Johnson Doe, 36, started working as a waste picker in the sprawling Kpone Landfill in Accra, Ghana, 20 years ago.

It’s not the type of job he imagined for himself as a young man, but it’s how he supports his wife, two children and his parents.

”I wanted to be a military pilot but, you know, life happens,” he said.

He collects items such as plastic bottles, aluminum cans and scrap metal, which he sells to recycling companies that buy them by weight. The money it brings in depends on market demand, but typically, he makes $13 a day.

Often, the job is looked down on, he said: “Many people think the mentally ill people are those who work at the dumpsite — so, that’s how they see us, like we are illiterate. Some people even call us criminals.”

There are about 1,000 people at the Kpone landfill, but across the country it’s hard to get an exact count because they are mostly not organized.

More than 20 million people in the world work as waste pickers, according to the International Labour Organization. They are the largest workforce in the recycling chain responsible for recovering up to 60% of all plastics. And yet, waste pickers’ work is rarely valued — they struggle to earn a living, and are vulnerable to exploitation and exposure to pollution and toxic chemicals.

Environmentalist Kwame Peprah said that as the world grapples with climate change, it is important for governments and companies in Africa to support waste pickers, who help reduce greenhouse gas emissions.

“By helping society to sort out and recycle materials such as paper, plastic and metal, they are reducing the need for virgin materials to be extracted and processed, which requires significant amounts of energy and contributes to carbon emissions,” he said.

Everyday hazards at the landfill

At the Kpone Landfill, all sorts of insects, including maggots, and other pests can be found on decaying garbage, feasting on scraps of food and nesting in rotting material.

Piles of medical waste are scattered throughout — like syringes, blood, pins, needles and other equipment, which puts waste pickers at risk of infectious diseases such as HIV and Hepatitis B and C, Doe said.

Still, many of his colleagues sift through the garbage with their bare hands or worn-out gloves; some don’t have any protective gear at all.

Doe remembered a woman who, while sorting, punctured a plastic bag containing a toxic substance. The acid splashed on her body and burned her clothes.

“Now, she’s bedridden at home and looks completely deformed,” he said.

Unfortunately, emergencies happen all the time at the landfill, according to Doe. Last year, there were 112 emergencies recorded there — with people collapsing from exhaustion, or getting dehydrated, or experiencing breathing difficulties.

He said that when waste pickers seek treatment at hospitals, they face stigma from health workers who describe them as dirty and refuse to attend to them.

Waste picker Elizabeth Eshun has been working in the landfill for the past five years. She said that she’s been coughing and having a sore throat for the last two weeks. She suspects it is the work she does at the landfill.

“You know this work is dirty work so anything is possible. I should be going to the hospital, but where is the money?” she said.

Additionally, waste pickers do not have access to clean water, handwashing facilities or sanitation facilities.

As a woman, that can be especially problematic.

“There are no washrooms here to change your sanitary towel during that time of the month,” waste picker Grace Avemegah said. “This means you have to keep your pad on from morning till evening, which is not good for our health. When you become so pressed, you are compelled to do it in the open.”

Challenges of managing medical waste

Solomon Noi, the head of waste management at the Accra Metropolitan Assembly, has done a number of studies on how medical and industrial waste endangers waste pickers.

He said that a lot of industries channel harmful substances to the landfill.

As a result, “The air is heavily polluted, and it has the tendency to choke your respiratory system, and therefore, we cannot rule out upper respiratory tract infections,” he said.

This means that in addition to inhaling harmful gas at the landfill, waste pickers’ skin “will be exposed to certain corrosive and carcinogenic elements within the wastes that they are scavenging on.”

Also, plastics that the waste pickers come in contact with daily leach hazardous chemicals into the environment, including endocrine-disrupting chemicals (EDCs), which have been linked to reduced fertility, pregnancy loss and irregular menstrual cycles, among many other conditions, according to a report by the Endocrine Society and IPEN (International Pollutants Elimination Network) in December 2020.

Noi said that the health risks faced by waste pickers are rife across the developing world, particularly in Brazil, India, Colombia, Mexico and the Philippines where the amount of waste being generated is rising rapidly, but the technological and financial tools to manage it don’t exist.

“That’s why all these countries in Latin America, Asia and Africa record huge cases of waterborne diseases and infections like hepatitis, cholera and the rest. So, it is a global problem that should be tackled at the global level through concerted efforts,” he said.

Christy Adeola Braham works with the global action network Women in Informal Employment: Globalising and Organising. Her organization has been pushing for better conditions for waste pickers around the world.

“So we are seeing waste pickers being driven into debts needing to sell their belongings, sell lands, take out loans just to afford a single visit to the doctor. And so this is why it is so important for us to advocate for universal healthcare so that everybody has access to affordable, appropriate and high quality health services,” she said.

But beyond universal health care, Noi said he wants to see policy change in Ghana.

“We should have a sanitation master plan and there should be effective and efficient bylaws that will compel particular industries to treat their wastes and render them nonharmful,” he said.

Michael Affordefe, a medical waste expert at the Accra School of Hygiene, said that proper sorting and treatment of waste before it reaches the landfill coupled with personal protective items is crucial.

“That is the only way we can break the chain of transmission of some of these infections from the medical waste. Because when we safely separate the waste, we are not only protecting these people or the waste pickers, we are also protecting the communities because before the waste gets there [the landfill], it is treated, and that can reduce the risk of infections and for that matter all forms of hazards that may come from it,” he said.

But Ghana’s Health Facilities Regulatory Agency, which manages medical waste, said it is alarmed by the rate at which untreated medical wastes are being dumped at the Kpone Landfill.

The Agency’s Head of Operations Agyemang Badu said it is challenging to prosecute noncomplying hospitals.

“We know about the plight of the waste pickers but you see, it is just quite recent that as an agency, we were given a lawyer. Prior to that, we didn’t have any attorney to make sure that the enforcement bites.”

Next year, nations are set to develop a legally binding agreement on plastic pollution. The new global plastics treaty aims to put waste pickers like Doe at the center of its strategy to curb plastic use and pollution.

NB: This story was produced with support from the Pulitzer Center on Crisis Reporting.