J.3_HUJ_Draft_Environmental_Mitigation_Plan_and_Report_(EMPR).pdf

Haiti Health Infrastructure Program (HHIP) Environmental Assessment of the Platana Community Health Center 1

HAITI HEALTH

INFRASTRUCTURE

PROGRAM

DRAFT ENVIRONMENTAL MITIGATION PLAN

AND REPORT FOR THE JUSTINIEN UNIVERSITY

HOSPITAL PEDIATRICS WARD

DECEMBER 2014

This publication was produced for review by the United States Agency for International Development.

It was prepared by AECOM.

DRAFT

Draft Environmental Mitigation Plan and Report for the JUH Pediatrics Ward iii

DRAFT ENVIRONMENTAL

MITIGATION PLAN AND REPORT

For the

JUSTINIEN UNIVERSITY HOSPITAL

PEDIATRICS WARD

Submitted to:

USAID/Haiti December 20, 2014

Prepared by:

AECOM

DISCLAIMER:

The authors’ views expressed in this document do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

Draft Environmental Mitigation Plan and Report for the JUH Pediatrics Ward iv

Table of Contents

1. COVERSHEET

2. ENVIRONMENTAL MITIGATION PLAN & REPORT NARRATIVE

2.1 Background, Rationale and Outputs/Results Expected:

2.2 Activity Description:

2.3 Environmental Baseline:

2.3.1 Water Supply

2.3.2 Wastewater System

2.3.3 Medical, Biological, Hazardous, and Solid Waste Management

2.3.4 Power Supply

2.4 Evaluation of Environmental Impact Potential of Activities (Table B):

2.4.1 Safety to Construction Workers, Hospital Patients and Staff, and Neighboring

Community during Construction

2.4.2 Water Supply

2.4.3 Wastewater Treatment

2.4.4 Air Quality

2.4.5 Noise

2.4.6 Planning and Permitting

2.4.7 Solid and Biohazardous Medical Waste Management

2.4.8 Gender

2.5 Environmental Mitigation Actions (Tables B & C):

3. ENVIRONMENTAL SCREENING FORM (TABLE A)

4. IDENTIFICATION OF MITIGATION PLAN (TABLE B)

5. ENVIRONMENTAL MONITORING AND EVALUATION TRACKING TABLE (TABLE

C) ………………………………………………………………………………………………………..23

6. CONTRACTOR CONSTRUCTION REQUIREMENTS

6.1 Health and Safety Plan (HASP)

6.2 Storm Water Pollution Prevention Plan (SWPPP)

6.3 Dust Control

6.4 Work Hours

6.5 Waste Disposal

6.6 Storage and Handling of Chemicals and Hazardous Materials

6.7 Public Notification and Signage

6.8 Local Employment

6.9 Monitoring, Recording, and Reporting

7. REFERENCES CITED

8. STAKEHOLDER MEETING SUMMARIES

9. PHOTOGRAPHS

Environmental Mitigation Plan and Report for the JUH Pediatrics Ward 5

SECTION ONE

1. COVERSHEET

USAID MISSION SO # and Title: Haiti Health Infrastructure Program

Title of IP Activity: Design and Reconstruction of the Pediatrics Ward at Justinien University Hospital, Cap-Haitien, Haiti

IP Name: AECOM

Funding Period: FY 2013 – FY 2016

Resource Levels (US$):

Report Prepared by: Meg Findley, Kenson Theus, Nick Mason and Wayne Curry

Date: December, 2014

Date of Previous EMPR: NA

Status of Fulfilling Mitigation Measures and Monitoring:

YES Initial EMPR describing mitigation plan is attached.

NO Annual EMPR describing status of mitigation measures is established and attached (Yes or No).

YES Certain mitigation conditions could not be satisfied and remedial action has been provided within the EMPR (Yes or No).

USAID Mission Clearance of EMPR:

Contracting Officer Rep: ___________________________ Date: ______________ Manish Kumar

Mission Environmental Officer: ___________________________ Date: ______________ Ryan D. Knight

Regional Environmental Advisor: ___________________________ Date: ______________ Paul Schmidtke

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SECTION TWO

2. ENVIRONMENTAL MITIGATION

PLAN & REPORT NARRATIVE

2.1 BACKGROUND, RATIONALE AND OUTPUTS/RESULTS

EXPECTED:

The proposed project is a three year USAID-funded activity with the objective of replacing the existing 70-bed pediatrics facility at Justinien University Hospital (JUH) in Cap Haitien in order to facilitate improved delivery of pediatric care services to the approximately 825,000 citizens served by the hospital. The project began with initial design scoping in November 2013 as a first step to preparing design and construction drawings and will continue until approximately November 2016 when construction of the new pediatrics ward is expected to be complete.

The activities under this project were envisioned as part of USAID/Haiti’s support to Pillar C: Health and Other Basic Services of the USG Haiti Five-Year Post-Earthquake Strategy. The earthquake that shocked Haiti on January 12, 2010, caused extensive damage to an already weak health system, with historically poor health outcomes. According to Ministry of Health (MOH) estimation, even before the earthquake, a significant portion of the Haitian population had no access to basic health services; a health network capable of meeting basic primary care needs for all Haitians did not exist and access to tertiary care was extremely limited. The Reconstruction of the Pediatrics Ward at JUH is part of the Haiti Health Infrastructure Program (HHIP) which was designed to support the USG Health Strategy Priority of (IV) rebuilding public health infrastructure in earth-quake zones and USG development corridors. The project also supports USAID and the Government of Haiti’s (GOH) focus on child health and nutrition and reduced infant mortality rates.

JUH is the main hospital serving the needs of Cap-Haitien and the surrounding communities of northern Haiti, one of the USG development corridors. The hospital campus is fully developed with little additional area available for expansion. The existing Pediatrics Ward building is extremely deteriorated both visibly and structurally, and is overcrowded, resulting in severe space limitations and reduced quality of care for patients. Prior analyses of current conditions and needs at the pediatrics facility confirm that replacement of the facility is essential to improving the delivery of pediatric care and meeting current demand for these services in the vicinity.

The small-scale construction and renovation activities under this project have been identified as having the potential for negative impact on the environment and have therefore been issued a Negative Determination with Conditions under the Environmental Threshold Decision for USAID/Haiti Pillar C – Priority 1: Health (LAC-IEE-11-03) pursuant to 22 CFR 216.3 (a)(2)(iii). As such, this Environmental Mitigation and Monitoring Report (EMPR) was prepared by the HHIP Implementing Partner, AECOM, to provide an overview of the existing conditions of the environment at the project site, planned activities and their potential impacts, key issues associated with these activities, recommendations for measures necessary to mitigate the potential impacts, and a monitoring framework for the mitigation measures. It is based on information obtained during site visits and interviews with stakeholders at JUH, including interviews and meetings with hospital personnel and representatives of Konbit Sante, an NGO currently working at the facility to support operational improvements.

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2.2 ACTIVITY DESCRIPTION:

The proposed action includes the demolition of the existing single story pediatrics ward at JUH and the construction of a new, two-story, 74-bed ward (AECOM 2014b). The new facility will generally occupy the same footprint as the existing building due to space constraints on the campus. Three major activities are required to accomplish the proposed action, as further described in the sections below: (1) design of the pediatrics ward, (2) demolition of the existing building and construction of the building, and

(3) operations and maintenance of the new facility.

2.2.1 PEDIATRICS WARD DESIGN

The first major activity is the preparation of Design Documents by the Architectural & Engineering Services (A&E) Contractor for HHIP, AECOM. A&E Designs were prepared based on initial stakeholder consultations, as summarized in Section 8, to incorporate the specific needs and requirements of the hospital and community served. All design elements and specifications will comply with International Building Code 2009 and related codes. Plans are also approved by USAID, MOH, and JUH at the 35%, 65% and final design to ensure that the final product meets the host country standards and expectations.

This EMPR was prepared based on 65% designs, but as the interventions have already been well-defined and all environmental and other analyses are complete, no updates to this EMPR are anticipated to be necessary prior to construction.

2.2.2 DEMOLITION AND CONSTRUCTION

The second major activity is the demolition of the existing structure and construction of the new pediatrics ward. Once the designs and specifications are completed by AECOM, they will be tendered for construction by USAID. The selected construction contractor will construct the facilities based on the design plans and specifications, and will be responsible for implementing the majority of mitigation measures defined in this EMPR. They will also be responsible for preparing the annual EMPR to describe the status of mitigation measures for construction activities. AECOM will provide construction management and oversight on behalf of USAID during the construction period, including ongoing monitoring of compliance with the recommended mitigation measures in this EMPR.

The following key sub-activities are required to construct the new pediatrics ward:

1. Demolition and removal of the existing structure;

2. General site clearing and grubbing;

3. Removal and disposal of construction debris;

4. Temporary facilities for the construction contractor and work crews (toilets, water supply, staging and storage areas, office space);

5. Material sourcing, transport, and storage;

6. General building construction activities (excavation, backfill….)

7. Installation of equipment (anything specific for electric supply or other )?

In addition to the building construction itself, connected activities will include the installation of a new septic system and replacement of water supply piping and new chlorine water treatment system.

The need for additional swing space at the hospital to temporarily house pediatric services during demolition and construction of the new Pediatrics Ward was initially explored, in order to ensure that the delivery of pediatric patient care would continue uninterrupted at JUH. In response, the Hospital Administration has developed a plan for combining the use of some portions of the maternity building during construction, as well as off-site facilities for use as swing space. This plan will enable services to continue during the construction phase.

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2.2.3 OPERATIONS AND MAINTENANCE

After completion of construction, the building facilities will be handed over to JUH who will be responsible for operating and maintaining the new pediatrics ward with support from the MOH. This includes provision of adequate medical, administrative, and facilities staff as well as budgeting resources for annual operations (staffing, supplies, utilities) and ongoing maintenance. To support sustainability of the resulting infrastructure, a Sustainability Plan and Implementation Letter will be prepared by USAID and signed by MOH prior to commencing construction. The plan will assist the MOH and JUH in identifying the resources needed (human and financial) to adequately operate and maintain the pediatrics ward, and the Implementation Letter will define the responsibilities (fiscal and other) of MOH and JUH in regards to operations and maintenance of the building, including implementation of mitigation measures identified in Table B for the operations phase.

2.3 ENVIRONMENTAL BASELINE (TABLE A):

Justinien University Hospital is located in a densely populated community of Cap-Haitien. Traffic around the facility and the neighborhood is very congested due to limited street access, narrow streets and high flow of people at the hospital. The mid-afternoon period usually experiences less traffic.

Measuring approximately 484 m2, the current one-story facility lacks adequate space for patients, staff, and visitors. The cramped quarters also contribute to an increased likelihood of the spread of diseases between building occupants. The spaces in the existing facility occupy multiple floor levels with steps between a number of these spaces making it difficult for staff to move patients within the facility and creating barriers for persons with disabilities. The design team will address each of these challenges in the development of the new facility design.

2.3.1 WATER SUPPLY

The hospital water system currently obtains water from wells located on site. There are three wells on the hospital campus, but only two are operative. The first well is 98 meters (320 feet) deep, with an estimated sustainable discharge of 0.57-0.91 m3/hr. The field measured output for the well was 1.5 m3/hr. The second well, installed in 2009 to supplement the first well, is 36.5 meters (120 feet) deep, with an approximate sustainable discharge of 1.8 m3/hr. The field measured output was 0.7 m3/hr (AECOM 2014c). The hospital staff does not regard the water from the system as potable or suitable for drinking. However, it is possible that some patients drink from the system against better judgment.

The wells feed an elevated storage tank, and water is piped by gravity to the various underground cisterns which service their respective buildings on campus. From the cisterns, water is pumped to roof storage tanks where they are gravity fed to the buildings. The pediatrics building has its own cistern and several roof storage tanks. There have been numerous problems with water distribution and water pumping due to breaks in the system, open valves and lack of consistent city power. As a result, cisterns are often filled by water trucks, and water is manually transferred from the cistern to the respective hospital ward. Additionally, the Total Dissolved Solids (TDS) in the water leads to scale in autoclaves, encrustation of the piping, and deposition issues in the storage tanks. There is no adequate water treatment or softening system currently in place.

Altol Dominicana, SRL, a certified water testing laboratory in the Dominican Republic, analyzed grab samples taken by AECOM, from both JUH wells for inorganic compounds in their lab in Santo Domingo.

The results are summarized in Table 1 along with primary and secondary national drinking water maximum contaminant limits (MCL) set forth by the U.S. EPA Safe Drinking Water Act.

Table 1: JUH Well Water Quality Testing

PARAMETER TEST METHOD UNIT RESULTS MCL

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Well 1 Well 2 Alkalinity SM 2320B mg/L 258 423 - (**)Color SM 2120B µS/cm <5 <5 15 Conductivity HACH (Electrometry) mg/L 1,354 1,327 - Salinity HACH (Electrometry) mg/L 673 658 - (*)Nitrate HACH 8039 mg/L 4.1 2.7 10.00 (*)Nitrite HACH 8507 mg/L <0.003 0.004 1.00 (**)Sulfate HACH 8131 mg/L 30 47.5 250 (**)TDS HACH (Electrometry) mg/L 946 928 500 Turbidity HACH (Nephelometry) NTU 0.735 0.77 - (*)Total Chromium HACH 8024 mg/L <0.07 <0.07 0.10

* National Primary Drinking Water Regulations (EPA) ** National Secondary Drinking Water Regulations (EPA)

The results show that at the time of the grab samples, nitrate concentrations were below EPA MCL’s.

This would suggest the absence of groundwater contamination from JUH wastewater at the depth of the hospital wells pump intakes. However, the possibility of nitrates entering the water system through a break or leak in the water distribution line is still feasible. AECOM has noted that the nitrate contamination issue is of particular concern in regard to pediatric care, where high nitrates are linked to the “blue baby” syndrome (AECOM 2014a). Due to these nitrate concerns, bottled water is currently utilized as potable water at the facility.

2.3.2 WASTEWATER SYSTEM

The hospital campus does not have a centralized wastewater system. Two public pit latrine buildings located behind the Administration Offices appear to be the only sanitary service that is actively utilized by the public hospital population. Private pit latrines exist in several hospital wards as well. Additionally, a system of private septic tanks exists to meet the needs of individual wards in the hospital. These private septic tanks are set up to receive wastewater from flush toilets inside their respective wards;

however, the use of flush toilets is widely misunderstood by the general hospital population. This leaves the flush toilets out of service or reserved for staff and limited patient use. The septic tanks typically contain two chambers for solids settling and a third chamber which acts as a soakage pit. Both the pit latrines and the septic tanks discharge wastewater effluent directly into the subsurface stratum, and they are not regularly maintained and/or emptied. There are significant problems with wastewater back-ups, which present unsanitary conditions.

Very rarely, the septic tanks will be serviced by septage vacuum trucks, which take the septage to a disposal site. Jedco is the most prevalent company operating septage trucks in Cap-Haitien. Jedco uses two disposal sites located outside of Cap-Haitien.

o One of the disposal sites is operated and maintained by Jedco near the town of Quartier-Morin, approximately ¼ mile from the main highway, in an agricultural area with no buildings near the site. The trucks deposit the septage in one of two separate unlined earthen pits with earth berms surrounding them for containment, and a block wall around the larger pit. These pits are seen to be a serious environmental hazard.

o The other disposal site is operated and maintained by DINEPA near the town of Limonade. The trucks unload into a series of three wastewater lagoon basins approximately 20 meters wide by 30 meters long. The level of wastewater treatment at this DINEPA facility is unclear, and a site visit to the site would be necessary to confirm operation and treatment quality.

Jedco operates three pumping trucks with tank capacities of 3,000, 2,000 and 1,000 gallons, respectively.

The cost for the 3,000 gallon tanker truck was quoted by the Jedco to be 15,000 Gourdes ($333/tanker

Environmental Mitigation Plan and Report for the JUH Pediatrics Ward 10 load) during a visit to the facility in June, 2014. Due to budgetary constraints at the hospital, these services are not utilized often.

In order to determine if any shallow wells exist that could potentially be affected by wastewater from the seepage pits located in the vicinity of the JUH Pediatrics Ward, AECOM conducted an inventory of wells in the immediate area down-gradient of the JUH Pediatrics Ward for a distance of approximately 200 m. The investigation revealed that there were four deep wells (greater than 31m (100 ft) in depth) within 200 m of the JUH Pediatrics Ward, but no shallow water-producing wells down-gradient of the hospital were found. One shallow down-gradient well was found with a depth of 15.2 m (50 ft), however it was dry, indicating no shallow water-bearing zones exist to that depth in the area. The down-gradient wells ranged from 100 to 170 m in distance from the JUH Pediatrics Ward septic tank location. Grab samples were taken from the down-gradient wells, as well as nearby deep wells outside the zone of influence of septic tanks located near the JUH Pediatrics Ward. The water samples were sent to the Altol Dominicana, SRL Laboratory in Santo Domingo, Dominican Republic to perform water quality testing, with a focus on nitrate concentrations.

Table 2: Water Quality Results for Surrounding Wells

PARAMETER UNIT

RESULTS

MCL

Well 1 Well 2 Well 3 Well 4

Alkalinity mg/L 406 358 314 356 - (**)Color mg/L <5 <5 <5 <5 15 Conductivity µS/cm 1,488 1,325 811 923 - Salinity mg/L 742 657 395 448 - (*)Nitrate mg/L 2.15 5.65 1.05 1.85 10.00 (*)Nitrite mg/L <0.003 0.004 0.003 0.003 1.00 (**)Sulfate mg/L 32 23.5 17.5 15 250 (**)TDS mg/L 1,040 927 569 647 500 Turbidity NTU 0.575 6.96 0.72 0.335 - (*)Total Chromium mg/L <0.07 <0.07 <0.07 <0.07 0.10

* National Primary Drinking Water Regulations (EPA) ** National Secondary Drinking Water Regulations (EPA)

As shown in Table 2, the results of the analysis confirm that at the time the grab samples were taken, nitrate concentrations in all four wells were below EPA MCL’s, suggesting little or no influence of JUH’s wastewater on the surrounding wells.

To further assess the presence of localized contamination, AECOM collected soil samples in the location corresponding to the future Pediatric Ward septic tank near to the existing surgery and operating building septic tanks. Soil samples were taken at 1.5m (5 ft) increments until a depth of 6.1m (20 ft) was achieved. Samples were taken to the CRDD Laboratory in Bas Boen, Haiti, operated by FONHDAD.

Table 3: Soil Testing Results

PARAMETER UNIT

RESULTS

1.5 m Depth

3.0 m Depth

4.5 m Depth

6.1 m Depth

Nitrate mg/L 50 20 40 30 Nitrite mg/L <1 <1 <1 <1

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As shown in Table 3, the test results revealed the presence of nitrate concentrations in the subsurface soil stratum, the highest of which occurred closest to the surface. These results confirm that nitrate concentrations are variable in the soil stratum with depth and are likely caused by wastewater infiltration from various sources near the surface. Results also confirm the feasibility of nitrates entering the soil profile from leaks in nearby wastewater collection lines from buildings to septic tanks. These wastewater collection lines are buried at shallow depths beneath the ground surface in some areas.

2.3.3 MEDICAL, BIOLOGICAL, HAZARDOUS, AND SOLID WASTE MANAGEMENT

Solid waste and medical waste used to be managed properly by hospital staff at JUH. In the past, solid waste and medical waste were properly separated into designated bins with designated color-coded trash bags. Medical waste was taken to the incinerator for disposal and other solid waste was collected and transported to a public landfill by a private company.

Currently, however, solid waste and medical waste are not properly separated and most of the non-medical waste is being included with medical waste. This has increased the volume of medical waste significantly and created many managerial problems in disposing of the wastes. The hospital can no longer use a trash collection service for solid waste disposal because of potential contamination and disease transmission of medical waste. This leaves incineration or open burning as the only trash disposal option for all of the waste generated in the hospital.

JUH has two diesel fuel incinerators. However, JUH does not have properly trained incinerator maintenance personnel that know how to respond to the rise in medical waste volume. Additionally, the hospital cannot meet the increased diesel fuel demand created from the elevated medical waste load due to its budgetary constraints. The result of these managerial problems is that the diesel fuel incinerators have not been in regular operation since June of 2013. Presently, all medical waste generated by the hospital is either burned in a brick incinerator or in the open air behind the incinerator.

Hospital personnel have indicated that they intend to reinstate the former system of separating medical waste from nonhazardous waste and reserving the use of incinerators only for burning medical waste.

2.3.4 POWER SUPPLY

The hospital receives EDH power approximately 15 to 18 hours per day. Battery powered invertors and backup generators are used during power shortages. Fuel costs for generators are covered by the general hospital budget instead of individual budgets for each JUH ward. Most of the electrical work and electrical upgrades to the hospital have been performed by Tetratech, a USAID Contractor. The wiring for the Pediatrics Ward was specifically not upgraded given USAID’s plans to demolish the existing structure, however the overall campus electrical upgrade included a generator and distribution system with sufficient capacity to serve the new Pediatrics Ward.

2.4 EVALUATION OF ENVIRONMENTAL IMPACT POTENTIAL OF

ACTIVITIES (TABLE B):

2.4.1 SAFETY TO CONSTRUCTION WORKERS, HOSPITAL PATIENTS AND STAFF,

AND NEIGHBORING COMMUNITY DURING CONSTRUCTION

PRE-CONSTRUCTION AND CONSTRUCTION PHASE

Direct Effects. The construction of the new pediatrics building, including the transport of materials and supplies to the project site, will increase the risk of traffic and/or worker accidents. The handling and application of chemicals may expose workers to hazardous substances that can cause injury, illness, or

Environmental Mitigation Plan and Report for the JUH Pediatrics Ward 12 even death. With the implementation of an occupational health and safety program and adequate road accident preventive and safety measures, these impacts are minor.

The workers required to construct the pediatrics facility will likely either be sourced locally or temporarily reside near the site until construction is complete.

Indirect Effects. Transmission of sexually transmitted diseases, including HIV/AIDS, can increase due to the interaction of outside workers with the local population during health center construction. This can have serious negative impacts on public health and should be taken very seriously. With adequate mitigation measures in place to address this (as described in the section on mitigation measures below), this impact can be minimized.

Mitigation Measures. Asbestos will be prohibited from use. The construction manager will prepare and implement a Health and Safety Plan (HASP) to ensure health and safety during both construction and operation of the health center (Section 6). This will also include the provision of training on best practices for construction workers in order to minimize risks, and awareness raising information on STDs and HIV/AIDS. It will also include guidelines and training on safe practices in the handling of any hazardous chemicals and other materials.

To address construction worker needs, drinking water should meet WHO drinking water quality guidelines. Latrines should be constructed at least 30 m from drinking water sources and be properly maintained. Solid waste should be collected in designated locations and disposed of in designated disposal sites, in accordance with government authority’s current practices for solid waste disposal.

Access to the construction site should be controlled at all times to prevent entry and possible injury from persons not associated with the project. Security of the site will be the responsibility of the construction contractor. The construction contractor will also provide sufficient onsite potable drinking water, sanitation and washing facilities. All site personnel shall have personal protection equipment, including hard hat, safety glasses, hearing protection, reflective vest and protective boots.

2.4.2 WATER SUPPLY

PRE-CONSTRUCTION, CONSTRUCTION, AND OPERATION PHASE

Direct Effects. The existing cisterns servicing water to the pediatrics building and the maternity building will be demolished during the reconstruction of the pediatrics facility. Temporary water storage for the maternity building is required to continue facility operations. Similarly, a reliable source of safe water is required for the pediatric building and the maternity building’s operation once construction is completed. The lack of safe water can impose strong negative impacts, if not adequately addressed during design.

Mitigation Measures. Prior to the demolition of the maternity cistern, a temporary cistern structure will be procured for the duration of construction. During construction, new water distribution lines will be laid, a dual chamber water storage cistern will be constructed, and chlorine-based treatment system will be installed to service both the new pediatrics building and the existing maternity building. This will significantly improve the reliability and quality of the water supply to the facility. While the new treatment system will address bacterial contamination, it will not address the potential of nitrate contamination in the water. Therefore, bottled water will continue to be used for drinking during pre-construction, construction, and operation phases. To protect groundwater quality during construction, the construction contractor will prepare a Storm Water Pollution Prevention Plan (SWPPP) to control storm runoff and soil erosion throughout the site.

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All potential pollutants, hazardous materials, petroleum products, lubricants, hydraulic oil, paints, and coatings, shall be stored in an approved container and placed on a sealed surface with containment dikes to prevent soil and water contamination.

An operations and maintenance plan for the water supply system needs to be prepared as part of a Sustainability Plan that is required by USAID Mission Order No. 36 (September 30, 2014).

2.4.3 WASTEWATER TREATMENT

PRE-CONSTRUCTION AND CONSTRUCTION PHASE

Direct Effects The existing pediatric building wastewater facilities, including several pit latrines and an unsealed septic tank, will be demolished during construction of the new facility. This could expose the demolition work crew to an unsanitary environment. The contaminated materials taken during the demolition will need to be handled carefully, be transported and disposed of safely in a designated location specified by the local government.

Mitigation Measures The contractor will have GoH-approved waste collection service, remove wastewater and septage from existing septic tanks, and latrines if necessary, before backfilling them and performing demolition works.

OPERATION PHASE

Direct Effects. The selected wastewater treatment method requires soils with adequate percolation in order to promote effective seepage. If soil properties are not adequate, untreated wastewater may contaminate soil and groundwater.

Mitigation Measures. AECOM performed an evaluation of soils at the site, and determined the percolation rates were adequate for the current design concept, which is to provide a dedicated septic system for the new pediatrics building.

An operations and maintenance plan for the wastewater collection and disposal system needs to be prepared as part of a Sustainability Plan that is required by USAID Mission Order No. 36 (September 30, 2014).

2.4.4 AIR QUALITY

PRE-CONSTRUCTION AND CONSTRUCTION PHASE

Direct Effects. During construction, large amounts of soil will be excavated, stockpiled, and transported.

The machinery used for excavation will generate dust, which can be dispersed by the wind. Emissions in the air from exhaust fumes and dust from vehicle and machines may cause nuisance to surrounding homes, hospital wards, pedestrians and workers. Dust generated during transportation of materials will also pollute the air in the immediate local environment. Additionally, some exhaust fumes may be temporarily generated by the use of heavy equipment and increased traffic during construction.

Mitigation Measures. Excavation areas will be watered to limit dust emissions. Limits on the speed of construction vehicles will be established and enforced. Water tanker trucks will be used to spray dust and minimize dispersion into the surrounding air.

OPERATION PHASE

Direct Effects. The existing JUH Incinerator that will be used to treat and dispose of medical and biological waste burns efficiently with little to no smoke. Air quality is not expected to be compromised by incineration, as long as the waste to be burned is segregated and such materials as PVC plastics that will emit dioxins and furans during burning are removed prior to incineration.

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2.4.5 NOISE

PRE-CONSTRUCTION AND CONSTRUCTION PHASE

Direct Effects. Noise may be generated by the use of heavy equipment during construction. However, existing noise levels would not be increased substantially and would primarily apply to equipment noise related to the initial phase of construction, namely the demolition and removal of the existing Pediatric Building. The noise levels vary widely and depend on the type of activity performed. For example, a front end loader will generate noise on the level of 100 decibels (dB), while that of a truck will be approximately 85 dB. To put these noise levels in perspective, acceptable levels of noise are generally regarded to be 40 dB during the night (to avoid sleep disturbance) and 50 dB during the day (higher than 50 dB causes annoyance and interference with communication).

Mitigation Measures. Consideration should be taken of both daytime operation of the hospital and potential for sleep disturbance in the surrounding area at night before construction schedules are set, and protective ear equipment should be provided to all workers. Workers who fail to comply with safety guidelines should be terminated after repeated warnings are issued. All construction equipment and trucks must have functional mufflers to reduce exhaust noise.

2.4.6 PLANNING AND PERMITTING

After providing the project with building permit and authorization notice, the Mayor’s office will help coordinate with MTPTC and ISPAN (Institute for the Protection of National Heritage) including nearby dump sites, traffic signs and traffic redirection during construction.

2.4.7 SOLID AND BIOHAZARDOUS MEDICAL WASTE MANAGEMENT

PRE-CONSTRUCTION AND CONSTRUCTION PHASE

Direct Effects. Solid waste will accumulate during the construction phase, consisting of material scraps, containers for paint, solvents, glue, etc., material and equipment packaging, equipment filters and other materials that must be collected and disposed of in a safe manner. Oil, fuel and grease from equipment service and spills must also be collected and disposed of in a proper and safe manner.

Mitigation Measures. Solid waste will be managed by the construction contractor during the construction phase. It will be the responsibility of the construction contractor to properly transport and dispose of solid waste in a proper manner, working with MSPP and local authorities to identify designated locations and methods for waste disposal. The USAID Environmental Sector Guidelines for healthcare waste and solid waste are referenced for guidance

OPERATION PHASE

Direct Effects. Solid waste will be managed by the existing hospital staff provided by MSPP. The new Pediatrics Ward will add an additional 4 beds to the facility, which means that the quantity of medical waste generated by the facility could potentially be slightly more than that currently produced. Formal resource recovery for reuse and recycling is considered impractical as there are no identified recycling vendors in the vicinity of Cap-Haitien.

Biohazardous medical waste is expected to be incinerated using the existing incinerators at JUH. MSPP must manage the waste processing as part of the facility operations. A lack of safe handling, segregation, treatment and disposal of medical, biological and hazardous waste will cause very serious health and safety risks to staff personnel, and even patients or the local community due to contamination and the spread of infectious diseases.

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Mitigation Measures. While it is the responsibility of the Hospital Administration to deal with solid and medical waste management, including the provision of a budget to pay for fuel, it is recommended that the hospital find funding to obtain fuel to operate the incinerators in order to manage and dispose of medical waste more effectively, especially given the small additional increase in waste expected to be generated by the additional 4 beds. If the two advanced incinerators cannot be used because of the lack of fuel, as is reportedly common, it is recommended to use the third brick incinerator as a last-resort.

While it is vital that staff be adequately trained in safe handling and treatment of medical, biological and hazardous waste, and that appropriate waste management measures be implemented at all times, this is beyond the responsibility of the CMC or Construction Contractor. Guidelines such as those provided in USAID’s Guidelines for Medical Waste Management should be followed by the health center operations staff. Health center staff should be provided with appropriate PPE for handling medical and solid waste at all times. Red bag medical waste is considered hazardous waste and must be processed and disposed of separately to avoid potential contamination of air, soil, or groundwater.

Reference is also made to USAID Mission Order No. 36 (September 30, 2014) that clearly states a Sustainability Plan must be put in place. The Sustainability Plan would include details about methods and processes required to segregate and dispose of solid, medical and biological wastes, as well as requirements for allocation of funding by the GoH to support the effort.

2.4.8 GENDER

PRE-CONSTRUCTION AND CONSTRUCTION PHASE

Direct Effects. Despite the fact that Haitian women play a vital role in the informal economic sector and domestic affairs, they are often neglected in terms of formal employment, particularly with regard to construction. For the country as a whole, there are proportionally fewer women than men who are actively working in the formal jobs sector. Construction of the pediatrics building will offer new employment opportunities for both men and women in the Cap-Haitien area. Employment will offer higher income potential, which can help alleviate economic stress and improve the quality of life for families and children.

Mitigation Measures. It is important that the construction contractor offer equitable employment opportunities for men and women, which may involve additional encouragement to women who may not otherwise apply. Due to the relatively small number of jobs created by health center construction, the positive impacts on women, if recommended mitigation measures are followed, will be minor, but important to those women and their families that it will affect.

OPERATION PHASE

Direct Effects. Women nurses at the hospital were consulted on the matter of gender and gender related issues at the hospital and provided their input on the new operation of the pediatric ward. The main issue is a separation of sanitary services at the Pediatric Ward. Women have limited toilets at the pediatric ward currently and facilities provide little or no privacy, especially for female patients who have to spend the night and have no place to shower privately or sleep.

The other issue discussed during consultation was security. As the parents of the patients need to spend the night, most of the time there are no places where they can lodge or rest peacefully due to space limitations, and many visitors have complained.

Mitigation Measures. AECOM has considered elements integral to the design, including numbers of plumbing fixtures for each gender, the security of the facility and providing adequate space within the facility for patients’ family members in an effort to ensure that the facility operates effectively and takes into account the impact of the design for both women and men. The new Pediatrics Ward will have a

Environmental Mitigation Plan and Report for the JUH Pediatrics Ward 16 combined use toilet in the reception area and will have dedicated toilets in the interior treatment areas.

There will also be a provision for showers in the interior treatment area.

The current design does not provide for sleeping quarters as the hospital administration would prefer to have centralized quarters if they are eventually provided. However, the current plans allot nearly half the second floor of the new pediatrics building as unfinished space, giving the pediatric staff freedom to decide how they want to use it. This unfinished space can be transformed into overnight sleeping quarters as the pediatric leadership sees fit.

2.5 ENVIRONMENTAL MITIGATION ACTIONS (TABLES B & C):

See environmental mitigation tables below.

Environmental Mitigation Plan and Report for the JUH Pediatrics Ward 17

SECTION THREE

3. ENVIRONMENTAL SCREENING

FORM (TABLE A)

Name of Activity: Design and Construction of a new Pediatrics Ward at the Justinien University Hospital, HAITI

Type of Activity: Engineering Design and Construction

Implementing Organization: AECOM

Date: May 19, 2014

Column A

Column B

Col C

Yes No

If answered yes to Col.

A. is it a--?

High or

Unknown Risk

Medium-

Risk

IMPACT ON NATURAL RESOURCES & COMMUNITIES

1 Will the project involve construction1 of any type of structure (building, check dam, walls, etc)?

YES X

2 Will the project involve the construction2 or repair of roads or trails? NO 3 Will the project involve the use, involve plans to use or training in the use of any chemical compounds such as pesticides3 (including neem), herbicides, paint, varnish, lead-based products, etc?

YES X

4 Involve the construction of repair of irrigation systems? NO 5 Involve the construction or repair of fish ponds? NO 6 Involve the disposal of used engine oil? YES X 7 Will the project involve implementation of timber management4 or extraction of forest products?

NO

8 Are there any potentially sensitive terrestrial or aquatic areas near the project site, including protected areas?

NO

9 Does the activity impact upon wildlife, forest resources, or wetlands? NO 10 Will the activities proposed generate airborne gases, liquids, or solids (i.e.

discharge pollutants)

YES X

11 Will the waste generated during or after the project impact on neighboring surface or ground water?

YES X

12 Will the activity result in clearing of forest cover? NO 13 Will the activity contribute to erosion? NO 14 Is the activity incompatible with existing land use in the vicinity? NO 15 Will the activity contribute to the displacement of housing? NO 16 Will the activity affect unique geologic or physical features? NO 17 Will the activity contribute to change in the amount of surface water in any body?

NO

18 Will the activity deal with mangroves and coral reefs? NO 19 Will the activity expose people or property to flooding? NO 20 Will the activity contribute substantial reduction in the amount of ground water otherwise available for public water supplies?

NO

21 Will the activity create objectionable odors? NO 22 Will the activity violate air standards? NO

ENVIRONMENT & HEALTH

23 Will the project activities create conditions encouraging an increase of waterborne diseases or populations of disease carrying vectors?

NO

Environmental Mitigation Plan and Report for the JUH Pediatrics Ward 18

24 For road rehabilitation as well as water and sanitation grants, has a maintenance plan been submitted?

NO

25 Will the activity generate hazards or barriers for pedestrians, motorists or persons with disabilities?

YES X

26 Will the activity increase existing noise levels? YES X 27 Will the project involve the disposal of syringes, gauzes, gloves and other biohazard medical waste?

YES X

28 Is the activity incompatible with existing land use? NO

LOCAL PLANNING PERMITS

29 Does the activity e.g. infrastructure improvements, require local planning permission(s)?

YES

30 Does the activity meet the national building code (e.g. infrastructure improvements)?

YES

GENDER5

31 Do men and women benefit disproportionately or are involved unequally in the project’s activities?

NO

32 Does the project activity inhibit the equal involvement of men and women? NO 33 Are there factors that prevent women’s participation in the project? NO

RECOMMENDED ACTION (Check Appropriate Action): (Check)

(a) The project has no potential for substantial adverse environmental effects. No further environmental review is required (Categorical Exclusion). No EMPR required.

(b) The project has potential for minimal to medium adverse environmental effects, but mitigable environmental effects. Measures to mitigate environmental effects will be incorporated (Negative Determination with Conditions). EMPR Required.

X

(c) The project has potentially substantial or significant adverse environmental effects, but requires more analysis to form a conclusion. An Environmental Assessment will be prepared (Positive Determination).

No EMPR required.

(d) The project has potentially substantial adverse environmental effects, and revisions to the project design or location or the development of new alternatives is required (Deferral).

(e) The project has substantial and unmitigable adverse environmental effects. Mitigation is insufficient to eliminate these effects and alternatives are not feasible. The project is not recommended for funding.

1 Construction projects need to be reviewed for scale, planned use, building code needs and maintenance. Some small construction projects, such as building an entrance sign to a park, may require simple mitigations whereas larger buildings will require more extensive review and monitoring.

2 New construction of roads and trails will require a full environmental evaluation of the planned construction, i.e.

a Positive Determination.

3 The planned involvement of pesticides will trigger the need to develop a Supplemental Initial Environmental Examination that meets USAID pesticide procedures (Pesticide Evaluation Report and Safer Use Action Plan or “PERSUAP”) for the project.

4 Any activities that involve harvesting trees or converting forests will require a full environmental evaluation of the activity (i.e. Positive Determination).

5A positive response to gender questions require follow up only when there are other positive responses on questions 1 – 30, and an EMPR is developed.

SECTION FOUR

4. IDENTIFICATION OF MITIGATION PLAN

(TABLE B)

The mitigation measures below will be included in the construction contractor’s scope of work. The contractor will comply with requirements of work scope and submit plans to implement, monitor and report to USAID on all mitigation measures.

Sub-activity or component

Description of Impact

Mitigation Measures

DEMOLITION AND CONSTRUCTION PHASE

3, 6, 10, 11, 27

Pre-demolition preparation of existing building – waste removal, handling and disposition

Uncontrolled release of hazardous materials to the environment

Enforcement of construction contractor Health & Safety Plan (H&SP) will include provisions for removal of all hazardous and universal wastes from building premises prior to demolition including light bulbs, electrical switches, pressurized gas cylinders, fire extinguishers, asbestos containing materials (ACMs), oil/fuel, septic tank and latrine contents and medical wastes

Impacts to human health and safety from improper handling of wastes

Construction contractor H&SP will include provisions to enforce the use (including training and maintenance) of personal protective equipment (PPE) for workers handling hazardous wastes (i.e. hard hats, dust masks, safety glasses, gloves, work shoes)

Impacts to natural resources from poor waste disposal practices

Contractor will reuse, recycle or dispose of each waste according to local best practices including:

1. Identify beneficial reuse or recycling opportunities for construction materials (e.g. masonry, metal, roofing materials, plastics)

2. Coordinate with government authorities and/or HUJ management for best disposal practices for hazardous wastes that cannot be reused or recycled

3. Coordinate with government authorities and/or HUJ management for best disposal practices for sanitary waste

4. Coordinate with HUJ management for best disposal practices for medical waste (i.e. incorporate into standard incineration procedures as per HUJ protocols)

10, 11, 25, 29

Sourcing and transporting of construction materials

Impacts to natural resources from poor construction material collection practices

Identify approved quarry sites or stockpiled sources for procurement of sand, gravel and concrete aggregate

Impacts to air quality from poor transportation practices

1. Ensure the materials meet technical specifications before transport to site

2. Cover loads using tarpaulins to minimize fugitive dust emissions during transport

Generation of hazards or barriers due to improper storage and staging of construction materials

Before off-loading at the work site, contractor will coordinate with HUJ management to determine best locations for storing and staging construction materials nearby the work zone

1, 25 Public safety Risk of injury or death to hospital staff and patients due to movement of vehicles, heavy machinery or other construction equipment and materials

Construction contractor H&SP will include provisions for managing the public health and safety of HUJ staff and patients by including and enforcing provisions including the following:

1. Clearly demarcate and fence off construction and rubble stockpiling areas to avoid entry by patients, visitors and staff

2. Post a full-time guard at all construction site entry points

3. If possible, limit movement of vehicles, heavy machinery and other construction equipment and materials in and out of the construction area

4. When movement of heavy machinery is necessary, alert HUJ staff and provide persons to direct pedestrian and heavy machinery traffic 1, 25 Worker safety Risk of injury or death to on-site construction workers from general work site hazards

Construction contractor H&SP will include provisions for managing the health and safety of on-site workers by including and enforcing provisions including the following:

1. Provide and/or require appropriate standard PPE for all workers (i.e.

hard hats, dust masks, safety glasses, gloves, work shoes)

2. Welding and cutting activities involve exposure hazards to hot surfaces and intense light; PPE for these activities will include helmet with filter lens or hand shields with safety goggles and flame resistant/insulated gloves. Additional protection methods may include the use of welding barrier screens around the specific workstations (a solid piece of light metal, canvas, or plywood designed to block welding light from others)

3. Provide vapor-relief respirators for workers using chemicals in confined spaces (e.g.