Environmentally sustainable disposal of pathological waste: Evaluating the deep soil burial method in Malaysia

• This review highlights the environmental and health concerns of current medical waste treatments such as incineration and autoclaving. • It emphasises the need for better management of pathological waste, which poses high infection and contamination risks. • Deep soil burial is proposed as a sustainable, low-cost, and Shariah-compliant alternative to traditional disposal methods. • A case study from Hospital Pakar Universiti Sains Malaysia (HPUSM) demonstrates the successful use of this deep soil burial method. • The paper recommends adopting deep burial in national waste policies to support safer and more culturally appropriate practices. The escalating volume of medical waste poses significant environmental, public health and cultural challenges worldwide. Conventional disposal methods including incineration, autoclaving and landfilling are widely employed but remain constrained by high costs, toxic emissions, energy demands and regulatory limitations. In Malaysia, these issues are compounded by limited treatment infrastructure and religious sensitivities, particularly in the management of pathological waste. This review critically evaluates existing medical waste treatment technologies and their socio-environmental implications, while introducing deep soil burial as a viable alternative. Implemented at Hospital Pakar Universiti Sains Malaysia since 2018, the method involves the burial of pathological waste in engineered pits with layered soil coverage, formalin separation and post-burial site monitoring. Evidence demonstrates that this approach is cost-effective, environmentally safe and compliant with both regulatory frameworks and Shariah principles. Deep soil burial thus represents a scalable, context-appropriate solution for resource-limited settings where centralized biomedical waste facilities are absent. Its demonstrated success in Malaysia underscores the need for policy integration, international recognition of its sustainability potential and further research to refine techniques and assess long-term ecological impacts.