## 3 Results
### Greenhouse Gas Emissions  
A total of 20,722,957 kg (\(\approx\)20,723 tons) biomedical waste was generated in the study area between 2009 and 2019. It was confirmed by the authorities that each biomedical waste collection and transport vehicle carried approximately 1 ton of waste in each trip to the sterilization plant. Thus, the total trip numbers between 2009 and 2019 were 20,723, which included a round-trip drive from the first collection point to the sterilization plant and back to the same collection point. It was calculated, based on the information provided by the authorities, that approximately 863,457 L of gasoline was consumed by the biomedical waste collection vehicles between 2009 and 2019. For the calculation of fuel usage, an \begin{table}
\begin{tabular}{c c c c c c} \hline Year & \begin{tabular}{c} **Biomedical Waste** \\ **Generated** \\ **(kg.year–1)** \\ \end{tabular} & \begin{tabular}{c} **Trip Number to** \\ **Sterilization Plant** \\ \end{tabular} & \begin{tabular}{c} **Consumed Diesel** \\ **(L-year–1)** \\ \end{tabular} & \
\begin{tabular}{c} **Electric Consumed at** \\ **the Sterilization Plant** \\ **(kW.year–1)** \\ \end{tabular} &
\begin{tabular}{c} **Natural Gas** \\ **Consumed at the** \\ **(m\({}^{3}\)year–1)** \\ \end{tabular} \\ \hline
2009 & 1,361,545 & 1362 & 56,731 & 12,855 & 37,205 \\
2010 & 1,350,605 & 1351 & 56,275 & 12,751 & 36,904 \\
2011 & 1,572,606 & 1573 & 65,525 & 14,846 & 42,968 \\
2012 & 1,755,567 & 1756 & 73,149 & 16,572 & 44,789 \\
2013 & 1,758,089 & 1758 & 73,254 & 16,596 & 47,670 \\
2014 & 1,850,428 & 1850 & 77,101 & 17,467 & 50,552 \\
2015 & 1,946,386 & 1946 & 81,099 & 18,373 & 53,433 \\
2016 & 2,164,089 & 2164 & 90,170 & 20,427 & 56,315 \\
2017 & 2,231,941 & 2232 & 92,998 & 21,067 & 59,196 \\
2018 & 2,356,404 & 2356 & 98,184 & 22,241 & 62,078 \\
2019 & 2,375,297 & 2375 & 98,971 & 22,420 & 64,959 \\
**Total** & **20,722,957** & **20,723** & **863,457** & **195,616** & **556,068** \\ \hline \end{tabular}
\end{table} 
Table 2: Amounts of biomedical waste collected and treated from 2009 to 2019 and the associated fuel usages. average diesel consumption of 0.5 L per 1 km traveled was selected, which was also recommended by [PERSON] [20]. Yearly average electricity and natural gas consumptions at the sterilization plant were provided by the plant operator as shown in Table 2. The total amounts of electricity and natural gas consumed between 2009 and 2019 were 195,616 kW and 556,068 m\({}^{3}\), respectively. Table 3 summarizes the basic data and parameters used in the GHG calculation [21; 22; 23]. Figure 3 shows the amount of GHG emissions and global warming factors (GWFs) generated during the transportation and treatment of biomedical waste from 2009 to 2019. The amounts of yearly GHG emissions from the consumption of diesel fuel were calculated based on the emission factor of 3.2 kg CO\({}_{2}\)-e.L\({}^{-1}\)[21]. The total amount of GHG emissions generated from the biomedical waste collection and transportation vehicles between 2009 and 2019 was calculated as 2763 tCO\({}_{2}\)-e.year\({}^{-1}\). The International Energy Agency (IEA) reported that 1 kWh of electricity consumption in Turkey can generate 0.480 kg CO\({}_{2}\)-e [22]. Thus, by using the emission factor of 0.480 kg CO\({}_{2}\)-e.kWh\({}^{-1}\), yearly GHG emissions from electricity consumption varied between 6.12 and 10.76 tCO\({}_{2}\)-e.year\({}^{-1}\). The total amount of GHG emissions generated from the electricity usage at the sterilization plant between 2009 and 2019 was calculated as 93.9 tCO\({}_{2}\)-e.year\({}^{-1}\). The conversion factor for the electricity/natural gas energy equivalence was taken as 10.34 kWh.m\({}^{-3}\) natural gas (1000 Btu.ft\({}^{-3}\)) [23]. Thus, by using the emission factor of 0.480 kg CO\({}_{2}\)-e.kWh\({}^{-1}\) in this study, yearly GHG emissions from natural gas usage varied between 183.16 and 322.41 tCO\({}_{2}\)-e.year\({}^{-1}\).