DISEASE

PREVENTION AND CONTROL PROJECT

THE NEW VANADZOR MEDICAL CENTER

ENVIRONMENTAL IMPACT ASSESSMENT REPORT

AND

ENVIRONMENTAL MANAGEMENT PLAN

Yerevan,

November 2013

List of Acronyms

AEN -Armenia Electric Network

ANC - Ante-Natal Care

AOC - ArmeniaOncologyCenter

BOD -Biological Oxygen Demand

CJSC -Closed Joint Stock Company

CHD - Coronary Heart Deceases

EIA -Environmental Impact Assessment

EMF -Environmental Management Framework

EMP -Environmental Management Plan

HPIU-Health Project Implementation Unit

MAC -Maximum Admissible Concentration

MC - MedicalCenter

MCH -Maternal and Child Health

MPE -Maximum Permissible Emission

MPD -Maximum Permissible Discharge

MNP -Ministry of Nature Protection

MoH -Ministry of Health

NCD - Non-communicable Deceases

DPC - Disease Prevention and Control

PAD -Project Appraisal Document

PHC -Primary Health Care

RA -Republic of Armenia

SNCO -State Non Commercial Organization

VOC -Volatile Organic Compound

WB -World Bank

Table of Contents

EXECUTIVE SUMMARY

1. INTRODUCTION

2. METHODOLOGY

3. LEGAL AND ADMINISTRATIVE FRAMEWORK

3.1. National Legislation

3.2.Licenses and permits to be obtained by the project proponent and by works contractor to carry out project activities

3.3.World Bank Safeguard Policies

3.4.Administrative Framework

5.TECHNICAL STANDARDS AND REGULATIONS

6.PHYSICAL AND NATURAL ENVIRONMENT

6.1.Geographic location

6.2.Hydro-geological conditions

6.3.Seismic condition and tectonics

6.4.Climate

6.5.landscape and soils

6.6.Flora

6.7.Fauna

6.8.Specially protected natural areas

7.TECHNICAL DESCRIPTION OF WORKS

8.SENSITIVE RECEPTORS

8.1Ambient Air

8.2.Water Resources

8.3Land Resources

8.4Social Environment

8.5Cultural Resources

9.SOCIAL AND ECONOMIC ENVIRONMENT

10.EXPECTED ENVIRONMENTAL AND SOCIAL IMPACTS

10.1Construction phase

10.2Operation phase

11.IMPACT MITIGATION

11.1. Construction Phase

11.2. Operation Phase

12.ENVIRONMENTAL MANAGEMENT PLAN

12.1Responsibilities and Institutional Arrangements

12.2Responsibilities of Construction Contractor

12.3Monitoring of EMP implementation

13.STAKEHOLDER CONSULTATION

ANNEX I. List of References

ANNEX II. Environmental Management Plan (EMP)

Environmental Monitoring Plan

ANNEX III. Monthly Field Environmental Monitoring Checklist

ANNEX IV. Minutes of Public Consultation Meeting

ANNEX V. Location and Ownership of Land Plots Allocated for Vanadzor MC

ANNEX VI. Agreement for the Disposal of Construction Waste...... 51

ANNEX VII. Calculation of Volumes of Emissions, Water Use, and Water Discharge...... 52

ANNEX VIII. Classification of MC Wastes...... 57

EXECUTIVE SUMMARY

Introduction

Armenia faced enormous difficulties after the collapse of the Soviet Union. It led to the crisis in the provision of public services, including health care system. Main issues accumulated in the health sector of Armenia since independence were considered to be the following: low access and use of health services; under-funded healthcare system with poorly and inequitably used resources; high out-of-pocket informal payments; low perceived quality of care, especially in regions; excess capacity of physical infrastructure of hospitals and polyclinics; and geographic mal-distribution of health workforce between Yerevan and the regions of the country.The reform process, initiated in the mid-1990s, aimed at enhancing efficiency and ensuring accessibility and quality of essential health services, particularly for vulnerable groups.

The first WB-supported Armenia Health Finance and Primary Health Care Development Project was implemented in the years of 1997-2003 and significantly contributed to the success of the country health reforms and developments. A two-phase Adaptable Lending Program (APL) for the health systems modernization followed afterwards to support the reform of the health sector in Armenia in the three main areas: (i) development of primary health care, (ii) hospital optimization and modernization, (iii) and strengthening of the government institutional capacities. The first phase of the Health System Modernization Project (HSMP)was implemented in 2004-2010. The second phase started in 2007 and is scheduled to complete in December 2014.

Later, the Government of Armenia (GoA)applied forthe WB loan to increase the effectiveness of prevention and treatment of non-communicable deceases, in particular Coronary Heart Deceases (CHD), oncologic illnesses, and diabetes mellitus. The new WB-financed Disease Prevention and Control (DPC) Projectcommenced in 2013 and is scheduled to complete in December 2019.

The DPC Project Development Objective is to improve (i) Maternal and Child Health (MCH) services and the prevention, early detection, and management of selected non-communicable diseases at the Primary Health Care (PHC) level; and (ii) the efficiency and quality of selected hospitals in Armenia. One of the targets selected for the Project intervention is the Lori Marz (province) hospital network. In particular, the project will finance civil works; provision of medical equipment, furniture and supplies; training and other TA for the improvement ofVanadzor Medical Center (MC).

Technical and Environmental Standards and Regulations

The national legislation of Armenia includes a law on the Environmental Impact Assessment (EIA) . It does not establish categories of activities by the associated environmental and social risks, but provides description of activities that are subject to the EIA, and the State ecological examination. A project is cleared for implementation upon issuance of a positive conclusion of the ecological expert review. Construction of premises for Vanadzor MC is subject to the EIA procedure. Also, Armenia is a party to the Aarhus Conventionon Access toInformation, Public Participationin Decision Making, and Access to Justice in Environmental Matters. Disclosure of the EIA report and other environmental information related to the Project preparation and implementation is regulated by both – EIA law and the guiding principles of the Aarhus convention.

Following World Bank guidelines,the NDPC Project triggered OP/BP 4.01 Environmental Assessment, was classified as environmental Category B, and an Environmental Management Framework (EMF) was prepared to guide further environmental work required for the preparation and implementation of individual investments.

Environmental Screening

Based on the nature and scope of physical works required for the construction of a Vanadzor MC, as well as the general types of impacts expected from such kind of construction, this investment is classified as environmental Category B and requires EIA. Screening of the Vanadzor sub-project was conducted based on the OP/BP 4.01, and the Environmental Management Framework(EMF) prepared for the DPC Project.

Public Participation

According to the national legislation, as well as the WB requirements on the disclosure of information, the present draft EIA report will be disclosed in-country in Armenian and English languages by posting it on the web page of the Ministry of Health. A public consultation meeting will be held in the town of Vanadzor to discuss the draft EIA report with the locally affected people. The EIA report will be re-disclosed after incorporation of the received feedback, and attachment of minutes of the consultation meeting.

Sensitive Environmental Receptors and Potential Impacts

The new building of Vanadzor MC will be located at Nzhdeh Str. 2/42, next to the existing hospital No.1. The allocated land plot is 3.172 ha. It is State-owned and is currently not in any formal or informal use. There are several dilapidated buildings of the former military hospital on this plot. Other than the hospital No.1, there is a military base in the neighbouring area, while some land is staying idle. The selected location is convenient, because it is well accessible by public transport and at the same time it is close to the green zone surrounding the town. The plot is easily connectible to the water supply and sewage networks, power supply grid, and gas supply system of the Vanadzor municipality.

Environmental and Social sensitivities related to the construction and operation of the Vanadzor MC include: vegetative cover and topsoil of the allocated plot, a wider area of landscape which may get polluted with construction soil and/or may degrade as a result of borrowing for construction materials, soil and ground water that may get polluted with operational spills of fuel and runoff from the construction site, air that may be polluted locally with exhausts and dust from the construction site, and population of the Vanadzor city district within which the MC will be located.

Project Alternatives

At an early stage of planning optimization of the Lori marzhealth care system, two main options were considered for improving infrastructure and management of Vanadzor health case facilities. Given that Vanadzor MC CJSC had been established through a merger of the existing Vanadzor hospitals No.1and No.2, one option was to upgrade the old buildings used by these two hospitals, while the second option was to construct a new building to house the MC. Feasibility study for the new construction was carried out in October 2011. Outcomes of this study justified new construction due to excessively high estimated costs of capital reconstruction of the existing two buildings that are located in the seismically active area of Lori Marz and carry significant structural damages. Cost of the new construction was estimated to be some 1,148,000 USD less than works required for fundamental reconstruction of the two existing buildings. Therefore, a decision was made to provide new premises for the Vanadzor MC. Environmental footprint of this new construction is not going to be considerably stronger as compared to the option of reconstruction, because the plot allocated for the new construction is not a greenfield and carries dilapidated buildings of a former military base.

Environmental Impact Assessment Methodology

The present EIA covers the entire scope of the sub-project, including construction and operation of the VanadzorMC. The EIA process included the desk top work to review project documents and scientific literature, as well as the field work required for verification of the available baseline data, collection of missing information, and meetings with the local stakeholders. The background information was compiled on the biophysical environment around the sub-project site, on the land tenure and land use of the allocated plot and its adjacent area, and the photo material was also compiled. Based on the background material, sensitive environmental receptors were identified and potential environmental and social impacts were defined for the construction and operation phases. Estimated costs were calculated for several discrete and most important mitigation measures for the inclusion into the bill of quantities for the upcoming civil works. A detailed EMP was developed by listing specific activities that carry various environmental and social risks, and measures prescribed for their mitigation. Indicators for quantitative or qualitative measurement of the effectiveness of mitigation measures were selected and used for the development of an Environmental Monitoring Plan.

Environmental and Social Baseline

Vanadzor is the third largest city ofArmenia and the capital of the Lori Marz.It is located in the northern part of the country, around 128km north fromthe capital city of Yerevan. As of the 2012 estimate, the city had a population of 104,921, down from 148,876 reported at the 1979 official census. Unemployment in the Vanadzor municipality is quite high and seasonal migration is characteristic of the city. At a height of 1425 meters above sea level, Vanadzor is located in the valley of Pambak River, on the point where the rivers of Tandzut and Vanadzorjoin the PambakRiver. Vanadzor lies within a picturesque natural setting, however crumbledSoviet-era chemical factories dominate much of the valley below the city.

Expected Impacts and Mitigation

The expected environmental and social risks associated with the construction of the Vanadzor MC are moderate and can be effectively mitigated.

Impacts of the construction phase:

  • Air pollution from the operation of the construction vehicles and machinery;
  • Nuisance to local population from the dust, noise and vibration generated at the construction site;
  • Disruption of local traffic due to movement of construction vehicles and machinery;
  • Land degradation and erosion as a result of damaged vegetative cover and borrowing;
  • Land and water pollution with runoff and spillages from the construction site;
  • Landscape degradation and pollution due to improper disposal of access material and construction waste;
  • Generation of hazardous waste (asbestos) from the demolition of premises of the former military hospital and possible encounter of more types of hazardous waste, not visible and known upfront;
  • Traumatism and long term health damage among construction workers due to poor application of health and safety standards.

Mitigation measures of the construction phase:

  • Keep construction vehicles and machinery in adequate technical condition;
  • Organize fueling, washing, and other servicing construction vehicles and machinery at service centers or in the designated locations of the construction site which can contain operational and accidental spillages of oils and lubricants, and do not allow direct water discharge to the natural water bodies;
  • Operate vehicles and machinery within working hours and shutting engines when idle;
  • Move vehicles and machinery along the existing or designated access roads to avoid excessive damage of natural vegetation;
  • Keep subsoil and topsoil separately and using them for backfilling and reinstatement of the construction site;
  • Pile construction materials and waste within the construction site and periodically disposing them into formally designated locations;
  • Avoid opening of new quarries to the extent possible. Disallow unlicensed extraction of material Stabilize and reinstate used sections of quarries to avoid erosion and severe degradation of landscape;
  • Make special arrangements for the safe removal and disposal of asbestos containing fragments of the existing dilapidated buildings; Instruct contractor’s personnel on the course of action if potentially hazardous substances are encountered in the course of demolition and excavation works;
  • Provide workers with adequate personal safety gear and insure its proper use; ensure that personnel operating complex construction machinery is trained and licensed.

Impacts of the operation phase:

  • Accumulation of excessive amounts of waste on-site due to failure of its timely removal;
  • Open air burning or illegal dumping of waste resulting in the pollution of soil and water as well as in risks of spreading disease to local communities.
  • Public health and environmental damage caused by improper handling of medical waste;
  • Operation of the boiler house;
  • Damage to the MC building and deterioration of area around it due to leaking water/sewer pipes, and/or dis-functional drainage of storm water.

Mitigation measures of the operation phase:

  • Collect household waste in regular plastic binds and regularly dispose of at the municipal landfill. Make and maintain proper arrangements for out-transportation of waste with specialized covered scavengertrucks.
  • Strictly disallow burning of any type of waste in open air at or around the MC site.
  • Collect medical waste separately in special containers and regularly hand it over for disposal to a specially licensed entity.
  • Accumulate chemically active liquids separately from other liquid waste and hand it over for deactivation and disposal to a specially licensed entity.
  • Establish and consistently apply an organized system of the boiler house servicing and maintenance, including periodic checksof the technical condition of appliances and monitoringof emissions.
  • Undertake regular checking of communications inside and around the MC building to timely identify and fix any leakages that may occur. Arrange and maintain effective drainage system for the collection and discharge of storm water to avoid water damage to the building and waterlogging of the MC area.

Institutional Arrangements for Managing Environmental Impacts

Overall responsibility for managing environmental and social impacts of construction works at Vanadzor MC rests with the NDPC Project implementing entity, which is the Ministry of Health (MoH) of the RA. The Ministry will exercise environmental and social monitoring of works through the Health Projects Implementation Unit (HPIU) under it. HPIU is mandated to monitor implementation of the EMP by works contractor and to report on the outcomes of monitoring to the Ministry and to the WB. Once operational, the MC premises will be managed by the MC Directorate. Environmental compliance of the Center’s operation will be enforced by the Lori regional unit of the RA State Environmental Inspectorate.

Environmental Management Plan

The EMP is developed for the construction and operation of the MC’s premises in order to mitigate negative environmental and social impacts. EMP includes information on the risks arising atvarious stages of construction and operation activities, the sectors affected by the risks, as well as the list of mitigation measures, including parties responsible for their application, enforcement and monitoring. EMP will be included in the bidding documents for the construction of the MC and will become an integral part of the civil works contract.

1. INTRODUCTION

Armenia faced enormous difficulties after the collapse of the Soviet Union. It led to the crisis in the provision of public services, including health care system. Main issues accumulated in the health sector of Armenia since independence were considered to be the following: low access and use of health services; under-funded healthcare system with poorly and inequitably used resources; high out-of-pocket informal payments; low perceived quality of care, especially in regions; excess capacity of physical infrastructure of hospitals and polyclinics; and geographic mal-distribution of health workforce between Yerevan and the regions of the country. The reform process, initiated in the mid-1990s, aimed at enhancing efficiency and ensuring accessibility and quality of essential health services, particularly for vulnerable groups.

The first WB-supported Armenia Health Finance and Primary Health Care Development Project was implemented in the years of 1997-2003 and significantly contributed to the success of the country health reforms and developments. A two-phase Adaptable Lending Program (APL) for the health systems modernization followed afterwards to support the reform of the health sector in Armenia in the three main areas: (i) development of primary health care, (ii) hospital optimization and modernization, (iii) and strengthening of the government institutional capacities. The first phase of theHealth System Modernization Project (HSMP) was implemented in 2004-2010. The second phase started in 2007 and is scheduled to complete in December 2014.