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In Manila (Philippines), Médecins du Monde is leading a harm reduction programme amongst dismantlers of electrical and electronic waste. Through this pilot project, the medical charity is bringing this growing environmental issue within the scope of its activities. Above all, it is showing that health offers a short-cut way of reaching out to a particularly vulnerable community, overlooked by encouraging growth in the Philippines, and reduced to depending upon the scrap generated by our wealthy societies.

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Notes de l’auteur

Report prepared in June 2014

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1From the motorway which, with its congested flow of traffic, connects Ninoy Aquino International Airport to Manila, you can take stock of the size of this city which is no longer just one. Formerly called Maynila, “the place of the mango trees”, it has turned into a conurbation, extending its roots to devour the sixteen other cities making up Metro Manila, one of the largest cities in the world, with nearly twenty million inhabitants.

2Thanks to a ring road raised a little above the others, it is almost a shock to have such a commanding view of the megacity. Essentially flat, Greater Manila stretches as far as the eye can see, unfurling its asphalt carpets between blocks of houses roofed with corrugated iron. The only exception: - Makati. This “small town” of 500,000 inhabitants thrusts its ultra-modern towers towards a milky sky, an island of vertical ity and profligacy, symbol of a country where growth is shooting up (7.8 % in early 2013). In this business district deceptively seeming like Hong Kong, tower blocks, luxury villas and huge shopping centres ringed with armed guards represent the outpost of an ultra-liberal society which has hitched itself to the train of globalization. At the risk of overlooking a large proportion of its own people.

Makati-Capulong: back to the future

3To appreciate this, you only have to leave Makati and go on to Capulong, one of the four areas in the city where Médecins du Monde has become involved with informal e-waste dismantler communities. You only have to travel the dozen or so kilometres separating the attractive showcase from the other face of Metro Manila and spend an hour in chronic congestion in the process. The opportunity to catch a glimpse of pointers to the chaotic history which tell the story of this amazing mixture of East and West that are the Philippine Islands.

4Going along Jose Rizal Avenue is a return to the 19th century, to the Spanish East Indies and to the resurrected image of this national hero, a doctor, surgeon, poet, and novelist who paid with his life for his opposition to the colonial regime. Take Jesus Street and understand how, over three centuries, He made the Philippines one of the few countries in Asia dominated by the Catholic faith. Although Rizal’s sacrifice galvanized the supporters of independence to the point that the Spanish crown quit the Philippines, it only made easier their sell-off to the United States in 1898. And then you realise, as you go down Lacson Avenue, that you are driving down what was formerly Forbes Street, Forbes being the name of an American governor. It took a war, a million and a half Filipino dead and the country’s forced march towards Anglicization for it to finally realize Rizal’s dream of independence in 1946. To come back to the reality of 2014, nothing like the honking horns of Jeepneys, those old U.S.Army vehicles converted into cheap public transport...

5At the heart of Manila City, the juxtapositions of history are even more tricky. The neat, straight and modern avenues of Makati give way to winding, unhealthy alleyways - sometimes lined with houses as old as they are decrepit - where the poor go about the day-by-day business of survival. Lorry or car spares, plastic objects, everything that has moved down the long chain of consumption ends up here. A lot of the people living in Capulong Street have specialized in electrical and electronic waste.

Difficult community work

6The MDM (Médecins du Monde) logo on the poster written in Filipino is discreet. Just like the logo on the green sweat shirts proudly worn by members of the Capulong E-waste Dismantlers’s Association. This item of clothing says a lot about what has been accomplished in one year with the support of the French NGO. And the latter had a hard fight to convince them to get organized. Nards is in a good position to know. Aged 58, the MDM coordinator for the Capulong area has long experience of community work. And yet: “At the first meeting that I organized, only 2 people came along. They told me that no one would ever succeed in getting the community organised. I insisted. I came here each day, I sat down and nobody came to speak to me. And slowly confidence began to build up. ”

7Capulong is the most sensitive of the four areas in which MDM decided to have a presence. In this shanty town - one of the 500 in the capital and into which are packed some 40 per cent of its population - life is hard. It still does not appeal to any sense of solidarity. So the unwritten laws had to be learnt, as did how to keep safe in a district where drug trafficking arouses distrust as well as causing violence, and understand how the dismantlers operate: “Even if these people live right next to one another, that is all they know about each other. It is a very individualistic society ”. Nards and the rest of the team therefore had to patiently explain the project MDM planned to carry out in this micro society, for it and especially with it.

A project like no other, a global issue

  • 1 “Health is the balance and harmony of all a human being’s potential (biological, psychological and (...)
  • 2 Comments issued by the round table discussion transcribed in Humanitaire magazine, 38, July 2014, p (...)

8Astrid Heckmann, the general coordinator of the mission, was the one who had the idea of putting to MDM the growing issue of waste electrical and electronic equipment (WEEE) and its impact on the health of those involved in informal recycling: “If you stand a little aside from the concept of purely physical and medical health, if you adopt a dynamic and holistic approach to health as proposed in the Ottawa Charter1, then you sign up to MDM’s concerns about participating in social change”. In some ways, an extension to the field of health which had nothing obvious to do with this medical NGO, as Dr. Guillaume Fauvel, association manager for the mission and leader of the “Santé-Environnement” (Health and Environment) group stressed: “The health and environment theme had already been brought up several times at MDM in recent years. We often tended to think that this was a complex issue because of the many factors involved with intervention plans that did not necessarily come within the traditional framework of a humanitarian health NGO such as MDM. Whether it was the impact of nuclear testing on Moruroa, or the Chernobyl accident in Byelorussia, or even the issue of soils contaminated by mining activity in Bolivia, we always got involved in a fairly feeble way and in the end without acting with genuine, solid commitment. But along the way, the charity ended up by taking a little more interest in these matters, and it was realized that it was social issues which, in a way, allowed us to make the connection between health and the environment: certain groups of people targeted by Médecins du Monde who had a lot of difficulties in getting basic health care because of their extreme poverty and the extent to which they were excluded, were also exposed to environmental factors which bring an additional burden to their social and health difficulties. It therefore began to make sense to work on this overall approach”2.

  • 3 Or FVC: the maximum volume of air that can forcibly be blown out after full inspiration. This pulmo (...)
  • 4 See especially Kristen Grant, Fiona C. Goldizen, Peter D. Sly, Marie-noël Brown, Maria Neira, Marti (...)

9Scientific studies consider that there is a high probability of correlation between exposure to electronic waste, and changes to the lung, cell, and thyroid functions (in particular, a reduction of forced vital capacity3 in young children) or the phenomena of spontaneous abortions, death at birth, premature births and reduced birth weight4. These probable but still hypothetical links require confirmation via epidemiological studies carried through with the most vulnerable groups. Institutions have yet to accept that it is essential to finance such studies for which there are groups already lined up mainly in Ghana, Nigeria, India, Thailand, Vietnam or ... the Philippines.

Amongst the informal sector dismantlers

  • 5 To circumvent restrictions on the import of waste, many companies pass them off as “second-hand goo (...)
  • 6 The “Basel Convention on the control of transboundary movements of hazardous wastes and their dispo (...)

10Capulong Street extends directly from the harbour which, a few hundred metres away, houses one of the largest container ports of the world where tons of electrical and electronic waste5 arrive each year from China, Japan or Korea. Although the Philippines has ratified the Basel Convention6, it has not signed the amendment which would have purely and simply prohibited the arrival of such waste in the country. This is because the Philippines saw this as a financial resource, arguing that they had the facilities capable of handling these end-of-life-cycle materials. Astrid modifies this argument: “On paper, there should be 14 recycling plants in the country, Treatment, Storage and Disposal Facilities (TSDF); in reality there are only 2 dealing with e-waste. And paradoxically, lead contamination suffered by their workers is twice as high as that in the informal sector because they work in enclosed unventilated workshops and every evening sweep up the lead laden dust which immediately gets dispersed in the air ...” Yet, in a way, these plants have a monopoly on the treatment of waste from businesses and from abroad. All that is left for the informal sector dismantlers is the waste generated by private individuals.

11Here is the case of Samy, who is about 40 and who has been doing this work for twenty-five years. He describes himself as “a pioneer”: “I started by recycling bottles before moving on to electronic waste because there was more and more of it. And then others did the same as me. It has become less profitable, but it is the only way to feed the family. ”Samy has a wife, Imelda, and five children. This, even for such a Catholic country as the Philippines which prohibits abortion, puts them above the already high average of three children per woman. They all live together at the end of an alley no wider than a corridor. This is their “home”, a small sheet metal shack making a single room of approximately four square metres, a reduced sized model of a dream interior where, packed in, are television, hi-fi, and trinkets adorned with rosaries in the midst of which pious images preside. And also a few bits off fans or washing machines which are a reminder of Samy’s job.

  • 7 Depending to the neighbourhood, there are other lending practices, such as the “1 for 5": the Junk (...)

12Every day, it is the same ritual. Samy gets up at 4:00 am, prepares lunch for the children, and then goes and borrows capital of 2,000 pesos (approximately 30 Euro) from the “Junk shop”, a kind of wholesaler-scrap merchant7. He then gives 150 pesos to his children for their school day and then he also leaves the house. He goes a long way from Capulong to buy used equipment from private individuals who, because of the competition, are increasingly difficult to find in the neighbourhood.

13A little later, it is Jason’s turn to begin his daily search. He is 20 but his shy approach makes him seem 16, an embarrassed smile constantly plays on his lips, his surname “Soriano” is tattooed as if graffiti on his left arm. Like every other day, he too goes and borrows a modest nest egg to which is added the price of hiring a scooter, another “benefit” offered by the Junk shop. A long traipse round the streets of Capulong is in store. Loud hailer in hand, there he goes reciting his monotonous chant: “I buy your damaged or broken equipment: computers, processors, TVs, fridges, air conditioners ... I buy!” His voice becomes less and less confident but it will not stop resonating through the alleyways for close on five hours. In vain, or almost: for his only booty, Jason collects a DVD player. With a look that is a little wearier than usual, he lets slip that it has been a ”bad day“.

14On returning to Capulong Street at about 2:00 pm, it is now time to dismantle the equipment he bought. He has no choice: if he wants to eat, he must remove the tradable items, sell them on to the Junk shop and hope for a small profit when he has paid back his debt. He sits down in the roadway itself with his neighbours, his companions in misfortune and nevertheless his competitors. Samy has apparently made a good catch for he proudly hands over a few microprocessors to the Junk shop owner for which he is given a few notes - the equivalent of 5 Euro, his average salary. Things are a bit more complicated for young Jason: after a half-hour feverishly dismantling the DVD player, he takes out a few wires and processors which will get him, when all’s said and one, half a Euro.

15At least he took care to use the gloves and tools that MDM gave to the Capulong E-waste Dismantlers’s Association so it could distribute them to its members itself. Although taking things apart today proved relatively harmless to health, this is not the case in respect of the risky practices which alerted the French NGO: burning cables to recover the copper inside or breaking cathode ray tubes, low-consumption light bulbs and neon lights - so many arbitrary techniques which give off toxic fumes, and release lead dust, persistent organic pollutants and other fluorinated gases. These activities are often being carried out where people are living, with children close by - when they are not directly involved. And these dangerous substances get spread through the air or the sewers, affecting an entire population....

16Evelyn knows that these health considerations still weigh too little in the balance of daily survival. As coordinator of the MDM program for the four areas after spending 17 years as manager of social services and community work for Caritas in Manila, she knows her fellow countrymen well: ”I could not do what these people do every day, they have very difficult lives. This gives me even more motivation to help them. What keeps me going is feeling that we can do something for the lives of these people, that they are aware we are here to help. It is not so much the material support we give them, rather the fact of feeling involved in their lives which inspires me: to have a beneficial effect on a life, this is important ... “ Nards, ” the veteran of the team“ as he calls himself, is no less motivated; he has virtually modelled his existence on that of the Capulong dismantlers, getting up at 4 o’clock every morning and spending long hours at their side: ”For me, there is no difference between my work and my life. Each day is full of new experiences, there is no day when you get bored. These people are there, day after day, and they need us.“ Samy says this in his way: ”It is true that I was often pretty ill, I had headaches, and I felt very low. Things are better now, I am more careful.“ Samy was also a great help to MDM by enabling it to push open the door of his community and thus create this link without which nothing would have been possible.

Health: the way in to helping the dismantlers get themselves organized

17Astrid Heckmann admits: During the first year of the program (June 2012-June 2013), it took us several months to become accepted, having to explain, for example, that we were not police spies. We had originally conceived of this community work as being carried out in parallel with harm reduction and medical follow-up, but in fact it quickly became central to the project.“ This explains why the team is mainly composed of experienced community workers, a team of 10 employees of whom 9 are Filipinos.

18The program, which was designed to take place over 4 years until June 2016, is therefore simultaneously pursuing three main themes that also include its objectives: initially to reduce the risk of exposure of dismantlers and their community to heavy metals and toxic products, then to improve the community’s capacity to resolve its own problems, and finally to facilitate the community’s access to appropriate health care.

19Since the project had a technical dimension, MDM developed a partnership with the ”Fondation Véolia Environnement“ a pragmatic step which had been anything but obvious to the NGO. Guillaume Fauvel explains it very well: ”The discussions we had with some environmental organizations proved to be complicated, since they were more in favour of banning toxic products and prohibiting this dangerous activity. However, this situation is about small families of dismantlers who would continue to be exposed anyway because they have to carry out this activity in order to survive. The only effect of a ban would be to encourage illegal, clandestine activity which would undoubtedly be even more dangerous. So we therefore turned to the Veolia Foundation. Needless to say this created a lot of internal discussion, some of us not willing to admit that we could “get cosy” with the Foundation of a multinational company which, in some Southern countries, makes a profit on its sanitation and water operations. But we authorised it because it was not only a financial partnership, but also a technical one: through closer contact with Veolia technicians, we were able to work with recycling specialists who came to Manila to observe and make some very sound proposals which were perfectly adapted to the Filipino shanty towns, based on inexpensive but easily usable and reproducible equipment which enables these families to work without being exposed to danger“. In fact, the Program was a winner of one of the 2013 Trophies for corporate sponsorship of the environment and sustainable development offered by the French Ministry for the Environment: a distinction the Filipino members of the team are very proud of...

20The support of Veolia engineers, along with the team doctor, Christina, has helped to raise awareness very effectively amongst the dismantlers to the dangerous nature of their activities. These often invisible, odourless dangers with long-term consequences come up against the inevitable denial that many Filipinos express in matters concerning their health: ”This is the number 1 problem for the Filipino poor but they view it as an extra problem alongside their need to survive“, regretfully says Andy, the thirty something coordinator in the Camarin area. Up in the north of Manila, you only need to see how the children smash TV screens with stones, scattering the shards coated with chemicals so as to get at the cathode ray tube....

21The inescapable reality of this dangerous behaviour, justified by the logic of survival, has its roots deeply embedded in the brutal logic of poverty and the ”social invisibility“ of these communities. Given these facts, and eager to do not to be solely confined to harm reduction activities, Médecins du Monde structured its program around a self-help organisation for dismantlers and improving their skills.

22Once awareness amongst the communities had been raised and they had become motivated, an election of dismantlers’ representatives then took place. Organised into basic groups“”, they themselves put forward the principles of their organization, currently embodied by the existence of four associations - one per area- bringing together 450 members in total. They are gradually organising their general assemblies, electing their presidents, and establishing committees covering specific concerns. A giant step for these people who live so close by and yet are so far away, a move which delights Nards: “It was more or less me who developed the link between them and now they have created an association, they can claim to be a community!” As a result, they realize they have interests in common. Above all, once they have officially registered with the local authorities and the Presidential Commission on Urban Poor, they will finally be “visible”: they will have earned the right to be recognized representatives.

23They have already earned the respect of their own neighbourhoods: at the end of 2013, the four dismantler communities organized the cleaning of public spaces, and went as far as draining irrigation channels to get the water flowing through them again. After this people began to see in a new light the dismantlers who, if the truth be known, never really had a good Press precisely because of the waste that they themselves generated.

24In the coming months, this strengthening of the dismantlers ’ muscle will increase. The four existing associations are already talking about setting up a federation. They may even consider forming a co-operative. MDM will support then with this step by enabling them to have training (leadership, entrepreneurship, legislation about co-operatives, environmental legislation, etc.). In doing so, they will be the ones who could take over the ambition cherished by MDM to extend this program to other districts of the metropolis. Because even though the advances noted in the four existing areas already benefit some 2,000 people (including the dismantlers and their families), it should not be forgotten that dismantlers can be counted in tens of thousands in this city of 20 million inhabitants.

  • 8 Emerging from the English-speaking research community, the term “empowerment- describes a process (...)

25In any case, a dynamic process is under way which bears live witness to the energy people can discover when they have the ability to organise themselves. This dynamic process challenges the activities of the NGOs which set it going. According to Astrid, “the more people take ownership of the project, the more MDM must accept only a supporting role. Although we often talk of the empowerment8 of communities, we never talk of the disempowerment that this implies for the NGOs. In this case MDM included it right from the start of the project. ”

26In the long term, Astrid is convinced that “the informal sector must be helped to become formal. Why not imagine ”mini-factories“ in neighbourhoods where dismantlers would work in safety dismantling items before reselling the output to the formal sector? The purpose of our effort is to create a space for secure dismantling in one of the neighbourhoods which is closed during the day so that children cannot get access, with a water supply for cleaning up in the evening ”. In practice, the unequivocal support of the Philippine State must be relied upon so as to further regulate recycling activity in this country, which is featuring more and more prominently as the “regional dumping ground” for the whole of South East Asia.

27There is no doubt about what must be read into the recent Philippine law of 22 December 2013 which increased the dangerousness level of electronic waste to that of nuclear waste. In practice, until it was passed, this waste fell within a shadowy zone along with the work of the dismantlers because it was informal but not illegal. But now the matter is closed: as soon as electronic and electrical waste reach Filipino soil, it now comes under this legislation which imposes secure transportation and treatment arrangements, in other words management by the TSDF. This is undoubtedly an excessive measure as it deals with transporting electronic waste which is not in itself dangerous. It remains to be seen what must be done about this national legislation which seems to call for further modification since the government is expecting to vote on a new law specifically about this waste: MDM plans to make its position clear in this debate so that the informal sector dismantlers do not, in their turn, go down the chute.... Astrid is very hopeful: “The government is taking an interest in MDM’s work as it is well aware that banning informal dismantling would be tantamount to condemning thousands of poor people to losing of one means of subsistence only to find others which would undoubtedly be frankly illegal ”.

Health: a constant concern for the future

28Although this project is a perfect illustration of the social change that MDM fiercely defends, it is a concept which, for this medical NGO, necessarily remains underpinned by the fight for health for all.

29Now that the dismantler communities of Capulong, Camarin, but also Bagong Silang or Longos have to some extent taken hold of their future, that the messages about prevention and harm reduction continue to be hammered home, health is more than ever an insistent priority. This is the third theme set out by Astrid: “We are only now beginning to work on the genuinely medical component, not the diagnosis of poisoning, but challenging the Filipino medical system so that doctors start a dialogue with their patients, learn to take their job into account, suspect cases of poisoning, and be in a position to direct these people to toxicology services ”.

  • 9 Article cited above, Kristen Grant et al., "Health consequences of exposure to e-waste...”, art. ci

30It is also surprising that even though the dismantlers of Manila haunt the streets of the megacity, the medical community knows little about the problem of electronic waste. Lack of resources or shameful destiny as regards “the poor”? It is still difficult to get the authorities and medical profession to take an interest in the health of dismantlers, especially in regard to long term illnesses. However, MDM has managed to convince the 14 toxicologists in the country to come and meet the dismantlers of the four associations at a training session next July. Joining this panel will be a researcher in epidemiology at the American University of Cincinnati. Co-author of a recent article on the probable links between exposure to electronic waste and various pathologies9, this researcher has chosen the MDM project in order to carry out further necessary work, including monitoring groups of dismantlers. With regard to the possibility of blood tests which would enable the diagnosis of poisoning, for MDM this remains subject to assurances that free treatment will be available for those who are screened....When it comes to costly treatments, requiring monitoring and non-return to dismantling, you can bet on the Filipino public health system getting mobilised and the hostility of the dismantlers of Manila.

31Whatever happens, Evelyn is also betting on the future: “Although the project has got to end in 2 years’ time, I know that what we have done will have changed the lives of these people, that it will be ingrained in them”.

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1 “Health is the balance and harmony of all a human being’s potential (biological, psychological and social), that, on the one hand, requires the satisfaction of basic human needs, which are qualitatively the same for all human beings and, on the other hand, an unremittingly challenged adaptation by man to a permanently changing environment”: definition of health contained in the Ottawa Charter, adopted at the conclusion of the first International Conference for the Promotion of Health (21 November 1986) as a contribution to achieving the objective of health for all by the year 2000 and beyond.

2 Comments issued by the round table discussion transcribed in Humanitaire magazine, 38, July 2014, p. 8-23,

3 Or FVC: the maximum volume of air that can forcibly be blown out after full inspiration. This pulmonary function limit is measured by spirometry.

4 See especially Kristen Grant, Fiona C. Goldizen, Peter D. Sly, Marie-noël Brown, Maria Neira, Martin van den Berg, Rosana E. Norman, “Health consequences of exposure to e-waste: a systematic review”, The Lancet Global Health , vol. 1, 6, p. 350-361, December 2013.

5 To circumvent restrictions on the import of waste, many companies pass them off as “second-hand goods”, thereby falsifying the recycling traceability of waste producing countries and flooding the Philippines with even more of it.

6 The “Basel Convention on the control of transboundary movements of hazardous wastes and their disposal” came into force in 1992, and its objective is to regulate the movement of hazardous waste, in particular from developed countries to developing countries.

7 Depending to the neighbourhood, there are other lending practices, such as the “1 for 5": the Junk shop sells a discarded item to the dismantler who, for each peso of its purchase price, must give back 5 in the form of dismantled products at the end of the day. A usurious practice of which the dismantlers would obviously like to be rid.

8 Emerging from the English-speaking research community, the term “empowerment- describes a process by which individuals or groups acquire the means to improve their ability to act and set themselves free. According to Bernard Jouve, in order to be effective, communities have to be so constituted as to bring together all those members of society who are facing the same problem.

9 Article cited above, Kristen Grant et al., "Health consequences of exposure to e-waste...”, art. cit

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Référence électronique

Boris Martin, « Dismantlers of Manila: health as the engine of change », Humanitaire [En ligne], 38 | 2014, mis en ligne le 19 septembre 2014, consulté le 23 mars 2017. URL :

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Boris Martin

Boris Martin is editor-in-chief of the magazine Humanitaire that he has managed since it was first published. He is also the author, co-author or editor of several essays which include Critique de la raison humanitaire (edited with Karl Blanchet, prefaced by Rony Brauman), Le Cavalier bleu, 2006 (English edition, 2011: Many Reasons to Intervene: French and British Approaches to Humanitarian Action, Hurst & Co Publishers Ltd). He has also published accounts in Editions du Seuil (“C’est de Chine que je t’écris…”, 2004; Chronique d’un monde disparu, 2008) and a story published by Editions Elytis in 2010: Hong Kong, un parfum d’éternité. His latest work – L’iconoclaste. L’histoire véritable d’Auguste François, consul, photographe, explorateur, misanthrope, incorruptible et ennemi des intrigants – came out in May 2014 published by Éditions du Pacifique.

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