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Abstract:Selecting actions for improvement of solid waste management in low and middle income countries and understanding how a specific decision choice will fit and impact on a local context is key to identifying sustainable solutions. Assessment of the choice (be it technical or managerial) and assessment of the local enabling or disabling conditions are both important steps in the decision making process. Various assessment tools and methods are currently available to support decision-making in solid waste management. Assessment can be used to identify weaknesses or strengths of existing systems in a structured way and hereby highlight factors of success and failure. Assessment methods can also evaluate and compare different possible choices as in project scenarios. This overview describes established and innovative assessment methods serving both these purposes. A range of assessment tools are often designed to assess a specific sustainability domain (technical, environmental and health, economic and financial, social and institutional, organizational aspects), others attempt to provide a more holistic picture by integrating different sustainability domains into the same tool. This paper reviews a number of methods describing and discussing each of them, and referring to their use in low and middle-income countries if published in scientific literature. The overview concludes that in low-and middle-income countries the use of comprehensive assessment methods is yet very limited. We hypothesize that most formal methods of assessment are OPEN ACCESS Sustainability 2014, 6 546 still too complex and generally overburden the weak local capacities intended for their usage. The few applications identified, were conducted by academia for scientific purposes. Lack of resources to collect the vast data required for some assessment methods is a further restriction to their practical application. Future development is suggested to improve user friendliness of existing tools or to simplify certain approaches and develop more appropriate methods. A user-oriented focus in the development of assessment tools would enhance their application, provide sound data for informed decision making and foster a dialogue between technicians and policy makers in low-and middle-income countries.

1Health-care waste management requires technical, financial and human resources, and 2 it is a challenge for low-and middle income countries, while it is often neglected in 3 protracted crisis or emergency situations. Indeed, when health, safety, security or 4 wellbeing of a community is threatened, solid waste management usually receives 5 limited attention.

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The sustainable management of waste requires a holistic approach involving a range of stakeholders. What can often be difficult is to understand the manner in which different types of stakeholder networks are composed and work, and how best to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally while health-care facilities had a strong interest in waste management, they were generally poorly informed and had limited links to each other. The manner in which the networks operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. The lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management issues they were involved with, however segregation at the source was identified as a key requirement by most. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach served to raise interest and awareness at different levels (public authorities, health providers, supporting actors, others), stimulate the discussion about the adoption of specific policies, and identify the effective way forward.

A survey and a preliminary comparison were conducted between the waste management systems and schemes implemented in the Region of Umbria (Italy) and the West Bank (Palestine). The Region of Umbria operates in a wider political legal and economic supporting scheme, i.e., the one promoted by EU Directives. The West Bank showed all the typical economic, legal and political features of a developing country. From the economic point of view the incidence of the cost for waste collection and management with respect to the per capita GDP was 0.82% for the Region of Umbria and 1.2% for the West Bank. Although the incidence for the West Bank was higher, it was not enough to support the budget necessary for efficient waste management. A relevant aspect was the practically similar amount of organic waste generated per capita and per year in the two areas. The West Bank lacks infrastructures and adequate collection systems and there are no composting facilities. The number of mechanical sorting facilities was 0.034/10 5 inhabitants. The current recycling rate for the West Bank is about 6%. Some criticism about the sustainability of recycling and composting rates for the Region of Umbria are also highlighted. Some benefits for the West Bank, such as the introduction of home composting, are identified. This will affect both the amount and the costs of waste collected allowing the municipalities to allocate more money for separated collection of recyclables.

We have developed a new methodology for assessing solid waste management in a situation of armed conflict. This methodology is composed of six phases with specific activities, and suggested methods and tools. The collection, haulage, and disposal of waste in low- and middle-income countries is so complicated and expensive task for municipalities, owing to several challenges involved, that some waste is left in illegal dumps. Armed conflicts bring further constraints, such as instability, the sudden increase in violence, and difficulty in supplying equipment and spare parts: planning is very difficult and several projects aimed at improving the situation have failed. The methodology was validated in the Gaza Strip, where the geopolitical situation heavily affects natural resources. We collected information in a holistic way, crosschecked, and discussed it with local experts, practitioners, and authorities. We estimated that in 2011 only 1300 tonne day(-1) were transported to the three disposal sites, out of a production exceeding 1700. Recycling was very limited, while the composting capacity was 3.5 tonnes day(-1), but increasing. We carefully assessed system elements and their interaction. We identified the challenges, and developed possible solutions to increase system effectiveness and robustness. The case study demonstrated that our methodology is flexible and adaptable to the context, thus it could be applied in other areas to improve the humanitarian response in similar situations.