adverse affects on the normal smooth transportation of the city. Especially for Wushan component, the traffic impact will be more prominent during construction, because there will be a large quantity of earthwork (270,000 m3) needs to be abandoned during construction period, accounting for 74.6% of the total weight of abandoned earthwork under CURIP II (see Section 4.1.6). All these earthwork will be transported out along the S103 Provincial Highway to the solid waste disposal plant located in Group 2 of Hongmiao Village of Longjing Township. The transport distance is about 17.5km. Fuling District People's Hospital, Youyang County People's Hospital and Chengkou County People's Hospital, these 3 in-situ expansion hospitals are located in the larger urban area which the traffic volume is largely high, while the quantity construction solid waster generated by the demolition of old buildings before construction are accounting for 95% of the total construction waste under CURIP II (see 4.1.6 Section). Large amount of solid waste transportation and concentrated in a short period at the beginning of construction, is likely to induce urban traffic bottlenecks, especially in the construction vehicle entrances of the hospital site and adjacent roads, traffic jam may happen. Also the transportation volume of building materials is heavy. The effectiveness of traffic management during construction will not only affect social environment but also have a negative impact to the hospital's patients, and will have influence on the progress and quality of construction. 4.1.5.2 Traffic Impact during Construction and Mitigation Measures 72 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Measures to be taken to mitigate the traffic congestion are as follows ( 1) Early intervention, develop traffic program with efforts The Project owner and the contractor should make a detailed investigation of road traffic volume around the site to collect raw data and do a scientific analysis and evaluation. The transportation program should be prepared in line with the principle of minimizing the traffic impact. Temporary parking and turn around space should be set within the construction site. As many as possible entrances for the construction vehicle should be set to connect to the urban roads system. Before the construction programs are decided, the views and opinions of residents and surrounding streets and enterprises should be considered. After the construction programs are decided, the project owner and the contractor should ask for the advice and comments on the program from the planning, municipal management, traffic policemen, urban traffic management department and revise and improve the construction program accordingly. The project owner should take the traffic management during construction as an important part of the project, and put transportation costs and other costs which may arise as the costs of engineering measures, to be included in the project bidding documents and clearly marked. Project construction should be stick to the principle "not occupation of the road, less occupation of the road�. For the case that occupation of the municipal roads is unavoidable the contractor should make a temporary traffic program in accordance with the principal of “Occupy one, return one�. When the case of all of municipal roads have to be closed or partly closed or need to reduce the traffic lane, a practical regional road diversion program needs to be developed. Related traffic organization plan shall be submitted to public security traffic management department for approval before implementation. Optimize construction program to improve the efficiency of vehicle transportation For the in-situ hospital expansion components, it should try to use the existing structures and facilities as much as possible, so as to save investment and reduce the amount of demolishment and transportation capacity. Fuling District People's Hospital plans to use the existing building as a transitional space on the conditions that the construction of the project is not influenced until completion of the project. The existing buildings will be demolished when project is completed in order to ease traffic pressure during the construction period; Construction of civil works should be arranged in the non-rainfall season as far as possible to improve the vehicle's payload and transport efficiency and to reduce water loss and control the air pollution and dust, make the city clean. ( 2) Inform in advance, release information in various forms during the construction period Before the start of construction, together with the county government, notices and announcements regarding construction and traffic matters should be widely publicized through radio, television, newspapers to the community organization, in order to get the people's understanding, support and cooperation. In all major junctions, traffic signs should be set to improve the awareness of the driver and the masses of citizens and guide 73 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report the traffic participants to avoid construction traffic road. The organization, community leaders, workers and the masses should be informed within the construction area. We recommend that the people choose an easy and fast green way to travel, drive less and walk more to reduce traffic pressure, and create favorable conditions for the management measures for the smooth and effective implementation. The construction signs, pedestrian safety signs, responsibility commitment and telephone call number for complaints should be hanged at the main entrance of construction site. Where the traffic organization plan has significant changes and effects to the regional transport, the project owner should announce and publicize it on regional news media after the approval. ( 3) Contractor should strengthen self-discipline, safety management Specify protective measures: The contractor should set up eye-catching instruction signs and marks at the construction site. The contractor should arrange specific person to be in charge of construction vehicles at the exits to guide social vehicles and pedestrians. When the regional road diversion program is implemented, the contractor should set eye-catching shunt signs, and deploy security personnel patrolling around the construction area to prevent accidents. In Fuling District, Chengkou County and Youyang County projects, in case of construction over the pedestrian walkways, reliable roof and safety rails or protective wall lighting must be set on the upper and both sides. Building materials should be neatly stacked and isolation barrier be set to keep the roads open. At the vehicular access of the three projects, to reduce the noise impacts to nearby residents, schools and other sensitive areas, even in the daytime, whistle control and management are recommended. No honk is allowed during night time. Strengthen the construction vehicles and personnel management: Construction vehicles must have complete procedures. The vehicle drivers when driving on the construction road must obey the traffic instruction comply with regulations, non-drunk driving or fatigue driving; try every means possible to eliminate the safety risks. Carefully manage construction, municipal infrastructure protection : During civil work construction, the contractor should adhere to civilized construction, protect the municipal water supply and wastewater pipelines, gas pipelines and power lines or communication facilities, avoid traffic congestion induced by accident. Transportation of long building materials such as steel or the mobilization of ultra long and wide construction machinery should be arranged in the holidays as far as possible or 8-10 pm of lower traffic periods. Someone should be arranged to guide the vehicles to avoid damage to municipal public facilities, infrastructure or adjacent structures. In case it has to be done at night time, the prior approval is needed and measures should be taken to shorten the transport time and reduce noise of unloading the materials and prohibit honking Scientific management, improve the capacity of traffic at construction area Strengthen management within the construction site, shorten the time of loading and unloading of material in the construction area, improve traffic capability, and prevent the jams of vehicles when queuing. Purchase of local materials as much as possible to shorten the transport distance 74 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report ( 4) Apply for the support of police mobile patrol platform during construction period Apply for the policy patrol platform to manage the traffic with fixed post and mobile patrols on duty for the heavy traffic road during the construction period. Further strengthen the management of the key sections and key time, especially for the morning, noon and evening on-work and off-work hours, manage the illegal traffic, illegal parking, take efforts to eliminate the congestion caused by human factors. In addition, some extraordinary measures should be taken to maximize the flow of traffic No vehicles are allowed to park at the entrance road of the hospital to ensure smooth traffic; The vehicle which are not used for construction or not for the doctor and the patient should be diverted to bypass in a specific time and specific sections Optimize the traffic signals within the construction area to prevent traffic congestion Have traffic control at the construction area and the surrounding road, divert traffic or pedestrians; Let the passing big-sized trunk be remotely informed and diverted to reduce traffic pressure on urban areas For Chengkou in-situ expansion component, they plan to apply for mobile patrol platform to manage the social vehicles at the junction of the hospital and adjacent school in order to reduce the traffic jam and the adverse impact caused by it. Wushan, Youyang, Fuling projects and other construction site adjacent to the sub-urban transport corridors can learn from it. 5 Enhance road safety campaign in the school area The project owners and contractors should contact their local community or neighborhood community to do traffic safety education and pedestrian safety education for the project near schools and other children’s areas, such as publicity and education activities in schools. After taking the above comprehensive management and mitigation measures, the impact of CURIP construction on the traffic condition will be greatly reduced. 4.1.6 Impacts to Surface Water Environmental and Mitigation Measures 4.1.6.1 Environmental Impact of Construction Wastewater The main wastewater at construction sites are: Suspended matters by washing the transport vehicles, oil-type wastewater; wastewater from building, structures maintenance, washing, polishing and others, wasted oil caused by improper maintenance of equipment or misuse of fuel oil, lubricating oil drip and drain; exposed soil caused by site preparation, building foundation excavation and rain water runoff with entrained soil and other drain The above analysis shows that the washing water or run-off contains oil and suspended solids, having the impact on the adjacent surface water 4.1.6.2 The Impact of Construction Wastewater and Mitigation Measures 75 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Strengthen the management of construction machinery to avoid running, dripping and draining, set a fixed location for vehicle washing and set some treatment facilities such as oil separation and grit tank etc. Earthwork excavation in project area should be scientifically planned ,"the quantity excavated could be transported out or backfilled within the day�, to avoid soil erosion polluting the water body caused by unnecessary storing surplus soil In case of precipitation during construction period, the initial runoff contains high oil and SS concentrations. Therefore drainage ditch and sedimentation tanks of oil separation should be built at the construction site, and the wastewater can be discharged through drainage ditch, reducing construction wastewater impact on the surface water bodies. Improve the greening works or solidify the surface as soon as possible after the completion of the works, minimize the erosion of the rainwater to exposed surface, reduce the impact on surface water. 4.1.7 Impact of Solid Waste and the Mitigation Measures The volume and analytical dispose situation of labor and the construction solid waste such as building materials and excavation/filling, discarded stone of project hospital is shown in table 4-6. The statistics of construction solid waste is shown in table 4-7. Table 4-6 Construction solid waste of each project hospital District/County Project hospital labor, building materials and excavation/filling, discard stone The construction period is 12 months. The construction located in the people’s hospital of Fuling district, land scope is 87m from north to south and 73m from east to west. The construction wastes produced by dismantling of the original Medicament house, Pavilion, Inpatient building and Business building is about 5500t; a small amount of wastes and sludge produced by dismantling of the original medical wastewater treatment station with a capacity 250m3/d, and a bit of collected heat preservation Fuling District material asbestos by asbestos dismantling of boiler house, People’s Hospital and the asbestos together with sludge is about 2t; Fuling Inpatient Comprehensive preliminary estimation of labor work day for the Building construction are about 36.5 thousand days, construction wastes are 45t, livelihood wastes are 7.3t, excavation is 22,000 m3 , filling is 9,000 and discarded stone and soil is 13,000 m3, the discarded slag and stone is planned to be transported to the city abandon slag field in Fuling District, no other abandon slag field will be set; livelihood wastes will be send to livelihood wastes garbage treatment plant in Fuling District; there are sand factory and cement plant, timber and sales center of Chongqing steel factory, so three advocate material are near to purchase. The construction period is 16 months, preliminary estimate man-days is about 24,000 days, life garbage about Tongnan M&C Tongnan 4.8t, total construction excavation about 30000 m3 Health Care (natural), mainly from in field, underground garage, total filling 6,000 m3 (natural), the excess excavation will be 76 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County Project hospital labor, building materials and excavation/filling, discard stone transferred to the nearby site which needs filling, a small amount of building abandon slag (32.7 t)will be transported to slag field in Jintian neighborhood committees of Majiawan 6th group about 2km apart from Tongnan, no other abandon soil field will be set; livelihood wastes will be sent to the Tongnan livelihood wastes treatment field in Zitong Sub-district Office in QingYan hamlet, DongSheng village in Tongnan about 13 km apart. The main building materials reinforcing steel bar, steel, cement, sand dust will be purchased in Tongnan and Chongqing. The construction period is 18 months. preliminary estimate man-days is about 54,800 days; The main Wanzhou District building materials reinforcing steel bar, steel, cement, People’s Hospital sand dust can be purchased in district or neighborhood Economic districts/county; construction excavation about 100,000 Development m3, excavate and filling can be locally balanced; livelihood Wanzhou Area Branch Outpatient & wastes is about 11t, will be send to Changling livelihood Inpatient wastes landfill disposal field in Qiaojiacun village, Comprehensive Changling town Wanzhou District; Construction waste Building about 107.2 t will be send to slag field site of Jinkai building designated by construction committee of Wanzhou District, transportation distance is 5 km. The construction period is 22 months. preliminary estimate man-days is about 66,000 days; The main building materials reinforcing steel bar, steel, cement, sand dust can be purchased in county or neighborhood districts/county; construction excavation about 7000 m3, Dianjiang County discard slag about 1000 m3, filling about 6000 m3, discard TCM Hospital slag will be send to designated slag field disposal appointed Dianjiang Internal Medicine by construction committee of county; livelihood wastes is Comprehensive about 13.2t, a dustbin collection will be set and will be Building timely transferred to Nanyinsi domestic wastes landfill disposal filed in Xinmin town, Dianjiang county about 10 km apart; About 192t construction waste will be send to designated abandon slag field by municipal of Dianjiang county. The construction period is 30 months. preliminary estimate man-days is about 54,000 days; The main building materials reinforcing steel bar, steel, cement, sand dust can be purchased in county or neighborhood Wushan County districts/county or Chongqing city; construction TCM Hospital excavation about 27,000 m3, discard slag about 27,000 m3, Wushan Jiangdong Branch livelihood wastes is about 10.8t, construction waste about 68.9t; excavation, livelihood wastes and construction waste will be transferred to Wushan livelihood wastes disposal filed in Group 2, Hongmiao Hamlet, Longjin village, Wushan town. Chengkou County The construction period is 20 months. preliminary People’s Hospital estimate man-days is about 60,000 days; there are cement Chengkou Inpatient plant, timber fabrication plant and sales center of Comprehensive Chongqing steel factory, so building stone, earth, cement, Building 77 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County Project hospital labor, building materials and excavation/filling, discard stone Building rebar, timber and other materials for construction are near to purchase.; The soiled construction wastes are spoil and Construction waste produced by Concrete Architecture and Stone masonry. Beyond that, a small amount of livelihood waste by construction worker 12t. Demolition of 330 m2 original building and buried medical wastewater biochemical treating pond processing capacity of 250 m3/d of Chengkou people's hospital will produce about 400 t construction waste and a small amount of sludge, total construction waste about 451 t; The excavation is about 35,300 m3, filling 19,300 m3, the remaining 16,000 m3 discard earth and construction waste will be disposal at Xiejiaopo spoil disposal field designated by municipal department about 2 km apart; domestic waste send to ChengKouXian garbage treatment facility The construction period is 24 months. preliminary estimate man-days is about 36,500 days; The main building materials reinforcing steel bar, steel, cement, sand dust can be purchased in county or neighborhood Qianjiang District districts/county or Chongqing city; construction Central Hospital excavation about 13,000 m3, filling in field is about 10,000 Zhengyang m3,another 3000 m3 used for road filling; construction Qianjiang Branch Inpatient waste about 83.8t ,livelihood wastes is about 7.3t, Comprehensive construction waste will be transferred to abandon soil field Building designated by municipal department, livelihood wastes will be collected by dustbins and will be timely transferred to Qianjiang livelihood wastes landfill disposal filed in south office of Nanjia neighborhood committee of Liangjiawan, Fenshuilin which is 8km apart. The construction period is 18 months. preliminary estimate man-days is about 22,000 days; The main building materials rebar, cement, ballast and other materials for construction can be purchased in Youyang County and or neighborhood districts/county or Youyang County Chongqing city. The excavation is about 30,000 m3, except People’s Hospital a small amount of backfilling the rest transferred outside. Outpatient & There are construction waste and a small amount of Youyang Emergency sludge produced by demolition of outpatient building and Department medical technology building and an equipment buried Comprehensive medical wastewater treatment station with a capacity of Building 400 m3/d. The existing construction waste produced by demolition and new construction is about 2800 t, will be send to Banxi town Building waste flied in Youyang county which is 20 km apart ; livelihood waste 4.4 t will be send to Youyang livelihood waste landfill disposal field Longdong village, LongTan Town, about 40 km apart. Note: According to consideration, the livelihood waste is 0.2 kg/people per Day; New buildings construction waste by 2 kg/m2; According to consideration the construction waste of dismantle brick building structure 1 t/m2; livelihood waste treatment filed and construction waste residue field of each district/county see table 4-7 Table 4-7 Construction solid waste statistical information 78 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/Co Excavation Filling 104 Spoil 104 Construction Domestic Sludge unty 104 m3 m3 m3 waste T waste T Fuling 2.2 0.9 1.3 5545/5500 7.3 2t District Tongnan 3.0 0.6 2.4 32.7 4.8 County Wanzhou 10.0 10.0 0 107.2 11 County Dianjiang 0.7 0.1 0.6 192 13.2 County Wushan 27.0 0 27.0 68.9 10.8 County Chengkou 3.53 1.93 1.6 451/400 12 About0.5t County Qianjiang 1.3 1.0 0.3( Balla 83.8 7.3 District st filling) Youyang 3.0 / 3.0 2800/2715 4.4 About0.5t County 50.73 X104 14.53X104 36.2X104 9280.6/8615 70.8 Dangerous Total m3/71.022 m3/20.342 m3/50.68 waste 104t 104t 104t about 3t 516151 Dangerous Total amount of spoil, t waste about3t Note 1: Above / is the total amount for construction waste, under / is the waste of old building dismantle; The bulk specific weight of earth and stone is 1.4 t/m3. Note 2: The sludge is produced from dismantling the original medical wastewater treatment station, and the 2t of sludge from Fuling Hospital includes about 0.4t of old asbestos heat preservation material from dismantling the original boiler house. By the analysis of the above two table, solid waste during the construction of hospital of each district/county under CURIP conditions is mainly abandoned earth and stone, which takes 98.2% of the total solid waste disposal amount; Among them, abandoned earth and stone of Wushan County takes 74.6% of the total amount; And among the construction wastes from the site construction waste produced by Fuling District, Youyang County and Chengkou County hospital expansion in original site accounted for 92.8% of the total. Therefore, the impact of the solid waste control is mainly come into the traffic impact control for abandon earth and stone, the second is construction waste, especially for the construction waste produced by hospital expansion in original site of Fuling District, Youyang County and Chengkou County and air impact control. The construction site of People’s Hospital Inpatient Comprehensive Building in Fuling District is original land located in spare plot in the north of the hospital land, in which there are 4 existing brick building (the original medical house) and the pavilion will be demolished. After the Comprehensive Building completed and put into use, the Inpatient building, office buildings will be demolished and removed. Because there are relatively few buildings in the hospital and with a few floors, do not belong to high buildings, therefore, the removal is relatively less. In the process of removal and rebuilding, the main environmental impact to the neighboring hospital buildings and residents is mainly dust and construction noise. The artificial work is used to old building demolition process, all day time construction with short period , acoustic environmental impact to the nearby neighboring residents and hospital is acceptable limited; thanks to the less dust strength and areas by artificial demolishment, 79 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report according to the analogy material analysis, the concentration of pollutant process produces dust is expected to 1.0 mg/m3, the contribution value to construction area and outside the scope of 50m can meet secondary standard environmental air quality. During the demolition of buildings in Fuling hospital, about 0.2 t asbestoses will be generated from demolition of an existing boiler house. The sludge and asbestos are hazardous waste, asbestos and the dried sludge will be packed and take measures to prevent from leakage and rain, and then sent to Changshou District hazardous waste disposal treatment center designated by municipal department. The staff for disposal of it should wear blinkers, dustproof clothes and cap, and gloves. The name, location, capacity, distance (from the hospital site) and transportation roads of the municipal waste landfill facility, construction waste residue field and hazardous waste disposal treatment center for each hospital in District/County, see table 4 - 8. In addition, the landfill facilities disposing of domestic and construction solid waste have agreed to receive the water from the project. 80 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 4-8 Situation of the wastewater disposal facilities for each hospital District/County Name Location Volume/Capacity Distance, Transportation roads km Responsible department Fuling District Spoil ground of Group 1,Quntuozi 2 million m3 8 Renmixi road→Binjiang The construction and Jiangdongmopangou, Fuling community, Road→Wujiang bridge→Fuqin environment office of Jiangdong Jiangdong Sub- Road→Pengle Road Sub-District Office, Fuling District Office, District Fuling municipal waste landfill field of Group 2, Minxie 30 million m3 10.5 Renminxi Road→Liminbei Municipal devices of Fuling Fuling village, Lizhi Road→Taijida Road→Fuhao Road District Sub-District Office, Fuling municipal sewage treatment Group 7, Chaqi 0.14 million m3/d 8 Admit into: Yangzi River The Fuling drainage limited plant village, Jiangdong liability company of Sub-District three gorges Water Authorities Office, Fuling Solid waste disposal center of Group 5, Tuanjie Incineration 3t/d; 12 Renminxi Road→Liminbei The environment protection Fuling village, Lizhi Additions: Road→Taijida Road→Fuhao Road agency of Fuling District Sub-District Steaming 5t/d; Office, Fuling Tongnan County Group 6, 30 million m3 2 Jintian Sub-District Office Construction waste residue field Majawan, Jintian Sub-District Office domestic waste landfill field Qingyan Hamlet, 1.48 million m3 13 Construction committee of Dongsheng Tongnan County Village, Zitong Sub-District Office 81 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County Name Location Volume/Capacity Distance, Transportation roads km Responsible department municipal sewage treatment Guanyin village, 20 thousand m3/d 3 Admit into: Fujiang River Dewatering company of plant Guilin Sub- Tongnan County District Office Treatment center of medical Shuangshi town Incineration 15t/d 130 Chongqing Zhongming wastes industry area, Environmental management Yongchuan Co., LTD District Wanzhou District Construction waste residue site slag field of / 5 landfill site economic and development area building Municipal solid waste landfill Group 5, Qianjia 500t/d 30 Environment and sanitation site village, Changlin station of Wanzhou District town Sewage treatment plant of Group 6, 800m3/d 1 Gaofeng Town Xinglong Village, Giafeng Town Treatment center of medical Group 5, Qianjia steaming: 8t/d 30 wastes village, Changlin town Dianjiang County Construction waste residue field place Designated by construction committee domestic waste landfill field Nanyinsi, Xinmin 190t Capacity 10 Guixidadao passed by 102 Bianmin Sanitation development town 1,930,000 provincial road to Xinmin town Co., LTD Danjiang County m3;190t/d Municipal sewage treatment Zoujiaba,Shiling Recent capacity 30 3 Admit into: Guixi River plant village, Guixi thousand town m3/d; Future capacity 60 thousand m3/d 82 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County Name Location Volume/Capacity Distance, Transportation roads km Responsible department Specified hazardous waste Group 5, Tuanjie burning 3t/d; 108 Yuyi High Environmental Protection disposal treatment field village, Lizhi new way→Fuling/Changshou→Changfu Bureau of Fuling District Sub-District construction :5t/d; High way→319 National Office, Fuling road→Wujiang road→Gongyuan road→Guangchang road→Guangchanghuan road→Wutai road Wushan County Construction solid waste landfill Group capacity 1.3 million 17.5 From 103 provincial road to Huiqin Environmental health field 2,Hongmiao t Miaowan Co., LTD hamlet, Longjin village, Wushan domestic waste landfill facility county Medical hazardous waste Group 5, Qianjia steaming and 150 Mainly rely on Hurong High way Wanzhou District disposal facility village, Changlin boiling town, Wanzhou process: 8t/d District Chengkou County Construction waste landfill Xiejiaopo 55 thousand m3 South west Bureau of Urban Utilities and 2 S 202 Provincial road Landscaping of Chengkou County domestic waste landfill facility Xiejiaopo 28 thousand m3 South west Bureau of Urban Utilities and 2 S 202 Provincial road Landscaping of Chengkou County municipal sewage treatment Group 5000t/d Length of Admit into: Renhe river plant 2,Guanzhangzi Pipe hamlet, Longtian network Village 3.6km Medical hazardous waste Group 5, Qianjia Steaming and 130 S102,KaiCounty, S102,Wankai Wanzhou District disposal facility village, Changlin boiling High way town, Wanzhou process: 8t/d District Qianjiang District Construction waste landfill site Liangjiawan, Total Volume 8 Banpo —Chuchanggou— Environmental protection 83 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report District/County Name Location Volume/Capacity Distance, Transportation roads km Responsible department Municipal waste landfill facility Fenshuiling, m3 180万 , 200t/d Fenshuiling bureau of Qianjiang District Nanjia community office, Chengnan Xincheng municipal sewage Phrase I 30 10 Admit into: Apeng river treatment plant (Local name thousand m3/d; Liangqiao)Tuanjie total capacity of 90 neighborhood thousand m3/d committee, Zhengyang street Medical hazardous waste Group7,Nanjia Decatizing3t/d; 8.5 Environmental protection disposal facility neighborhood bureau of Qianjiang District committee, Chengnan Sub- District Office, Qianjiang District Youyang County Construction waste landfill Banxi Town, 0.2 million m3 20 Huancheng road→Youyang to Municipal Utility of Youyang County Banxi segment 319 national road Youyang County Domestic waste treatment field Longdong village, 1.07millionm3, 40 Huancheng road→Youyang to Longtan town, Service life 15 Banxi segment 319 national road Municipal Utility of Youyang Youyang County Years County Municipal sewage treatment Shanshuwan, 20 thousand m3/d 5 Admit into: Youyang River plant Hejiaba village, Huayuan town Medical hazardous waste Group7,Nanjia Decatizing3t/d; 90 Environmental protection disposal facility neighborhood bureau of Qianjiang District committee, Chengnan Sub- District Office, Qianjiang District 84 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 4.1.8 Ecological Environment Impact and Mitigation Measures During the construction period, the ecological impacts to construction sites are mainly from the damage to vegetation and soil erosion. Because in addition to evaporation, the rainwater surface runoff into the surface water, or the penetrates into groundwater aquifers, therefore, this evaluation of soil and water loss is mainly refers to soil loss on ground surface. 4.1.8.1 Water and Soil Loss Analysis and Mitigation Measures There are no borrow pits in all component sites under CURIP . The soil and water loss is mainly related to the excavation and filling in construction site, and stockpiled earth. 1 Forecast analysis under scenario of without soil and water conservation measures The excavation site would create the loose topsoil, soil erosion will happen when rainfall and Surface runoff are flushing the site, the spoil produced by construction also easy to produce soil erosion in transportation, dumping process if without proper management The mathematics model is used in the prediction of water and soil erosion, mathematical model is as follows: Mss=A·F Where: Mss——Soil loss tolerance, t/a A——Quadrate loss tolerance, means etching modulus t/km2·a A R·K·LS·P R——Rainfall factor K——Soil erosion factors LS——topographic factors P——Vegetation factors F——Corrosive region km2 According to the statistics, after the excavation of ground, the square loss of Quadrate land before excavation is increased about one times. Each District/County average erosion modulus is provide by Chongqing Land and Resources Bureau. In addition, construction site or deposit site will also produce earth loss. The formula for forecasting soil loss in piled up process Ms=A·Q T In which Ms——New soil loss 85 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report t/a A——Loss coefficient take 0.05 according to pile up form 0.05 Q——stocked cubic volume m3 T——Pile time of stocked cubic, Year. According to the above method of forecasting, if no soil and water conservation measures taken during the construction of the hospitals under CURIP , the soil loss prediction results are given in Table 4-9. Table 4-9 No soil and water conservation measures taken during the construction of the components under CURIP will cause soil loss District/County Construction Average Disturbance stocked the soil loss Total site area, erosion after volume in piled up soil km2 modulus surface soil m3 area t/a loss t/a t/km2·a loss, t Fuling District 0.0063 4169 53 0.44 308 361 Tongnan 0.0133 3107 83 0.6 420 503 County Wanzhou 0.067 3000 402 2.0 1400 1802 District Dianjiang 0.006 2655 32 0.16 112 144 County Wushan 0.0404 1200 97 4.0 2800 2897 County Chengkou 0.0029 5489 32 0.71 497 529 County Qianjiang 0.0045 3776 34 1.6 1120 1154 County Youyang 0.028 3763 211 0.6 420 631 County Total 944 7077 8021 Note: stocked cubic volume calculated by 20% of the excavation amount, bulk specific weight 1.4 t/m3. 2 Mitigation measures for soil erosion 86 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report According to the above analysis and forecast calculation, if no conservation measures been taken to prevent soil and water loss, the soil and water loss may mainly caused in stockyard of earth and stone, therefore, prevention of soil and water loss is the most effective measures to reduce the soil erosion is to minimize the amount of earth stockpiled and the duration of the stockpiling. The contractor shall establish a plan of excavation/filling scheme according to the earth-rock properties, climate and road transportation conditions of the construction site , At the construction site, the spoil should be timely disposed. Temporary stockpile should avoid sharp slope or the gully as far as possible. The slope also should not be too steep, and as close as possible to the planned filling field to avoid landslide and flying dust problem. Do not arrange large-scale earth and stone construction in the rainy season as possible , when construction in rainy season, earth and stone works should be timely excavated, transported, filled, compacted, to avoid soil and water loss. The temporary stockpile in rainy season shall be fenced peripheral ditches and simple settling basin, The stockpile should be covered in heavy rains or high winds, to reduce the rain and surface runoff erosion. In construction site like Wushan hospital and other site has similar natural large slope, the most effective measures is to dig flood interception ditch on the upper section of the construction site. As to promote the vegetation restoration, before the construction, the top soil layer should be removed and stockpiled, so that it can be used for land reclamation or greening works in hospital after the construction is completed. Measures should be taken to prevent drop of spoils during transportation so as to prevent from generating oil and water loss and flying dust pollution. Through the water and soil conservation measures, the water and soil erosion can be effectively mitigated. 4.1.8.2 Vegetation Protection Measures during Construction The vegetation protection should be included in the contractor's construction plan, and should be the first step in construction. The measures should focus on the protection and relocation of the rare plants and older plants and rare flowers and young plants, and the expenses for transportation and replanting should be included in the environmental protection budget. brushes etc. should be considered to be used in greening works. The brush should not be burned and buried in sites to prevent from release of GHG. 4.1.8.3 Management of Spoil 1 Management of the surplus earth and stone According to opinion of EIA unit and PIUs, the transportation of surplus earth and stone generated from construction of each hospital should be transported by contractor to the designated construction waste facility, and can be used to grade filling. To achieve the comprehensive utilization and for the purpose of energy saving,, it is suggested that in condition of an economy transport distance, the residual earth and stone can be sent to the municipal solid waste landfill facility of neighboring District/ County as cover soil, it may reduce the needs of landfill soil, also indirectly promoting the regional ecological environmental protection, reduce unnecessary soil erosion. 87 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 2 Treatment for contaminated soil and sludge of building removal During the hospital construction of Fuling District, Youyang County and Chengkou County, new medical wastewater treatment stations need to be constructed prior to the demolition of the existing buildings, then the old medical wastewater treatment stations will be demolished; after the demolition of the existing MCH hospital of Tongnan County, the site will be transferred to the local government. After the removal of the old medical waste water treatment stations, the remaining sludge of 2.8 t should be naturally dried after disinfection with lime in construction site, after that the dried sludge will be sealed and transported to the hazardous waste disposal facility in neighboring district (Fuling District, Changshou District, Yongchuan District). The site of the wastewater treatment stations should be sprayed with lime for stabilization before the civil works is started. 4.1.9 Impact on Physical Cultural Resources and Mitigation Measures The EA team has surveyed the information on ground physical cultural heritages in the proposed construction sites and found that there are no physical cultural sites or relics. The local cultural bureaus of the project counties/districts also confirmed that there are no such physical cultural heritages at any level protection in the project sites, the confirmation letter is attached in Appendix D. In case of discovery of any relics during the construction, following procedure should be followed: 1. Once any physical cultural relics are found during the construction phase, the construction must be immediately suspended and protected by the Contractor; 2. The Contractor should immediately inform the local cultural bureau on the presence of the relics; 3. The construction should not be resumed until permit from local cultural bureau issued to the Contractor. 4.2 Environmental Impact and Mitigation Measures during Operation Stage 4.2.1 Environmental Impact on Traffic and Mitigation Measures After the completion and put into operation of the project, the improved health care condition, promoted health care service quality, and upgraded hospital environment will lead to higher satisfaction of the patients and nursing personnel as well as significant rise of the hospital visits and bed uses. On the other hand, however, the pressure on the hospital traffic will also be heightened with increasing traffic flow in adjacent roads or junctions, worsened traffic jams, decreased access for ambulances to get in and out of the hospital, inconvenient parking, long queue for vehicles getting in the hospital, difficulty in getting a taxi, passers-by and vehicles occupying each others’ paths and disrupted traffic environment, etc.. Therefore, maintaining a sound traffic environment for the hospital represents an important part for building a green hospital. 88 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report It’s of the greatest urgency for Fuling People’s Hospital, Youyang People’s Hospital and Chengkou People’s Hospital to solve the problems relating to hospital traffic issues, and these three hospitals also have the potential to score the most significant achievements in this aspect. Constrained by the expanding on the original site, the three hospitals, located in the urban centers, are under great impact in terms of their internal traffic and the connection with outside traffic. They should not only take the advantage brought by expanding but also mitigate the negative impacts on traffic from the perspective of their management. There is only one-way road for vehicles entering into the Fuling People’s Hospital inpatient building project, which means all the vehicles enter the hospital through its northwest entrance of its Emergency Building located on Limingdong Road, and drive out of the hospital into Ankang Road after passing the underground garage. On the other hand, pedestrians can choose to enter the hospital through the North entrance (-7F) on Ankang Road, or to access the inpatient building through the Emergency Building on Limingdong Road and then the square above the underground garage building, It can be judged that pedestrians and vehicles have been separated. On the other hand, although the entrance on Limingdong Road can be expanded during construction, shortages mentioned above such as traffic jams will be still inevitable, exerting a negative impact on the urban traffic and the pedestrians walking into the hospital through that entrance. To mitigate the negative impact on the traffic at the entrance and exit, it is proposed to adopt the following mitigation measures 1 Strengthening Operation Efficiency Through Scientific Management of Internal Traffic This section will take Fuling District People’s Hospital as an example for the reference of Chengkou County Hospital, Youyang County Hospital and other project hospitals. Internal traffic management has a direct impact on the internal and external traffic linkage and the overall traffic environment. It is recommended that the entrance gateway on Limingdong Road can be set away from the city road as much as possible so as to avoid traffic jam arising from queuing in front of the hospital entrance. As for the underground parking management, a guiding system can be introduced so as to provide guidance for vehicles and prevent them from unnecessary detour in the park. A fee-in-advance model can also be considered aiming at reducing waiting hours at the exit gate way and avoiding vehicle congestion. 2 Improving Hospital Traffic Conditions Through Optimized External Traffic Organization It is proposed to set noticeable directing system and signs on the surrounding roads outside the hospital so as to avoid social vehicles detouring to Lingmingdong Road or Ankang Road. Some crossroads can also be adjusted, expanded, or channeled after consulting with relevant civil management and traffic management departments. Application shall be delivered to establish patrol police platform nearby. No-parking signs shall be set in the vicinity of hospital entrance and exit gateways. Temporary parking space for taxi shall also be reserved near the hospital for the convenience of passengers. Besides, it is recommended that traffic management departments shall strengthen their efforts in patrolling the surrounding roads. Security monitoring gadgets and red-light camera shall also be equipped on the entrance so as to videoing and punishing the illegal parking. 89 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report According to the statistics given by Shenzhen Binhai Hospital, the rush hour into the hospital is around 7:00-8:00 o’clock and 14:00 o’clock, and out of the hospital is around 11:00 o’clock and 15-17 o’clock (see Fig 4-1). Management over the vehicles going in and out of the hospital should be strengthened during the rush hours mentioned above. Fig 4-1 Traffic Flow of Shenzhen Binhai Hospital Vendors and peddlers are prone to do business in the vicinity of the entrance and exit of hospitals. The establishment of police patrol platform can prevent these dealers from occupying vehicle or pedestrian paths and therefore effectively avoid traffic congestions caused by the above-mentioned reasons. 3 Improving Surrounding Public Transport Facilities and Walking Environment Application shall be delivered to civil transportation management departments to set bus routes to the hospital through Limingdong Road and Ankang Road. The bus stations shall be placed in the vicinity of but not too close to the hospital. The surrounding walking environment shall also be improved. The 24-hours pedestrian paths shall be set to connect the hospital pedestrian path entrance and nearby bus stations. A transportation model integrating buses and taxi with pedestrians can serve the needs of visits in all kinds. 4 Promoting the Hospital Parking Utilization Rate and the Efficiency of Vehicle and Population Distribution Setting more parking spaces as much as possible; Adopting pyramid feeing system regulating visiting vehicles; Reducing the lingering hours of patients and nursing personnel through deepened hospital reform. 90 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report The phenomenon of “four long and one short� in hospital is very prominent. Specifically speaking, “four long� refers to “long hours for register, for queuing for the diagnosis, for paying the fee, and for getting the medicine; and “one short� refers to the short time for making the diagnosis. Project counties in CURIP II should comply with the Several Opinions on Improving Public Hospital Service Management issued by the Ministry of Health so as to bring more convenience to the patients. They should also explore ways to reform the medical affairs scheduling system so as to properly arrange and distribute the medical resources according to patient number and rush hours. The process control and linkage between the outpatient service and supplementary should also be strengthened for better coordination among various departments. Institutional reform of hospitals should be deepened in terms of process optimization, medical personnel capacity building, and service efficiency upgrading. Besides, noticeable signs directing diagnosis and treatment should be set in the hospital so as to provide guidance for the patients and accompany personnel and shorten their stay in the building. The signs should include the layout of the whole hospital and the outpatient service hall, signs indicating the functions of individual buildings, inner diversion signs, and department distribution maps. 5 Some project hospitals can consider increasing the exits and entrances in the hospital and channel the traffic so as to separate the vehicles and pedestrians. 6 Detour routes in the adjacent roads should be provided for options in case of traffic jams or congestions. The above-mentioned measures can meet the demands of visiting and passing-by vehicles and people in terms of transport convenience. 4.2.2 Medical Wastewater Impact and Mitigation Measures 4.2.2.1 The Sources and Perils of Medical Wastewater ( 1) The Sources of Medical Wastewater Medical wastewater is mainly produced by the following departments and facilities: treatment rooms, laboratories, wards, laundry, X-ray photographic prints, isotope therapy diagnosis, operation rooms. Besides, domestic wastewater produced by hospital administrative and medical personnel represents another source of wastewater. Therefore, hospital wastewater sources are more complicated than that of domestic wastewater. ( 2) Perils Incurred by the Medical Wastewater Considering the complicated nature of its sources and compositions (usually contains pathogenic microorganism, toxic and harmful physical and chemical pollutants and radioactive contaminants), medical wastewater, featuring space pollution, acute infection and latent infection, may become a major source of disease spreading and serious environmental pollution if not be treated properly. 91 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Hospitals with infectious disease departments are subject to contamination brought out by stool, infectious bacteria and viruses and pathogenic microorganism pollution. Medical wastewater contains toxic and harmful materials such as acid, alkali, suspended solids, BOD, COD and plant and animal oil. Wastewater from dental treatment, laboratory and testing process contains heavy metals, disinfectants, and organic solvents, some of them are carcinogenic and teratogenic, and therefore may harm human health and the environment in the long run. 4.2.2.2 The Medical Wastewater Quality and Volume of CURIPII Hospitals Giving to their technical and economical restraints, project hospitals failed to separate the wastewater of the ward areas and other areas. Therefore, both ward and none-ward wastewater is regarded as medical wastewater during the prediction. The results show that the pathogenic micro-organisms, toxic, harmful physical and chemical pollutants in the medical wastewater produced by the project hospitals are relatively low, and the major contamination factors after disinfection are conventional factors such as COD, SS, BOD5, NH3-N and fecal coliform. According to The Design Specification of Wastewater Treatment, Technical Guide on Wastewater Treatment, the report has referred to the data provided by Chongqing Environment Monitoring Center and Wastewater Treatment Station, and confirmed the major contaminants and their concentration of the wastewater produced by the project hospitals based on their monitoring results. And medical wastewater volume is measured based on the bed number, outpatient visits, and the number of medical and other assistant personnel of the proposed hospitals. For the expanded hospitals, current wastewater volume of the original site has also been taken into consideration. 92 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 4-10 Medical Wastewater Quality and Volume of Project Hospitals Project Waste Before /After Waste Water Quality mg/L Fecal Corliform number/L Proposed Waste Permit to Enter Hospital Water Treatment Water Treatment the Waste Water Volume COD BOD5 SS NH3N Fecal Animal/Plant Process and Treatment Plant m3/d Corliform Oil Capacity or not Fuling 265.4 Before 398 106 153 15 / 10 Biological contact Permit (after meet oxidation the pre-treatment After 180 70 60 3.8 / 1.1 process 290m3/d standard) Tongnan 122.4 Before 300 150 120 30 1.6×108 / Secondary Permit (after meet anaerobic the pre-treatment After 250 100 60 25 5000 / treatment and standard) disinfection process 130m3/d Wanzhou 257 Before 300 150 120 30 1.6×108 / Secondary Permit to treatment and discharge into the After 60 20 20 15 500 / disinfection Yangtze (after process 257m3/d meet the discharge standard) Dianjiang 104 Before 400 200 / 50 1.6×108 / Enhanced primary Permit (after meet treatment and the pre-treatment After 250 100 / 35 5000 / disinfection standard) process120m3/d Wushan 134.86 Before 300 150 120 30 1.6×108 / secondary before Jiangdong treatment before Sewage Plant After 60 20 20 15 500 / the completion of completion, Jiangdong Sewage discharge into 93 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Project Waste Before /After Waste Water Quality mg/L Fecal Corliform number/L Proposed Waste Permit to Enter Hospital Water Treatment Water Treatment the Waste Water Volume COD BOD5 SS NH3N Fecal Animal/Plant Process and Treatment Plant m3/d Corliform Oil Capacity or not Jiangdong Sewage discharge into After 200 100 60 25 5000 / Plant; and class 1 Daning River; treatment after the After completion, completion of the follow the pre- plant 200m3/d treatment standard Chengkou 285.5 Before 300 150 120 30 1.6×108 / Enhanced primary Permit (after meet treatment and the pre-treatment After 250 100 50 20 5000 / disinfection standard) process 300m3/d Qianjiang 180.2 Before 300 150 120 30 1.6×108 / Secondary Permit (after meet anaerobic the pre-treatment After 250 100 60 25 5000 / treatment and standard) disinfection process 200m3/d Youyang 370.16 Before 300 150 120 30 1.6×108 / Biological contact Permit (after meet oxidation the pre-treatment After 250 100 60 25 5000 / process 400m3/d standard) Note 1: Water disinfectant: chlorine dioxide (site preparation) (Dianjiang County TCM Hospital plans to use sodium hypochlorite for disinfection); Disinfectants for sludge: lime Note 2: Pre-treatment standard in the Table refers to the pre-treatment standard in the Medical Institution Water Pollutants Discharge Standard GB18466- 2005 Note 3: In the short term, the Jiangdong Branch of Wushan TCM Hospital adopts the aerobic biological contact oxidation and disinfection process, and follows the standard listed in Table 2 in the Medical Institution Water Pollutants Discharge Standard; in the long term, it will adopt the secondary anaerobic treatment and disinfection process, and follows the pre-treatment standard in the Medical Institution Water Pollutants Discharge Standard. 94 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 95 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 4.2.2.3 Mitigation Measures on Medical Wastewater Impact ( 1) Taking Full Advantage of District/County Infrastructure and Strictly Complying with Discharge Standard CURIP II project hospitals will treat the medical wastewater in strict compliance with the Medical Institution Wastewater Pollutants Discharge Standard ( GB 18466-2005) jointly issued by the Ministry of Environmental Protection (the former National Environmental Protection Bureau and the State Administration of Quality Supervision Inspection and Quarantine. Hospitals, such as Jiangdong Branch of Wushan County TCM Hospital, that directly or indirectly discharge wastewater into surface water bodies, shall implement the discharge standard of the Standard Limiting the Wastewater Pollutants Discharge (Daily on Average) from General Medical Institutions and Other Medical Institution. Where wastewater is discharged through sewer network into municipal wastewater treatment plant, the pre-treatment standard of the Standard Limiting the Wastewater Pollutants Discharge (Daily on Average) from General Medical Institutions and Other Medical Institutions shall be implemented. Project hospitals (Wushan TCM Hospital in exception) should implement pre-treatment standard. Among these hospitals, the wastewater treatment plant located in the new town of Qianjiang County is under construction (30,000 m3/d), which is expected to be put into use by the end of 2010. Therefore, Zhengyang Branch of Qianjiang Central Hospital should also follow the pre-treatment standard. The capacity of the WWTP in Gaofeng Town in charge of Wanzhou People’s Hospital wastewater treatment stands only at 1,200m3/d, and WWTP in Wanzhou Economic Development Zone (20,000m3/d) is still in the planning stage. Therefore, it is required that the WWTP of Wanzhou project should adjust its treatment process from the original enhanced primary treatment to secondary treatment plus disinfection to ensure that the effluent meets the standards. Municipal Wastewater Treatment Plants relating to CURIP II Project are summarized in Table 4-11. 96 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 4-11 Summary on Municipal WWTPs Further Treating Effluent from CURIP II Hospitals Project – Location Design Actual Major Standard Meeting and Other related Capacity Capacity Process Receiving Water Body of WWTPs 10,000m3/d 10,000m3/d Discharged Water Fuling Hengliangzi, 8 6 A2/O Discharged into the Yangtze after Combined collection system in old city and WWTP Jiangdong, secondary meeting the Class 1 B standard in separate system in new city, consisting of primary Fuling District biochemical Urban WWTP Pollutant and secondary intercepting sewers, pre-treatment treatment Discharge Standard station and midway lifting pumping station. The intercepting sewer pipeline is totally 46.2 km in length. Tongnan Jiangbei New 4 <2 Improved Discharged into Peijiang River The municipal WWTP in Tongnan Township has WWTP District, alternant after meeting the Class 1 B been put into operation and sewer trunk has been Tongnan oxidation standard in Urban WWTP extended to nearby plot. ditch Pollutant Discharge Standard process Gaofeng Xinglong 0.12 / Automatic Under construction, Discharged Under construction, and put into operation in WWTP Village, Gaofeng aeration and into the Yangtze after meeting the 2013. But its surplus capacity is limited, and Town rapid Class 1 B standard in Urban cannot meet Gaofeng Town’s need for infiltration WWTP Pollutant Discharge development sewage Standard treatment Dianjiang Shiling Village, Phase 1: 3; <2 Modified Discharged into Guixi River after put into operation in 2006 Guixi Guixi Town oxidation meeting the Class 1 B standard in WWTP Long term:6 ditch Urban WWTP Pollutant sewage pipeline network has been connected with process Discharge Standard the east side of the hospital Wushan Jiangdong New / / secondary / Jiangdong WWTP is in the planning stage Jiangdong District, Wushan biochemical WWTP County treatment 97 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Project – Location Design Actual Major Standard Meeting and Other related Capacity Capacity Process Receiving Water Body of WWTPs 10,000m3/d 10,000m3/d Discharged Water Chengkou Siwan Village, 0.5 0.2 A2/O Discharged into Renhe River after sewage pipeline network is reserved for the new WWTP Longtian, secondary meeting the Class 1 B standard in WWTP Chengkou bio- Urban WWTP Pollutant County chemical Discharge Standard treatment Qianjiang Zhengyang 3 Phase / C-JECH Discharged into Apeng River Proposed hospital is in the city with complete New City Street, Qianjiang One after meeting the Class 1 B sewage network. WWTP is under construction WWTP District standard in Urban WWTP and to be completed in the end of 2010 Pollutant Discharge Standard Youyang Hejiaba Village, 2 Phase 1 Orbal Discharged into Youyang River Sewage pipeline network has been connected County Zhongduo Town, One 4 oxidation after meeting the Class 1 B with Heping Road adjacent to the hospital WWTP Youyang County Long Term ditch standard in Urban WWTP process Pollutant Discharge Standard 98 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 2 Wastewater Treatment Process should be Designed according to the National Requirements WWTP should choose the treatment process according to the scale and nature of the hospital, and where the wastewaster is discharged. Project hospitals should guarantee that their wastewater treatment should meet the above-mentioned standards, and their design in compliance with the medical wastewater treatment technique recommended by the National Standard GB 18466-2005 . Specifically speaking, except for Wushan County which adopts Secondary treatment plus disinfection process, all the other district and county hospitals adopt the enhanced primary treatment plus disinfection process. The screenings from the medical wastewater treatment stations for CURIP II hospitals is regarded as medical waste (hazardous waste) and should be disposed of together with the sludge from other water treatment facilities such as the septic tank. Therefore, the Chongqing Municipal Environmental Protection Bureau requires that the sludge discharged by the medical wastewater stations should be treated and disposed as medical waste. Sludge from medical wastewater treatment stations (including septic tanks) should be treated through lime disinfection and kept in impermeable reservoir for temporary storage. The contracted medical waste treatment institutions are responsible for the collection and disposal of these wastes. Hazardous waste of Wanzhou District, Wushan District and Chengkou County are subject to the treatment of Wanzhou Solid Waste Treatment Center; that of Qianjiang County and Youyang County are subject to Qianjiang Solid Waste Treatment Center; and that of Tongnan are subject to Yongchuan Hazardous Waste Disposal Site. Please refer to Section 3.5.2.2 for relative information about the hazardous waste disposal sites. ( 3) Pre-treatment or Separate treatment on Some Special Wastewater When designing the WWTP, it is recommended that wastewater from infectious disease areas and non infectious disease wards should be collected in separate ways according to the clinical departments and ward allocation. Project hospitals in Tongnan County, Wanzhou County, and Youyang County have set fever clinics, and therefore install septic tanks for infectious disease to sterilize infectious waste including fecal excretions. Wastewater and fecal excretion of infectious disease ward shall be treated together with other medical wastewater after further disinfection. The following wastewater should be collected and disposed separately, and then discharged into the hospital wastewater treatment system: Oil wastewater treatment in oil separating tank Processing of low level radioactive wastewater in decay tank Waste recycling and precipitation of silver Collecting and processing of dental wastewater containing mercury by mercury filtering recovery device Separate collection and treatment of laboratory wastewater according to the nature of chemicals 99 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report ( 4) Investment and Operation Cost Saving in Medical Wastewater Treatment Design On the precondition of meeting the technical standards, the design of medical wastewater treatment station should take full advantage of the bits in hospital construction and the land used for greening so as to promote the land utilization rate and save construction cost. Terrain elevation with urban wastewater sewer network should also be taken into consideration so as to facilitate gravity flow drainage, save operation cost for PIUs, and conserve energy as well. ( 5) Both Development and Risk are Considered during Medical Wastewater Plant Design For the scale of WWTPs, the design should leave enough space for hospital development. After completion, projects should satisfy the wastewater treatment demand of project hospitals in a relatively long service period. At the same time, it should be capable of handling potential emergencies and impacts, such as: WWTP Equipment Emergencies WWTP equipment accident or pipeline leakage; Sudden hike in the number of hospital visits and the volume of medical wastewater due to epidemic outbreak. According to the analysis above, it can be inferred that the ward and none-ward medical wastewater of project hospitals in CURIP II are together collected instead of separately and therefore mostly are conventional waste with the relatively low volume or concentration of pathogenic microbes, toxic, harmful physical and chemical pollutants. In full compliance with discharge standard, the design has taken full use of existing or under-construction WWTP and pipelines. The medical wastewater treatment process is designed based on the national standard and preliminary or separate treatment is given to special wastewater. On the precondition of meeting the technical standards, the design of medical wastewater treatment plant should take full advantage of the bits in hospital construction and the land used for greening so as to promote the land utilization rate and save construction cost. Terrain elevation with urban wastewater sewer network should also be taken into consideration so as to facilitate gravity flow drainage, save operation cost for PIUs, and conserve energy as well. Besides, both development and risk are taken into consideration during the plant design. In the principle of full-process control, on-site treatment, standard-meeting and risk- management, as well as ecological security required in the Hospital Wastewater Treatment Technical Guide, CURIP II hospitals have taken the full process of wastewater production, treatment and discharge under control in designing their WWTPs. Above all, CURIP II hospitals have made full use of infrastructures such as existing WWTPs and medical waste (hazardous waste) disposal sites, and strictly complied with national standards in designing wastewater treatment. Preliminary or separate treatments have been conducted to some special wastewater. Besides, construction and operation cost control are emphasized during design. Consideration has also been given to development space and risk containment. All of these can meet the demand for impact mitigation. Therefore, it is feasible after some proper adjustment. ( 6) Adjustment Analysis on the Wastewater Treatment Process of CURIP II Hospitals According to the Bank’s recommendation about cost saving and safe operation, CPMO has invited professional medical wastewater treatment specialists to offer recommendation based 100 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report on technical and economic analysis. Fig 4-2 shows the enhanced primary treatment and disinfection process recommended; Fig 4-3 shows the secondary treatment (hydrolytic acidification and biological contact oxidation) and disinfection process. As a matter of fact, the secondary treatment process happens to be the choice of Wushan County TCM Hospital for its wastewater treatment and environmental analysis. Waste gas Deodorization Grease trap Coagulant Disinfectant waste gas emission Non-communicable Coagulation and Septic tank Regulator Sedimentation Contact chamber Medical wastewater Screen pool Disinfection Municipal sewage pipe network Sludge removal Sludge tank Instruction of the process: The medical wastewater flows from the septic tank into the regulator pool, in the front of which automatic screens are installed and within which there is a sewage lift pump. The wastewater, after being lifted (or using the gravity flow) enters into the next pool for coagulation and sedimentation. After that, the wastewater flows into the disinfection rank to be disinfected and then is discharged after meeting certain limits. 101 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Fig 4-2 Enhanced primary treatment and disinfection process recommended Waste gas Waste gas emission Other preprocessed Deodorization waste water Waste Waste Waste Septic tank gas gas gas Disinfectant Biological Contact Dechlorination Non-communicable Septic Dechlorination Scre Regula Hydrolys chamber Contact wastewater tank ens tor is pool Oxidation pool Drainage standard or into Disinfected the surface Fecal water sludge Sludge precipitatio Sludge precipi n sterilization tation Sludge removal Communicable waste water Pre-disinfect Disinfectant Lime pool disinfection 102 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Fig 4-3 Secondary treatment process of the medical waste water Instruction of the secondary treatment disinfection process: regulator pool→hydrolysis acidification pool→biological contact oxidation pond→disinfection. The medical wastewater flows from the septic tank into the regulator pool, in the front of which automatic screens are installed and within which there is a sewage lift pump. The wastewater, after being lifted (or using the gravity flow) enters into the hydrolysis acidification pool to reduce its COD and improve its biodegradability. After that, the wastewater flows into the biological contact oxidation pond for further treatment and then into the disinfection tank for disinfection. Finally it is discharged after meeting certain limits. Fig 4-4 shows the secondary anaerobic biomedical treatment process, a kind of enhanced primary treatment, to be adopted by CURIP II hospitals in Tongnan County and Qianjiang District. Precipitation and regulator Anaerobic Anaerobic Medical Screens Tank Re-precipitation pool Tank wastewater tank Sludge lumps removal Sludge pool ClO2 The pre-processes wastewater is Clear water discharged to the sewage treatment station Disinfection tank tank in accordance with the Medical Organization Wastes Discharge Standards (GB18466-2005) 103 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Fig 4-4 The secondary anaerobic biomedical treatment process of the CURIP II hospitals in Tongnan County and Qianjiang District. To further standardize the medical wastewater treatment process of CURIP II hospitals, with reference to the comprehensive comparison and analysis of various biological treatment processes and disinfection methods in the Hospital Wastewater Treatment Technical Guide ( [2003]197), hospitals using secondary treatment processes are advised to adopt hydrolysis acidification and biological contact oxidation method for the medical wastewater biological treatment recommended by concerned specialists. Sludge disinfection uses the cheap and widely available lime. The on-site preparation and usage management of ClO2 are familiar to most domestic water supply plants in Chongqing. Though it costs a bit more than liquid chlorine, ClO2 remains a good choice given the fact that the limited scales of CURIP II hospitals’ wastewater treatment centers, the small amount of ClO2 to be used and that hospitals are more sensitive to liquid chlorine. ClO2, a strong oxidizer, will not produce any chloride byproduct in the disinfection process, and can remove Fe2+� Mn2+ ,bromide in the water and the odor. Moreover, such deficiencies of the domestic equipments as the unstable output, the limited capacity per machine and the low automatic level have been remedied by the technological progress, as is evidenced by the strong presence of running water disinfection plants in Chongqing in recent years. Therefore, it is proven to be environment-friendly and secure to use the on-site made ClO2 as medical wastewater disinfectant for CURIPII hospitals. Table 4-12 and Table 4-13 show the comprehensive comparisons of various conventional biological treatment processes and disinfection methods. Table 4-12 Comprehensive comparison of various biological treatment processes Types of advantages disadvantages Scope of application Capital processes cost Activated Bad operational stability; Big hospital with over 800 beds; SBR sludge prone to sludge bulking method for hospitals with less than 800 process Wide adaptability to wastewater of and washout; undesirable beds Relatively different natures separation efficiency 104 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Types of advantages disadvantages Scope of application Capital processes cost different natures separation efficiency small Biological High impact load capacity; steady; big Slightly high suspended Small and medium sized hospitals with Medium contact volumetric capacity; Small occupation solids concentration in the less than 500 beds; suitable for such oxidation area; relatively low sludge yield; no discharging water as a situations as small space, small water process sludge refluxing; simple operation and result of the abscission of quantity, fluctuating water qualities and management. biological membranes poor microorganism growing (BCO) environment, etc. Membrane High impact load capacity; operationally Low air-to-liquid ratio; Small hospitals with less than 300 beds; Bios- stable and good-quality discharging backwash needs for the suitable for such situations as small Reactor water; free from suspended solids and membranes; high energy hospital floor space, high water quality big viruses; Small occupation area; small or consumption and requirements (MBR) even zero excess sludge yield operational cost good-quality discharging water; Backwashing needed; Small hospitals with less than 300 beds; Relatively operationally stable; High impact load operationally complicated; big Biological capacity; no sludge bulking; high volume high consumption for Aerated load ratio; no need for the use of backwashing water Filter secondary sedimentation tank; no sludge refluxing; Small occupation area 105 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Types of advantages disadvantages Scope of application Capital processes cost Low price and energy consumption; easy Risks of failing to meet As interim measures for hospitals in management the physiochemical remote mountain areas and under- Simple indexes developed areas to realize secondary small biochemical treatment or enhanced primary treatment treatment process Table 4-13 Comparisons of conventional disinfection methods Disinfectant Advantage Disadvantage Disinfecting effect Lasting disinfecting effects; simple and carcinogenic and teratogenic THMs are produced; Effective in killing mature techniques; operationally easy; chlorine or Chlorophenol smell; Cl2 is strongly germs but not viruses liquid chlorine wisely accurate investment corrosive; slightly dangerous in operation and management NaOCl innocuous; safe in operation and carcinogenic and teratogenic THMs are produced; rising The same with that of management the PH value of water Cl2 (bleaching powder) Strong oxidation effect ; no THMs slightly dangerous in operation and management; on-site Superior to Cl2 byproducts; operationally simple and production and use only; sophisticated production ClO2 convenient; free from PH influence equipment; high standards for operation and management 106 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Disinfectant Advantage Disadvantage Disinfecting effect convenient; free from PH influence management Strong oxidation effect; short reaction slightly dangerous in operation and management; Effective in killing time; no organic chlorides byproducts; operationally complicated; low productivity of O3; high germs and viruses free from PH influence; increase the energy consumption, facility cost and operational cost determination of DO in water O3 107 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 4.2.2.4 Recommendation to and Requirements for Medical Wastewater Treatment Stations of CURIP II Hospitals The following is recommended for the design of next stage: 1 CURIP II hospitals are recommended to adopt the enhanced primary treatment plus disinfection process; or the secondary treatment (hydrolytic acidification plus biological contact oxidation) plus disinfection process in medical wastewater treatment. 2 Wanzhou District People’s Hospital is required to upgrade its WWTP from the enhanced primary treatment plus disinfection process to the secondary treatment plus disinfection process in medical wastewater treatment. 3 The site of medical wastewater treatment station should be confirmed with hospital internal and external environment and development into consideration Considering the special nature of medical wastewater, its treatment structure should be located on the downside of the prevailing summer wind with the main building as reference. Medical wastewater treatment building or structure of the general hospital with infectious wards should be strictly separated from the main building and other facilities. Medical wastewater treatment facilities should be located at least 10m from the ward and residential buildings, and should be isolated with green belts so as to minimize the negative impact of odor and fan noise on patients and residents. Space should be reserved in the overall planning when designing the medical wastewater treatment station for the benefits of expanding, construction, operation and maintenance. 4.2.3 Environmental Impact on Surface Water and Mitigation Measures Table 4-14 summarizes the wastewater discharge and disposal facility status. Table 4-14 CURIPII Hospital Wastewater Quantity and Treatment Facility Status Hospitals Domestic Domestic Medical Waste Medical Waste Sewage Quantity Sewage Water Water Treatment Treatment Quantity m3/d Capacity,m3/d m3/d Capacity m3/d Fuling District / / 265.4 270 Hospital 108 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Tongnan County / / 122.4 130 Hospital Wanzhou District / / 257 500 Hospital Dianjiang County / / 104 120 Hospital Wushan County 72.46 100 134.86 200 Hospital Chengkou County / / 285.4 300 Hospital Qianjiang District / / 180.2 200 Hospital Youyang County 108 The original 370.2 400 Hospital biochemical pool 110 After completion, storm water and sewage will be strictly separated by their respective pipelines. Storm water will be discharged into surface water so as to avoid any impact on the smooth operation of the terminal wastewater treatment plant. Before the completion of Jiangdong WWTP, Wushan County TCM Hospital’s Jiangdong Branch will discharge its wastewater into Daning River on the precondition of meeting the Medical Institution Water Pollutants Discharge Standard GB18466-2005 . And Wanzhou district component will discharge its wastewater into the Yangtze after meeting the standard. The wastewater of other project hospitals should first be treated by their own WWTPs, then be conveyed through sewer pipelines to district/county Municipal WWTPs for further treatment and finally discharged after meeting the standard. As the wastewater discharged (can only be discharged after standard meeting) is very small in amount with its regional flow no more than 0.012 m3/s. mostly only contain conventional pollutant factors, and COD, BOD5 and other pollutants are featured by low concentration and small amount, therefore, the project’s impact on surface water is extremely minor. The following measures are adopted to minimize the impact on surface water Strengthening management and guarantee equipment O&M Project hospitals should strengthen their management on medical wastewater treatment stations, and strictly implement the O&M requirements so as to ensure that the wastewater discharged meet the discharge standard or preliminary treatment standard. This represents the basic safeguard and mitigation measures of minimizing the impact on surface water. Strengthening protection of water source in project areas Wanzhou District People’s Hospital is adjacent to the water source of Gaofeng Town Water Plant 1,500m3/d , only 1.2 km away. But the hospital is not located in the water source protection zone, and the wastewater will be gullied into the Yangtze without entering the reservoir, therefore, it will not have any effect on the water quality of the reservoir. 109 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report However, considering that Wanzhou project is located in the catchment area of Gaofeng reservoir and that pollutants may flow into the reservoir accompanying drainage at the initial stage, it is recommended to set rainwater collection tank and system guiding drainage flow in the design of next stage so as to protect Gaofeng reservoir. Specifically speaking, measures may include the following: setting of rainwater collecting openings at the appropriate position on roadside to collect rainwater from road, sidewalk and roof; setting of rainwater collection pool; discharge of initial rainwater after a long period of drought after disinfection; building of rainwater pipe (about 0.5 km) to guide the drainage flowing into rivers on the downstream of Gaofeng reservoir so as to protect the water quality. The measures mentioned above can effectively reduce the project’s impact on surface water and ensure the quality of surface water meeting the function requirements. 4.2.4 Medical Solid Waste Impact and Mitigation Measures Featured in space pollution, acute infection and latency, medical solid waste may contain toxic materials such as infectious bacteria, virus, chemical pollutants and other harmful substances. Therefore, it must be treated by qualified institutions to avoid any environmental pollution. 4.2.4.1 Environmental Impact of Medical Solid Waste Medical solid waste is the carrier of both environmental pollution and disease spreading. It is infectious, injurious, genetic and chemical toxic, and offensive. Therefore, it will lead to water body, atmosphere, soil pollution, and endanger human health. (1) Infection Infectious waste can enter human body through the needle stick, abrasions or cut, or through mucosa, respiratory tract, gastrointestinal tract and other channels. Infectious wastes are major medical waste with relatively huge potential risk against human health and environment. (2) Injury Hypodermic needles and scalpels contaminated by blood, body fluid and other contaminations will not only cause cuts or wounds but also cause infection, and therefore has a very strong risk. (3) Biological toxic Toxic waste drugs can be passed through the aerosol in the air, and some cytotoxic drugs may lead to strong irritant and local damage after skin and eye contact. (4) Chemical toxicity Chemical toxicity is mainly from chemicals, disinfectants, developers, fixers of health care institutions. They are usually in small doses, and will lead to mucosal damage through breathing, swallowing and skin and eye contact. The most common injury is burns. (5) Offensiveness Offensiveness mainly comes from people’s horror toward medical waste and their disgust toward anatomy waste, mainly organs and stillbirth left after operation and anatomy. 110 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 4-15 and 4-16 show the chemical compositions of medical solid waste and their physical and chemical characteristics Table 4-15 Chemical Compositions of Medical Solid Waste glass plastic paper dressing kitchen wood biological metals brisk other Composition garbage organization and stone (%) 26.61 22.81 15.89 16.63 9.66 2.79 1.73 1.25 0.28 2.34 Table 4-16 Physical and Chemical Characteristics combustible calorific value humidity density chlorine mercury calcium lead average 83%-99% 3000- 35% 0.3kg/m3 0.4% 2.5mg/kg 1.5mg/kg 28mg/kg 6000kcal/kg Please see Table 4-17 for the amount of medical solid waste generation in CURIP district/county, and its collection, temporary storage and transportation( GB 18466-2005) . 111 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Table 4-17 the amount of medical solid waste generation in CURIP hospitals and its collection, temporary storage and transportation Hospitals Medical Collection and temporary storage Transportation and treatment waste, t/a 240.9 Collection: The waste is removed for centralized treatment in an anti- leak, sealed, safe and sanitary manner by special vehicles Fuling District Plus 4.2(sludge) Separate collection of waste in both bags and boxes of the solid waste treatment center of Fuling district in Hospital Chongqing. Temporary storage: Medical waste after disinfection treatment is packed in solid, impermeable and moist-proof airtight containers with adequate tensile The proposed temporary storage spot is 12 km away from strength and clear color logos. The medical waste is temporarily stored in Fuling medical waste treatment center. The transport the second floor of the basement in the proposed inpatient complex. This route is as follow: the hospital → Renming West Road → floor, covering an area of 30m2, is big enough to accommodate three Liming North Road → Liming South Road→ Taiji days’ waste, and is far from both the medical district and the patients’ Avenue → Fuhao Road→ the solid waste treatment recreational area. Storage facilities for medical garbage and living center garbage are separated, with the wastewater from the temporary storage floor directly channeled, through pipes, to the medical waste water treatment station. Medical waste can be transferred from the temporary storage floor to lower floors through the nearest elevators for medical waste, and then directly to the medical waste transfer vehicles through the waste channels on the west. The whole transferring route will not pass such sensitive areas as wards so as to avoid the risks of cross infection. In accordance with the regulation, preventive measures will be adopted in this new medical waste temporary storage spot. Brick walls and baffles will be built; Bold notice board will be set up; The spot will be cleaned and disinfected on a regular basis. Medical Waste Management Regulation shall be strictly implemented, 112 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospitals Medical Collection and temporary storage Transportation and treatment waste, t/a with professionally trained stuff dealing with the daily collection and transference of the waste under a strict registration system. Tongnan 33.58 plus The two medical waste temporary storage spots will be located at the Yongchuan district-located Chongqing Mingzhi District Hospital 4(sludge) northwest corner of the second floor and the east side of the fifth floor Environmental management Co.Ltd is responsible for the respectively, both far away from the medical district, food processing transference and treatment. The distance between the district and the patient’s recreational area. Storage facilities for medical hospital and this company’s centralized treatment site is garbage and living garbage are separated, with the wastewater from the 90km. The fine road condition and convenient temporary storage floor directly channeled, through pipes, to the medical transportation facilitate the transference process, mainly waste water treatment station. Medical waste can be transferred from the relying on Provincial Road 205, Chongqing Suining temporary storage floor to lower floors through the nearest elevators for Expressway, and Chengdu Chongqing Expressway. medical waste, and then directly to the medical waste transfer vehicles through the waste channels in the northeast corner. The whole transferring route will not pass such sensitive areas as wards so as to avoid the risks of cross infection. Wanzhou 76.3 plus 20 Medical waste is transferred to the storage spot by special hand trucks or The distance between the proposed spot and Yongchuan District Hospital (sludge) trailers which will be rinsed and disinfected on a regular basis. The district’s centralized treatment site is 20 km. The fine medical waste temporary storage spot under this project is located at the road condition and convenient transportation facilitate the southeast corner of the hospital (near the sewage treatment station), transference process, mainly relying on Wanzhong Road, separated from the living garbage storage facility and equipped with Changjiang Bridge, Wanzhou Avenue, Wanzhou Lichuan rainproof devices. It is in the waste concentration area, far from the National Road 318. medical district, food processing district, and populated areas. There are special entrances and exits around, making it convenient for the loading and unloading of medical waste and the staff’s and transfer vehicles’ in and out. In accordance with the policy requirements, the medical waste storage spot will have little impact on the surroundings. With hardened ground, the seepage-proof medical waste storage room avoids direct sunshine and is separated from the food preparation and supply area and the garage. Beside it is locked to prevent random in and out. Only the cleaning staff and vehicles with permission are allowed in for transference and cleaning purposes. Measures are also adopted to prevent 113 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospitals Medical Collection and temporary storage Transportation and treatment waste, t/a the rodents and insects. The existing water resource will be used for cleaning and disinfection. The drainage system within is linked with the sewage treatment station. Besides, the room is equipped with lighting, ventilation, protective clothing, standby bags and vessels. Dianjiang 56.9 plus 8(sludge) To strictly implement the medical waste management regulations, the Chongqing Fuling District Medical Treatment Center, County Hospital medical waste will be treated after classified collection. A new medical 108km away from the proposed spot under this project waste temporary storage room of 4m2 will be built in the southwest will be responsible for the waste removal. The detailed corner of the hospital complex. Clear signposts will be put up. Efforts route is as follow: Dianjiang→ Chongqing Yibin will be taken to ensure that the room is airtight and anti-leak, and that the Highway → Fuling/Changshou → Changshou Fuling proliferation of pathogenic bacteria is prevented by means of daily Highway → National Road 319 → Wujiang Road → disinfection and sterilization. Special attention will also be paid to the Park Road →Square Road → Square Ring Road →Wutai management work of the temporary storage, transference and treatment Road → Fuling District; of the medical waste. Wushan County 47.82 plus Each floor in all buildings of the hospital has a medical waste disposal The distance between the hospital and Wanzhou Medical Hospital 35(sludge) room and the inpatient department is equipped with medical waste Waste Centralized Treatment Center is 150 km. The fine channels. These wastes, after classified collection, are temporarily stored road condition and convenient transportation facilitate the in the first floor of the basement from where this waste is removed and transference process, mainly relying on the Shanghai treated by a qualified medical waste treatment company (Wanzhou Chengdu Expressway. Senhao Co.Ltd). Chengkou 88.56 plus 7.29 The medical waste temporary storage spot is located at the basement The distance between the proposed spot and Wanzhou County Hospital (sludge) storey 2 of the proposed project, far away from the medical district, Medical Waste Centralized Treatment Center is 130 km. patients’ recreational area, facilitating the in and out of the staff and The route is as follow: Chengkou County (Provincial transfer vehicles. The disinfectant and fluid, used after the daily removal Road S202)→ Kaixian (Provincial Road S102 and of medical waste, can be channeled into the sewage treatment station. Wanzhou Kaixian Highway) →Wanzhou (G318)→Changling Town Qianjiang 67.71 plus The waste temporary storage spot is located at the southern part of the The medical wastes are dealt with by Qianjiang Medical District Hospital 1.0(sludge) Zhengyang District, covering an area of 112 m2, far away from the Waste Centralized Treatment Facilities, which covers a medical district, food processing district and the patients’ recreational distance of 8.5 km, mainly through the Zhengzhou Road, 114 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospitals Medical Collection and temporary storage Transportation and treatment waste, t/a area. Storage facilities for medical garbage and living garbage are to offer on-site collection and removal service. separated, with the wastewater from the temporary storage floor directly channeled, through pipes, to the medical wastewater treatment station. Medical waste can be transferred directly to the transfer vehicles without passing such sensitive areas as wards so as to avoid the risks of cross infection. Youyang After the extension, the medical waste temporary storage spot will be The medical wastes are dealt with by Qianjiang Medical County Hospital located at the basement storey of the emergency complex, with clear Waste Centralized Treatment Facilities. The 43.8 plus 4.2 signposts. Preventive measures will be adopted. Medical Waste transportation distance is 50km, mainly relying on the (sludge) Management Regulation shall be strictly implemented, with National Road 319. The road condition is fine, and the professionally trained stuff dealing with the daily collection and transportation is convenient. transference of the waste under a strict registration system. Medical wastes, amounting to 100kg daily can be transferred from the temporary storage floor to the basement storey through the nearest elevators for medical waste, and then directly to the medical waste transfer vehicles. The whole transferring route will not pass such sensitive areas as wards so as to avoid the risks of cross infection. Sub-contractors will deal with the centralized treatment of these wastes. The waste water from the temporary storage spot will be channeled, through pipes, directly to the medical wastewater treatment station. The living garbage will be put in barrels and kept in rain-proof and anti-leak areas until the sanitation department staff come to remove them and get them treated on a regular basis. Note: The preventive measures aforementioned in the charts refer to preventing leakage, preventing little animals (mouse, mosquito, fly, cockroach, etc), and preventing direct sunshine and raindrops; The major measures for preventing little animals are: installing metal net at the sewers, using special door and putting mice-guard board beside doors to prevent mice; using screen windows and doors, transparent curtains with small holes, fly glue, mosquitoes and flies killer devices, etc; spraying cockroach-killing drugs on a regular basis; adopting measures to protect the ground and the paneling below 1 meter from water leakage. 115 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 4.2.4.2 Measures for Mitigating the Impacts of Medical Solid Wastes In view of the enormous harmfulness of medical wastes, the collection, temporary storage and transference of the medical wastes from the CURIP hospitals have inherent risks. To ensure the effective treatment and minimize the risks so as to avoid negative impact on environment, the following measures are to be adopted. 1 To establish a medical waste management responsibility system A medical waste management responsibility system is to be established in accordance with Requirements on Strengthening the Regulation over Management of Hazardous Waste and Medical Waste jointly issued by the Ministry of Environmental Protection and the Ministry of Health( [2011]19) . The Medical Waste Management Regulations (No 380 by the State Council) and Management Practices of Medical Waste from Medical and Health Institutions (No 36 by the Ministry of Health) will be strictly implemented. Integrated management will be put into place, covering all links from the procurement, utilization of medical products to the classified collection, removal and treatment of medical waste, etc. The medical and health institutions will be in charge of the classified collection and management of medical waste and its transference to concerned organizations for centralized treatment. The medical waste treatment organization will be responsible for the harmless disposal. The legal persons of the hospitals and medical waste treatment organizations will be the number-one responsible for preventing spread of diseases and environmental pollution caused by medical wastes, particularly preventing the illegal processing and utilization. 2 Disposal only, no recycling and utilization of medical waste It is stipulated in Article 14 of Medical Waste Management Regulations that no one is allowed to transfer or trade medical waste, and in Article 19 that the medical and health institutions should have the medical waste sent to the nearest treatment organizations for centralized treatment. Article 33 stipulates that before the completion of medical waste treatment facilities, relevant local government departments should work out a transitional medical waste disposal plan covering the collection, transference, disposal method and organization, which should meet the requirements for environment protection and sanitation. All of the aforementioned articles have made it clear that medical waste can only be disposed and that utilization is prohibited. Notification about Strengthening the Management Work of Medical Waste According to Laws issued by the Ministry of Health clearly put forward that no organization or personnel is allowed to traffic in, dump, recycle or utilize medical waste. (3) The sorted collection of medical wastes Equal attention should be given to the principle of maneuverability and the principle of suiting local conditions when the CURIP hospitals have their medical wastes disposed in accordance with the World Bank’s safeguard policy and EHS Guide and national laws and regulations. A feasible plan for the collection and disposal of medical wastes should be mapped out with full consideration given to such factors as regional identity, economic strength, environmental condition, technological practicability, cost validity, public attitudes, ecological and environmental conservation, etc. Practices have shown that in the process of implementing the World Bank’s EHS Guide, Medical Waste Management Regulations and Management Practices of Medical Waste in Medical and Health Institutions, classified collection proves to be the basic guarantee of 116 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report pollution prevention and harmless disposal. The wastes, stored in special containers with distinct marks and packed and stacked separately, shall be collected in a timely, convenient, safe and quick manner. Infectious wastes, pathological wastes, injury wastes, drug wastes and chemical wastes cannot be mixed; the first three kinds of wastes, once put in bags or containers, cannot be taken out again. When wastes fill 3/4 of the bags or containers, the bags or containers must be sealed in an effectively tight way. Plastic bags for medical wastes collection should meet the following specifications: Yellow—700×550mm plastic bag Infectious wastes Red—700×550mm plastic bag Contagious wastes Green—400×300mm plastic bag Injury wastes Red—400×300mm plastic bag Infectious injury waste The outer packing cartons shall meet the following specifications: Red carton with “Infectious Wastes � on it—600×400×500mm Green carton with “Injury Wastes � on it—400×200×300mm Red carton with “Infectious Injury Wastes� on it—600×400×500mm Such high-risk medical wastes as pathogens culture mediums, specimens, microbial strain and virus preservation solution, etc, should first go through pressure-steam sterilization or chemical disinfection at Laboratory, Pathology and other departments where they are produced, and then are classified into infectious wastes. Lot-sizing waste chemical reagents and disinfectants in the chemical wastes should be disposed by specialized agencies; Lot- sizing abandoned mercurial thermometers, sphygmomanometers and other medical instruments should be handed from instrument department to specialized organizations. The isolation and treatment of infectious wastes must be safe, effective and economical. Gloves and protective clothing must be put on when dealing with infectious wastes and any potentially hazardous waste. Medical wastes mixed with various components should be disposed in the same way as the most dangerous component is dealt with. Infectious wastes are thrown into classified garbage bags, confirmed by professionals and then isolated from non-infectious wastes. In accordance with related regulations, all containers for infectious wastes shall be marked “Biological Hazard�. Containers must be ensured to be anti-leak in the case of liquid infectious waste. All sharp objects shall be stored separately and be treated as medical wastes. Packing containers for sharp objects should be hard, anti-leak and puncture-proof. Needles and knives should be stored in anti-leak and puncture-proof containers with clear marks. Puncture-proof gloves should be put on when dealing with sharp infectious wastes. Besides, harmful chemical wastes cannot be mixed with ordinary, harmless or infectious wastes. Dilution, in most cases, cannot reduce the toxicity of the harmful chemical wastes. Each type of harmful chemical wastes shall be separately collected, transferred, stored and treated. When different types must be mixed, the incompatibility issue shall be considered. In case of accidents, leak and damage during the generation, stacking and storage of medical wastes, necessary control measures must be adopted, such as ventilation, relatively closed isolation system, safety measures, fire precaution measures and safety channels. During the 117 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report generation, classification, stacking and storage of the medical wastes, their packing and labels must meet the following requirements: wastes are classified and put in different containers; containers are marked with “harmful wastes�, wastes containers are ensured to be sealed at any time; fragile glass and plastic objects are packed with wrinkled package materials with adsorbent materials also packed in. (4) Strict adherence to related regulations about the storage and transportation of medical wastes All CURIP hospitals have their own medical wastes storage facilities and equipments. It is prohibited to place or pile up medical wastes in the open air. The wastes can be stored for at most two days before they are treated timely and effectively, for this can lead to offensive smell which has much to do with the decay of organic matters in the wastes and which contains such major pollutants as hydrogen sulphide, trimethylamine, methanthiol and ammonia, etc. The offensive smell is bad for health, for it is a malignant stimulation to the cerebral cortex. Soaking in the offensive smell for a long time will make people feel nausea, dizzy, fatigued and inappetent, etc. Moreover, offensive smell can lead to the worsening of some diseases. The temporary storage facilities of CURIP hospitals should meet the following requirements: The location of the facilities should be as far as possible from the medical area, the food processing area, the patients’ recreational area and storage facilities for domestic garbage, and convenient for the staff’s and transfer vehicles’ in and out. Watertight containment measures should be carried out and special management posts be set up to prevent unauthorized access to the medical wastes. Safety measures should be taken to prevent little animals (mouse, fly, cockroach, etc), leak, rainfalls and direct sunshine. The facilities should also be easy to clean and disinfect. Medical waste signs and the warning signs “No Smoking and Food� should be placed. To temporarily store pathological wastes, low-temperature storage and antiseptic facilities are needed. There should be “Biological Hazard� sign and entrance restriction management system for the infectious wastes and waste sharp objects storage facilities, which should be near to the wastes’ producing places. Meanwhile, the storage of these two types of wastes should meet the following requirements: The contents must not be exposed to air or moisture The storage temperature and period shall not lead to decay. When it is necessary, low- temperature storage facility should be used to prevent the proliferation of microorganisms and the offensive smell. The contents should be kept safe from mice and other animals. The storage facilities should not be open to the public. 118 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report After the removal of medical wastes, the temporary storage places and facilities should be cleaned and disinfected. It is prohibited to dump or stack solid medical wastes at places beyond the collection and storage spots, to mix medical wastes with other wastes and living garbage, and to desert medical wastes on the halfway of transference. ( 5) The manifest system of medical waste transportation will be strictly complied with. The manifest shall be filled by producing organization, transportation organization and receiving organization respectively, giving reference to the serial number, characteristics, features, package types, major dangerous components, taboos, emergence measures, the shipper, the model and plate number of the transfer vehicles, serial number of the manifest, etc. By strictly controlling the whole process of transportation, the surface water and the ecological environment along the transportation route are saved from accidental damages. ( 6) The due diligence review shows that the chosen institutions for medical waste disposal are qualified. The institutions chosen for medical waste disposal for CURIP hospitals are Fuling District Medical Waste Disposal Site, Yongchuan District Medical Waste Disposal Site, Wanzhou District Medical Waste Disposal Site, Qianjiang District Medical Waste Disposal Site respectively. The detailed information about these disposal facilities' capabilities and the amount of medical wastes of related CURIP hospitals being disposed is shown in Table 4- 18. Table 4-18. The amount of the medical solid waste to be generated by CURIP hospitals and the disposal capability of corresponding waste disposal facilities Name of the Treatment process scope of service The amount of wastes generated by plant and scale CURIP hospitals , t/d Fuling incineration process: Fuling district, Fuling District People’s Hospital, District 3t/d Changshou district, 0.67 Medical Dianjiang county, Waste high temperature steam Wulong county, Dianjiang County TCM Hospital, Disposal Site cooking process: 5t/d Fengdu county, 0.18 (the cooking process is Shizhu county Sum:0.85 under construction and is expected to go into service in 2012) Yongchuan incineration process: Districts and counties Tongnan M&C Health Care,0.1 District 15t/d in western Medical Chongqing Sum:0.1 Waste Disposal Site Wanzhou incineration process: Districts and counties Wanzhou District People’s District 5t/d in northeastern Hospital,0.26 Medical Waste steaming process: 8t/d Chongqing Wushan County TCM Hospital,0.23 Disposal Site Chengkou County People’s Hospital0.26 119 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Sum:0.75 Qianjiang High temperature The four districts and Qianjiang District Central District steaming cooking counties in Hospital,0.19 Medical process: 3t/d southeastern Waste Chongqing Youyang County People’s Disposal Site (the cooking process is Hospital.0.24 under construction and is expected to go into Sum:0.43 service in 2012) The medical solid waste disposal sites listed in Table 4-18 have been under planning and construction by Chongqing municipal government since 2004 (CQDO[2004]312) . Fuling District Medical Waste Disposal Site, Yongchuan District Medical Waste Disposal Site, Wanzhou District Medical Waste Disposal Site have passed the acceptance check and obtained their business licenses (for detailed information, see Section 3.5.2.2). The three sites have been running smoothly in recent years. Wanzhou District Medical Waste Disposal Site have accumulatively disposed 2 170 t medical wastes for Wanzhou district, Yunyang county, etc, yet there has been no negative impact on the surrounding surface water, environment and air and no complaint has ever been sent to environmental protection departments. All of this has shown that the supporting institutions are wise choices, not only for their disposal of the medical waste but also for their efforts in controlling their negative impacts on the environment so as to maintain the quality of the surface water and the air. Besides, according to the statistics in the above table, the amounts of medical wastes generated by CURIP hospitals only account for 10.6%, 0.7%, 9.4% and 14.3% of the capability of the four supporting institutions, showing that these disposal sites are capable of disposing the medical wastes of other health and medical institutions in their area in addition to the CURIP hospitals and that the accumulation of medical wastes by the CURIP hospitals are also acceptable and controllable for the supporting institutions. Summary: The three important measures for mitigating the impact of medical waste, including the establishment of the medical waste management responsibility system, the adherence to the whole-process management of the medical waste disposal, and the prohibition of recycling the medical waste, have largely controlled the spread, pollution and transmission routes of the medical waste. The classified collection is the basic guarantee for pollution prevention and harmless treatment. By sticking to the manifest system of medical waste transportation and related regulations about the storage and transportation of medical waste, the whole process of transportation is strictly controlled so that the surface water and the ecological environment along the transportation route are saved from accidental damages. The due diligence review has shown that all the supporting institutions are dutiful not only for their disposal of the medical waste but also for their efforts in controlling their negative impacts on the environment so as to maintain the quality of the surface water and the air, as well as the ecological environment. Turnover boxes are to be used the loading and unloading in the transportation process, for in this way the loading and unloading staff no longer need to touch the packets of medical waste directly so that the security concerns about being wounded by sharp medical wastes and infection risks are avoided. 120 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 4.2.5 Mitigation Measures on Radiation Environment Because project hospitals don't involve application of radionuclide in the medical practice, the report only analyzes mitigation measures on ionizing radiation. Safeguard measures should be adopted to minimize potential hazard on the radiation staff, receivers and their descendants by reducing radiation dose and improving radiation safety level. The target groups protected against the impact of project hospital radiation includes working staff engaging in radiation diagnosis, non-radiation staff and the public. 4.2.5.1 Sound Radiation Environment of Hospitals in New Sites and Expanding Hospitals According to the monitoring results by Chongqing Radiation Technology Service Center on the radiation environment of Tongnan MCH Hospital and Chengkou County Project Hospital, the average γ rates are 76 nGy/h and 94 nGy/h~121 nGy/h respectively, without noticeable fluctuation comparing to 78.0-83.2 nGy/h and 81 nGy/h (cosmic rays included) in Chongqing Radiation Environment Quality Report, proving that the radiation environment is sound in project hospital sites. 4.2.5.2 Project Hospitals Adopt Class III Low Risk Ray Device Radiation department of project hospitals mostly adopt medical X ray, CT and digital gastrointestinal machine (The inpatient building of Qianjiang district hospital hasn't set up radiation equipment). According to Classification Management Approach on the Ray Device ( issued by the State Environmental Protection Administration [No. 25 of 2005 ]) , class III ray device ( CT, X ray ) are adopted to carry out medical imaging videoing, diagnosis and treatment. Class III ray device, classified as low risk device, usually causes little injury to radiation receivers if accident happens. In addition, DR is adopted in filming, with no radioactive wastewater and solid waste generated. 4.2.5.3 Layout of Radiation Room and Radiation Protection in Line with National Standard 1 The layout of radiation room is in line with national standard The Project hospitals' layout of X ray device is reasonable with X ray room and CT room set in the one side on the bottom floor of hospital building in compliance with the requirement that "X ray device room for medical treatment should be arranged by taking the safety of neighboring rooms and places into consideration" in Medical X Ray Safeguard Standard( GBZ130� 2002) . ( 2) Protective measures of radiation room should be in compliance with national standard The following protective measures should be taken for medical equipment to be procured and installed according to Protective Equipment Standard of X Ray for Medical Diagnosis( GB8279-87) . X ray room with enough space should be set on the bottom floor of the building with the safety of surrounding environment taken into consideration. The newly built X ray room 121 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report should be at least 36 square meters and the space of multiple head X ray machine room can be larger according to actual condition. The protective layer thickness of the X-ray beam directing wall should be 2 mm lead equivalent, and that of other walls and ceilings should be 1 mm lead equivalent; The protective layer thickness of perspective room wall should be 1mm lead equivalent. The door and window of the machine room should be properly set with reasonable protective lead thickness. The machine room should be reasonably arranged. Things unrelated to diagnosis should not be put in the room. The waiting position of the examinees should be properly set, and be protected by appropriate measures. Good ventilation should be guaranteed and indicating light should be equipped outside the room. Protective facilities of all kinds with thickness of 0.5 mm lead equivalent should be adopted. Various auxiliary protective equipment should be equipped for each X ray machine, such as 0.25 mm lead equivalent lead rubber gloves, lead rubber apron, lead chair, etc. Auxiliary protective equipment for gastrointestinal and other special examinations should have relative larger lead thickness. Auxiliary supplies and those for special examinations should be provided to examinees. ( 3) Radiation dose outside the radiation room should be managed in compliance with national standard The radiation dose of working staff and people outside the radiation room in the project hospitals is shown in the Table 4-19. The control limit in the Table is the standard value used in Basic Standard on the Safety of Protection Ionizing Radiation and Radiation Sources (GB18871-2002) , and management limit is stricter limit required by CURIP II. The Table also shows that the radiation exposure dose allowed is in compliance with the Bank EHS guidelines. Table 4-19 Radiation Does Management Limit Standard or EHS Dose Control personnel Dose Limit Recommend Guideline Limit radiation workers 20 mSv/a 6 mSv/a( P 120µGy/W) GB18871-2002 public 1 mSv/a 0.1mSv/a( P 2µGy/W) workers above 50 mSv/a the age of 19 EHS Guideline disciples between 6 mSv/a the age of 16-18 Note: The P in the Table is target value for shield design 122 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report According to UNSCEAR, the additional dose of X ray radiation on working staff is 0.013 mSv/a and on the public is 0.004 m Sv/a based on the calculation in Annex A of the 1993 report, the control limit and management limit are fully met. 4.2.5.4 Protective Measures Against Radiation for the Working Staff and Examinees ( 1) Protective measures against radiation for the working staff Shorten the radiation hours; radiation staff should improve their diagnosis capacity and operation skills, shorten the exposure hours and avoid unnecessary long exposures as much as possible. In X ray radiation, the times of exposure should be minimized and repetition should also be avoided. The distance between the X ray pipe and the patients should be lengthened as much as possible Protective measures should be adopted; protective coats and clothes should be put on, and the photo should be given to the examinees in a separate room. When babies and toddlers should be examined and the staff have to be with them, lead robber protective coat should be taken. In chest and gastrointestinal fluoroscopy examination, bare hands should not extend into the x-ray beam. Regular monitoring should be conducted to the working staff so as to maintain the radiation dose within the limit required; X ray workers should wear X ray dosimeter, so as to get timely knowledge of the actual dose. The results of individual dose monitoring should be recorded into the file, and properly maintained. If the dose exceeding the limit, reasons should be found out and protective measures should be adopted. Potential exposure should be avoided: although the X ray radiation is kept low on the workers, potential exposure to the radiation still exist. Therefore, effective measures should be taken to prevent potential radiation. ( 2) Protective measures against radiation for the examinees a X ray should be properly used: The clinician must master the characteristics and indications of medical imaging technology of all kinds. In the practice of medicine, the clinician should make sound clinical judgment based on the examinee's medical history, physical examination, clinical laboratory. X ray examination application should be delivered based on the actual demands after option comparison.; X ray examination should not be blindly proposed to the examinees. Besides repetition of X ray examination for no good reason should not be proposed; X ray working staff should carefully review the application, and reserve the right to reject unjustified applications; The necessity and scope of group X ray exam should be confirmed based on the endemic prevalence, expected results and long term effects. For each time of radiation, only one person is allowed to receive radiation in the room and stay in the room; 123 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Based on the actual condition, the examinee number, inspection area, and examination frequency should be put under control in group examination for the sake of medical care. X ray examination on women of childbearing age and pregnant women must be consistent with the requirement that Protection Standard on X Ray Examination of Women of Childbearing Age and Pregnant Women (GB16349-1996). X ray radiation of babies and toddlers should be put under strict control b) Major measures reducing examinees radiation dose include: The performance, protective facility, and operation of X ray machine should be in compliance of Standards for Radiological Protection in Medical Diagnostic X Ray GBZ130-2002. Optimization analysis should be adopted to choose the best ways for X ray examination so as to obtain the diagnosis information and minimize the negative impact on the examinees. When X ray check is determined, it's advised to select X ray imaging examination except for some special needs. Principles of "high voltage, low current, and thick filter" should be followed according to the target subjects and objectives on the precondition of not affecting diagnosis information obtaining. X ray imaging should adjust the collimation system of the rectangular irradiation field, pay attention to accurate contraposition, and control the use of the minimum radiation field. Radiated area should not exceed 10% of the film; According to the projection direction, radiation area should be carefully selected, and other parts should be avoid from radiation. Non-radiation parts should be shielded with special attention paid to protection of sensitive organs including the gonads, bone marrow, female breast, fetal and child bone marrow. Exposure time should be shortened in X ray radiation. When X ray transmission is needed for orthopedic reconstruction and removal of aliens, continuous exposure should be avoided , and cumulative exposure time should be shortened. Before examination, X ray working staff should carefully examine the performance of all the equipment and facilities, scrutinize the examination plans and working conditions. Special attention should be given to the positioning and fixing to avoid mistakes in photographing. Besides, repetitive filming should also be averted with focus given to film technology. 4.2.5.5 Summary and Recommendations for Radiation Impact Mitigation ( 1) Summary of Radiation Impact Mitigation Measures 124 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report After adopting the above mentioned measures, Tongnan MCH Hospital will meet the standard with the machine's annual working hour amounting to 68h, and annual additional radiation dose of operators standing at about 0.17 mSv. The additional dose of other people is of limited amount due to their short stay. CURIP II project hospitals have followed the principle and requirement of "justification of practice" in the use of medical X ray machine, CT, gastrointestinal machine. According to the requests and suggestions proposed in the radiation evaluation, the annual dose of staff and people in or around the room is within the limit. The project, with acceptable level of radiation, is in line with Protection Standard against Ionizing Radiation and Radiation Sources ( GB18871-2002 ). Therefore, the project is feasible. ( 2) Recommendations With the expanding of hospital, the treatment and diagnosis items conducted in the radiation department will also increase with the increase of examinees. To protect the environment and the health of the staff, the following recommendations are proposed: Regulations and operation standard should be strictly followed. Over-dose, long-hour and short distance exposure should be avoided. Accidents hampering the public should be averted including mistakenly entering into the radiation room, radiation leak and scattering. Training on knowledge about protection against radiation should be strengthened for the working staff; regulations should be improved, and necessary measures should be taken to shorten the contact hours with the radiative factors. More staff should be engaged in the radiation department, and rotating mechanism should be adopted, for packaging, injection and scanning personnel in particular, so as to minimize radiation dose to the staff in an effective way. Testing equipment for radiation prevention and quality control should be installed to monitor the machine operation and radiation leaks. X ray room of Chengkou Hospital is constructed with solid barium brick and solid barium mortar. The construction quality should be ensured to meet the requirements of the shielding. Tongnan MCH Hospital can put a dual-head X ray machine and camera ( tube voltage, tube current are 125 kV, 500 mA respectively) in one room of 49 m2 , so as to meet both the Standard for Radiological Protection in Medical Diagnostic X- Ray( GBZ130� 2002) and the principle of "optimization". 4.2.6 Impact on Air Environment and Mitigation Measures 4.2.6.1 Analysis Air Environment during Operation Stage Major air pollutants generated during operation stage are odor, automobile emission, boiler gas, exhaust fumes of power generator using diesel and canteen. Major air pollutants emitted are CO, THC, NOx from automobiles and power generators using diesel; NOx, little SO2 and dust from boilers; and volatiles and aerosols of edible oil and food in high temperature with diameter less than 10 micron. Air pollutants generated by 125 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report WWTP are mainly H2S, NH3, and other fetid pollutants. These air pollutants, if emitted without any control, will not only harm environment quality but also hamper the patient health in the project hospitals. 4.2.6.2 Measures Mitigating the Impact on Air Environment During Operation Stage Vehicles parked in the garage of project hospitals are majorly small-sized EFI cars with their emissions reaching the standard. Although the cars in the garage are large in amount in certain period, their stay in the garage is short and emission small, therefore, their impact on hospital environment is minor. Besides, mechanical air supply and ventilation system are installed in the garage and lead to acceptable air quality for the hospital with limit impact on the environment. The power generator, as the only backup power supply, is not mobilized in most cases. It adopts light diesel oil as fuel with sulfur in it less than 0.2% so as to reduce NOx and HC emissions produced in the runtime. Gases emitted by diesel generator are exhausted through special flue to the roof of the hospital building. The discharge time is short, and amount is small, therefore the impact on ambient air is very small. Gas emitted by the canteen are defueled through electrostatic oil smoke purifying machine with fume removal efficiency of about 85% and emission concentration of about 1.01.8mg / m3. The gas is discharged through the flue pipe, therefore the impact on the ambient air is minor. The gas fired boiler adopts natural gas and other clean energy, and exhaust gas is going through flue and emitted above the roof of the building with small influence on the environment Exhaust gas of WWTP are collected and handled by activated carbon and then discharged from the roof through special pipe after reaching Medical Institution Water Pollutant Emission Standard( GB18466� 2005) . The activated carbons used are collected by the supplier. Therefore, impact on the environment is minor. After adopting the above mentioned measures, the gas emitted exerts limited impact on the environment. Regional air can still meet the ambient air quality requirement. Recommendation: Exhaust pipe should be set far away from residential areas, and not close to the doors and windows of adjacent buildings. The exhaust pipe should be higher than the surrounding buildings, so as to avoid disputes over pollution. The built-in smoke well of diesel engine need the heat insulation measures. 4.2.7 Impact on Acoustic Environment and Mitigation Measures 4.2.7.1 Acoustic Environment Noise during the operation stage are majorly generated by the exhaust fan of the underground garage, the water pump, the cooling unit, the sewage treatment station, backup diesel generators and noises at garage entrance and from the traffic outside. Wanzhou district hospital also generates compressor noise from the air negative pressure system. 126 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Noises generated by the equipment or facilities will not only impact surrounding environment but also hinder recovery of patients. Because project hospitals are located in the urban areas, hospitals are also affected by the traffic noises or daily life. 4.2.7.2 Measures Mitigating Impact on Acoustic Environment ( 1) Mitigation measures for noises generated by diesel generators, fans, air compressors The main noise sources of the proposed project are located in the basement or special equipment room. The backup diesel generator is set in special generator room in the basement with vibration isolation designs and solid-brick-made walls. Its ceiling hangs sound absorption structure, and is protected by galvanized perforated plate and filled with rock wool. The diesel generator room adopts the glottis; the generator is equipped with silencers; vibration reduction is designed for the exhaust fans of the generator room with the use of bend muffler for noise elimination; noise eliminating facilities are provided in the exhaust passage. Noise is significant reduced by taking measures such as sound insulation, noise and vibration elimination. See Table 4-20. Table 4-20 Measures Mitigating Noise of Project Hospitals and Effects Average Noise Level after Average Noise Source Mitigation Measures Mitigation Measures Noise Level Attenuation dB( A) Backup diesel 80~90 in underground floor 40~50 generators Central air- in underground floor or 70~80 10~20 conditioning room equipment room Underground 80~90 in underground floor 40~50 ventilation machine Vehicles in and out in the garage entrance 60~65 / of the garage and exist Cooling tower 60~80 on the roof / pumping 70~80 in the pumping room 10~20 compressor on the underground floor 80~90 20~30 machine or in the equipment room Central air-conditioning room of Fuling hospital is on the roof of its inpatient building ( 2) Measures mitigating noise from the cooling tower on the roof Reducing the vibration of cooling tower by shock absorber and robber; Setting a muffler on the outlet of cooling tower Using water cushion and silencer to eliminate noise; adopting glass reinforced plastics or steel angle to make a framework with PVC water plastic; and adopting louvered roof tiling in cooling tower with iron network for noise insulation. 127 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 15 The noise generated by the cooling tower can be reduced to 10~ dB( A) after taking above mentioned measures。 ( 3) Measures mitigating noises of vehicles and outside traffic Noise should be controlled by delineation of motor vehicle driving range, speed limiting, and vehicle whistle-prohibiting. Measures should be taken with reference to Section 4.2.1 so as to alleviate traffic congestion, and whistle-prohibiting should be taken to some road sections or during some period so as to relieve the impact of traffic noise Dianjiang TCM Hospital is impacted by the traffic noise of Guixi Road 10 m away with noise level at 56.8 dB( A) at daytime and 45.2 dB( A) at night. Its noise can be reduced further after the adoption of measures such as speed limiting and whistle prohibition. After moving to the new site, the distance between the edge of Tongnan MCH Hospital and the road center is 27 m. According to the environmental impact evaluation, the impact of the traffic noise is relatively significant on the hospital buildings against Lianhua road. Greenbelts and walls surrounding the hospital can be set within 23 m of the hospital to counter the impact. Besides, measures including speed limiting and whistling prohibition are also recommended for the nearby roads. Therefore, the following recommendations are provided: In addition to the measures mentioned above, the project hospitals can reserve more funds for noise reduction and refer to monitoring measures during operation period. Double layer hollow glass window are not necessary at the beginning of the project, because the monitoring results may indicate that it’s unnecessary for further noise reduction measures. Wanzhou project hospital is close to the newly planned Wanzhong Road. In the long term, the inpatient building and the east side of Wushan TCM Hospital Jiangdong Branch is under great impact of traffic noise at night. Qianjiang People’s Hospital Zhengyang Branch, 60m from Zhengzhou Road, is also influenced by the noise. Therefore the above mentioned measures should also be adopted to relieve noise impacting these hospitals. Based on the analysis above, CURIP II project hospitals will not exert any significant impact on their surrounding and internal environment after adopting optimized designs and preventive measures. Therefore, the project can meet the regional requirement for acoustic environment and will not affect citizen living in the surrounding residential areas during operation period. 4.2.8 Analysis on Environmental Risk 4.2.8.1 Analysis on Environmental Risk Major risk sources that may lead to environment quality deterioration or toxicity effect if accidents or emergencies happen during operation include: ( 1) Pathogenic microorganisms spreading through air ( water ) In clinical or non-clinical treatment, pathogenic microorganism exhaled by patients infected by respiratory disease may be spread through air and lead to cross infection with the use of the central air-conditioner. ( 2) Scattered medical waste Medical waste may be scattered in collection, carrying, and transportation. 128 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report ( 3) Medical wastewater leakage The medical wastewater pipe and WWTP may leak. WWTP may overflow when the amount is large. ( 4) Potential risk incurred by management of hazardous chemicals ( including dilute hydrochloric acid, sodium hypochlorite used by chlorine dioxide generator of WWTP) ( 5) Risk of radiation leakage The following accidents may lead to radiation leakage Doors - light interlocking device failure: diagnosis device can be operated no matter door is open or closed, and people can enter the room whenever and wherever possible for irradiation; Personnel stranded in the room: the staff or other people accompanying the sick into the room and not leave may be subjected to irradiation. Human error Major reasons leading to human errors include: the staff’s unawareness about the basic performance and structure of X ray machine, lack of experience or knowledge in radiation prevention, unfamiliarity with business technology and protection knowledge, no sense of responsibility; operation errors caused by violation of rules and regulations; poor management and leadership mistakes. Unnecessary repetition of radiation caused by insufficient analysis and operation mistakes. Unjustified radiation Unnecessary radiation due to X ray diagnosis abuse. 4.2.8.2 Measures Preventing Environmental Risks ( 1) Measures against pathogenic organism spreading through air Infection management responsibility system should be set up in medical institutions at various levels and operation standard should be strictly followed so as to prevent and control infection in the hospitals and avoid spreading of infectious pathogens, antibiotic resistance virus, conditional pathogenic bacteria and other pathogens. To control the scale of infection, infectious disease virus, once spotted, should be immediately delivered to infectious disease department. Special concern should be given to infectious disease and disinfection measures should be taken so as to contain the tendency and minimize the contact. To avoid cross infection, the project hospitals with fever clinic should set independent air- conditioning system for treatment and check room. The air-conditioning system should be isolated from the central ventilation system. ( 2) Measures to prevent medical waste scattering 129 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Medical waste management should be strengthened, and corresponding regulations should be established to link the responsibility with people. Strict medical waste transfer system should be set. ( 3) Measures against medical wastewater leak Requirement on operation and testing should be strictly followed; facility maintenance should be strengthened; aging fittings and valves should be replaced in a timely manner; emergencies tank with volume no less than 1/6 of the capacity should be set in the WWTPs of project hospitals whose wastewater are directly discharged into surface water after treatment. Emergency disinfectants (such as bleaching powder) should be prepared to avert the treatment equipment accidents that the wastewater may be discharged without proper treatment. ( 4) Measures against risks incurred by hazardous chemical management Management over the collection, storage, and transfer of hazardous waste should be improved and enhanced. Staff in charge of hazardous waste treatment should be appointed after receiving training on relevant laws and operation methods. Records should be carefully kept on hazardous waste. Vehicles transporting and warehouse storing hazardous waste should be equipped with emergency facilities for heat stroke prevention, fire control, and communication so as to ensure the rescue measures and communication ability after accidents. Emergency handling training should be held regularly to improve emergencies handling capacity. ( 5) Measures preventing radiation leakage According to the operation rules, all the interlock devices should be checked on a regular basis. Faults should be spotted and removed. And illegal operations should be prohibited. The number of people evacuated from the room should be counted. The machine room should be checked from all perspective. If some one is lingering during operation, staff in the control room should press the stop button immediately. The staff staying in the room can also press the emergency button on the wall so as to minimize the perils from radiation. The staff should strictly follow the requirement in the Medical X Ray Diagnosis Safeguard Standard( GBZ130-2002) . Under special conditions that the patient is accompanied into the room, the accompanying person should be protected by preventive measures and radiation should be minimized on the examinees and accompanies. Radiation workers must strengthen their study and training on professional knowledge, continuously improve the operation level and safeguard skill, and avoid common mistakes; improve the occupation morals, strengthen the sense of responsibility; strictly abide by the rules and regulations; managers should strengthen management, implement the safety responsibility system, and carry out regular supervision and inspection. When overdose accident happens, radiation receivers should be subject to medical examination and monitoring, and be reported to administrative departments as soon as possible. 130 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report It should be pointed out that the above mentioned measures are adopted under the condition that the ray device is out of control. In general, medical X-ray machine produces electromagnetic wave that radiation source can be cut off when the power is off. In the limited exposure range of X machine, the occurrence possibility of acute accident is very small. Attention should be given to chronic accumulative damage. 4.2.8.3 Environmental Risk Emergency Plan To prevent emergencies, handle major environmental pollution accidents in a timely and reasonable manner, and safeguard people’s health and daily activity, CURIP II project hospitals should formulate appropriate environmental emergency plan of high feasibility in accordance with The Law of Environmental Protection of People’s Republic of China, Chongqing Emergency Plan for Public Accidents, and Emergency Plan for Public Accident of Water Environment of Three Gorges Reservoir Area within Chongqing. Major contents of environment risk contingency plans include: Environmental factors identification, organization and responsibilities, handling procedures, emergency safeguard measures. Emergency handling procedures include: 1. rapid report; 2. fast response; 3. field control; 4. scene investigation; 5. field report; 6. pollution disposal; 7. regional planning of pollution area and news release; 8. pollution track; 9. alarm release; 10. investigation and case filing. Emergency handling mainly includes emergency handling capacity, communication security and training and drills. 4.2.8.4 Summary The potential environmental risks of CURIP II project hospitals include the spread of pathogenic microorganisms, medical waste and wastewater leakage, leakage of dangerous chemicals, hazardous chemical management risk, and radiation leakage risk. Risk management should be strengthened, and labor protection should be improved. Active measures should be adopted to prevent risks, reduce the probability of accidents, and reduce accident worsening degree and range of influence. Emergency response plan should be developed in aspect of organization, staff, facilities, training and so on. As long as appropriate preventive measures are adopted, risks can be controlled or prevented. 4.2.9 Social Environment Impact CURIP II project hospitals should not only highlight the safety, efficiency, energy saving and environmental protection of hospital buildings and facilities, but also introduce green hospital concepts including proper construction scale, reasonable architectural layout, complete building function, scientific supporting environment, procedure design science, fine patient service, hospital infection control, dangerous source management, efficient and reliable logistics, sound fire control facilities and a strong cultural atmosphere. The project has fully met the requirement proposed by Health Bureau of Chongqing that “medical service should be oriented toward patients, medical service should be improved and medical safety should be guaranteed�. It represents a major measure to reform the three-level medical institution, improve medical treatment system in project districts and counties, promote disease prevention system and health monitoring system, and establish public health emergency response mechanism. Standardized hospitals should be established with the introduction of hi- 131 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report technology and equipment including distance diagnosis so as to fill in the medical gap, build up medical personnel capacity, and improve the medical service quality of district/county hospitals. Through the project, residents in the project districts and counties can get access to equitable medical service at higher level. People’s living standard and health condition can be promoted and problems of “high cost of and difficult access to medical service� in districts and counties can be significantly relieved. Leapfrog development can be realized in fulfilling the objective of “treating common or minor diseases in local hospitals� and laying a solid foundation for “Health Chongqing.� The implementation of CURIP II will optimize the medical resource allocation in project districts and counties and provide medical safeguard for the development of Wanzhou, Qianjiang, Dianjiang, Wushan, and Tongnan. Therefore, the project is widely welcome by the residents in the project districts and counties. Projects in Fuling, Youyang, and Chengkou will not only improve medical service capacity and quality but also replace the stinky old wastewater treatment stations, and therefore are also welcome by the residents in neighboring areas. CURIP II will improve the consciousness of medical waste management and remove the faults in waste collection, transport and register. Ecological and residential environment will be improved after the implementation of CURIP II. Based on the analysis above, the positive benefits and effect of CURIP II is significant. 5 Alternative Comparison 5.1 With and Without Project Comparison The project hospital were established long time ago. 7 hospitals out of the 8 hospitals, were established before 1958, of which Youyang County People’s Hospital was even established during the Second World War period (1940). Only Qianjiang District Central Hospital was founded after Chongqing was directly managed by central government. Along with the improvement of people’s living standard and requirement of living quality, as well as the reform degree of health system, the size of current hospitals cannot meet people’s requirement. Due to poor design of buildings of existing hospitals, some new equipments and new technical proposals cannot be implemented, which seriously limit the upgrading of local health service level and the improvement of health service condition for local people, meanwhile limit the health service development of People’s Hospitals in project districts / counties, making it difficult there to realize the “Health Chongqing� objective within the 12th Five Year Plan period. Under the direction of general strategic objective of urban and rural integration development and reform by Chongqing Government, one of the promotion measures of health service capacity in “Health Chongqing� action plan (2008-2012) proposed by Chongqing government is: “Strengthen the construction of grass-root health institutions, establish whole county, township and village, three level rural health service network, start the standardization construction of 21 county hospitals, to ensure that at least there is one standard health center in administrative township and one village clinic which can reach standard level step by step in administrative village, try to realize that “minor illness can be cured in township and serious illness can be treated in county�; improve the health service network in urban communality, to ensure that at least there is one standard communality health center in each neighborhood community, realize complete coverage of communality health service network�. The construction of CURIP is corresponding to “start the standardization 132 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report construction of 21 county hospitals� in the government plan. Therefore, according to macroscopic social analysis and health service demand analysis of people, the implementation of health project is much better than without the proposed health project, which shows that the implementation of health project of CURIP is imperative under the situation. Based on macroscopic analysis, the detail environmental impact comparisons between with and without Wanzhou District hospital have also supported the implementation of the project. The environmental impact comparisons, between with and without Wanzhou District People’s Hospital (founded in 1977) Economic Development Area Branch Outpatient & Inpatient Comprehensive Building Construction Project, are shown in Table 5-1. Table5-1 Environment Impact Analysis between with and without Economic Development Area Hospital Branch Outpatient & Inpatient Comprehensive Building Wanzhou District People’s Hospital Economic Development Area Branch Outpatient & Inpatient Comprehensive Building Comparison With project Without project Comparisons Factor It will improve local health The local health Comparison results service condition obviously, and service condition is show that the promote the development of poor and it is difficult implementation of the planned Gaofeng Group in for local villagers to project will bring Economic Development Area. It see the doctors, which better social benefits will benefit the economic will limit the for the economic construction and improvement of development of development of the investment environment in Gaofeng Group in Economic the Economic Development Economic Development Area Social Area, and promote the economic Development Area. and local villagers, Environment development for the rural villagers nearby. It will not affect the living environment Land acquisition will only affect and production the living environment and measures of the production measures of few villagers in the villagers, and general in planned land improvement trend. It may acquisition area. partially increase regional traffic load. The medical wastewater will be The wastewater The construction of treated centrally and discharged pollutant discharge the project will according to related standard. quantity will not improve local water However it will also increase the change. Regional environment. pollutant load for the Gaofeng water environment Town WWTP and decrease the will not be obviously Water surplus treatment capacity of the improved or even Environment WWTP. It will bring less impact worse. It will increase on the pollutant discharge of the medical quantity in Yangtze River, and wastewater quantity not affect one of the drinking of various small water sources of Gaofeng health service Town� Gaofeng Reservoir. institutions, which cannot be effectively 133 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report treated completely due to poor medical wastewater treatment facilities of the small health service institutions. The project will bring a little No air pollutants The construction of waste gas, which has little discharge. the project has little Ambient Air impact on regional ambient air impact on the ambient and surrounding villagers. air quality. The medical solid wastes will be More medical solid collected, stored, transported and wastes will come disposed according to related from various small The construction of regulation, which has no obvious health service the project has little impact on environment. institutions, with poor impact on the solid collecting, storage waste issues. The and disposal collecting, storage, Solid Waste facilities, which may transportation and increase the negative disposal of medical impact of the medical solid waste according solid waste. to related regulation by big hospital may has less impact on the environment . The noise equipments will be No obvious noise The construction of arranged underground with noise sources. the project has little Acoustic prevention facilities, which have impact on regional Environment little impact on regional acoustic acoustic environment quality and surrounding quality. villagers. The land acquisition will destroy Original agriculture The construction of the farmland, but not concern ecological system the project will not forest and important ecological will be kept. affect important sensitive targets. The agriculture ecological sensitive Ecological ecological system will be targets. The transfer Environment transferred to urban ecological scope of the system. ecological system is small, which has no obvious impact. Recommendation Recommended Compared 5.2 Alternative Comparison 5.2.1 Comparison of Site Locations This section is mainly concentrated on the site location alternative comparison for the new construction hospitals, such as Tongnan County M&C Health Care Hospital, Dianjiang County TCM Hospital Internal Medicine Building and Wushan County TCM Hospital Jiangdong Branch, and the results are shown in Table 5-2. 134 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Table5-2 Site Location Alternative Comparison for New Construction Hospitals in Tongnan County, Dianjiang County and Wushan County Hospital Alternatives Technical and Environment Recommendation Economic Impact Analysis Tongnan County Reconstruction in The original Huge resettlement M&C Health Care the original site, buildings became works of the Hospital (original No.2 Jianshe dilapidated houses villagers nearby; land area 3,300 Road, Zitong due to impact of stop the whole m2, very crowded, Neighborhood Wenchuan service of M&C inpatient building Community, earthquake; small Health Care; with total building Tongnan County. land area; need obvious impact on area of about demolish plus the environment 4,400 m2, construction including mode; with high operational rooms investment of about 3,800 m2) Relocated in Land Relocation with Planned D6-4, Jiangbei less investment development land; New without Recommended Development resettlement Area, Tongnan works of County villagers; small environment impact from both degree side and scope side Dianjiang County Alternative 1 Increase of 500 Located in the Close to existing TCM Hospital beds, high central of the hospital, Internal Medicine North side of resettlement County Town; convenient for Comprehensive Dianjiang County expense, difficult more traffic jam; service and Building TCM Hospital, for construction, huge resettlement management. Construction close to the high investment, works and Project existing inpatient with total difficult for building in the investment of implementation; hospital RMB 160 million big impact on the environment during the construction period. 135 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Alternative 2 Increase of 240 Located at Guixi beds, no Avenue with West side of north resettlement better traffic A little far away section of Guixi works, with condition, no need from the existing Revenue, Guixi convenient for the hospital, not Town, linear transportation and construction of convenient for the distance about more access road, with management. 700m from the development convenient existing hospital room, with total transportation; investment of less impact on the 108.5 million environment Recommended RMB during the construction period; easier for construction Wushan County North side of Suitable location, Land area of TCM Hospital provincial convenient for the 40,437.99,m2, Jiangdong Branch highway S103, health service for 2.2km from the Jiandong New the villagers both central of Wushan Development in old town and County Town, Recommended Area new urban area; more excavation convenient for quantity during hospital process the construction layout, easy to period. satisfy the natural lighting and ventilation requirements of Green Hospital; with a little more investment About 800m A little faraway Land area south side of location, not 10,067.17 m2, 3.5 provincial convenient for the km from the highway S103, health service for central of the old Jiandong New the villagers both Wushan County Development in the old town Town; with less Area and new urban excavation area; not quantity during convenient for the the construction hospital process period, but the layout; with less land area is too investment small to satisfy the construction requirements of the TCM hospital 5.2.2 Medical Wastewater Treatment Technical Options The technical options comparison results for medical wastewater treatment of project hospitals are shown in Table 5-3. Table 5-3 Technical Options for Medical Wastewater Treatment of Project Hospitals 136 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Proposed WW Treatment Suggested Option by Preferred Process Option Medical Wastewater option Treatment Experts and PMO Fuling District Screen → Regulating Tank Septic Tank → Screen → Proposed option People’s Hospital → Hydrolysis and Regulating Tank → is as same as Inpatient Acidification → Biological Hydrolysis and Acidification suggested option. Comprehensive Contact Oxidation + ClO2 → Biological Contact Building Disinfection Oxidation + Disinfection Tongnan M&C Secondary Anaerobic Septic Tank → Screen → Health Care Treatment + ClO2 Regulating Tank → Hospital Disinfection Hydrolysis and Acidification Proposed option → Biological Contact (Enhanced Primary Oxidation + Disinfection Treatment + ClO2 Disinfection) Wanzhou District Secondary Anaerobic Septic Tank → Screen → People’s Hospital Treatment + ClO2 Regulating Tank → Economic Disinfection Hydrolysis and Acidification Suggested option Development → Biological Contact Area Branch (Enhanced Primary Oxidation + Disinfection Outpatient & Treatment + Disinfection) Inpatient Comprehensive Building Dianjiang County Enhanced Primary Treatment Enhanced Primary Treatment Proposed option TCM Hospital + NaClO Disinfection + ClO2 Disinfection is as same as Internal Medicine suggested option. Comprehensive Building Wushan County Biological Contact Oxidation Septic Tank → Screen → Proposed option TCM Hospital + Disinfection Regulating Tank → is as same as Jiangdong Branch Hydrolysis and Acidification suggested option. → Biological Contact Oxidation + Disinfection Chengkou County Secondary Anaerobic Enhanced Primary Treatment Proposed option People’s Hospital Treatment + Disinfection + ClO2 Disinfection is as same as Inpatient suggested option. Comprehensive (Enhanced Primary Building Treatment + Disinfection) Qianjiang District Secondary Anaerobic Enhanced Primary Treatment Proposed option Central Hospital Treatment + Disinfection + Disinfection is as same as Zhengyang suggested option. Branch Inpatient (Enhanced Primary Comprehensive Treatment + Disinfection) Building 137 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Youyang County MSBR Process Biological Contact Oxidation Proposed option People’s Hospital + Disinfection Outpatient & Emergency Department Comprehensive Building The alternative comparison shows that the construction of CURIP is corresponding to the action plan of strengthening of county level health institutions and standardization construction of district / county hospitals mentioned in “Health Chongqing� (2008-2012) proposed by Chongqing government. The implementation of health project of CURIP is imperative under the situation. The proposed site locations of the new construction hospitals are based on the requirements of suitable size and hospital process design, technical and economic feasibility, as well as environmental considerations, which are identified and analyzed together by Project Owners and FSR Design Institutes. The proposed options are reasonable and feasible. The technical options comparison of medical wastewater treatment is based on the FSR design and project environmental impact analysis, according to “less investment and lower operation cost� principle proposed by WB environment expert. Chongqing PMO has invited medical wastewater treatment experts to provide suggested options, which are compared with the proposed medical wastewater treatment options in the EIA. Considering the situation of hospital departments’ arrangement and related facilities, the medical wastewater treatment plans for project hospitals have been confirmed finally, which can satisfy the medical wastewater treatment requirements for each project hospital`. 6 Environment Management Plan ( EMP) CURIP II Environment Management Plan for construction and operation period consists of proposed mitigation measures, environment monitoring, reporting requirement, emergency response procedures, institutional arrangement, capacity building & training, cost estimate and performance indicators, general code of practice in construction stage and medical wastes management plan. EMP will be a part of project management work. Project management offices at municipal, district/county level have appointed special staff to supervise EMP implementation status. Requirements in EMP must be incorporated into contractual document: 1) to ensure that the bid winner understands exactly their duties during construction; 2) to be a basis of enforcement and reporting once substandard measures taken due to breach of contract. Besides, the major mitigation measures and completion status of monitoring assignment could be linked with disbursement condition of the contract. 6.1 Purpose of EMP The purpose to prepare EMP is to improve activities of project screening, location selection, planning, design and implementation by establishment of practical and feasible measures to mitigate or compensate adverse impact and enhance favorable impact. In conclusion, measures required in EMP is to be taken to mitigate adverse impact and will be evaluated by 138 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report environment monitoring plan, then the further mitigation measures will be proposed based on the monitoring result. EMP includes mitigation, monitoring and institutional building measures in period of project design, construction and operation, which will be applied to mitigate or compensate adverse environment impact to an acceptable level and meet the requirement of related state and local environmental protection standard. 6.2 Environment Management Organization and Its Duties Environment protection management organization and its duties are shown in Figure 6-1. EMP organization consists of management agency, supervision agency, implementation agency and monitoring agency. 139 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Environmental management agencies involved at design and construction stages Supreme Supervision Agency Environment Management Organization during design and construction Chongqing Development and Ministry of Environmental Protection of PRC; Reform Committee (CDRC) The World Bank Ministry of Health of PRC Safeguard inspection Chongqing Environmental Protection Bureau; The Chongqing World Bank Management Chongqing Health Bureau Office (CPMO) Executive departments of the Chongqing environment Fuling EPB; Health Bureau of Fuling; protection bureau, Chongqing Development & Reform Tongnan EPB; Health Bureau of Tongnan; communication bureau, Committee and PMO at Project Implementation Unit Wanzhou EPB; Health Bureau of Wanzhou; Chongqing Health Bureau etc. district/county level; (PIU) Dianjiang EPB; Health Bureau of Dianjiang; (Participating hospitals) Wushan EPB; Health Bureau of Wushan; Chengkou EPB; Health Bureau of Chengkou; Qianjiang EPB; Health Bureau of Qianjiang; Liuyang EPB; Health Bureau of Liuyang; Environment Environment Communication Bureau of Fuling; Contractor Construction Design assessment units monitoring units Communication Bureau of Tongnan; supervising units units Executive departments at Communication Bureau of Wanzhou; district/county level: environment Communication Bureau of Dianjiang; protection bureau, communication Communication Bureau of Wushan; bureau, health bureau etc. Communication Bureau of Chengkou; Communication Bureau of Qianjiang; Communication Bureau of Liuyang’ Project Implementation Unit (PIU) Environment (participating hospitals) monitoring units Fig. 6-1 Environment Management and Supervising Organization of CURIP Environmental management agency II 140 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 6.2.1 Management Organization Environmental protection management organization and its duties are presented in Table 6-1. Table 6-1 Environment protection management organization and its main duties Organization Duties Remarks 1 daily environmental protection expert at On behalf of Chongqing Municipal least. Environment Chongqing Government and Chongqing Development supervisor (engineer) World Bank and Reform Committee, CPMO will is planned during Project coordinate and manage for CURIP, be construction, who is to Management responsible for making the environmental supervise the Office(CPMO) protection meeting requirement of WB environmental safeguard policy. protection measure as required in EMP and bidding document. Instruct construction unit to execute the state’s environment protection laws and regulations; be responsible for or Chongqing Responsible for supervise domestic approval of EA Environmental approval of EA report documents of sub-components, supervise Protection of major sub- implementation of environment protection Bureau components measures; be responsible in total for checking and acceptance of environment protection. Be responsible of Chongqing health Responsible for approval of EA report of major sub- project design, capacity building & components Chongqing training, supervision and management of Health Bureau health facilities at construction and operation stages. On behalf of government and Integrate and Development and Reform Committee at coordinate local health district/county level, it will coordinate and bureau, EMP, DRC at district manage for CURIP in their own communication bureau / county level jurisdiction, be responsible for making the to advance project. environmental protection meeting requirement of WB safeguard policy. Health bureau To be the health policy Supervising and managing of participating at district & guidance of local hospitals 141 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report county level hospitals hospitals To coordinate for a Communication Traffic management of participating smooth city bureau at hospitals at construction and operation transportation network district & stages at construction and county level operation stages Supervising and managing of Responsible for environmental protection measures within approval and their jurisdiction at construction and registering for EPB at district operation stages; Responsible for EA supplementary EA & county level approval & recording, and check and report of sub- acceptance of environment protection of components EA. 6.2.2 Supervising Organization Environment protection supervising organization and its main duties are described in Table 6- 2 Table 6-2 Environment protection supervising organization and its main duties Organization Duties Remarks Responsible for check and confirmation of EA files of Administrative projects. Supervising and management to the EP department of environment protection of the construction; organize Chongqing City and coordinate relating structures to serve for the environment protection; supervising implementation of EMP; responsible for final acceptance of Chongqing environment protection facilities of the project; Environmental Confirm the environment laws and regulations the Protection project should abide with; instruct environment Bureau protection bureau of areas and counties to supervise and manage the environment during construction and operation; accept, investigate and coordinate public complaints about the environment , supervising improvement of environment protection facilities and measures. 3 EPBs at district Accept guidance from Chongqing Environmental level: Wanzhou, Protection Bureau, detailed supervise the construction Fuling, unit to implement EMP, execute concerning 8 EPBs at Qianjiang; environmental management laws, regulations; district / county coordinate the departments to perform environmental level 5 EPBs at county works; responsible for construction, completion, level: Tongnan, check-up of operation conditions, supervision and Dianjiang , management of the environmental facilities for sub- Wushan, items inbound; accept, investigate and coordinate Chengkou, environmental complaints from public, supervise 142 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report environmental complaints from public, supervise Liuyang environmental facilities and improve measures. 6.2.3 Agencies Responsible of Implementation, Execution and Monitoring 8 hospitals under CURIPII are executing agencies for EMP. Contractors, being the implementing agencies for EMP, will implement contractual measures as requested in EMP and carry out internal environment monitoring. Chongqing Environment Monitoring Center and district/county level environment monitoring stations whose environment monitoring qualification have been certified by the State, will perform the individual and objective monitoring according to contractual agreement with executing or implementing agencies. 6.3 Code of Good Practice for Environmental Management The codes of good practice for environmental management are presented in Table 6-3. 143 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Table 6-3 Codes of Good Practice for Environmental Management Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) A. Design period / 1.Location Comprehensive analyzing and comparison of hospital sizing and location in aspect of Design CPMO, Health selection & environmental protection, social demand, technology, economy and engineering; institute, EA Bureau, DRC at dimension unit, social district/county The determined sizing and location shall be approved by related departments of governments at assessment level municipal, district/county level, as well as PIUs. unit 2.Ecological The location selection and general layout shall respect the principle of occupying fertile land Design CPMO, DRC & protection and quality forest land as little as possible. institute, EA EPB at measures unit, social district/county In order to mitigate acoustic environment impact, the green belt (sound filter) and bounding assessment level, Chongqing wall with plant attached will be planned in the adjacent area between proposed hospital and unit EPB, Forestry planned road or city road. Bureau etc. The layout of plant shall be highlighted in waiting area and in-patient building. 3.Traffic noise Optimize hospital flow design and general layout to mitigate impact of traffic noise during Design EPB at operation period. institute, EA district/county unit level The hospital location shall be easy accessible for patient and the beyond the noise reachable area. 4.Surface water Expansion of hospital at the existing location shall make fully use of domestic wastewater Design EPB at pollution treatment facilities in good operation. district/county institute, EA level, Water The appropriate process for medical wastewater treatment shall take advantage of current unit Resource Bureau infrastructure facilities with consideration of operation status for domestic wastewater 144 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) treatment plants of participating districts/counties (or town, economic development zone). The process shall meet the pre-treatment (WWTP in operation) or discharge (no WWTP). Subcomponent located in the catchment area of drinking water, the diversion and drainage system for rain water must be designed in detail as well as wastewater treatment. Under the precondition of process requirement, location for medical wastewater treatment station shall make full use of wing area, take fully consideration of green area at aiming of raising land utilization rate. Gravity flow is more preferred in water treatment process for the sake of energy saving. In addition, design capacity of medical wastewater treatment station shall consider development as well as risk. 5.Atmospheric The deodorization treatment for waste gas from medical wastewater treatment station shall be Design EPB at pollution in good design; optimization of layout of self-supplied diesel generator and noise control district/county design; optimization of ventilation design of underground parking lot; institute, EA level unit Optimization of layout of eatery and boiler room, and design of oil fume removal and vent system. 6. Medical waste General layout for temporary storage point of medical waste requires prevention of rat, fly and Design EPB at cockroach; district/county institute, EA level Water – sewage separation design is required in medical waste collection and transportation. unit Rinsing, drainage and diversion design for temporary storage point and waste collection trunk/barrel. Seepage control design for temporary storage point; 7.Lighting, natural Natural lighting and ventilation shall be well used in design. Design CPMO, DRC and ventilation, and EPB at 145 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) natural scenery district/county The hospital design shall take advantage of local natural scenery. institute, EA level unit 8.Radiation The general layout and prevention of radiation room shall meet the national code. Design Chongqing EPB, prevention EPB at The layout of radiation room must meet the requirement stated in “Standard for Radiological institute, EA district/county Protection in Medical X-Ray Diagnosis (GBZ130-2002)�: the placement of X-Ray diagnosis unit level, Health room shall fully consider the prevention and safety issues in the surroundings. Bureau 9.Risk control Based on the emergency response plan in relation to accidents of hazardous chemistry Design CPMO,DRC at transportation or medical waste collection and transpiration. district/county institute, EA level Design optimization: Clo2 disinfection room in WWTP, raw material (on-site preparation of unit clo2) storage room; ventilation facilities be put in place to strengthen ventilation; the smooth evacuation is the key point in designing of disinfection room where needs to be equipped by automatic alarm system for clo2 leakage. 10.Cultural relics The existence of cultural relics shall be investigated in the area where project located. Design CPMO institute, cultural heritage department 11. Water & soil The design needs to be optimized in: earthwork balance, dumping site, location of temporary Design CPMO, EPB at conservation piling point for surface soil. district/county institution, A level If the dumping site is built by subcomponent itself, the approvals from local Land & unit Resource Bureau and EPB are required and the water & soil conservation measure needs to be taken: retaining wall and intercepting ditch to be built respectively in downstream and upstream of dumping site, drainage ditch at both sides, outlet of drainage ditch needs to be 146 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) connected with sediment tank; leveling and forestation are required once dumping site completed. The temporary piling area for surface soil (used as an overlay) shall be designed with interception ditch and sediment tank, the color stripped cloth shall be atop on surface soil. 12. Construction Construction camp shall be located in the existing village or nearby, instead of closing to the Design CPMO, DRC and camp / access road environmental sensitive points. EPB at to construction institute, EA district/county site Access road to construction site shall make full use of existing road or to be built inside land unit level occupying area under the subcomponent; Access road for temporary use shall 1) be built on the village road with avoid area with large-scale residential point, school, hospital and natural vegetation in good condition, Construction camp not built in the existing village shall equipped by septic tank or urine directing toilet 13.Traffic effect The proposed hospitals will be located in the built-up or planning area and are adjacent to Design CPMO, DRC and municipal road. To prevent traffic jam in construction and operation period, the design shall be institute, EA EPB at optimized in hospital inside & outside layout, exit & entrance, parking lot. unit district/county level, Communication Bureau 14. Earthquake The level of anti-seismic capacity of the hospitals should be at least one level more than the Design CPMO, DRC and Has been ordinary civil structures in the project area. institute, EA EPB at included in the unit district/county main structure level, Health cost Bureau, 147 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) B. Construction refer to period chapter6.9 Interruption to The contractor should separate the construction area from the hospital medical services, set Contractor, CPMO, DRC and routine operation aside or build new secure channel for medical services and patients, specially assign full-time EPB at of Fuling District staff to ensure the clear access to the ambulance; district/county Hospital, level, Health Chengkou County The hospital should set up the flowers or fish tank in the hospital outpatient waiting area for Bureau, Forestry Hospital and viewing , to adjust the waiting crowd psychology, in particular, to strengthen the setting of Bureau Youyang County fixed and mobile medical advisory services; Hospital and impact on the Construction in night is prohibited. Optimization of medical care processes, shorten the waiting surrounding area time for the type-B ultrasonic, endoscope and other examinations. During the noon, operation of equipment with high noise should be banned. Hospital inpatient building adjacent to the construction site side, the windows and balconies should be closed properly. Contact the urban management department, to rectify unlicensed vendors and people occupied the road or places to do business in front of the hospital. The construction sites should be fenced with steel plates or wall with height more than 2.5 m and more than 3 m in sensitive sections. Open space should be established between the construction sites and the hospital buildings with warning signs set up near the site. Full-time staff should be signed by constrictors to guide people avoid the construction sites. Safety nets should be installed at site to protect the people near the site. Separate entrance and exit should be established exclusively for construction vehicles and workers. 148 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) Preparation should be done before the commencement of construction covering survey of local roads, power supply and communication. The contractor should develop construction plan with relevant authorities; emergency plan should be included in the construction plan to ensure the normal activities of the residents. Contractor should cooperate with traffic department and police bureau in guiding the traffic flow where necessary, and information on traffic management near the hospitals should be disseminated to the public via radio, TV or newspaper. Bulletin board should be set up at the construction site informing the construction schedule and the hotline number for complaints. The contractor should contact the relevant departments for development of water supply and water supply. In the area where the power capacity is low, the power supply line should be established for the construction site prior to the commencement of the construction. Access roads should be provided for pedestrians on the sensitive sections where hospitals, schools, residential blocks and commercial areas are located. Construction in night should be banned; where construction in night is necessary, permit should be obtained from local environmental department and the construction plan for night construction should be disseminated to the public near the construction site. Traffic flow of pedestrians and the construction fleet should be separated; Local me trials are preferred for procurement so as to reduce the transportation distance. Bus should be used for workers to travel between the camp and the construction sites. Mitigation to noise impact on surrounding area: 149 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) Noise control measures should be used and the location of equipment should be far from sensitive areas. Equipment with low noise level should be used and well maintained. Construction should be carefully scheduled on the section near sensitive areas. Travel speed of construction vehicles should be reduced when entering the area sensitive to noise. Construction in night should be banned; where construction in night is necessary, permit should be obtained from local environmental department and the construction plan for night construction should be disseminated to the public near the construction site. Equipment should be well maintained to reduce noise. Operation staff of equipment should be shifted to reduce the exposure to the noise; the worker near the noise source should be equipped with ear plugs. Transportation route of materials should be far from noise sensitive areas, i.e. schools. Equipment with strong noise and vibration should be banned from operating on noon. The road sections near the construction sites should be frequently sprayed with water. Before the construction, the site should be enclosed, the ground for construction and entrance should be hardened, vehicle washing devices should be provided on site. Construction site should be sprayed with water in excavation work; during the backfilling the site should also be spayed with water. 150 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) Stockpile yard for materials should be covered or sprayed with water. Spoil and construction waste should be collected and cleaned in timely manner. Overloading of vehicles should be avoided and the transportation vehicles should be covered. The transportation route for materials should be planned to avoid the area where traffic is intense. On the sections where traffic control is implemented, transportation in night should be carefully planned; the dust leaked during transportation should be cleaned. Before construction is started, the contractor should develop earth balance plan; spoil should be reused where possible, if not, the spoil should be transported to the deposit sites or landfill sites designated by municipal department. The solid waste should be collected and transported on daily basis to the landfill sites designated by municipal sanitation department. The earth and spoil should be piled and compacted, the pile should be covered. The area beside the roads should be prohibited from stockpiling of materials. Permit should be obtained for transportation of construction solid waste; Burning of construction solid waste should be banned. Management of wastewater The wastewater from construction sites should be treated in settling tanks before discharging into municipal sewers. Direct discharge of construction wastewater into surface waters should be banned. Education on surface water protection should be provided to the contractors. 151 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) Full-time staff should be assigned by contractors to supervise the collection and transportation of spoil. Direct dumping of spoil into surface streams should be banned. 1.Ecological Before construction kickoff, public bulletin board shall be set up around the job site for the Contractor, CPMO, DRC and 4.8 protection protection of wildlife and natural vegetation. And promotion and education for ecological supervision EPB at measures protection shall be conducted to the contractors; company district/county level, Health As soon as the construction staff enter the jobsite, ecological protection education shall be Bureau, Forestry conducted immediately, and relevant knowledge, laws and regulations regarding ecological and Bureau environmental protection shall be promoted; Full time staff from the supervision company and contractor shall temporarily undertake the supervision job on ecological and environmental protection. In the manner of patrol supervision, the execution of eco-protection measures and the staff’s protective behaviors shall be inspected; Issues regarding construction sites, camp sites, and access roads, etc. shall be coordinated with the local forestry administration before hand, so as to reduce the destruction to the uttermost upon the soils and vegetation around the jobsites; While temporarily using the farming land or forest land, the surface 30-40 cm soils on the land shall be scooped off, piled up or collected and preserved, and shall be reclaimed as soon as the construction is finished; Strengthen the management during construction period. Capturing and killing wildlife by construction staff, and abuse in cutting and slashing forest are strictly forbidden; The unidentifiable plants within the lands of the project shall be identified by the technicians from the local forestry administration station. If belonging to the protection by the nation, the plant shall be marked and transplanted to a safe location before construction kickoff; 152 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) For the hospitals in expansion, the principle of “protection on the spot� shall be applied to all the existing trees along both sides of the subgrade, the original ecological resources shall be preserved as far as possible. The civil work shall be arranged in non-rainy season so as to 1)improve effective load and transportation efficiency of vehicle;2)keep city clean by reducing water loss, making the air pollution by cyclone dust under control. Earthwork excavation in the project area shall be planned scientifically with the principle of “the earthwork transported and backfilled shall be as much as excavated� to avoid water pollution by water & soil erosion resulting from unnecessary piling and spoil earthwork. Side ditch and intercepting/flood discharge ditch shall be built before construction start to avoid the loose earth being flushed into river, pond, culvert or farm land by runoff. Earthwork in large scale shall not be arranged in rain season; earthwork in rain season shall be in a consecutive process of excavation, transportation, filling, compacting to avoid water & soil erosion; the temporary piling site shall be placed with simple bar, flood interceptor and simple sediment tank; the piling earthwork needs to be covered and compacted when storm comes Wushan County TCM Hospital Jiangdong Branch to be built under the sharp gradient geological condition is required to design with interceptor on the upper slope to discharge runoff. 2.Construction Keep the construction machines and vehicles in good working condition, reduce the Contractor, CPMO, DRC and 9.9 noise simultaneous working time of noisy equipments; supervision EPB at company district/county Properly choose and arrange construction machines, strive to use low noise equipment and level, Health place high noise equipment far away from noise sensitive areas; Bureau 153 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) Strive to avoid sensitive areas such as dense residential area, school and hospital in selection of transportation route; The climbing slope shall be avoided as much as possible; vehicle shall be at a slower speed and reduce whilst as much as possible. Strive to adjust construction time, and avoid affecting environmental sensitive locations such as hospital, school etc; When constructing around sensitive locations, adopt temporary noise reducing measures, such as assembled baffle plate around the construction area, pile up soil Bank as temporary noise reducing walls with excavated and compacted soil that was to be disposed. For continuous operation such as construction casting etc that require night noisy operation close to residential area, or day time noisy operation around schools, 3 days before the continuous construction, the construction company must apply to the local protection bureau following the application and approve procedure regulated in “Administrative Measures of Chongqing municipality on Prevention and Control of Environmental Noise Pollution�. After approval, a “Temporary Permit of Pollutant Discharge� will be issued; the construction company must keep the “Temporary Permit of Pollutant Discharge� on the construction site for reference before the continuous construction work begins, and announce it to the public in the form of bulletin board to try to prevent the noise from affecting the public population. Within 15 days before the college entrance exam and senior high school entrance exam, construction work at night that causes noise pollution is forbidden (excluding emergency repair) Construction machines such as pile driver and excavator must stop working at night (22:00— 6:00) Exit & entrance for construction vehicle for Fuling, Liuyang and Chengkou, the instruction from traffic management department is advisable to control or whilst forbid whilst 154 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) and no whilst at night with the purpose of mitigate noise impact to the surrounding resident, school etc. 3. Surface water Construction material, such as asphalt, oil, paint etc must not be placed close to rivers, fish Contractor, CPMO, DRC and 7.8 pollution pond or drinking water well etc, there must be sufficient canvas for cover to prevent the supervision EPB at material from entering water body on rainy days. company district/county level Farmland irrigation, might be affected by construction, shall be equipped with temporary ditch or water transmission pipeline to restoration or reconstruction permanent irrigation and water drainage system. When constructing close to water body, the water side of construction site must set up temporary retaining walls, to prevent earth and rocks from clogging up rivers, ditches, or irrigation & draining system, avoid affecting the water body or animal and plant in the water; To strengthen construction machinery management; the regular site for car washing and facilities for oil separation and sediment shall be put in place. Rainfall in construction will bring surface runoff with high content of SS and oil, the diverted drainage ditch and oil separation sediment tank are required on the construction site. The initial rain water through process of oil separation and sediment will be used to control dust or rinsing of construction machinery. The rain water in extra will be leached through land for discharging with reduced impact to surface water. Do not set up construction camp close to environmental sensitive point but the existing house can be used. To ensure the good health condition in construction site. To ensure the safety of drinking water. 155 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) To strive for using municipal wastewater pipeline to domestic wastewater discharge; construction camp not equipped with septic tank or urine directing toilet, the waste shall be mixed with soil and used for materials for greening or agriculture after construction completed. The temporary material piling site shall be at a hidden place instead of riverside, occupying farmland and place with beautiful scenery. The greening work or ground consolidation shall be completed as soon as possible after construction finished to reduce impact to surface water caused by rain water flushing. 4.Atmospheric It is suggested that asphalt mixing station use enclosed stirring device with dust-removal Contractor, CPMO, DRC and 6.6 pollution device; soil and concrete mixing station use enclosed stirring method; supervision EPB at company district/county Set up vehicle washing facilities and simple sand traps at the exit of construction sites; the level surface of the roads leading in and out of the stock ground and borrow site, dumping place etc must be kept wet and pave bamboo fence or grass mat etc to reduce the dust when vehicles pass by, or windy times. Soil transported with existing roads must not have high water content, or else mud will drip along the way, affect the tidiness of road, and produce secondary dust. In dry, rain-less and windy weather, the construction company must equip or rent certain numbers of street sprinkler to sprinkle water on unpaved temporary road, construction road and stock ground, twice a day (once each morning and afternoon) to reduce dust pollution. For sensitive locations such as school, hospital, residential area etc, sprinkle times should be increased in dry and windy weather. For stock ground that easily get sprinkled with fine powder substance, the location of the ground should be chosen downwind to sensitive locations, wind prevention and covering measures should also be taken to reduce dust; For the transportation of bulk concrete, sand and lime, covering measures must be taken to 156 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) reduce dust; Strengthen the maintenance of construction transportation machines and reduce exhaust gas discharge 5. Solid waste In the Fuling, Youyang, Chengkou and Tongnan county hospital projects, the sludge generated 3.0 during the demolishment of old medical wastewater treatment station should be limed on sites. Then the naturally dewatered sludge should be sealed and transported to hazardous waste disposal plant located in adjacent counties ( Fuling, Wanzhou and Yongchuan districts). Before civil works construction or transfer, the original sludge pond sites should be limed and stabilized. The asbestos as heat insulation material of old boiler room in Fuling people’s hospital should also be sealed and transported to Fuling hazardous waste disposal plant. The construction solid waste generated by demolishment of old building and construction shall be disposed in the slag disposal pit appointed by relative district/county construction commission. The extra rock and soil can be taken as covering soil in landfill or transported to construction waste disposal sites. The domestic solid waste collected by rain prevention litterbin should also be disposed in the appointed site. For works with large volume of soil, rock and solid waste transportation, as Wushan county sub project, spillage prevention measurement must be addressed during the transportation to avoid impact on urban environment and dust problem. 6. Cultural relics During the construction, once possible cultural relic is founded, the construction must be Contractor, CPMO, DRC and 1.8 stopped immediately. supervision EPB at company district/county The contractor shall protect the site and informing the relative cultural relic department at the level, cultural 157 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) same time. heritage management Construction can’t continue until confirmation from relative department obtained. department 7. Traffic impact Feasible construction plan and transportation impact mitigation plan should be included in the 27.9 bidding document: Logical arrangement of transportation timing and routes to avoid traffic jam; Setting up bulletin board on construction transportation road intersection to remind the social vehicles to detour. Construction material should be tided up and setting up fences in the construction sites adjacent road; If possible, extra size material, such as steel, and machines should be arranged in holiday or 20:00 to 22:00 with low traffic load. Specific staff should be designated to introduce vehicles to avoid destruction on municipal public facilities and adjacent buildings. Unless reported and approved, previous actions can’t be arranged during the night. Unloading noise mitigation measures and no-whilst measure should be adapted. Reduction of unloading vehicle lagging time on site to avoid traffic jam. During the construction period, the municipal water supply, sewer, natural gas pipes and electricity & communication line should be protected to avoid possible traffic jam cause by accident settlement. Applying for supporting from traffic patrol platform for following aspects; No parking in the access road of hospital construction sites; 158 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) In the specific time and road section, non-construction or non-patient vehicles should detour. Optimization of traffic signal in construction affected area; Traffic control in the construction area and adjacent roads on vehicles and pedestrian; Remote informing and diverting to passing big vehicles to alleviate traffic load; 8.Public Transportation of bulk material should not pass the township trade road or on the market Contractor, CPMO, DRC & 4.8 disturbance trading day. supervision EPB at company district/county Transportation at night shall at the slower speed and no hooking. level The construction activities should not ruin public service facilities at neighborhood. The municipal approval for temporary occupying sidewalk in construction is required; besides, the temporary access road for pedestrian shall be built. Seeped materials at construction site or splash by transportation vehicle to pedestrian shall take drainage measures timely; the vehicle for construction transportation must in slow driving in water gathered section. Fuling hospital, Chengkou hospital and Liuyang hospital: if the construction has to occupy overhead space of sidewalk, the solid platfond, rail and breast wall must be set, as well as lighting facilities. To easy contact with related agencies when complaints caused by noise, air pollution and other impact, billboard must be placed in a striking place on each construction site with information related to name of constructor, supervision company, hotline of local EPB, contact name. 159 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) 9.Health and Provide epidemic disease prevention information to construction workers; Contractor and CPMO, 3.6 safety supervision district/county Provide sufficient labor protection equipment to construction workers; company level DRC/EPB/Healt Provide safety prevention information to public population around the construction site; h Bureau Set up warning sign for danger at the construction site, forbid public population from entering the construction site or any other dangerous location; Strictly handle dynamic and explosive operation Interruption of The construction sites for the hospital of Fuling, Chengkou and Youyang should be fenced and Contractor Supervision - Hospital operation the entrance and exit of the site should be guarded by full-time staff assigned by the company, PMO contractors; During hoisting materials in the site, full-time staff of contractors should warn the people and guide them to avoid the proximity of the site; Material transportation vehicles should lower speed when entering the construction sites; The entrance and exit of the hospital should be guided Construction activity should be banned from 22:00 pm to 8:00 am; Lower noise equipment should be preferred and used on site. 10.Disease and Timber for construction (wood package for equipment included) from other areas must pass the local forest district/county 1.8 pest prevention inspection at local Forest Prevention Stations. prevention level forestry stations bureau 160 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) subtotal 72 training in EP training shall be provided to each contractor and 2 supervisors from supervision company CPMO CPMO, EPB 19.8 construction (senior leader included) before construction. period EMP and other EP document must be incorporated into special conditions of bidding document for making EP as a legal responsibility to contractor. C� Operation RMB 104/year 1.Traffic Traffic management inside of hospital to improve operation efficiency: to avoid traffic jam participating Chongqing EPB, 64.8 environment causing by vehicle lining up to hospital; to establish guiding system in the underground parking hospital, EPB at effect lot; to introduce a charge mode of paying parking fee in advance to avoid traffic block at exit. related liner district/county (to be covered departments level, Health by operation Optimization of external traffic organization to improve vehicle distribution condition: bureau, cost, 2 persons establishment of striking guiding system and sign board; consulting with municipal district/county for each management and communication departments to adjust, widen and channel part of roads level subcomponent) outside hospital. management department of Applying to municipal traffic management departments for taking administrative measures to municipal road at strengthening traffic management at exit and entrance of hospital. 1) �No parking� board will be placed nearby exit and entrance of hospital; taxi temporary stop will be set in the principle of proximity. 2) Improvement of public traffic facilities around hospital, as well as walking environment. 3) Rectification of occupying space by vendor to avoid traffic jam caused by people. 161 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) 2.Medical Medical wastewater treatment facilities for each hospital is in good operation, outgoing participating 17 wastewater wastewater can meet the national standard (pre-treatment standard for discharge standard); hospital Chongqing EPB, To make fully use of domestic wastewater treatment plant in each participating district/county: EPB at accepting hospital treated water which has met the pre-treatment standard. district/county level, Health The special wastewater in small amount needs to be pre-treated or individual treatment. Bureau Medical wastewater needs to be disinfected before discharge. The flat grate outlet will be placed at the road outside Wanzhou Hospital to collect rain water from road, sidewalk and house roof. The rainy water collection tank will have disinfection treatment on the initial rain water after a long period of drought. The rain water pipe to be built (0.5km in length) will divert the runoff to the downstream river of Gaofeng Reservoir with purpose of ensuing water quality of Gaofeng Reservoir. 3.Medial waste The classified collection trunk (barrel) shall be adopted for medical waste. participating Chongqing EPB, 198.5 hospital, EPB at The medical temporary storage point shall be placed with established prevention measures of medical waste district/county rat, fly and cockroach, leakage and raining water. treatment unit level, Health bureau Sorting collection barrel and temporary storage point shall have striking logo (signs) with different color; the cleaning and disinfection at a regular time basis is required. “Administrative Rules of Medical Waste� must be strictly followed with a routine procedure of collection & transportation by the appointed person in every day and filling up the shifting registration. Medical waste shall be transported by turnover box or small noise free rubber tire vehicle as much as possible. 162 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) The vehicle transporting hazardous substance and medical waste shall certified by three licenses (Business License, Business Permit to collect and handle dangerous waste, Business Permit to Transport for dangerous waste); The special purpose vehicle is required to transportation of hazardous waste and medical waste. The medical waste transfer system shall be respected. After transportation of medical waste piled at temporary storage point, the corridor passing through, elevator shall be in process of disinfection and sterilization. The emergency response team for handling leakage accident of hazardous goods and medical waste shall be established in each involved district/county; the emergency plan shall be developed too. 4.Radiation Standards for radiological protection in medical diagnostic X-ray( GB8279-87) shall be participating Chongqing EPB, ( to be listed respected in procurement and installation of medical facilities. hospital EPB at under operation district/county cost) The external exposure of radiation room shall meet the national standard. level, Health bureau The safety and prevention measures shall be taken to the working staff of radiation and examinee. Primary measures: radiation protection wall, protection door, lead glass to be put in place; strengthening management and training of technician in x-ray department; establishment of emergency response plan. 5. Solid waste The waste activated carbon in medical wastewater treatment station will be recycled and treated participating Chongqing EPB, 26.5 by qualified unit. hospital EPB at district/county Sludge (screenings included) in medical wastewater treatment station will be 1) in a sealed level package before lime disinfection and natural evaporation dehydration; 2) transported and 163 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) package before lime disinfection and natural evaporation dehydration; 2) transported and disposed by medical waste disposal site. Domestic waste will be collected and transported by the nearby waste collection station. 6. Waste gas Waste gas collected by medical wastewater treatment station will be in process of activated participating EPB at 58 carbon absorption to meet the “Discharge standard of water pollutants for medical organization hospital district/county (deodorization); (GB18466-2005)�before discharging on the rooftop through special pipeline. level The material used in the boiler room shall be the clean fuel such as natural gas. 84( to be listed Gas & smoke discharge facilities shall be placed in the eatery. under operation cost) 7. Noise Diesel generator, ventilator, air compressor (main source of noise) etc, shall be placed participating EPB at 44.1 basement or special equipment chamber. hospital district/county level ( to be listed Roof cooling tower: mitigation measures include vibration absorption, water muffler, external under operation blinds; cost) Track monitoring on external acoustic effect: Lianhuadong Road side of Tongnan Hospital; Wanzhong Road side of Wanzhou Hospital; Provincial highway S103 side of Wushan Hospital, eastern planning road of Wushan Hospital; Zhengzhou Road side of Qianjiang Hospital. The comprehensive noise control will be taken, together with track monitoring; if beyond 2nd grade of acoustic environment standard, further management measures will be taken. 8.Disease Physical check for the staff working in medical wastewater treatment station and being participating Health bureau at ( to be listed prevention responsible of classified collection; hospital district/county under operation level cost) 164 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Stage Code of Practice Implemented Supervised by Budget by (RMB104yuan) level cost) Staff in medical wastewater treatment station and being responsible of classified collection and staff engaging in classified collection shall be equipped with labor protection supplies, as well as rinsing & disinfection facilities. subtotal 300 /year Training in Dissemination of medical waste classified collection to hospital staff: to understand the participating district/county 8.4 operation period meaning of different color labeled on the classified collection bag (red: contagious waste; hospital level PMOs, EPB yellow: infectious waste; green: damage waste) D. Monitoring Environment monitoring at a regular time basis, refer to monitoring plan. district/county EPB at level district/county environment level monitoring agency Note: RMB 1.929mil yuan/year in operation period will be covered by operation cost; the medical wastewater treatment station and diesel generator will be included in engineering cost and is not presented in the table above. 165 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 6.4Environment Monitoring Plan CURIP II monitoring plan is presented in Table 6-4. Table 6-4 CURIP II Monitoring Plan Item Parameter Location Duration & Monitoring unit Supervision & Budget Frequency management unit (RMB, 104) Construction period refer to Chapter 6.9 Domestic wastewater Name of wastewater Internal monitoring: domestic wastewater Contractor, PIU, and PIU 1.6 on site treatment facilities, all of construction outlet at a random commissioned status (in operation or sites, all of domestic check monitoring unit not), effect, wastewater outlet discharged to pH� NH3-N� BOD5� External monitoring: twice/year, once for Chongqing EPB at district/county 6.4 COD� Oil� fecal coli selected construction dry and rainy season, environment level form sites 1 sample / each time monitoring center, or district/county environment monitoring stations Construction pH� SS� Oil Internal monitoring: non-polluted Contractor, PIU, and PIU 1.0 wastewater all of construction industrial wastewater commissioned sites outlet at a random monitoring unit check External monitoring: Twice/year, 1 sample Chongqing EPB at district/county 2.0 selected construction /each time environment level sites monitoring center, or 166 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Item Parameter Location Duration & Monitoring unit Supervision & Budget Frequency management unit (RMB, 104) sites monitoring center, or district/county environment monitoring stations Ambient air TSP� SO2� NO2 external monitoring: Once at the peak of Chongqing EPB at district/county 6.2 environmental construction every environment level sensitive points at year; sampling monitoring center, or school and residential requirement: 8h of district/county areas close to daytime for environment construction site (1 consecutive 5days for monitoring stations point) each point every time Acoustic environment Leq(dBA) Internal monitoring: random inspection but Contractor, PIU, and PIU 1.0 construction site at least once every commissioned boundary and adjacent month, 1 day for each monitoring unit residential building (2 time (day and night) points) External monitoring: once at the peak of Chongqing EPB at district/county 4.0 environmental construction every environment level sensitive points close season, 1day for each monitoring center, or to school & residential time(day & night) district/county area environment monitoring stations Traffic environment Traffic smoothness of Internal monitoring: random inspection Contractor, PIU PIU 2.0 related township road roads close to construction site 167 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Item Parameter Location Duration & Monitoring unit Supervision & Budget Frequency management unit (RMB, 104) Water & soil Top soil storage, Internal monitoring: random inspection, at Contractor, PIU, and PIU 1.0 conservation detention pond, construction site and least once for rainy commissioned intercepting ditch, all of dumping sites of season of every year monitoring unit flood discharge ditch, spoiled earthwork retaining wall etc. Disease prevention Clean water supply, Internal monitoring: random inspection Contractor, PIU, and PIU, Health bureau 1.0 medical consultation construction camp, commissioned etc. construction site monitoring unit subtotal 26.2 Operation period RMB, 104/year Medical wastewater pH� NH3-N� BOD5� External monitoring: Twice/year, 1 sample Chongqing EPB at district/county 7.2 COD� oil� fecal external outlet of /each time environment level, health bureau coliform medical wastewater monitoring center, or treatment plants for One time/quarter, 3 district/county participating hospitals samples/each time for environment Wanzhou and Wushan monitoring stations Hospitals Domestic wastewater External monitoring: once/year, 1 sample Chongqing EPB at district/county 1.6 external outlet of /each time environment level medical wastewater monitoring center, or treatment plants for district/county participating hospitals environment monitoring stations Medical waste collection facilities, Internal monitoring: Twice/year participating hospital EPB at district/county 1.8 temporary storage collection points, level, health bureau 168 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Item Parameter Location Duration & Monitoring unit Supervision & Budget Frequency management unit (RMB, 104) temporary storage collection points, level, health bureau facilities, pollutant- temporary storage cleaning distributary, points; collection – operation record, temporary storage handling loading & point;; temporary unloading, duplicate storage point – forms for transfer of loading site; hazardous waste Radiation effect radiation prevention Internal monitoring: Twice/year participating hospital EPB at district/county 1.8 measures; safety inside & outside of level, health bureau measures for working radiation room staff and examinee ionizing radiation External monitoring Once/year qualified environment EPB at district/county 2.0 monitoring station level, health bureau Solid waste waste activated Internal monitoring: Twice/year participating hospital EPB at district/county 1.8 carbon, sludge from medical wastewater level medical wastewater treatment station, treatment station; collection and domestic waste temporary storage points for domestic waste Waste gas NH3; Internal monitoring: Random inspection, at participating hospital EPB at district/county 1.0 neighborhood of least twice /year level, medical wastewater treatment station 169 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Item Parameter Location Duration & Monitoring unit Supervision & Budget Frequency management unit (RMB, 104) External monitoring: Twice/year Chongqing EPB at district/county 1.6 in the area of 10m environment level, outside perimeter of monitoring center, or medical wastewater district/county treatment station environment monitoring stations Noise Leq (dBA) the public Internal monitoring: Twice/year, 1 day for Contractor, PIU, and PIU 1.0 disturbed by the in-patient building, each time (day and commissioned noise? Or Leq (dBA) medical room, night) monitoring unit residential building outside hospital or school Leq(dBA) External monitoring: Twice/year, day for Chongqing EPB at district/county 3.0 environmental each time (day and environment level, sensitive points inside night) monitoring center, or and outside hospital (2 district/county points) environment monitoring stations Traffic environment Traffic in smoothness Internal monitoring: Twice/year Contractor, PIU, and PIU 1.0 exit & entrance of commissioned hospital, municipal monitoring unit roads close to the hospital Disease prevention Labor safety Internal monitoring: Twice/year Contractor, PIU, and PIU 1.0 wastewater treatment commissioned station for hospital monitoring unit and household; waste 170 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Item Parameter Location Duration & Monitoring unit Supervision & Budget Frequency management unit (RMB, 104) and household; waste collection and temporary storage points for hospital and household; subtotal 24.8 6.5 Capacity Building 6.5.1 Training Program To ensure effective implementation of EMP, the PIUs and monitoring agencies must be competent. Given the extensive coverage of mitigation measures and monitoring, the EMP training will be provided to PIUs and district/county PMOs in purpose of distinguishing their own duties so as to seek the agreement in object, methodology and detailed measures of environment management. Contractor, being the important trainee of training, is supposed to carry out mitigation measures required in EMP during construction period, be responsible for environmental safety of construction, and ensure the construction activities is within environment capacity. EMP training at construction period will be covered by project budget, while EMP training in operation period will be covered by operation & maintenance cost. Refer to table 6-5 for capacity building and training plan. Table 6-5 Capacity building and training plan Subject Trainee Content Frequency Day/ Person/ Budget, 104Yuan 171 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report time time Construction period Environmental PMOs at 1.EP laws & regulations 9 0.5 4 4.5 protection regulations district/county level & policies 2.EP policy & plan 9 0.5 5 PIU 3.WB environment 9 0.5 5 Contractor management EMP implementation Contractor 1.EP responsibility in 9 0.5 4 13.5 construction PIU 2.Main task of EP in 9 0.5 4 construction 3.Main content of EP in 9 0.5 5 construction 4.Reports required in EMP 9 0.5 5 5.Improvement or revision 9 0.5 4 of EMP 6.Internal monitoring 9 0.5 5 method, data collection & processing Crisis management PIU crisis management measure 9 0.5 4 1.8 172 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Contractor subtotal 45 19.8 operation period Environment PIU EP facilities, ecological 9 0.5 4 3.6 monitoring inspection, restoration, inspection of reporting soil & water conservation, environment quality monitoring, report preparation Environmental PIU 1.Research & management 9 0.5 5 4.8 protection facilities & of medical wastewater measures discharge 2.Medial waste: collection, 9 0.5 5 temporary storage and final disposal management 3.Environment safety 9 0.5 5 regulations & policy, procedure 4.Emergency response plan 9 0.5 5 subtotal 24 8.4 total 69 28.2 173 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 6.5.2 Equipment (Material) Procurement Plan CURIP II will carry out environment-friendly procurement plan. The environment-friendly principle could be extended to contract management, disbursement via procurement document, which requires contractual party to take mitigation measures and perform environment monitoring as requested in EMP. As high-cost of environment protection activities are classified into engineering measures, such as soil & water conservation, ecological restoration, medical wastewater treatment station, medical waste storing point etc, the corresponding materials and facilities have been included in engineering procurement plan. The corresponding procurement plan will be provided by contractor and operation units with fund being covered by project cost. Procurement plan for EMP equipment (materials) will focus on requirement of procurement procedure. In the implementation of EMP (mitigation measure) and monitoring process, the procured raw material and equipment supplier have to be certified by local EP executive department via environment acceptance procedure, while the kind of equipment & materials with lower cost but being unfriendly to environment and resource/energy wasting should be refused. Environment monitoring unit shall make commitment that: 1) no damage to vegetation, no garbage left on site; 2) wastewater and gas generated by monitoring or analyzing shall be treated to discharge standard. The procurement for compact equipment of medical wastewater treatment plant, such as pump, boosting pump, ClO2 disinfection facilities shall: 1) meet the requirement in terms of process demand, capacity and standard; 2) meet the requirement of EP regulations in relation to noise, waste gas leakage/discharge. The grass and sapling suitable to local soil and climate or being planted in an adjacent area shall be preferred in vegetation restoration, which will prevent the alien organism invasion. In conclusion, the raw materials and equipment to be procured shall meet 1) the requirement of process demand, treatment capacity; 2) the environment friendly requirement in terms of low environment load, energy saving, long service life, easy recycling and treatment, convenient to disassemble. As for NBF procured material and equipment, it’s still a part of CURIP II. The alternative procurement procedure is allowed but the quality has to be satisfactory, matching with others, timely delivery, environment friendly and cost effective. In addition, liquor, cigarette and other hazardous substance are non-environmental friendly and it’s inappropriate to be procured. 174 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report 6.6 Public Complaint and Feedback Mechanism 6.6.1 Public Complaint During environment impact assessment period, the public could 1) express their opinions via forum or filling up questionnaire sent by EA units; 2) put forward their comments or suggestions by sending a letter, email, fax, making a call to the contractor or EA units; 3) make complaint to district/county level EPB, local petition office. During construction or operation period, the public could 1) put forward their comments or suggestions by sending a letter, email, fax, making a call to the contractor or PIU; 2) make complaint to district/county level EPB, local petition office. In receipt of complaint from EP departments or rectification notice from administrative agency and the EA units, the contractor and PIU, together with related agencies, shall organize the site-visiting, investigation, publicize the rectification plan to solve EP dispute. 6.6.2 Feedback Mechanism Based on the environment monitoring report and inspection by supervision agencies, the mitigation measures in EMP will be adjusted accordingly and the environment management activities will be further improved. If major deviation from EMP found during inspection, or huge adverse environment impact caused by project variation, or the number of affected people by adverse environment increased a lot, CPMO will consult with the Consultant immediately. Meanwhile, WB will organize EA team to conduct additional assessment. The public consultation will be carried out, if necessary. The revised EIA with EMP inclusive must be submitted to WB after approved by EPB. The revised EMP shall be informed to PIU and contractor to perform accordingly. 6.7 Report Mechanism EMP implementation report schedule for CURIP II (Health Project) is shown as Table 6-6. The reports shall also include record (in form of picture and writing) of investigation, handling and response of public complaint. Table 6-6 EMP Implementation Report Schedule Stage and Name To be Prepared To be received by Frequency Report Type by Construction Stage Internal Internal Contractor Project Hospital twice each Monitoring Monitoring half year and Inspection Report Internal project Hospital District/county EPB, 1 each half Monitoring District/county PMO, year Report CPMO 175 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report External Each external contractor or District/county EPB, As per monitoring monitoring qualified District/county PMO, monitoring and inspection report environmental CPMO plan monitoring station Report to WB Semiannual CPMO WB 2 each year progress report Operation stage External Trial contractor or District/county EPB, once monitoring operation qualified District/county PMO acceptance environmental report monitoring station Internal Internal project Hospital District/county EPB, 1 each year Monitoring Monitoring District/county PMO Report 6.8 Emergency Procedure for Major Environment Impact during Construction Period During construction period, if major environmental impact incident happens (i.e. serious traffic jam or other cause which leads or could lead to suspension of hospital daily operation), contractor should take the following emergency procedure: Make the following analysis: whether the onsite equipment, material storage layout and route of transportation traffic is reasonable; whether the hydrological/climate condition is abnormal; whether any significant factor is interfering with construction and transportation; whether the supply of water, electricity, fuel and communication is normal; whether the staff from contractor strictly follow the construction procedure/rules, etc. Whether the environmental mitigation measures have been strictly followed during construction After excluding external factors, improvement suggestion on mitigation measures should be proposed or emergency plan to mitigate negative impact should be implemented, and supplementary environmental monitoring should be conducted following implementation of improvement suggestion or emergency plan The process/result of implementation of improvement suggestion or emergency plan shall be included in contractor’s internal monitoring report If, following investigation, construction and transportation factor are ruled out, measures should be taken to curb the spread of the negative impact, and report should be made to related government administration and PIU. 6.9 EMP Cost Estimate Costly environmental protection activities for CURIP II (i.e. water/soil conservation, ecological recovery, medical wastewater treatment and medical waste temporary storage facility) are all structural measures and their cost have been incorporated into engineering cost, which will be listed in the bid for the project. Cost listed in EMP is mainly for 176 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report environmental management during construction and operation period, which covers mainly mitigation measures, environmental monitoring and training with the total amount being RMB 4.512 mil. Cost estimate for the hospitals under CURIP II is summarized in Table 6-7 and 6-8. Table 6-7 CURIP II Environmental Protection Cost Estimate for Hospitals Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) Fuling After collection, to be District Odour deodorized and WWT Station discharged through 4 special pipe leading to housetop Air Pollution To be conveyed by 3 included in Diesel oil engine SO2� flue special pipe and engineering (temporary use) gas� NOX� CO discharged high above cost roof 162 included COD� BOD5 To be treated by newly in built WWT Station engineering Hospital wastewater SS� NH3-N (270m3/d, Enhanced cost Water Primary Pollution Fecal coliform Treatment+disinfection) Heavy metal, To be collected and Clinical laboratory acid, disposed of by external 3 wastewater qualified organization Alkaline Medical waste / To be temporarily stored in allocated room before disposed of by sludge / qualified external organization 25 Solid Waste Recovered by qualified Used active carbon / organization before reuse To be collected by Domestic garbage / sanitary service and 2 sent to landfill Proper layout, vibration Noise 5 included in mitigation, noise Equipment noise Noise engineering elimination, building as cost noise barrier Subtotal RMB 0.34 mil listed in mitigation cost in operation period 204 177 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) Tongnan After collection, to be County deodorized and discharged through WWT Station Odour special pipe leading to 5 housetop air Pollution To be conveyed by 5 included in Diesel oil engine SO2� flue gas, special pipe and engineering (temporary use) PM10� NOX� CO discharged high above cost roof Oil smoke purifier, to 10 included be conveyed by special in Kitchen oil smoke Oil smoke pipe and discharged engineering high above roof cost To be treated by newly COD� BOD5 built WWT Station 100 included (130m3/d, two stage in Hospital wastewater SS� NH3-N anaerobic+disinfection), engineering Water a canteen oil screening cost Fecal coliform Pollution tank to be built To be collected and Clinical laboratory Heavy metal, disposed of by external 3.0 wastewater acid, alkaline qualified organization To be temporarily stored in allocated room Medical waste / before disposed of by 9.0 qualified external organization Disinfected/water absorbed by lime and Sludge / 1.0 sent to medical waste disposal site Solid Waste Recovered by qualified Used active carbon / organization before / reuse To be collected by Domestic garbage / sanitary service and 2.0 sent to landfill To be cleared and Kitchen garbage / disposed of by qualified organization 178 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) Proper layout, vibration 3 included in mitigation, noise Noise Equipment noise noise engineering elimination, building as cost noise barrier other EIA, Environmental acceptance, environmental monitoring 20 Subtotal RMB 0.20 mil to be included in operation period mitigation measure 158 Wanzhou After collection, to be District deodorized, disinfected and then conveyed WWT Station Odour 12 through special shaft to be discharged high above roof Mechanical smoke discharge system/ transmission system to 20 included Air Pollutant be set up for gas fired in Boiler SO2� NOX� CO boiler, smoke to be engineering conveyed and cost discharged above rooftop of in-patient building To be conveyed by 8 included in SO2� flue special pipe and Diesel oil engine engineering gas� NOX� CO discharged high above cost roof A 500m3/d medical wastewater treatment station will be built; Clinical laboratory COD� BOD5 wastewater (containing 250 Water heavy metal ) to be Pollutant Hospital wastewater SS� NH3-N collected and disposed included in of by qualified engineering Fecal coliform organization; cost sewage network to rehabilitated and incorporated into municipal network. Solid waste Medical waste / Temporary storage 80 room for medical waste 179 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) room for medical waste to be set up, designated handcart/trailer and lift to be used; after being collected by type, to be sent (by Wanzhou Senhao Waste Sludge / Treatment Company) to Wanzhou Medical Waste Disposal Site to be treated in high temperature boiling workshop/ incineration workshop. Recovered by qualified Used active carbon / organization before reuse Stored in designated room to be sent by Domestic garbage / sanitary service to 10 Wanzhou Changling Landfill Proper layout, vibration 10 included Noise mitigation, noise in Equipment noise noise elimination, building as engineering noise barrier cost Temporary enclosure structural measures, plastic clothing fencing, Water/soil temporary drainage, conservation and 100 sand sedimentation others greening facility, permanent drainage ditch, landscaping EIA, Environmental acceptance, environmental monitoring 33 subtotal RMB 1.20 mil to be included in operation period mitigation measure 523 Dianjiang 20.0 to be County Dust control, noise control, wastewater treatment, construction noise, listed Construction construction waste clearing, spoil removal, water/soil conservation separately Period measure To be deodorized by Medical wastewater Waste gas Odour Granular Activated 11 station Carbon 180 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) 38 included 120.0m3/d WWT in Waste water Medical wastewater Fecal coliform Station engineering cost 10 included Noise separation/ Central air- in Noise Noise elimination treatment conditioner engineering for air cooling tower cost Medical waste: a 4m2 room for temporary storage; collected by type and disposed by Chongqing Fuling Medical Waste Treatment Center; to build a new medical waste temporary storage room 20 (enclosed and antiseepage); to be disinfected and sterilized every day to prevent pathogen spread; medical waste to be cleared daily Sludge from wastewater treatment system (medical waste): to be 5 treated by Chongqing Fuling Medical Waste Treatment Center Solid waste Used active carbon (hazardous waste) :Recovered by qualified organization before reuse Common waste(domestic waste): to add a 2m2 solid waste collection 3 room Hogwash oil from oil screening tank: to be collected and treated by organization authorized by EP and Health Administration 1800 m2 greening area 2 Other Regular monitoring by EP and Health Service; 1 online monitoring 20 facility at wastewater discharge point Subtotal RMB 0.39 mil to be included in operation period mitigation measure 129 Wushan Collected and County deodorized by granular activated carbon and WWT Station Odour conveyed through 5 special shaft to be discharged above rooftop Air Pollutant To be conveyed by 5 included in SO2� flue special pipe and Boiler, Diesel Engine engineering gas� NOX� CO discharged high above cost roof Oil smoke purifier, to 10 included be conveyed by special in Kitchen oil smoke Oil smoke pipe and discharged engineering high above roof cost 181 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) 2 WWT Station and 1 Oil Screening Tank to be built to treat medical COD� BOD5 wastewater and 200 domestic wastewater Hospital Wastewater SS� NH3-N with capacity at included in 200m3/d and 100m3/d engineering Fecal coliform respectively, emergency cost tank at the same capacity will also be Water built Pollutant To be collected and Clinical laboratory Heavy metal, disposed of by external 3.0 wastewater acid, alkaline qualified organization Collected separately and dried and put into Dentistry wastewater Heavy metal grind mouth bottles, to 2.0 be recycled by manufacturer Medical waste / To be temporarily stored in allocated room before disposed of by 20 sludge / qualified external organization Recovered by qualified Solid waste Used active carbon / organization before reuse To be collected by Domestic garbage / sanitary service and 2.0 sent to landfill To be cleared and Kitchen garbage / disposed by qualified organization 3.0 included Noise Proper layout, vibration in Equipment noise Noise mitigation, noise engineering elimination, building as cost others EIA, Environmental acceptance, environmental monitoring 30 Total RMB 0.32 mil to be included in operation period mitigation measure 280 182 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) Chengkou Spread water to reduce County dust, enclosure, harden 4 to be Site Dust the road at listed exit/entrance, flush separately vehicle/tyres Wastewater from construction equipment maintenance to be used SS for dust control 1.2 to be Construction following oil screening oil listed wastewater sedimentation; separately wastewater from COD personnel to be treated Construction by existing biochemical Period tank Construction debris and Spoil, spoil to be sent to construction Xiejiaopo Construction 6.7 to be Construction debris debris and Debris Landfill; listed domestic domestic garbage to be separately garbage disposed of by local sanitary service Temporary noise 5 to be Construction insulation wall to be set Noise listed noise up between site and separately original hospital, etc. 6 included Mechanical ventilation/ in Garage NO X THC airing engineering cost Waste gas Collected by blower and deodourized by WWT Station odour activated carbon before 11 discharge above rooftop through special duct 183 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) To discharged to municipal sewage network following meeting pretreatment COD� BOD5 standard after treatment 42 included with secondary in Medical wastewater SS� NH3-N anaerobic process in engineering Wastewater 300m3/d medical cost Fecal coliform wastewater station (enhanced primary treatment + disinfection) Included in Heavy metal and to be disposed of as Clinical laboratory solid waste organic hazardous waste by wastewater treatment chemical, etc qualified organization cost Collected by type and then packaged, sent to Medical waste, Chongqing Wanzhou / 8.5 medical sludge Senhao Waste Treatment Company for Solid waste innocuous treatment Garbage from medical area must be disinfected Domestic garbage / and sent by sanitary 3.5 service to designated landfill Foundation noise 5.1 reduction/ underground included in Noise Traffic and equipment Noise building noise engineering insulation cost Landscaping, topography and vegetation recovery, water/soil Others 37 conservation cost; EA, environmental monitoring etc. subtotal RMB 0.23 mil to be included in operation period mitigation measure 130 Qianjiang Collected and absorbed Odour by activated carbon Waste gas WWT Station then to be discharged 5 above rooftop through special duct To be conveyed by Diesel 5 included in SO2� flue special pipe and Engine(temporary engineering gas� NOX� CO discharged high above use) cost roof 184 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) Oil smoke purifier, to 10 included be conveyed by special in Kitchen oil smoke Oil smoke pipe to be discharged engineering high above roof cost To be treated by newly COD� BOD5 built WWT Station 162 included (200m3/d, two stage in Hospital Wastewater SS� NH3-N anaerobic+disinfection), engineering Waste water a canteen oil screening cost Fecal coliform tank to be built To be collected and Clinical laboratory Heavy metal, disposed of by external 3.0 wastewater acid, alkaline qualified organization Medical waste / To be temporarily stored in allocated room then to be disposed of 10 sludge / by qualified external organization Recovered by qualified Solid waste Used active carbon / organization before reuse To be collected by Domestic garbage / sanitary service and 2.0 sent to landfill To be cleared and Kitchen garbage / disposed by qualified organization Proper layout, vibration 3.0 included mitigation, noise in Noise Equipment noise noise elimination, building as engineering noise barrier cost subtotal RMB 0.20 mil to be included in operation period mitigation measure 200 Youyang After collection, to be deodorized, then Odour conveyed through WWT Station 5 special shaft to be discharged high above Waste Gas roof To be conveyed by Diesel oil SO2� flue gas 2 included in special pipe to be engine(temporary engineering discharged high above use) NOX� CO cost roof 185 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Hospital Environ- Investment mental Discharge Source Pollutant Prevention Measure Impact (104 yuan) COD� BOD5 To be treated by newly 200 included built WWT Station in Medical wastewater SS� NH3-N (400m3/d, two stage engineering anaerobic+disinfection) cost Waste water Fecal coliform To be collected and Clinical laboratory Heavy metal, disposed of by external 3 wastewater acid, alkaline qualified organization Medical waste / To be temporarily stored in allocated room and then to be disposed 20 sludge / of by qualified external organization Solid waste Recovered by qualified Used active carbon / organization before reuse To be collected by Domestic garbage / sanitary service and 2 sent to landfill Proper layout, vibration 5 included in mitigation, noise Noise Equipment noise Noise engineering elimination, building as cost noise barrier Environmental others 5 monitoring Total RMB 0.30 mil to be included in operation period mitigation measure 242 CURIP Of which: medical waste water station: RMB 11.54 mil included in engineering cost; Total 1866 Total operation period mitigation measure cost: RMB 3 mil (including medical waste RMB 1.985 mil) In Table 6-7, for Wanzhou, Dianjiang and Chengkou hospitals, the construction period mitigation measure cost and cost in “others� column listed in EA were not adopted due to huge difference among hospitals (total RMB 2.839 mil); Cost for diesel engine noise control and canteen oil smoke control (total RMB 1.281 mil) was listed in engineering cost; Cost for medical wastewater station (RMB 11.54 mil) was listed in engineering cost; Therefore cost for operation period mitigation measures are RMB 3 mil (including medical waste RMB 1.985 mil). If the following cost are to be included: • construction period mitigation measure (RMB 0.72 mil, as Table 6-3); 186 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report • environmental monitoring cost in construction period (RMB 0.262 mil) and operation period (RMB 0.248 mil) (as Table 6-4); • capacity building training (RMB 0.282 mil), The total environmental protection cost estimate for CURIP II is around RMB 4.512 mil, summarized in Table 6-8. Table 6-8 CURIP II Environmental Protection Cost Estimate Summary Training Mitigation measure ( Monitoring cost RMB 10 4 yuan ) ( RMB 10 4 yuan ) ( RMB 10 4 yuan ) Period Construction Operation Construction Operation Construction Operation period period period period period period Amount 19.8 8.4 72 300 26.2 24.8 Subtotal 28.2 372 51 Total 451.2 Note: Medical wastewater station RMB 11.54 mil was listed in engineering cost; Noise control cost for air-conditioner and stand-by diesel engine, and canteen oil smoke control cost were listed in operation cost. 6.10 Medical Waste Management Plan 6.10.1 Implement the Provisions of Medical Waste Management in Chongqing Strictly implement the notice on further strengthening medical waste management issued by Chongqing Municipal People's Government (CQ Gov.[2007] No. 71) during the operation period of CURIP . . To develop regulations and emergency plans for safe disposal of medical waste and equipped with appropriate facilities and equipment, set part-time or full time personnel responsible for the implementation, inspection, supervision and management of medical waste. To provide training to the staff involving medical waste collection, transportation, storage and disposal on relevant laws, regulations, professional and technical. Medical waste generated should be collected separately and stored temporarily. The final collection, transportation and disposal will be done by the organization which has hazardous waste (medical waste) operating permit. The disposal fee should be paid to the disposal company. a) Medical waste generating units should enter a waste disposal agreement by a unified, standardized format with medical waste disposal unit before the end of each year. b) Packaging of medical waste should meet the requirement of “The Regulations on Special Packaging for Medical Waste, Containers and Warning Signs �. 187 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report c) Medical waste generating units should use the special facilities and equipment to temporarily store the medical waste. Medical waste shall not be openly stored and the time for temporary storage will not be more than 2 days; d) Medical waste generating units should accurately measure the quantity of medical waste transferred, strictly implement the relevant provisions for registration and keep the records for future reference. Implementation licensing systems and the transfer record system for transfer of hazardous waste . a) The project hospital should fill out “The medical waste transfer registration form for medical and health institutions in Chongqing " and "Chongqing hazardous waste transfer form (medical waste only)"; b) The project hospital should go to the local EPA to apply for medical waste transfer license for the next year and get the "Registration Form" and "Medical waste sheet" by 30 December each year. c) When the medical waste is transferred to the disposal company, the project hospital should fill in the “registration form" and the form should be checked and signed by both parties. Each unit from where the medical wastes comes from should prepare a monthly summary of the quantity of medical waste and fill in the sheet based on "Registration Form" and give to the disposal company. Prohibitions The following actions are prohibited: transfer, buying and sale of medical waste, throw the medical waste during transportation drop and scatter; storage the medical waste in a non- storage place or medical waste mixed with garbage or other waste. Company without license or permit is not allowed to do medical waste collection, storage, transportation and disposal activities or the company with license or permit is not allowed to do medical waste collection, storage, and transportation and disposal activities not in accordance with the license. 6.10.2 Development of Medical Wastes Management Plan 6.10.2.1 Medical Wastes Management Medical Wastes management responsibility system should be established in project hospitals, and the hospital legal representative is the first person in charge of fulfilling responsibility earnestly, so as to avoid the infectious disease transmission and environmental pollution accidents resulting from medical Wastes. The project hospitals should formulate the rules and regulations related to safety disposal of medical Wastes and the emergency action plan. Monitoring department or full-time (part- time) personnel responsible for the examination, supervision, and implementation of medical Wastes management work should be provided to prevent the behavior in violation of national Medical Wastes Management Regulation occurs. The project hospitals should provide trainings in connection with related laws and professional skills, safety protection and emergency treatment for the staff who are engaged in collection, transport, storage, disposal of medical Wastes. 188 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report The project hospitals should take effective professional health protection measures for the staff who are engaged in collection, transport, storage, disposal of medical Wastes, such as providing necessary protective equipments and providing regular physical examinations; When necessary, provide immunization to the related personnel to prevent health damage. The project hospitals should carry out the medical Wastes transfer manifest system according to the provisions of Law of the People''s Republic of China on the Prevention and Control of Environmental Pollution by Solid Wastes and Announcement on Further Strengthening the Medical Wastes Management issued by Chongqing Municipal Government (Yufufa [2007] No. 71). The project hospitals should register the medical Wastes, the items to be registered include: the source of medical Wastes, types, weight or quantity, handover time, disposal method, final destination and signature of responsible person. The register material should be kept for at least three years. The project hospitals should take effective measures to prevent the loss, leakage and spread of medical Wastes. Any units and individual are forbidden to transfer, buy and sell medical Wastes. Medical Wastes are forbidden to be thrown away in the process of delivery, to be dumped, piled up in the non-storage site or mixed with other Wastes and life rubbish. Medical Wastes are forbidden to be posted. Medical Wastes are forbidden to be transported by railway, waterway and air. For the medical Wastes management organization and their responsibilities of the project hospitals, please see the Table 6-9 and Fig 6-2 Table 6-9 The project hospital medical Wastes management organization and their responsibilities Wastes Structure Responsibility Monitoring on Management Management Parameter Organization Hospital leader Hospital director and Set up Wastes management leader be assigned team, specify HWO, arrange funds and manpower, ensure the implementation of monitoring measures, ensure the key personnel to be trained. Medical Section leader, Control the collection of Analysis of the Wastes Wastes infection control internal Wastes, ensure correct discharge amount management personnel, hospital storage, coordinate disposal according to the member/team logistics, operation, and supervise classification of Wastes (HWO) management Wastes transport, liaison with producer's structure per personnel, director director of section office to month; check the material of the hospital ensure the trainings, monitor balance sheet, reduce the 189 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report pharmacy the production, disposal, cost Wastes; cost accounting department, radiation of Wastes and its impact to for training, collection, management public. temporary storage and personnel transportation & disposal; The most important task of analysis of the accident HWO: coordination and causes of each section in centralized management of the Wastes disposal.. Wastes and operation of Wastes management system in accordance with actual situation. Hospital Leader HWO Medical Department Nursing Department Administrative Inspection Nurse Department Clinic Nursing Aid, etc Administration Pharmacy, etc Logistics, etc Fig 6-2 Medical Wastes management organization system chart The key points of Wastes management in project hospitals are: the of leadership’s attention, setting up Wastes management team (organization), good management plan, compliance with the laws and regulations, appropriate funding support, trainings for qualified personnel, the whole staff participation and management in whole process. 6.10.2.2 The Collection and Temporary Storage of Hospital Solid Wastes Hospital solid Wastes should be disposed cost effectively and quantity decreasingly by project hospitals according to related national laws. Hospital solid Wastes from project hospitals should be collected by themselves, as well as sorted and stored in the special package or airtight container, which is leakage proof and sharp tool penetrate proof. Hospital solid Wastes temporary storage facilities and equipments should be arranged for project hospitals. Hospital solid Wastes should not be stored in the open air, and the storage period cannot be more than two days. Hospital solid Wastes temporary storage facilities and equipments should be far away from medical service area, food process area, people active area and domestic solid wastes storage 190 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report site. Obvious warning sign and safety measures for leakage proof, mouse proof, mosquito & fly proof, black beetle proof, theft proof and child contact proof, should be prepared. Hospital solid Wastes temporary storage facilities and equipments should be disinfected and cleaned regularly. Hospital solid Wastes should be collected and transferred to temporary storage site by project hospitals through special vehicles, which are leakage proof and scatter proof, according to the confirmed internal transfer time and route of hospital solid Wastes. Transfer vehicles should be disinfested and cleaned in the appointed sites of the project hospitals after utilization. Based on the principle of centralized disposal nearby, hospital solid Wastes should be sent to hospital solid Wastes centralized disposal center for treatment in time. High hazardous solid Wastes, such as culture medium, specimen and bacteria colony of pathogen, and storage liquid of poisonous colony, etc., should be disinfected on site before being transferred to hospital solid Wastes centralized disposal center. Medical wastewater from project hospitals, as well as excretion from epidemical patients or dubitable epidemical patients, should be disinfected strictly according to related national requirements by project hospitals, which can only be discharged into wastewater treatment system after reaching the national discharge standard. 6.10.2.3 The Training Plan on Hospital Solid Wastes Management The knowledge promulgation about the harm of hospital solid Wastes and pollution prevention, as well as training on accident disposal should be conducted by project hospitals, to ensure that the staffs can reach the requirements, and know their character and duties on the management of hospital solid Wastes. The training plans on the management and control of hospital solid Wastes should be prepared. 6.10.2.4 The Management and Control of Hospital Solid Wastes Accident Actions for management and control of hospital solid Wastes accident include: preparing the emergency prevention plan on hospital solid Wastes leakage and pollution accidents during the collection, temporary storage and management of hospital solid Wastes; preparing operation process for the safety collection and storage of hospital solid wastes; preparing emergency disposal process, and arranging related training and exercise. Once accident occurs, it should be investigated and recorded; the related accident records on hospital solid Wastes should be investigated and reviewed; health service administration department should be contacted, etc.. The emergency disposal process of hospital solid Wastes for project hospitals is shown in Table 6-10. 191 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Table 6-10 Emergency Disposal Process of Hospital Solid Wastes for Project Hospitals Cleaning Process of Instant Treatment of Report of Emergency Extravasations Exposed Body Accidents Confirm the property of the If skin problem, use soap and All emergency accidents and extravasations; evacuate the water to wash the wound; if nearly leakage event should be inhabitants from the affected mucous membrane problem, use reported as following process: areas of extravasations; inform flow water to wash the wound; description of accident, the appointed staffs to control use of antibiotic (no evidence); occurrence time and place, and collect the extravasations press for flood immediately; concerning people, other related with the protection facilities topical application of drug and details, which should be (including protection cloths) topical injection of antibiotic are reported and recorded. mentioned in the emergency not recommended. plan; provide initial assistance and clean the affected areas; seek for necessary measures to clean eyes and skins. 6.10.2.5 PDCA Cycle in Medical Solid Wastes Management It is suggested in the comprehensive assessment report that the PDCA Cycle should be implemented in the medical solid Wastes management in the project hospitals. The PDCA Cycle includes four stages, they are: Plan stage: to identify and confirm contents; Do stage: to implement the plan and realize the objectives; Check stage: to conclude the results through evaluation and find out the weak points; Action stage: to summarize the experiences obtained and the lessons learnt for a continuous improvement. The preliminary plan for implementation of PDCA Cycle in medical solid wastes management in project hospitals is shown in the Table 6-11. Table 6 11 Implementation of PDCA Cycle in Medical Solid Wastes Management in Project Hospitals Plan Do Check Action Contents Current To analyze the medical Wastes First to To find out To adjust situation producing flow and its quantity, and implement weak management investigation plan how to dispose it. Based on the it in pilot points aiming to and analysis locations of facilities to store the wards, then through eliminate weak of Wastes Wastes to determine the collection extend it to evaluation points and for a disposal flow and establish the relevant whole and continuous process organizations, various principles, hospital; analysis; improvement. requirements and detailed timetable, emergency hazard to detailed transportation routes, action, human maintenance and cleaning plans. accident being, report. economic 192 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Establishment To provide various solutions, evaluate report. economic of detailed options selected and determine the risks; measures detailed measures. hazard to environme Establishment To establish record system: nt and of record To record (whole process, to protect public system himself, government requirements); health. Records keeping (records should be kept for three years, for control and monitoring, and as evidence); Record types (records of transportation, disposal, processing, training, instruction, harm and accident record, auditing report). Contents recorded (Wastes producer and location, date of production, type of Wastes, collection and disposal unit, signature of person to deal with it). Estimation of To estimate the costs according to the relevant costs types of medical Wastes, facilities for collection, transportation and disposal, manpower, time, etc. Training and The target groups of training, training monitoring contents, items to be monitored and monitoring frequency. 6.10.3 Implementation of Mitigation Measures for Disposal of Medical Solid Wastes After implementing the mitigation measures for disposal of medical solid wastes as mentioned in Section 4.2.4 and when the planned hospitals for all the projects are completed and put into operation, it is estimated that around 777.06 t/a (including sludge 121.49 t/a) medical waste will be produced, which will be centrally disposed of in medical waste (hazardous waste) sites in Fuling District, Yongchuan District and Qianjiang District respectively. Given that medical waste is highly hazardous, certain risk exists in collection, storage and transportation of medical waste in this project. To ensure effective treatment of medical waste, minimize the involved risks and avoid negative impact on the environment, the following specific preventive measures are proposed: ( 1) separation/collection by type for medical Table 6-12 listed the measures for separation/collection Table 6-12 Measure for Medical Waste Separation/Collection No. Type Separation 193 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Contagious waste, pathological waste Yellow or red bag/container, Including waste which may contain pathogen (such as with marks of “infectious� and bacteria, virus, parasitic or epiphyte), or the pathogen international infection symbol. concentration or amount can cause disease for vulnerable 1 High strength antiseepage plastic host. Also including pathological and anatomy bag or container which can material(such as tissue, organ, body part, human fetus, sustain pressured steam will be animal body, blood and other bodily liquid), cloths, used. dressing, equipment/instrument and other material which contacted infectious stuff Yellow or red, with marks of “sharp stuff�. Hard, impermeable, antipenetration container with cover (such as Sharp stuff: including needle, scalpel, razor, transfusion 2 steel or hard plastic) will be set, saw, broken glass and nail, etc. used. Container for sharp stiff should be put into sealed yellow bag, with tag marking “infectious waste� Waste medicine: including medicine that passed shelf life, unused, decayed and contaminated medical, vaccine and Brown bag/container. 3 useless blood serum, including vessel and other material Antiseepage plastic bag or which may have been contaminated (such as small container. medicine bottle, test tube) Chemical waste: whether the waste is hazardous depends on its toxicity, corrosiveness, combustibility, reaction and genetic toxicity. Chemical waste, which may take the form of solid, liquid and gas, are produced by using Brown bag/container. 4 chemical during diagnosis/test, cleaning, internal Antileakage, bags or containers housekeeping and disinfection. The chemical include with anticorrosion for chemical formaldehyde, photographic chemical, halogenated and non-halogenated solvent, organic and inorganic chemical (such as acid and alkaline) used for cleaning/disinfection. Waste containing large amount of heavy metal: battery, Waste containing heavy metal 5 broken thermometer, blood pressure meter(containing should be separated from general Hg,Cr) medical waste. Pressure container: including container/air Pressure container should be 6 injection/cylinder containing nitrogen oxide, oxygen, separated from general medical ethylene oxide, CO2, pressured air waste Black bag/container. Halogenated plastic (e.g. PVC) should be separated from general General medical waste (including food waste, paper, 7 medical waste to avoid plastic, card board) hazardous gas emission (such as dioxin) during incineration treatment. (2) Medical Waste Collection/Temporary Storage Measure Medical waste collection/temporary storage measure is listed in Table 6-13. 194 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Table 6-13 Medical Waste Collection/Temporary Storage Measure No. Type Collection/Temporary Storage Measure When the quantity reaches around 3/4, the bag/container should be sealed and replaced. Bag/container should be replaced immediately if full. Collection and 1 Bag/container should be identified and tagged before removing. Storage Designated hand cart/trailer should be used for transferring waste to storage area. The hand cart/trailer should be cleaned and disinfected regularly. Medical waste storage room should be separated from domestic waste storage space and should have rain-preventing facility. It should be far away from food processing area and intensive human activity area, but should be in waste central area. Special exit/entrance should be set up at a close distance to facilitate loading/unloading of waste, access of workers and transportation vehicle. Foundation level should be high enough to ensure that facility will not be flooded or submerged; strict enclosure measures must be taken and superintendence must be conducted by designated person to avoid non-staff access and to prevent rats/mosquito/cockroach, burglary and children’s contact; The floor and 1.0 m high dado must be properly treated in respect of 2 Waste storage area antiseepage. Floor should be well drained, easy to clean and disinfect. Wastewater produced should be directly transferred to nearby WWT Station through pipe. Direct discharge to outside environment should be banned. It is advisable that tap water faucet be installed outside the storage room as water source for cleaning. Direct sunshine on interior storage room should be avoided and the room should be well lighted and ventilated. Inside the storage room warning sign of “No Smoking, No Food Eating� should be put up. Warning sign showing the existence of Hazardous Waste and Medical Waste should be erected in eye- catching place outside the storage room. Strong odour due to decaying of medical waste which are stored in temporary storage room or designated cabinet should be avoided. It is advisable that waste should be cleared daily. If daily clearing 3 Storage time practice cannot be adopted and local maximum temperature is above 25 , waste should be stored in low temperature condition (below 20 ) and maximum storage time should be within 48 hours. Mercury (Hg) should be placed in sealed and impermeable container 4 other and stored separately in safe place; 195 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Cytotoxic waste should be separated from other waste and stored separately in safe place. The risk prevetion measures and the emergency action plan as described in Section 4.2.8 should be strictly implemented, and staff and working place for medical wastes collection and temporary storage should be safeguarded in terms of health and safety, so as to prevent the secondary and cross infection. By strictly implementing the regulations on the medical wastes management issued by Chongqing Government and establishment of medical waste management rule, the whole- process management of medical waste will be strictly adopted. Recycling/reuse of medical waste is banned to prevent medical waste from being illegally processed and reused, which will, to large extent, curb the spread of medical waste, disease and contamination, and is also one of the most important measures to mitigate medical waste’s impact. Collection/separation by type is the basic guarantee for contamination elimination and innocuous treatment. By strict enforcement of related rules on medical waste storage and transportation, and medical waste transfer sheet joint-signature rule, the whole waste transportation process will be under strict control; hence damage to surface water and ecological environment along waste transportation routes will be prevented. 6.11 EMP Performance Indicators for CURIP II Based on the guideline that the performance indicators should be relevant, economical, easy to monitor, sufficient and clear, the EMP performance indicators for CURIP II are tentatively proposed (as shown in Table 6-14). 196 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Table 6-14 EMP Performance Indicators for CURIP II Design Objectives Performance Indicators Data Source/ Report Assumptions/ Risks Mechanism Goal/Impact Reduce Since the first year in operation, the negative Routine monitoring Assumption: discharge of environmental impact will be reduced. For the data in project Associated environmental protection waste gas, waste environmental air in the surrounding area, NH3 district/county EPB facility will be designed, constructed water and lower will meet “Medical Organization Water Pollutant EPB trial operation and put into operation concurrently noise; medical Discharge Standard� (GB18466-2005). acceptance report. with major project facility; The waste collected PM10� NO2 � SO2 in the environmental air and External monitoring environmental zoning plan and by type and COD� BOD5 � NH3-N, oil, fecal coliform in report during operation environmental protection standard disposed of by environmental air and environmental noise period. index of EPM remain unchanged. qualified monitoring data will all be within the limit CURIP II components are completed organization to specified in Function Zoning Plan. in accordance with design quality reduce level and schedule and operation is environmental normal. contamination. Risks: potential leakage danger exist Increase social for activated carbon absorption benefit as well facility, chlorine dioxide disinfection as financial facility and its raw material storage benefit of facility for medical waste treatment hospitals in the station, and these above dangers have project. not been effectively and timely eliminated. Purpose/Result To improve the By 2015, CURIP II project district/county hospital Operation report for Assumption: 8 project waste water treatment capacity to be increased by project hospitals CURIP components are completed in districts/counties 1280m3/d in total, BOD5, COD, NH3�N, oil and accordance with design quality level medical waste coliform discharged from medical WWT Station to EPB data from project and schedule and operation is normal. water treatment meet “Medical Organization Water Pollutant district/county EPB Risk: level Discharge Standard� ( GB18466-2005) . Extreme climate or geological disaster By 2015, for the 8 project districts/counties, 100% Environmental may affect disposal of medical of the medical waste and sludge from medical monitoring report from wastewater and waste. WWT Station will be sent to medical waste project district/county (hazardous waste) disposal site. ; Outputs Mitigation Contractor will implement mitigation measures PIU’s monthly report Assumption: Contractor, Operator, 197 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Design Objectives Performance Indicators Data Source/ Report Assumptions/ Risks Mechanism measures in during construction period to ensure: site particle during construction PIU and monitoring organization construction disorganized emission concentration <1mg/m3 ; period. Internal implement EMP in accordance with period be site noise meets Construction Site Noise Standard monitoring report contracts and schedule; properly ( GB12523 �90 ) ; production wastewater External Risk: Despite verbal promise, established and SS<70mg/L following sedimentation and be monitoring/appraisal Contractor, Operator and PIU fail to related reused as far as possible for site spraying and report strictly follow mitigation measures; monitoring is in equipment cleaning; 100% of domestic garbage Environmental protection facility only place. from site working camp will be sent to local serves as a means to pass acceptance Environmental domestic waste disposal site. Construction but is not put into stable operation; protection, From the first year of operation, medical acceptance report External monitoring organization water/soil wastewater treatment facility will be in normal approved by EPB delay submission of conservation operation, and water discharged will meet the monitoring/appraisal report more than facility pretreatment or discharge standard specified by 2 weeks or report, though timely associated with “Medical Organization Water Pollutant Discharge submitted, contains mistakes such as CURIP II be Standard� ( GB18466-2005) ; the landscaping wrong sampling place or monitoring completed area which can be restored in the project area and parameter. concurrently affected area will be 100% reinstated. with major Environmental management and pollution project facility prevention rules will be established/perfected. Rules for chlorine dioxide disinfection facility and storage facility for raw material (hydrochloric acid, soldium perchlorate) is in place; environmental risk emergency plan is established. Work program and target at various stage: Input: In Jan 2012, EMP to be prepared and submitted to WB for appraisal. The EMP, following WB’s clearance, will be For construction period: adjusted/improved based on monitoring/inspection results during project implementation. CURIP II hospital medical WWT Before or during construction of the 8 districts/county level hospitals, EMP implementation technique training to Station engineering cost is RMB be delivered to 100 persons. 11.54 mil, medical waste temporary storage facility is listed in engineering For each component, information on construction commencement will be notified to local community before cost; mitigation measure of negative construction starts. Implementation of EMP and monitoring results will be publicized to residents within project impact is RMB 0.72 mil; capacity area. building and training is RMB 0.198 Contractor and PIU to implement mitigation measures as specified in EMP; External monitoring organization will mil; Environmental monitoring cost is 198 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Comprehensive EIA Report Design Objectives Performance Indicators Data Source/ Report Assumptions/ Risks Mechanism conduct independent monitoring/inspection and submit report; RMB 0.262 mil. Environment related indicator to be established for Construction Progress Report in view of internal/external For operation period monitoring in order to obtain the implementation information, effectiveness and improvement suggestion of Mitigation measure cost is RMB 3 mitigation measures during construction period; mil/a (including medical waste Semiannual report to be submitted to WB since the year of construction commencement; mitigation measure RMB 1.985 mil); Operator and PIU to put into operation the completed project major facility and environmental protection facility capacity building and training RMB in operation period; 0.084mil; equipment noise(diesel power generator, etc) control and canteen oil smoke control cost RMB 1.281 is listed in engineering cost; daily operation cost for medical WWT Station is listed in hospital operation cost; environmental monitoring cost is RMB 0.208 mil. 199 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 7 Public Consultation and Information Disclosure 7.1 Public Consultation 7.1.1 The Purpose of Public Consultation The public consultation and information disclosure has been conducted for this project in accordance with the relevant requirements of the World Bank and Chinese domestic regulations. The purpose of public consultation is to obtain direct opinion from residents in project affected area, so the decision-making organization can find out the potential problems, and make timely modification to and perfect the design. Hence the questions raised by the public can be fundamentally solved and the process design and environmental protection/monitoring/management can be improved and perfected. Eventually, the construction of the project can be optimized in terms of environmental benefit, social benefit and economic benefit. Consultation will be made mainly with organization and individual in project affected area. In particular, the need and requirement of vulnerable persons (including women, impoverished people, ethnic minority and indigenous inhabitants, etc.) will be emphasized. 7.1.2 Methodology of Public Consultation During the EA development, two rounds of public consultations were made. The first round was made following environmental screening and before the finalization of EA TOR during Sept. to Oct. 2011. Project basic information and information of potential environmental impact was introduced through onsite and internet publication to the public directly affected by the project, to solicit their comments, suggestions and requirements. Questionnaires were issued to them for their opinion during public meetings. The people filled out the questionnaire themselves or expressed their opinions. The second round consultation was made following preparation of draft EA report during Oct. to Dec. 2011. The PIUs or EA institutes disclosed the full draft EA document to the public. EA institute has placed the draft EA report in the project hospitals with the full EA document disclosed via local web-site and notice to the public for the accessibility of the EA document on local prime newspapers. EA engineer introduced in detail the basic information of proposed project and the major conclusion of EA, including project size, long-& short-term impact during construction and operation period, proposed mitigation measures in public meetings, in order to learn the public’s attitude toward, requirement of and suggestions to the proposed project. Considering that hospital is mainly for people needing medical treatment or health care, PIU and EA organization conducted consultation with persons helping/accompanying patients in waiting room and in-patient building. 7.1.3 Record and Feedback of Public Consultation Summary of public consultation is as Table 7-1. Related pictures and documents for public consultation (information disclosure) are shown in attachment C. 200 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Feedback of public consultation is as Table 7-2. 201 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table 7-1 Summary of CURIP II Public Consultation (time, persons and method) Hospital Round Conducted by Participants Time Place 18 persons registering to see the doctor at the old Completion of Registration Hall of hospital site where the Sept. 5, 2011 Environmental Screening Fuling District Chongqing Yujia EIA Company proposed expansion of and before EA TOR/Plan People’s Hospital in-patient building is finalization located Fuling District People’s 60 persons in total, who Hospital Inpatient are residents, civil Comprehensive Building Following completion of servants, business men, draft EA Report, to company staff in area Yanwuting conduct public Chongqing Yujia EIA nearby Fuling District Meeting: Dec. 1, 2011 Community office consultation with the Company, Fuling District People’s Hospital at Guoren Subdistrict public in affected area on People’s Hospital Laodong Street, Fuling District environmental issue Renminxi Road, Binwu Road, Ankang Road, Liming Road in Fuling District 30 residents at the Issue questionnaire to Completion of proposed site of the 15-20 Oct, 2011. each family at the Environmental Screening project proposed site and before EA TOR/Plan finalization Tongnan M&C Health Care Tongnan M&C Health Hospital, Chongqing Yujia EIA Following completion of Care Hospital Company Meeting room at the draft EA Report, to 12 persons in hospital’s Meeting: Dec 8, 2011 4th floor of Tongnan conduct public waiting room and local M&C Health Care consultation with the residents Hospital public in affected area on environmental issue 202 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Hospital Round Conducted by Participants Time Place Outpatient department 30 persons including internet publication: Completion of and inpatient Chongqing Yujia EIA people in waiting room 1st time: Sept 30, 2011; Environmental Screening department at Company, Wanzhou District and area directly 2nd time: Oct 10,2011 Wanzhou District People’s and before EA TOR/Plan Wanzhou District People’s Hospital affected (Xilong Hospital Economic finalization People’s Hospital Village) questionnaire issued Development Area Branch during publication period Outpatient & Inpatient Comprehensive Building Chongqing Yujia EIA Meeting with 20 persons Company, Wanzhou District at Xinglong Village and Meeting: Dec 6, 2011 Xinglong Village(the Following completion of People’s Hospital surrounding area project site) draft EA Report 100 persons including Outpatient department Completion of EA Center of China Academy local residents and staff Onsite publication: 9-19 of the hospital and Environmental Screening of Engineering Physics at outpatient department Sept, 2011 nearby proposed site and before EA TOR/Plan of the hospital and finalization nearby proposed site Dianjiang County TCM Internet publication: Hospital Internal Medicine 64 persons who are Following completion of 20-30 Dec,2011 Meeting held at 6th Comprehensive Building relatively highly affected draft EA Report, to floor meeting room of Dianjiang County TCM by the project including conduct public Dianjiang County Hospital; EA organization patient visiting the consultation with the TCM Hospital Internal hospital, hospital staff, public in affected area on Meeting: Dec 4, 2011 local residents environmental Completion of Chongqing Yujia EIA Company 30 persons at Wushan Wushan County TCM Wushan County TCM Oct 10,2011 Environmental Screening ,Wushan County TCM Hospital County Hospital Hospital Jiangdong and before EA TOR/Plan Branch finalization 巫 巫 巫 巫 巫 203 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Hospital Round Conducted by Participants Time Place Publication: 2011.10 At the proposed site Following completion of 12 persons who may be 10~25 (Jiangdong New draft EA Report, to significantly affected by 2011.12.18~1.8 District Wushan Wushan County TCM Hospital conduct public the project are surveyed/ 2011.12.19 County: sub-village 1 and EA organization consultation with the interviewed Longjing Village public in affected area on Meeting: 2011.12.11 Jiangdong New environmental issue District) Completion of 50 persons who are staff, Chengkou County Environmental Screening Chongqing Dehe Environmental teacher, residents at the People’s Hospital and 2011.10.09~ 21 and before EA TOR/Plan Engineering Co., Ltd apartment building nearby area Chengkou County finalization nearby the hospital People’s Hospital Following completion of 20 persons who are local Meeting room at 4th Inpatient Comprehensive draft EA Report, to Chengkou County People’s residents, teachers, staff Meeting: Nov. 12,2011 floor of Chengkou Building conduct public Hospital; EA organization nearby the hospital and County People’s consultation with the patients. Hospital public in affected area on environmental issue 50 persons who are Zhengyang Dongping Chongqing Yujia EIA Completion of Community Office Dongping Community Company, Qianjiang District Sept 1,2011 Environmental Screening personnel and local Office Zhengyang Central Hospital and before EA TOR/Plan resident nearby the Subdistrict finalization project Qianjiang District Central Hospital Zhengyang Branch Inpatient 18 persons of Comprehensive Building Following completion of Zhengyang Dongping Internet publication: 1-10 draft EA Report, to Qianjiang District Central Dongping Community Community Office and Oct, 2011 conduct public Hospital, EA organization Office Zhengyang local residents nearby Meeting: Oct 24, 2011 consultation with the Subdistrict the project public in affected area on environmental issue 204 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Hospital Round Conducted by Participants Time Place Area nearby Youyang Completion of 60 persons who are staff Chongqing Yujia EIA Sept 12, 2011 County People’s Environmental Screening and residents Company, Youyang County Hospital and before EA TOR/Plan surrounding hospital People’s Hospital finalization Youyang County People’s Hospital Outpatient & Emergency Department Following completion of Internet publication: 59 persons including Meeting room at Comprehensive Building draft EA Report, to Youyang County People’s 7-17 Nov, 2011 local residents, hospital Youyang County conduct public Hospital, EA organization staff, patients at waiting People’s Hospital consultation with the Meeting: room, persons public in affected area on Dec 6,2011 accompanying patients; environmental issue . 205 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report The statistic analysis sheet of the second public consultation results based on the returned questionnaires are shown in Table 7-2. Table 7-2 Explanation and Reply for Questions in II Public Consultation Explanation/ reply and the result Comments and question from the Components public PIU expresses that all preparation work before construction will be timely and properly carried out, so the expansion to existing The public hope that a first class hospital on original site can be completed soon public health institution can be to offer 1st class medical service for the people completed as soon as possible to in Fuling District. serve all the people in the district and safeguard their health. Environmental protection work EA organization gives the following must be well done. Wastewater, explanation: To make full use of current solid waste and waste gas must be existing infrastructure for waste treatment to properly disposed and discharged avoid redundant construction. Medical waste after complying with related water only needs to be treated to meet standard. Treatment equipment Fuling District discharge level specified in national standard must be first class and forward People’s and then discharged to Fuling District WWTP looking, and their treatment Hospital through municipal network. It is also feasible capacity must be realistic without Inpatient that the Hospital collect/temporarily store any inflation; Contractor should be Comprehensive medical waste by category and transfer them to selected through bidding so a first Building Fuling Medical Waste Disposal Site. class contractor will be selected to ensure quality. The public attending the meeting is satisfied. They hope that the proposed hospital can be located near their home so they will enjoy 3.3% of interviewee thinks that the convenient medical service. Following proposed hospital will not benefit explanation, they believe that so long as the them since the hospital is too far medical service is improved, it will be better away from them and they will not for them not to go to larger city for medical come all the way to the hospital for treatment (which will save so much time and treatment. money). Hence they express understanding and will support the project. The residents consider dust, The PIU express: environment hygiene as their major concern. Since this is a project thanks for the public’s understanding and Dianjiang designed to serve the people, they support County TCM can accept those unavoidable Hospital Internal negative impact during construction to implement the project following its Medicine and hope for quick completion. approval Comprehensive Building Though representatives of local in accordance with WB requirement, residents agree with proposed mitigation measures will be incorporated in mitigation measures, they pointed bidding document to ensure that they are out that these measures must be followed. strictly followed. Especially, 206 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Explanation/ reply and the result Comments and question from the Components public contractor, supervision agency must strictly follow these measures. In the meeting, the public express that the explanation is acceptable. EA organization suggested that Wushan County TCM Hospital cooperate with local government on resettlement, listen to and adopt Wushan County The public expressed concern local residents’ comments and suggestion and TCM Hospital about resettlement arrangement and help to solve resident’s difficulty to create a Jiangdong hope for proper arrangement and harmonious social environment; PIU expressed Branch reasonable compensation. that resettlement arrangement will be made in strict accordance with national and WB safeguards policy; Local residents express satisfaction at the meeting. ( 1) The public requires that EA organization and PIU expressed that: practical pollution prevention work be properly carried out. In Chengkou particular, medical waste water and County People’s medical waste treatment measures The public’s comments will be adopted. Hospital need to be strengthened. Construction noise will be mitigated by good Inpatient construction practice, enclosure measures, Comprehensive 2 The public hopes that proper scheduling, construction equipment Building effective noise elimination measure related measures and proper construction is taken during construction in method. order to avoid disturbance to patients and local residents. Youyang County EA organization and PIU expressed that: Good communication with local People’s residents and in-patients during Hospital The public’s comments will be adopted. construction will be maintained to Outpatient & Construction noise will be mitigated by good obtain their understanding. Emergency construction practice, enclosure measures, Meanwhile, environmental Department proper scheduling, construction equipment protection measures will be Comprehensive related measures and proper construction strengthened and implemented. Building method. As a primary public concern, the EIA and feasibility study design has solved the design of medical wastewater and medical waste disposal as a key engineering of environmental protection measures, and has done various analysis and comparison from the location, investment estimation, process scheme selection, the disinfection scheme selection and so on, optimized design and the EIA. In order to mitigate the impact of dust and noise during construction, the EIA adopted comprehensive pollution prevention and control measures, and enrolled these measures and related investment, monitoring fees into environmental management plan, so as to reduce and control the impact of dust and noise to the surrounding neighboring areas from the project as much as possible. Explanations and answers have been provided to the questions or suggestions from the public in the public consultation of CURIP II, which was well understood and 207 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report supported by the public. Public Consultation Results and Feedback of CURIP II are shown in Appendix E. During the consultation, the people understood that this project is intended for improving their living conditions, and a key works financed by the WB and the government for public welfare, so they are supportive of the project. Of the 409 persons who were willing to complete the questionnaires no one was against the CURIP II, and the support rate reaches 96.3%. 7.2 Information Disclosure Information disclosure has been made twice for each hospital under CURIP II. The first was made shortly after environmental screening in view of project design and specific environment. The second was made following completion of draft EA report and before finalization of final version. Method adopted includes through internet, bulletin board and local newspaper. In the second disclosure, the whole draft EA report and EMP were disclosed to the public to review (the EA report and EMP were placed in the guard’s room of project hospital, an easily accessible place). The public can obtain information through internet and newspaper, and they can also express their requirement and suggestions through internet and hotline. In the above mentioned place where the information was disclosed, personnel from PIU/EA organization responsible for collecting/recording feedback were assigned Effective information disclosure means that the information is widely known to the public in project affected area. Since only small percentage of people in project affected area use the internet, the internet disclosure just serves as a supplementary method. To ensure the right to know of the affected public, information disclosure and public consultation for CURIP II was made mainly through the following methods: publication in bulletin board, the local newspaper, and questionnaire issued in local and nearby area, site visit, meeting in area inhabited by large number of affected residents Record of public information and related documents are shown in Table 7-1 and Appendix D. the notice on newspaper is attached in Appendix C. Please see the Table 7-4 the Summary of the information disclosure for this project Table 7-4 the Summary of Information Disclosure Disclosed time of EA No Hospital Name of websites Place of Full EA information . document First time Second time 1 Fuling 2011.9.5~ 2011.9.26~1 Chongqing Yujia Environment Rception room of District 20 0.16 Assessment Net: the hospital http://www.cqyjpg.cn 2 Tongnan 2011.10.1 2011.12.15~ http://www.cqyjpg.cn Rception room of County ~15 30 the hospital 3 Wanzhou 2011.9.3 2011.10.10 http://www.cqyjpg.cn Rception room of District the hospital 4 Dianjiang 2011.12.1 2011.12.20~ Chinese Medicine Hospital of Rception room of County 3 30 Dianjiang Net the hospital : www.cqdjzyy.com. Environment Protection of Dianjiang County Net: bbs.dianjiang.cn 208 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 5 Wushan 2011.10.1 2011.12.18~ http://www.cqyjpg.cn Rception room of County 0~25 1.8 the hospital 6 Chengkou 2011.10.9 2011.11.1~1 EIA Amateur: www.eiafans.com Rception room of County ~21 6 the hospital 7 Qianjiang / 2011.10.1~1 http://www.cqyjpg.cn Rception room of District 0 the hospital 8 Youyang / 2011.10.15~ http://www.cqyjpg.cn Rception room of County 25 the hospital 9 Full draft / 2012.2.2 http://www.eiafans.com/thread- Chongqing PMO EA 314313-1-1.html document The information disclosed contents of the first round included: (1) overview of the project; (2) related information of assessment units; (3) work procedure and main contents of EIA; (4) main issues to solicit and collect comments from the public; (5) the main way of comments proposed by public. The disclosed information contents of the second round informed: the preparation work of draft EA document has been finished; the public can read the full text online or the document in the project hospitals and give comments and suggestions online or by the ways of telephone, facsimile. 8 Conclusion and Suggestion 8.1 The Profile and Necessity of CRUIP II Project 8.1.1 Project Profile The Bank's loans Chongqing urban and rural development and reform phase II project (CURIP )-health project mainly focus on the medical service system improvement the District/County of Chongqing, key points include: The ability and facilities improvement and medical personnel service ability ascension, medical hospital information system construction and remote diagnosis and treatment, institutional capacity strengthening and project management for medical institutions of eight poor districts in Chongqing. 8.1.2 Necessity of the Project Since Chongqing became municipality city, although many achievements of the social economic development have been obtained, Chongqing is still facing huge challenges. Due to the combination of big cities, rural, Big reservoir areas, big mountain areas and minority areas, about 21 million rural people live mainly in rural areas, of which 16 counties each holds a population of over 800 thousand, and health resources excessive concentration in the downtown area, medical and health resources distribution and the masses demand is not harmonious, and the hospital facilities and ability in district/county is difficult to assume its key role in level-3 health services network, the standardized hospital construction and ability together with performance requires to be improved. CURIP project conforms to the requirements of "healthy and Chongqing" health action plan puts forward by Chongqing municipal government (2008-2012) for the county level 209 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report medical institutions and the hospital the standardized construction plan for District/County, to implement CURIP health project is imperative. 8.2 Environmental Assessment Conclusion The environment quality of the project areas are good, without native vegetation in the surrounding site and neighboring areas, without concentration forest distribution in the scope of the project, forest land vegetation is mainly cultivated scattered trees; According to the EIA unit inspection and investigation by environmental protection department, no nature reserve, scenic spot, as well as protection national wildlife in evaluation scope; Through field investigation and analysis, the ecological environment of project areas are in good quality, the project cover an limited area and will not affect to regional ecological environment and interference recovery capacity afterwards. 8.2.1 Ambient Atmosphere no major industrial enterprise outside traffic and roads rounded byproject hospitals, the present situation SO2, NO2, TSP of air environmental quality monitoring or average concentration PM10 all can reach the secondary standard environmental air quality standards GB3095-96. 8.2.2 Surface Water The environment situation of surface water related to District/County hospital construction is found in good quality, the main evaluation index of COD, BOD5, HH3-N, petroleum, all meet the waters of water quality standards requirements of Fecal coliform over the surface water environment quality standards (GB3838-2002) . 8.2.3 Acoustic Environment Although local monitoring was impacted by traffic noise, the acoustic environmental quality of proposed site filed or surrounding is still meet the secondary standard for acoustic environmental quality "(GB3096-2008) , daytime noise between a range of 45.8 -59.2 dB (A), nighttime noise between a range of 33.2-52.8 dB (A), AcousticEnvironment quality is good. 8.3 CRUIP II Project is in Consistency with China's Sectoral Policy and Chongqing City and District/County Planning All links from the screen classification to preparation, design, immigrants and environmental impact assessment, etc. of each stage of hospitals of CRUIP II project, strictly according to the world Bank OP4.01, OP4.12 and related business policy implementation, accord with the Bank's security policy. This project belongs to the encouraged category of industrial structure adjustment guidance catalogue (in year 2011) " medical health service facilities "and" digital medical imaging products and medical information technology development and application "; At the same time, the facilities that project rely on: hazardous waste (including medical waste) concentration treatment equipment, medical wastes clean burning, harmless high-temperature 210 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report cooking technology equipment which also belong to the encouraged category; that all shows the project meets the country industrial policy. Among the project hospitals, hospital of Fuling District, Chengkou County and Youyang County are expansion in original site; The rest of the site are planned medical land area for hospital by counties, meet the requirements of the plan. On a premise condition of meet the appropriate location scale and the requirements of hospital design process of new hospital and on the basis of comprehensive comparison of technical and economic feasibility scheme and environment impact, through consultations with the PIUs and feasible design units, puts forward the location of the recommended scheme is feasible. 8.4 Conclusions of the Environmental Impact Assessment and the Mitigation Measures 8.4.1 Environmental Impact Assessment and Mitigation Measures during Construction The noise, dust, exhaust gas, wastewater, spoil and surplus stone, construction solid waste will have adverse impact on the surroundings around the construction site. The construction truck will not only cause the noise impact, but also give an unfavorable impact on the traffic. The people’s living standard will also be affected by the resettlement. The impact of the construction on the environment is short term, and except the resettlement of some residents and the geographical changing, most of them can be reversible. The impact of the noise, wastewater, exhaust gas and dust produced in the mechanical work is light as the heavy mechanical work is not applicable for the small sized engineering work and the hill geography. When the provisional mitigation and management measures are taken, these impacts on the environment can be better controlled and the environmental quality can basically meet the requirements of the functional zone classification. The impact on the surrounding traffic can be reduced. 8.4.2 Mitigation and Resettlement Impact Analysis Only the Wushan and Wanzhou components will involve the resettlement work. Totally 159.24 mu of land will be acquired and 159 households, 644 residents will be affected. A resettlement office will be established to be in charge of all the resettlement work same as the other similar projects. The living quality of the farmers can be improved by taking the measures such as improving compensation programme for the land acquisition, better resettling the farmers, conducting the occupation training and providing the farmers with the social insurance, supporting the affected vulnerable groups and helping the farmers with the job opportunities etc.. 8.4.3 Environmental Impact in Operation Period The favorable social impacts will dominate during the operation period, while the impact from the hospital wastewater, solid waste and the traffic for the increasing out-patients will be secondary, and will be better controlled after the mitigation measures such as the hospital wastewater treatment, hospital solid waste classification, sorting and centralized treatment are carried out. 211 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report The standardization construction of the hospitals in the counties and districts of CURIP II, the introduction of the high-tech appropriate equipment, the implementation of the new technologies and new business ideas such as the remote diagnosis and treatment and the introduction of the green hospital can not only fill in the health care gaps in these districts and counties and enhance the capability of the medical staff , but also improve the health care services and the quality of the three-level medical service. More people can acquire the higher level and equal medical services so as to improve the people’s quality of life and health, alleviate local residents’ problem of “high cost of and difficult access to medical service�, realize the leapfrog development goal of “serious illness to be solved in the county and district� and it is also an important safeguard to implement the “Health Chongqing�. The implementation of the World Bank funded CURIP II optimizes the medical resource allocation in the counties and districts, provides the necessary medical safeguard for the new area development in Wanzhou, Qianjiang, Dianjiang, Wushan and Tongnan, and is welcomed by the local people. The expansion of the Fuling, Youyang and Chengkou People’s Hospitals not only provide high level of the medical treatment and service and is more acceptable to the surrounding resident for replacing the old and stinky medical wastewater treatment station. After CURIP II is implemented, the weak awareness of the medical waste management in the past will be substantially changed, the disadvantages existed in the medical waste sorting collection, transport, storage, and record will be corrected and the eco-environment and the inhabitation environment will be improved in the affected areas. The positive social benefit and impact of implementing the CURIP II is obvious 8.5 Public Consultation and Information Disclosure The attitude of the people surveyed for the CURIP II is voluntary and serious. The public in the project areas know the project and are consulted mainly by the ways of the government’s announcement, newspaper, site surveys, visiting as well as public meetings. The information collected is reliable. The CUPIRP II is called as the “engineering work with great popularity� as nobody out of the 633 surveyed local residents is against this project and the supporting rate reaches 96.3%. 8.6 Environmental Management and Monitoring Plan Environmental management and monitoring with strong operation ability and applicability and obvious results of controlling the disadvantageous environmental impact shall be conducted so as to ensure the effective control and mitigation of the disadvantageous environmental impact during the construction and operation. The mitigation and environmental monitoring measures shall be carried out strictly and the capability of the PIUs and the contractors to protect the environment shall be trained and improved. Requirements in EMP must be incorporated into contractual document: 1) to ensure that the bid winner understands exactly their duties during construction; 2) to be a basis of enforcement and reporting once substandard measures taken due to breach of contract. Besides, the major mitigation measures and completion status of monitoring assignment could be linked with disbursement condition of the contract. 212 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 8.7 Conclusions in Summary The objectives of the CURIP II are to improve the district/county-level health service system of the Chongqing Municipality, as it is very weak comparing with other public service industries. Hence, the improvement of the capability of the health institutions will play an important role in the establishment of the county/district-level health service network, including the rural health service institutions and the community health service institutions in the urban areas, and the improvement of the health service from the grass root. The CURIP II will assist to narrow the gap between the urban and rural of the Chongqing Municipality and increase the county and district public service capability and the accessibility to the public service source. As one of the trial cities to promote the urban-rural integration reform and development in China, the implementation of the CURIP II can accumulate some experience and find out the breakthrough in the above aspects and be an example in the terms of the health service of the urban-rural integration reform and development. The disadvantage of the project implementation can be controlled effectively after the corresponding environmental protection measures are taken. The social environmental benefits will be obvious after the project is completed. In general words, the CURIP II Project is feasible in terms of the EIA. 8.8 Suggestions ( 1) When the construction work is prepared, the PIUs, contractors and supervisors shall apply for the support from police mobile patrol platform for the traffic management during construction period. The policy patrol platform will manage the traffic with fixed post and mobile patrols on duty for the heavy traffic road during the construction period. Further strengthen the management of the key sections and key time, especially for the morning, noon and evening on-work and off-work hours, manage the illegal traffic, illegal parking, take efforts to eliminate the congestion caused by human factors. In addition, some extraordinary measures should be taken to maximize the flow of traffic near the hospital. ( 2) The surplus spoil during the construction can be used to cover the landfill The surplus spoil can be transported to the landfill for the domestic solid waster nearby which will indirectly protect the eco-environment and reduce the unnecessary water and soil erosion. ( 3) Suggestions on the design of the hospital wastewater treatment stations of the CURIP II. a) Hydrolysis and Acidification → Biological Contact Oxidation +Disinfection; The enhanced primary treatment plus disinfection process or the secondary treatment (hydrolysis acidification+ bio-contact oxidation) plus disinfection process can be taken for the medical wastewater treatment. b) Enhanced Primary Treatment + ClO2 Disinfection, The medical wastewater treatment station in Wanzhou hospital can be upgraded from the enhanced primary treatment plus disinfection process to the secondary treatment plus disinfection process which will be confirmed in the design stage. 213 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report c The comprehensive considerations of the internal & external environment and the development of the hospital will be taken for the site selection of the medical wastewater treatment stations. The site of the medical wastewater treatment station be located on the downside of the prevailing summer wind with the main building as reference. Medical wastewater treatment building or structure of the general hospital with infectious wards should be strictly separated from the main building and other facilities. Medical wastewater treatment facilities should be located at least 10m from the ward and residential buildings, and should be isolated with green belts so as to minimize the negative impact of odor and fan noise on patients and residents. Space should be reserved in the overall planning when designing the medical wastewater treatment station for the benefits of expanding, construction, operation and maintenance. ( 4) Rainwater run-off outside of the rooms of the hospital of the Wanzhou component It is recommended for Wanzhou project hospital to set rainwater collection tank and system guiding drainage flow in the design of next stage so as to protect Gaofeng reservoir. Specifically speaking, measures may include the following: setting of rainwater collecting openings at the appropriate position on roadside to collect rainwater from road, sidewalk and roof; setting of rainwater collection pool; discharge of initial rainwater after a long period of drought after disinfection; building of rainwater pipe (about 0.5 km) to guide the drainage flowing into rivers on the downstream of Gaofeng reservoir so as to protect the water quality. ( 5) Recycling containers are recommended for the loading and unloading in the transportation process, for in this way the loading and unloading staff no longer need to touch the packets of medical waste directly so that the security concerns about being wounded by sharp medical wastes and infection risks are avoided. ( 6) Follow-up monitoring management on the noise from the surroundings during the operation will be conducted. Since the parts of buildings of the hospitals in Tongnan County, Wanzhou Dist., Dianjiang County, Wushan County and Qianjiang County are located near the traffic roads, the environmental impact evaluation predicates that the impact of the traffic noise is relatively significant on the hospital buildings. But considering that greenbelts and walls surrounding the hospital can be set, and measures including speed limiting and whistling prohibition are also recommended for the nearby roads, therefore, the following recommendations are provided: in addition to the measures mentioned above, the project hospitals can reserve more funds for noise reduction and refer to monitoring measures during operation period. Double layer hollow glass window are not necessary at the beginning of the project, because the monitoring results may indicate that it’s unnecessary for further noise reduction measures. Since the parts of buildings of the hospitals in Tongnan County, Wanzhou Dist., Dianjiang County, Wushan County and Qianjiang County are located near the traffic roads, the impact of the noise from the surrounding traffic will be a little big, but some measures will be taken such as the setting-up of the landscaping belt and closure walls, avoiding to use the rooms near the roads as the sick room, the traffic management of the speed-reduction, horn-ban. The EIA suggests that except the above measures, the fund for the further measures to reduce the 214 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report noise is suggested to reserve and the tracing monitoring process management during the operation is suggested to take but the double -layer medium-empty glass window is not suggested to use widely as it is possible that the tracing monitoring results show it is not necessary to further reduce the noise from the surroundings. 9 Main Conclusions and Suggestions 9.1 Main Conclusion The CURIP II is very necessary since it complies with the targets of the municipal government to fulfill the plan for standardized construction of the district/county- level medical institutions and district/county level hospitals. The CURIP II complies with the safeguard policies of the World Bank, the national industrial policies and the Chongqing Municipal and the County and District Planning. The site locations are feasible. The construction and operation of the wastewater treatment plant, solid waste treatment plant and hospital waste disposal plant have established a good external condition for the implementation of CURIP II project. The current environmental quality of the project area is good and the recovery capability will not be affected after the project is implemented. After adopting the measures for the comprehensive prevention, mitigation and management measures as specified in the environmental management plan, the environmental impact during the construction can be well controlled and the environmental quality can meet the requirement of the environmental functional zone classification and the impact on traffic can also be alleviated. During the operation period of CURIPP II the beneficial social impact will be the dominant impact while the impacts from the medical wastewater, medical solid waste and the increase in traffic flow as a result of the increasing out-patients are secondary. These impacts will be under better control after the implementation of the mitigation measures in the environmental management plan, such as medical wastewater to be treated in the hospital wastewater treatment stations, medical solid waste to be classified by types and disposed of by qualified institutions. The implementation of the CURIP II will receive the public support for its positive social benefits and impacts. 9.2 Main Suggestions During construction preparation phase, the PIU and the construction, supervision unit can be palpitated to Traffic patrol platform of related District/ County for support of traffic management. In the components in Wushan County, Chengkou County, redundant earth and stone can be sent to the livelihood waste landfill field of neighboring District/ County as garbage disposal filling, to a certain extent may reduce the needs of landfill soil, also indirectly promoting the regional ecological environmental protection, reduce unnecessary soil erosion. medical waste water treatment plant of project hospitals in Wanzhou District was adopted enhanced primary treatment+ disinfection process or secondary treatment (hydrolysis 215 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report acidification + biological contact oxidation process) + disinfection process technology, and determined in the design of next phase; The next stage design of Wanzhou District hospital is situated at a flat land in proper place outdoor road side, collect rainwater from roads, sidewalks and roof rainwater; Set the rainwater collection pool and carry out disinfected processing to early rain water after long term drought; build about 0.5 km of rain water pipe to row in the runoff into the downstream river of Gaofeng Dam ,to ensure the quality protection of the drinking water into Gaofeng Dam. The environmental noise affect tracking and monitoring management should be taken to hospital building and the surrounding traffic of the hospitals of Tongnan, Wanzhou District, Dianjiang County, Wushan County and Qianjiang District during the operating period. 216 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Appendix A: Environmental Assessment Standard and Method A1 Environmental Quality Standard a) Air Ambient air quality assessment in construction and operation period implements (GB3095-1996) Class 2 star nard, waste gas emission from hospital wastewater treatment plant refer to (TJ 36-79) (Table A-1) Table A-1 Ambient air quality assessment standard Item Time Standard value mg/m3 Annual average 0.20 TSP GB3095—1996 Class 2 Day average 0.30 Annual average 0.10 PM10 GB3095—1996 Class 2 Day average 0.15 Annual average 0.06 SO2 GB3095—1996 Class 2 Day average 0.15 1 hour average 0.50 Annual average 0.08 NO2 GB3095—1996 Class 2 Day average 0.12 1 hour average 0.24 ammonia (TJ 36 79) maximum allowable 0.20 concentration in residential area H2S (TJ 36 79) maximum allowable 0.01 concentration in residential area b) Noise According to (GB3096-2008) and Chongqing environmental Protection Bureau published ([2007]78) Class 4 standard applied area, Class 4a standard are applied at the area of: 1) If most of the buildings around CURIP subcomponents hospital adjacent road are lower than 3 floors (including open-area) and adjacent area are classified to 2a standard applied area, then class 4a standard is applied at hospital adjacent road side 30m area. 2) If most of the buildings around CURIP subcomponents hospital adjacent road are higher than 3 floors, then Class 4a standard is applied at hospital adjacent road side area where first line building faced on the road side; the noise limit of Class 4a standard area are 70dBA at day-time and 55dBA at night-time. Other area implements 217 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report (GB3096-2008) class 2 standard, i.e.: day-time noise limit 60dBA; Night-time noise limit 50dBA. Assessment in construction period implements (GB12523-90). Standards of noise and Vibration are shown at the Table A-2 and A-3. Table A 2 Environmental quality standard for noise (GB3096—2008) No. Area Type Day- Night- Note time Ld time Ln Wanzhou, hospital adjacent road side less Jinzhou, than 30m area, exclude school, Tongnan, hospital, kindergarten and nursing Dianjiang, homes Fengjie, 1 4a 70 dB(A) 55 dB(A) Wushan hospital adjacent road side area Peiling, where first line building face on the Chengkoou, road side, exclude school, hospital, Youyang kindergarten and nursing homes hospital adjacent road side more than 30m area or hospital adjacent 2 2 60 dBA 50 dBA road side area where first line building back on the road side 3 School, hospital and residential area 2 60 dBA 50 dBA Mixed area, business centre, Z direction 4 Vibration 75dB 72 dB industrial area and road sides. Vibration Table A-3 Noise limits for construction site LeqdBA Constr uct Noise limit ion Main noise period Day-time Night-time Earth work Excavators , bulldozers , loaders, etc. 75 55 Piling All kind of piling machine 85 Not allowed Concrete mixing machine, Vibrating great, Structure 70 55 electric saw, etc. decorations Crane, lifter, etc. 65 55 c) Surface water 1 Assessment standard Surface water implements GB3838 2002 Class 3 standard.(Table A-4) 218 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table A-4 Environmental quality standards for surface water (GB3838 2002) No. Items Class 2 Class 3 1 pH 6 9 6 9 2 COD ≤15 mg/L ≤20 mg/L 3 BOD5 ≤3 mg/L ≤4 mg/L 4 petroleum ≤0.05 mg/L ≤0.05 mg/L 5 Total phosphorus ≤0.1 mg/L ≤0.2 mg/L 6 Ammonia Nitrogen ≤0.5 mg/L ≤1.0 mg/L 7 Dissolved Oxygen ≥6 mg/L ≥5 mg/L 8 Fecal coliforms ≤2000 /L ≤10000 /L ( 2) Assessment methods Water environmental quality adopts single pollutant index assessment, Computation formula is as follows General water quality factor ( water quality deteriorated when water concentration increase) Si,j=Ci,j/Csi Si,j : Standard Index Ci,j——assessment factor i measured concentration at j point, mg/L; Csi——assessment factor i assessment standard, mg/L PH standard index: SpH,j=(7.0 pHj)/(7.0 pHsd) pHj≤7.0 SpH,j=(pHj 7.0)/(pHsu 7.0) pHj 7.0 SpH,j——pH standard index pHj——pH measured value pHsd——PH lower limit (water quality for surface water) pHsu——PH upper limit (water quality for surface water) d) Potable water Drinking water quality in construction and operation period implements (GB5749-2006). Table A-5 Standards for drinking water quality (GB5749-2006) Items type and name Standard Type Name 219 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Items type and name Standard Type Name Colourimetry 15 1,water source and Water purification turbidity technology limit: 3 Smell and taste No odour Visible material Negative pH 6.5 8.5 Al 0.2mg/L Fe 0.3mg/L Properties and Mn 0.1mg/L general Cu 1.0mg/L chemical Zn 1.0mg/L index Chloride 250mg/L Sulphate 250mg/L TDS 1000mg/L Total hardness [CaCO3] 450 mg/L 3 water source limit saw water oxygen oxygen demand [CODM O2] demand 6 hours: 5 mg/L volatile phenol [phenol] 0.002 mg/L Anionic synthetic detergents 0.3 mg/L As 0.01mg/L Cd 0.005mg/L Cr[Cr VI] 0.05mg/L Pb 0.01mg/L Hg 0.001mg/L Toxicology Se 0.01mg/L Indexes prussiate 0.05mg/L fluoride 1.0mg/L Ag 0.05mg/L 10mg/L underground water source limit: Nitrate (N) 20 mg/L Total coliforms [MPN/100mL Negative or CFU/100mL] Thermotolerant coliforms Negative Biological [MPN/100mL or CFU/100mL] index Escherichia coli [MPN/100mL Negative or CFU/100mL] Total plate count [CFU/ml] 100 Radioactive Total α radioactive 0.5Bq/L index Total β radioactive 1Bq/L MPN Most Probable Number CFU: Colony Forming Units if total coliforms is detected, test should goes to thermotolerant coliforms or Escherichia coli, otherwise no need to test thermotolerant coliforms and Escherichia coli. If radioactive index exceed radioactive standard, nuclide analysis and evaluation is adopted to determine whether it is suitable for drinking. Table A-6 Drinking water disinfectants index and requirement(GB5749-2006) Disinfectants name Contact time Outlet water Outlet water Pipe tail end 220 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report limit residue limits residue limits Chlorine and free Free chloride Free chloride Free chloride chloride ≥30min 4mg/L ≥0.3mg/L ≥0.05mg/L preparation Monochloramine ≥120min 3mg/L ≥0.5mg/L ≥0.05mg/L [Total Chlorine] Ozone [O3] ≥12min 0.3mg/L ≥0.02mg/L Chlorine dioxide ≥30min 0.8mg/L ≥0.1mg/L ≥0.02mg/L [ClO2] A2 Discharge Standard 1 Wastewater Construction and operation period wastewater discharge of each subcomponents implements (GB8978-1996) class 1 and class 2 standards. Operation period medical wastewater implements (GB 18466-2005), Operation period incinerator implements (GB 19218-2003)(Table A-7 A-9). Urban wastewater treatment plant emissions standard is shown in the Table A-10 below. Table A-7 wastewater discharge standard (unit mg/L, PH) Total NH3- faecal Items pH COD BOD5 petroleum SS residual N coliforms chlorine Class 1 6 9 100 20 15 5 70 100 /L 0.5 Class 2 6 9 150 30 25 10 150 500 /L 3 Note: contact time less than 1h, construction period does not implements faecal coliforms and total residual chlorine standards. Table A-8 Discharge limits of water pollutants for integrated medical organization and other medical organization ( day average) Discharge Pre-treatment No. Control Items standard standard 1 Fecal coliforms MPN/L 500 5000 2 Enteropathogenic bacteria Negative - 3 Wnterovirus Negative - 4 pH 6-9 6-9 COD concentration mg/L 60 250 5 Mixum discharge load g/bed 60 250 BOD concentration mg/L 20 100 6 Mixum discharge load g/bed 20 100 SS concentration mg/L 20 60 7 Mixum discharge load g/bed 20 60 8 Ammonia nitrogen mg/L 15 - 221 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Discharge Pre-treatment No. Control Items standard standard 9 Plant Animal Oil mg/L 5 20 10 petroleum mg/L 5 20 11 Anionic surfactant mg/L 5 10 12 Chromaticity Dilution Factor 30 - 13 Volatile phenol mg/L 0.5 1.0 14 Total Cyanides mg/L 0.5 0.5 15 Total Hg mg/L 0.05 0.05 16 Total Gd mg/L 0.1 0.1 17 Total Cr mg/L 1.5 1.5 18 Cr VI mg/L 0.5 0.5 19 Total As mg/L 0.5 0.5 20 Total Pb mg/L 1.0 1.0 21 Total Ag mg/L 0.5 0.5 22 Total α(Bq/L) 1 1 23 Total β(Bq/L) 10 10 24 Total residual chlorine 1 2 mg/L 0.5 - Chengkou, Peiling, Operation Wastewater treatment plant build up and Wanzhou, period operate before hospital build up Tongnan, Youyang Operation Wastewater treatment plant did not build up short Jinjiang and operate before hospital build up period Operation Wastewater treatment plant operate after Jinjiang long period hospital build up Note: 1 Requirements of disinfection process for Cl disinfectant: Class 1 standard contact time in disinfection tank≥1h Total residual chlorine in outlet of contact tank 3-10 mg/L Class 2 standard contact time in disinfection tank ≥1h Total residual chlorine in outlet of contact tank 2-8 mg/L 2) No total residual chlorine requirement for other disinfectants. Table A-9 Discharge limit of wastewater for medical waste incinerator Discharge limit* mg/L No. Pollutants Class 1 Class 2 Class 3 1 pH 6 9 6 9 6 9 - 2 F 10 10 10 3 Hg 0.05 4 As 0.1 5 Pb 0.5 6 Cd 1.0 7 Fecal 100/L 500/L 1000/L coliforms ** 8 total <0.5 >6.5(contact >5(contact time 222 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report residual time≥1.5h) ≥1.5h) chlorine Note: Class 1 standard is adopted when wastewater discharged into level 3 water body(defined in GB3838); Class 2 standard is adopted when wastewater discharged into level 4 and 5 water body; Class 3 standard is adopted when secondary wastewater treatment plant is included in urban drainage system; Dechlorination is required after chlorination. Table A-10 Urban wastewater treatment plant discharge standard (Class 1 B) unit mg/L Class 1 No. Items Class 1 B No. Items B 1 COD 60 7 Total nitrogen N 20 Ammonia 2 BOD 5 20 8 8 15 nitrogen N 3 SS 20 9 Total phosphorus P 1 Plant Animal Chromaticity Dilution 4 3 10 30 Oil( mg/L) Factor 5 petroleum( mg/L) 3 11 pH 6-9 Fecal 6 Anionic surfactant 1 12 10 4 coliforms Number/L Note: 1)Removal rate index is implemented in the following circumstances: influent COD> 350mg/L, removal rate > 60%; BOD>160mg/L, removal rate> 50%. 2) Ammonia nitrogen concentration 8mg/L is adopted when water temperature more than 12 , Ammonia nitrogen concentration 15mg/L is adopted when water temperature less than 12 . ( 2) Noise Construction period implements (GB12523-90) (Table A-11). Table A�11 Noise limits for construction site LAeq[dB(A)] Construction Noise limits Application area period Day Night Earth work Excavators , bulldozers , loaders, etc. 75 55 Piling All kind of piling machine 85 Not allowed Concrete mixing machine, Vibrating Structure 70 55 great, electric saw, etc. decorations Crane, lifter, etc. 65 55 Operating period implements (GB12348-2008) (Table A-12). Table A-12 Emission standard for industrial enterprises noise at boundary LeqdBA AcousticEnvironment function Period area categories outside boundary Day-time(6:00 ~22:00) Night-time (22:00~6:00) 223 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 0 50 40 1 55 45 2 60 50 3 65 55 4 70 55 ( 3) Waste gas Particulate matters, oxynitride and asphalt gas in construction period implements Class 2 standard, operation period waste gas emission form hospital wastewater treatment plant implements (GB 18466-2005) maximum concentration limit, operation period hospital incinerator implements (GB 19218-2003) (Table A-13~A-15) Table A-13 Integrated emission standard of air pollutants (GB16297� 1996 Class 2 standard) Process or pollutants concentration, mg/m3 Note equipments On-site particulate Out edge disorderly emission / construction matters concentration 1.0mg.m3 Construction Out edge disorderly emission oxynitride / equipments concentration 0.12mg.m3 Smelting 40 Emission rate 0.18kg/h(15m exhaust), obvious disorderly Construction asphalt gas 75 emission is not allowed at mixing production equipment Table A-14 Highest concentration limits of waste gas emission from medical organization waste water treatment plant No. Control items limit 1 Ammonia( mg/m3) 1.0 2 Hydrogen Sulphide( mg/m3) 0.03 3 odor concentration( dimensionless) 10 4 chlorine( mg/m3) 0.1 Methane( highest volume 5 1% percentage in the plant %) Note: monitoring point is less than 10m of the boundary of plant Table A-15 Emission limits of incinerator pollutants form medical waste Emission limits in different incinerator No. Pollutants volume( mg/m3) ≤300(kg/h) 300~ 2500( kg/h) ≥2500 (kg/h) Exhaust gas blackness 1 Ringelmann 1 2 Soot 100 2 Soot 3 CO 100 3 CO 224 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Emission limits in different incinerator No. Pollutants volume( mg/m3) ≤300(kg/h) 300~ 2500( kg/h) ≥2500 (kg/h) 4 SO2 400 4 SO2 5 HF 9.0 5 HF 6 HCl 100 6 HCl 7 NO2 500 8 Hg 0.1 9 Cd 0.1 10 As+Ni 1.0 11 Pb 1.0 12 Cr+Sn+Sb+Cu+Mn 4.0 13 Diopxin like chemicals 0.5TEQng/m3 ( 4) Solid waste The sludge and active carbon from wastewater treatment plant is required to process as hazardous wastes. Sludge should be tested before washing up, and follow the requirement of (GB18466-2005) (Table 4 Standard of sludge control for medical organization). The relevant standards are listed in the table A-16 below: Table A� Standard of sludge control for medical organization 16 Dead rate faecal Type of medical enteropathogenic tubercle of Ascaris coliforms enterovirus organization bacteria bacillus eggs (MPN/g) ( %) Comprehensive medical organization and ≤100 - - - >95 other medical organization Discharge of medical waste implements regulations of ; ; ([2003] 206); (HJ 421-2008) and (GB18597-2001). Domestic solid waste implements (GB18599-2001). 5 X-ray The absorbed Annual effective dose of hospital worker and public implements . The indicators of X-ray device listed at Table A-17. 225 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report Table A-17 Radiation dose limit and contaminant discharge indicators Dose Control Limits GB18871-2002 Dose Control Limits( mSv/a) Annual effective Annual effective dose Objective objective dose limit management limit Radiation workers 20 Radiation workers 6 Public 1 Public 0.1 Air kerma rate control values at machine room wall surface Unit: µGy/h Out of shield edge 30cm 2.5 machine room area limit Unit: m2 Medical X-ray double tube: 36 CT 30 machine room Single tube: 24 6 Soil (SL190-96) appendix A-18 Appendix A-18 Soil erosion intensity grading standards Grade Average erosion Average erosion thickness, mm/a modulus, t/( km2.a) 1 lowest <500 <0.37 2 500~2500 0.37~1.9 3 2500~5000 1.9~3.7 4 5000~8000 3.7~5.9 5 8000~15000 5.9~11.1 6 highest >15000 >11.1 226 The World Bank Funded Chongqing Urban-Rural Integration Project Phase II (CURIP II) - Summary of EIA Report 227