Biological aerated filters (BAFs) have high filtration efficiency due to their tolerance of hydraulic and organic shocks are suitable for the treatment of complex and sanitary wastewater. In this study, for the first time, natural media of date kernel from Bam city was used as the BAF reactor media, with a meshing sand filter separated by a standard metal grid from the natural filter section used at the end of the reactor. This can be considered an innovation in the media and filtration. Aeration in the related reactor with 160 cm height was performed bilaterally as up-flow and continuously by nozzles throughout the reactor media. In this work, the actual effluent of the hospital wastewater treatment plant was employed as the inflow wastewater to the reactor, and its organic and inorganic parameters were measured before and after the treatment by the BAF reactor. The backwashing process was also studied in three ways: bottom backwashing (TB), top backwashing (BB), and top and bottom backwashing (TBBS), to determine the amount of water consumed and to achieve the desired result. According to the results obtained in this study, the removal efficiencies of inorganic and microbial contaminants, amoxicillin and azithromycin were obtained as follows: BOD5: 98.48%, COD: 92.42%, $${\text{NO}}_{3}^{ - }$$
NO
3
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: 99.4%, P: 93.3%, Coliforms: 97%, Color: 42.8%, Turbidity: 95%, Sulphate: 30%, TSS: 98.9%, Amoxicillin: 20% and azithromycin: 13%. In the backwashing process, the amount of water consumed in these three TB, BB, and TBBS methods were obtained 300, 164, and 118 L, respectively, So, TBBS method was selected as the optimal method. Based on the results obtained in this study, it is concluded that the BAF process with natural date kernel has a high efficiency in removing organic and inorganic contaminants from hospital wastewater, also the concentration of most of the effluent parameters was less or in accordance with EPA standard.
