Waste management has long been an issue of critical concern for the health sector, environmental protection agencies and civic authorities in the country. None of these bodies has the resources, facilities or expertise to ensure environmentally sound waste management. Toxic pollution, resulting from hazardous waste sites, is rapidly on the increase; damaging the environment as well as threatening the public health, especially the health of the vulnerable population. A recent study report by Sustainable Development Policy Institute (SDPI) about the initial assessment of 38 sites in three provinces of the country has also indicated a growing significant risk, both to the environment and the health of the people in general and those living in the vicinity and around the investigated sites in particular. It is well established that public health, in more than one way, ultimately impacts the national economy. Like most neighbouring South Asian countries, the Pakistani economy has also been centred on agriculture. However, in the recent past, manufacturing and services have also emerged as major contributing sectors. Poor environmental legislative control, environmentally unsound and unfriendly manufacturing processes adopted by many industries in the country would further enhance environmental degradation, compound the environmental issues and increase the number of hazardous sites in the country. Over the years, Environmental Protection Agencies (EPAs) and the Ministry of Environment have done well, within the most constraint financial and technical resources, by establishing institutions, developing and to the extent possible, implementing with the involvement and support of stakeholders, environment policies, action plans, strategies and legislation to regulate industrial pollution for the protection of the environment and safeguarding public health. It was heartening to observe that the self-monitoring and reporting/SMART program promoted a culture of self-monitoring by industry and reporting the emissions and releases of their respective industrial unit data to provincial EPAs in the country. However, the progress on these initiatives and arrangements, though steady for some time, has been slow, with varying degree of successes. The presence of factories, in/around the residential area, discharging chemicals containing effluents/wastewater, without any pre-treatment at the site, may continue to cause environmental pollution; affecting public health. The waste problem gets more complicated and serious, as the residents of the surrounding wastes areas are most often very poor, uneducated, lack awareness and do not have any health care facilities. At many studied sites, the industrial effluents were discharged into the sewerage system causing adverse health impacts on the local population. A few industrial units employing deep injection wells for the released wastewater/effluents further contaminated the underground water reservoirs. At some locations, investigated in the SDPI study, the underground water was chemically contaminated at around 40 feet depth. The water of the nearby water streams at such locations had turned partly coloured due to wastewater and effluents discharged directly into the streams. Some seasonal Nallahs, finally carried the wastewater into the river, passing by irrigated/cultivated land. There were complaints by the local farmers of decreasing soil fertility over the past few years due to wastewater/ effluents discharged from the industrial units in the area/s. Although some hazardous sites are located in thickly-populated residential areas, no effort seems to have been made by any stakeholder about the management of wastewater/discharged effluents. Business/working approach of the industry owners appears to be environmentally unfriendly. Generally, some initial interventions, as required and feasible for the site, may include active site controls and treatment; clean up; treatment plant installation; alternate water supply for drinking/domestic needs of the local population; introduction and promotion of water treatment system (including households water treatment); waste dump and contaminated soil removal; soil remediation around the site; training; awareness-raising and development; implementation of specific legislation for hazardous sites and further research, if so required. Although some hazardous sites are located in thickly-populated residential areas, no effort seems to have been made by any stakeholder about the management of wastewater/discharged effluents Waste reduction at source, with Best Environmental Practices (BEP) within the industrial units/factories and immediate installation of an effluent treatment plant, are considered most viable options to protect the environment and reduce the hazardous exposure to safeguard local population health, especially that of the children. Preferably effluent treatment may be carried out at point source within the industrial unit. However, because of so many similar industrial units (very especially the textile, tanneries and leather) in the same area, a joint effluent treatment plant could be the best feasible option, with support/financial sharing by all stakeholders (industry, government, international bodies, industrial associations etc.). Experience sharing/technical support may also come from some similar plants already operating in/outside the country. For establishing a combined treatment plant at hazardous sites, the awareness & the need appeared to be growing up among many industry owners, as well as the willingness to contribute/pay the waste treatment cost of their respective industrial units at the site. Some other available options in Karachi and other cities regarding waste management are to either sell/manage it through private contractors or to dump directly in the landfill sites. Stakeholders also recommended engaging multinational companies in tackling waste management issues. Industrial sector should follow National Environmental Quality Standards (NEQSs), recycle any form of waste/s generated by their industrial units and reuse recovered chemicals in their other industrial units. Establishment of the Cleaner Production Centres, like the one in Sialkot, is a right step in the right direction: in promoting best available (green) technology (BET), best environmental practices (BET) and awareness-raising about hazardous exposure to public health. The effectiveness of such service providing centres could be further enhanced with relevant legislation support. Given these scattered polluting industrial units, within and close to the vast residential areas, the development of industrial zones (with a joint industrial effluents/wastewater treatment facility), far away from the main cities has been planned and sites acquired to shift the industrial units (especially leather/tanneries and textiles spinning/dyeing) from the main city residential areas to the fast developing industrial zones in the country. The land in and around the hazardous site (demolished structures, legacy sites areas) must not be sold or put to any residential, commercial, agricultural, children’s park or sports/recreational activities, without an environmental impact assessment (EIA) and the approval of the same by the respective EPAs Several stakeholders are of the view that the major barrier in combating the industrial pollution problem was the lack of political will and the low priority of the government. It’s time that political parties give an appropriate emphasis and affirm some level of commitment to environmentally sound chemicals and hazardous waste management and the effective addressal of the long-awaited environmental issues in the country. This should be aimed to protect the environment and safeguard public health in general and that of children in particular. The civil society can also play a vital role in industrial pollution control by building awareness and an understanding of concerns among all stakeholders and sections of society; providing relevant information; helping marginalised and vulnerable groups (women, children, elderly and sick) and by carrying out national and local campaigns. Several tried and tested methodologies/technologies have been described, reviewed, reported and are accessible for disposal of chemically contaminated toxic wastes, remediation and detoxification of contaminated sites. Addressing environment health issues, including hazardous waste sites remediation, directly supports the Millennium Development Goals (MDGs), as it would significantly improve health and reduces poverty. The writer is a senior advisor (Chemicals, Wastes/Sites, Sustainable Industrial Development and Children Health) at the Sustainable Development Policy Institute (SDPI), Islamabad. He can be reached at khwaja@sdpi.org