Research Article | | Peer-Reviewed

Environmental Impact Assessment of Effluents from Mohammed VI University Hospital in Marrakech (Morocco) Through Physicochemical Characterization

Received: 21 May 2025     Accepted: 21 July 2025     Published: 8 August 2025
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Abstract

The releasing of untreated hospital wastewater into municipal sewer systems is of great environmental and public health concerns. In this study, an analysis of environmental implications of Mohammed VI University Hospital of Marrakech's effluent were made using extensive physicochemical studies. Regular samples collected bimonthly from October 2022 to January 2023 from the main hospital collector showed high concentrations of organic pollutants. Recorded mean concentrations of Chemical Oxygen Demand (COD), 5-day Biochemical Oxygen Demand (BOD5) and Total Suspended Solids (TSS) were 750 mg/L, 512.14 mg/L, and 879.86 mg/L, respectively, which surpasses Morocco's discharge standards, reflecting an added burden to municipal as well as larger environmental ecosystems. Nutrient analysis showed similarly high concentration values, while average concentrations of total phosphorus, sulfates, nitrates, and nitrites were 5.92 mg/L, 427.97 mg/L, 7.39 mg/L, and 0.60 mg/L, which pose alarms about eutrophication as well as water quality decline. Though this study mostly engaged itself in physicochemical parameters to analyze implications, bacteriological analysis (not discussed here but part of the larger framework) also reflected elevated levels of fecal coliform as well as occurrence of nosocomial pathogens, thus augmenting environmental as well as health implications. The moderate biodegradability of COD/BOD5 ratio of 1.46 suggests significant treatment considerations based on method choices. In consideration of these, direct dumping of this effluent is an overarching environmental issue. Implementing sufficient treatment measures, like activated sludge processes, sequencing batch reactors (SBR), or membrane bioreactors (MBR), is important to reduce these implications and ensure public health as well as aquatic ecosystem safety.

Published in American Journal of Environmental Science and Engineering (Volume 9, Issue 3)
DOI 10.11648/j.ajese.20250903.15
Page(s) 131-137
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Hospital Effluents, Physicochemical Characterization, Environmental Impact Assessment, Wastewater Treatment, Organic Pollution

1. Introduction
The problem of water security in Moroccan cities is becoming increasingly pressing due to population growth, urbanization, and climate change, which altogether put water resources under strain and are expected to cause acute water scarcity in the next 25 years . In response to these problems, Morocco has established measures like Water Law 36-15, which promotes integrated water resources management practices and public-private partnerships for infrastructure development, such as wastewater treatment .
Healthcare centers, as represented by the Mohammed VI University Hospital of Marrakech, a major public facility with about 1,139 beds, generate complex wastewater harboring a number of pollutants, comprising chemical, biological, and pharmaceutical substances, such as harmful drugs, radioactive isotopes, and pathogenic microbes . The uncontrolled or poorly controlled release of such effluent into urban sewage systems, as seen with the Mohammed VI University Hospital, constitutes a significant threat to environmental sustainability and public health. These risks stem from the persistence of toxic compounds, such as pharmaceuticals and pathogenic organisms, that can potentially pollute aquatic and terrestrial ecosystems, leading to long-term harmful effects on ecological systems and human health . Conventional wastewater treatment plants often lack the potential to adequately remove these emerging pollutants, thus allowing their discharge into natural water bodies and potentially creating issues like antibiotic resistance . The peculiar character of hospital wastewater can also interfere with municipal treatment processes . In addition, lack of appropriate infrastructure or regulation can lead to groundwater contamination, causing serious concern, particularly in areas where groundwater is the main source of potable water .
While many developing countries often suffer from shortages of advanced treatment facilities due to financial as well as technical constraints and possibly even limited regulation , Morocco embarked on introducing various treatment methods. Such methods include physical, biological, and tertiary advanced treatment, i.e., filtration, disinfection techniques (chlorine, ultraviolet, ozone) and, in specific locations, even electrocoagulation . However, the efficiency and widespread application of such treatment methods, especially for advanced hospital effluents, require ongoing assessment.
The main focus of this study is Mohammed VI University Hospital in Marrakech, and the plan is to assess the environmental impacts related to its wastewater using an in-depth physicochemical analysis. Measuring fundamental parameters of pollution such as Chemical Oxygen Demand (COD), Biological Oxygen Demand (BOD), pH, and nutrient content in the wastewater before it is released to the municipal network, this study aims to find out just how extensive is the pollution and areas that require immediate attention to reduce environmental damage.
2. Materials and Methods
Sampling took place from October 2022 to January 2023, with monthly collections carried out. On this occasion, wastewater samples were collected from the main collector covering all odorous manholes within the hospital site (see Figure 1). In order to achieve representative composite samples, four different wastewater samples were collected. In addition, sampling took place over an interval of 24 hours to allow for daily monitoring of PPCM changes in hospital effluents. On collection, samples were stabilized following General Guidelines for Storage and Sample Handling and Good Practice Guidance issued by the National Office for Drinking Water . The water samples were decanted into plastic bags and taken to the laboratory within two hours, at 4°C using an electric cooler (see Figure 2). All field measurements for water comprised temperature, pH, and conductivity, which were measured using a multiselector instrument (see Figure 3). Other chemical parameters were determined in the laboratory using standard methods as stipulated by the French Association for Normalization .
Figure 1. Primary effluent collector of Mohammed VI university hospital in Marrakech..
Figure 2. Electric cooler used for the transport of samples.
Figure 3. Multiparameter sensor used in the analysis of effluents.
3. Results
3.1. Air Temperature
The air temperatures at the locations we observed exhibited typical seasonality. The maximum temperature was 26.6°C at the beginning of our observation time. For instance, on October 2022, it was 26.6°C at 11:00 AM, that were warm days at that time. Conversely, the lowest temperature of 19.6°C was observed at 7:00 AM, December 2022, which were cold winter mornings. All these observations are tabulated in Table 1.
3.2. Water Temperature
The temperature of the effluent water also followed the same pattern but was influenced by hospital activities. The maximum reading, 25.6°C, was also taken at 11:00 AM in October 2022, perhaps due to the discharge of hot water utilized for laundry or sterilization throughout the day. The temperature of 19.5°C was the lowest reading recorded at 7:00 AM during January 2023, both indicating the fall in ambient temperature and fewer heat-generating activities in the morning hours. This is illustrated in Table 1.
3.3. pH
Effluents from the hospital are pH-stable within the time of study, with readings predominantly inclined towards neutrality. The readings ranged from the lowest to be 6.9 (at 7:00 AM in December, perhaps as a result of night cleaning done using comparatively mildly acidic products) to the highest to be 8.42 (at 4:00 PM in January, possibly as a result of night dumping of alkaline detergent products). The average of around 7.5 as a whole implies that the effluents were neither consistently strongly acidic nor strongly basic. These variations are illustrated in Table 1.
3.4. Electrical Conductivity
Electrical conductivity, as a measure of total dissolved ionic load, ranged extensively. The maximum of 2750 µS/cm at 4:00 PM in October was possibly due to massive discharges of dissolved salts from laboratories, theaters, or large disinfectant use. The minimum of 1314 µS/cm at 7:00 AM in December. See Table 1 for individual values.
3.5. Biological and Chemical Oxygen Demand (BOD5 and COD)
The organic content of the effluents, as determined by BOD5 and COD, registered extreme variations. COD varied from a maximum of 925 mg O2/L at 4:00 PM in November to a mini-mum of 600 mg O2/L at 7:00 AM in December. Similarly, BOD5 recorded a maximum of 692 mg O2/L and a mini-mum of 390 mg O2/L during the same periods. These results are shown in Table 1.
3.6. Nutrients: Nitrates, Nitrites, and Total Phosphorus
All nutrient concentrations are detailed in Table 1. The nitrogen and phosphorus nutrient analysis revealed varying concentrations:
1) Nitrates (NO3-) varied between 5.6 mg/L and 9.3 mg/L, with a mean of 7.6 mg/L.
2) Nitrites (NO2-) were present in lower concentrations, ranging from 0.3 mg/L to 1.2 mg/L.
Total Phosphorus (P-total) varied from 3.88 mg P/L to 8.13 mg P/L. All nutrient concentrations are presented in Table 1.
3.7. Sulfates (SO42-)
Sulfate levels ranged from 260 mg/L to 770 mg/L, with higher levels generally occurring in the afternoon. (Table 1).
3.8. Total Suspended Solids (TSS)
Total Suspended Solids (TSS) showed the highest variability among all parameters, with values ranging from 124 mg/L to 3353 mg/L. These fluctuations reflect the diverse nature of hospital effluents and the influence of operational activities. Detailed data are presented in Table 1.
Table 1. Monthly and Diurnal Variation of Physicochemical Parameters in Hospital Effluents (October 2022 - January 2023).

Month

Time

Air Temp. (°C)

Water Temp. (°C)

pH

Cond. (µS/cm)

BOD5 (mg/L)

COD (mg/L)

NO3- (mg/L)

NO2- (mg/L)

Total P (mg P/L)

SO42- (mg/L)

TSS (mg/L)

October 2022

7:00 AM

22.5

24.0

7.2

1900

460

690

6.8

0.5

5.2

380

500

11:00 AM

26.6

25.6

7.7

2450

580

850

8.5

0.9

7.0

550

1100

4:00 PM

26.0

25.0

7.9

2750

650

900

9.3

1.0

7.8

650

1500

8:00 PM

23.0

24.2

7.5

2100

500

750

7.5

0.6

6.0

450

700

November 2022

7:00 AM

21.0

22.5

7.0

1700

420

640

6.2

0.4

4.7

320

400

11:00 AM

24.0

23.8

7.6

2300

550

810

8.0

0.8

6.8

500

900

4:00 PM

23.5

23.5

7.8

2500

692

925

9.0

1.2

8.13

770

3353

8:00 PM

21.5

22.8

7.4

1950

470

710

7.2

0.5

5.7

400

600

December 2022

7:00 AM

19.6

20.5

6.9

1314

390

600

5.6

0.3

3.88

260

124

11:00 AM

22.0

22.0

7.4

2000

510

760

7.3

0.6

6.1

430

750

4:00 PM

22.8

22.5

7.7

2200

560

830

8.2

0.9

7.2

580

1300

8:00 PM

20.0

21.0

7.3

1800

440

670

6.5

0.4

5.0

350

450

January 2023

7:00 AM

20.0

19.5

7.1

1500

400

620

5.8

0.3

4.3

290

250

11:00 AM

21.5

21.2

7.5

2150

530

790

7.8

0.7

6.5

480

850

4:00 PM

22.0

21.8

8.42

2600

670

910

9.1

1.1

8.0

720

2800

8:00 PM

19.8

20.0

7.6

2050

490

730

7.0

0.5

5.8

410

550

Min.

19.6

19.5

6.9

1314

390

600

5.6

0.3

3.88

260

124

Max.

26.6

25.6

8.42

2750

692

925

9.3

1.2

8.13

770

3353

Avg.

22.52

22.89

7.51

2094.06

523.00

770.94

7.61

0.69

6.24

476.88

1120.25

Standard Deviation

2.18

1.79

0.39

388.07

96.94

108.66

1.13

0.29

1.33

159.94

988.19

4. Discussion
The temperature of the sample, which ranged from 19.6 to 25.6°C with an average of 23.21°C (Table 1), falls within the Moroccan discharge limit of <30°C and suggests a negligible direct thermal impact. Similarly, the slightly alkaline effluent pH values ranging from 6.9-8.42 with an average of 7.53 (Table 1) fall within acceptable discharge limits . However, electrical conductivity (EC) tests show elevated mineralization, from 1,314 to 2,750 μS/cm (mean 2122 μS/cm; Table 1). These levels place the effluents in Class 3 of the water quality network and near the cut-off value for direct discharge of <2,700 μS/cm, suggesting a high level of inorganic and organic matter content .
One of the key issues was the high organic load, as indicated by Chemical Oxygen Demand (COD) and 5-day Biochemical Oxygen Demand (BOD5). The COD concentrations were extremely high and varied from 600 to 925 mg/L (mean 750 mg/L; Table 1). These are significantly greater than reported in other hospital wastewater studies by Boillot et al. and higher than mean values documented by Verlicchi et al. and Akin . They also surpass the upper limit commonly found in community wastewaters (300-1,000 mg/L ). The mean BOD5 was 512.14 mg/L (Table 1). The calculated mean BOD5/COD ratio based on our findings (512.14/750) is approximately 0.68. This value suggests that a large percentage of the organic matter is biodegradable. In contrast, studies such as Yilmaz et al. report that a ratio of COD/BOD5 of 1.46 (which would be BOD5/COD of approximately 0.68, consistent with our findings) is an indicator of easily biodegradable organic matter. While desirable for potential biological treatment, this biodegradability also implies high oxygen demand if released without treatment.
Total Suspended Solids (TSS) contents were also extremely high with a range of 124 to 3,353 mg/L at an average of 879.86 mg/L (Table 1). This is well over the Moroccan standard for indirect discharge of 600 mg/L , note: was likely intended here for discharge standards, was for sample storage] and much higher than typical municipal wastewater concentrations (150-500 mg/L ) or other Moroccan hospital values, e.g., the provincial hospital in Sidi Kacem (mean TSS 165.99 mg/L ). The tight correlation (R2 = 0.87, as per your original text) between BOD5, COD, and TSS also validates the high organic and particulate burden in such effluents as a result of medical devices and lab testing.
As for nutrients, the mean nitrate (NO3-) was 7.39 mg/L and nitrite (NO2-) was 0.60 mg/L (Table 1). They are considerably higher than Yaoundé, Cameroon, and Dakar, Senegal studies , but could still be within some receiving or discharge water quality standards. The average concentration of total phosphorus (3.88 to 8.13 mg/L, average 5.92 mg/L; Table 1) is below the Moroccan standard of 10 mg/L for indirect discharges. The levels of sulfate (SO42-), ranging from 260 to 770.6 mg/L and averaging 427.97 mg/L (Table 1), exceed the Moroccan standard of 400 mg/L for indirect discharges .
Combined, these findings (Table 1) demonstrate Mohammed VI University Hospital effluent is mineral and organically rich. This is highly dangerous to the ecosystem and human health and potentially toxic when discharged into the natural waterways or urban sewerage system without processing. The inherent risks necessitate proper and efficient treatment processes that are tailored to these specific contaminants. Achieving complete purification and conformity to regulatory standards is crucial for environmental preservation and public health safety.
Because the COD/BOD5 ratio (approximately 1.46, or 0.68 BOD5/COD) indicates a large biodegradable component, biological treatment methods appear to be viable. Viable options can include the activated sludge process, in which aeration is utilized to cause microbial degradation of organic pollutants. Sequencing Batch Reactors (SBR) possess variable load flexibility , and Membrane Bioreactors (MBR) combine biological treatment with membrane filtration in order to generate high-quality effluent with effective removal of biodegradable as well as non-biodegradable organic components . Anaerobic digestion can be another option for wastewaters with high organic content, with the additional benefit of production of biogas . Furthermore, in the removal of recalcitrant organic pollutants not sufficiently removed by biological processes, tertiary treatment with Advanced Oxidation Processes (AOPs), such as ozonation or UV/H2O2, may be unavoidable .
5. Conclusions
This study of environmental effects, through physicochemical analysis of the effluents from Mohammed VI University Hospital in Marrakech, confirms significant environmental issues. Discharge by direct flow of largely untreated wastewater into municipal sewerage networks with minimal specialist collection from operating theaters and laboratories yields a high polluting load.
Physicochemical analysis (Table 1) revealed that the major parameters of Total Suspended Solids (TSS), Chemical Oxygen Demand (COD), and 5-day Biochemical Oxygen Demand (BOD5) were far in excess of permissible Moroccan point of discharge. These figures reflect a huge negative impact on the receiving water body, resulting in organic overloading and potential deoxygenation. While not the prime concern of this title's characterization strategy, concomitant bacteriological contamination, i.e., high fecal coliform content and presence of nosocomial pathogens (many of which are resist-ant to antibiotics), adds to the environmental as well as public health issues arising from these effluents.
The findings underscore a critical need to mitigate the environmental cost of such hospital effluents. The common practice of releasing wastewater with such physicochemical characteristics straight into the public network is unsustainable and is environmentally and health-impairing to both environmental health and public health. Therefore, the implementation of on-site pre-treatment strategies, especially for minimizing the heavy organic and particulate loads that were ascertained through this physicochemical analysis, is essential before dis-charge. The effective implementation of treatment interventions, taking into consideration the specific effluent profile and best international practice, is crucial in reducing environmental effects as well as ensuring the preservation of the nearby ecosystem and public health. This study provides important information to inform interventions like this and emphasizes the necessity of effective management and treatment of hospital wastewater at its point of origin.
Abbreviations

AOPs

Advanced Oxidation Processes

BOD5

5-day Biochemical Oxygen Demand

COD

Chemical Oxygen Demand

EC

Electrical Conductivity

MBR

Membrane Bioreactors

NO2-

Nitrites

NO3-

Nitrates

PPCM

Physicochemical Parameters

SBR

Sequencing Batch Reactors

SO42-

Sulfates

TSS

Total Suspended Solids

UV

Ultraviolet

Acknowledgments
The authors express their profound appreciation to all who contributed to making this study possible. Special thanks are extended to A.B. Ayoub, the corresponding author, for his significant role in wastewater collection, analyses, and manuscript preparation. The authors also extend their gratitude to L. Mandi, Director of the National Center for Research and Study on Water and Energy, for providing the essential tools and resources necessary for conducting the analyses. The support and resources provided by this center were instrumental in the success of this work.
Author Contributions
Ayoub Ait Bella: Conceptualization, Resources, Formal Analysis, Investigation, Writing - original draft
El Habib El Azzouzi: Data curation, Methodology, Validation, Writing - review & editing
Funding
This work is not supported by any external funding.
Data Availability Statement
The data is available from the corresponding author upon reasonable request.
Conflicts of Interest
The authors declare no conflicts of interest.
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    Bella, A. A., Azzouzi, E. H. E. (2025). Environmental Impact Assessment of Effluents from Mohammed VI University Hospital in Marrakech (Morocco) Through Physicochemical Characterization. American Journal of Environmental Science and Engineering, 9(3), 131-137. https://doi.org/10.11648/j.ajese.20250903.15

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    Bella, A. A.; Azzouzi, E. H. E. Environmental Impact Assessment of Effluents from Mohammed VI University Hospital in Marrakech (Morocco) Through Physicochemical Characterization. Am. J. Environ. Sci. Eng. 2025, 9(3), 131-137. doi: 10.11648/j.ajese.20250903.15

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    Bella AA, Azzouzi EHE. Environmental Impact Assessment of Effluents from Mohammed VI University Hospital in Marrakech (Morocco) Through Physicochemical Characterization. Am J Environ Sci Eng. 2025;9(3):131-137. doi: 10.11648/j.ajese.20250903.15

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  • @article{10.11648/j.ajese.20250903.15,
      author = {Ayoub Ait Bella and El Habib El Azzouzi},
      title = {Environmental Impact Assessment of Effluents from Mohammed VI University Hospital in Marrakech (Morocco) Through Physicochemical Characterization
    },
      journal = {American Journal of Environmental Science and Engineering},
      volume = {9},
      number = {3},
      pages = {131-137},
      doi = {10.11648/j.ajese.20250903.15},
      url = {https://doi.org/10.11648/j.ajese.20250903.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajese.20250903.15},
      abstract = {The releasing of untreated hospital wastewater into municipal sewer systems is of great environmental and public health concerns. In this study, an analysis of environmental implications of Mohammed VI University Hospital of Marrakech's effluent were made using extensive physicochemical studies. Regular samples collected bimonthly from October 2022 to January 2023 from the main hospital collector showed high concentrations of organic pollutants. Recorded mean concentrations of Chemical Oxygen Demand (COD), 5-day Biochemical Oxygen Demand (BOD5) and Total Suspended Solids (TSS) were 750 mg/L, 512.14 mg/L, and 879.86 mg/L, respectively, which surpasses Morocco's discharge standards, reflecting an added burden to municipal as well as larger environmental ecosystems. Nutrient analysis showed similarly high concentration values, while average concentrations of total phosphorus, sulfates, nitrates, and nitrites were 5.92 mg/L, 427.97 mg/L, 7.39 mg/L, and 0.60 mg/L, which pose alarms about eutrophication as well as water quality decline. Though this study mostly engaged itself in physicochemical parameters to analyze implications, bacteriological analysis (not discussed here but part of the larger framework) also reflected elevated levels of fecal coliform as well as occurrence of nosocomial pathogens, thus augmenting environmental as well as health implications. The moderate biodegradability of COD/BOD5 ratio of 1.46 suggests significant treatment considerations based on method choices. In consideration of these, direct dumping of this effluent is an overarching environmental issue. Implementing sufficient treatment measures, like activated sludge processes, sequencing batch reactors (SBR), or membrane bioreactors (MBR), is important to reduce these implications and ensure public health as well as aquatic ecosystem safety.},
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Environmental Impact Assessment of Effluents from Mohammed VI University Hospital in Marrakech (Morocco) Through Physicochemical Characterization
    
    AU  - Ayoub Ait Bella
    AU  - El Habib El Azzouzi
    Y1  - 2025/08/08
    PY  - 2025
    N1  - https://doi.org/10.11648/j.ajese.20250903.15
    DO  - 10.11648/j.ajese.20250903.15
    T2  - American Journal of Environmental Science and Engineering
    JF  - American Journal of Environmental Science and Engineering
    JO  - American Journal of Environmental Science and Engineering
    SP  - 131
    EP  - 137
    PB  - Science Publishing Group
    SN  - 2578-7993
    UR  - https://doi.org/10.11648/j.ajese.20250903.15
    AB  - The releasing of untreated hospital wastewater into municipal sewer systems is of great environmental and public health concerns. In this study, an analysis of environmental implications of Mohammed VI University Hospital of Marrakech's effluent were made using extensive physicochemical studies. Regular samples collected bimonthly from October 2022 to January 2023 from the main hospital collector showed high concentrations of organic pollutants. Recorded mean concentrations of Chemical Oxygen Demand (COD), 5-day Biochemical Oxygen Demand (BOD5) and Total Suspended Solids (TSS) were 750 mg/L, 512.14 mg/L, and 879.86 mg/L, respectively, which surpasses Morocco's discharge standards, reflecting an added burden to municipal as well as larger environmental ecosystems. Nutrient analysis showed similarly high concentration values, while average concentrations of total phosphorus, sulfates, nitrates, and nitrites were 5.92 mg/L, 427.97 mg/L, 7.39 mg/L, and 0.60 mg/L, which pose alarms about eutrophication as well as water quality decline. Though this study mostly engaged itself in physicochemical parameters to analyze implications, bacteriological analysis (not discussed here but part of the larger framework) also reflected elevated levels of fecal coliform as well as occurrence of nosocomial pathogens, thus augmenting environmental as well as health implications. The moderate biodegradability of COD/BOD5 ratio of 1.46 suggests significant treatment considerations based on method choices. In consideration of these, direct dumping of this effluent is an overarching environmental issue. Implementing sufficient treatment measures, like activated sludge processes, sequencing batch reactors (SBR), or membrane bioreactors (MBR), is important to reduce these implications and ensure public health as well as aquatic ecosystem safety.
    VL  - 9
    IS  - 3
    ER  - 

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