Healthcare Emissions in the GCC: Anaesthetic Gases, Single-Use, and Pharma Scope 3

Healthcare produces roughly 4.4% of global greenhouse gas emissions, and most of it is indirect. In the GCC, three upstream sources carry a disproportionate share and are routinely left out of measurement: anaesthetic gases vented from operating theatres (Scope 1), single-use devices whose emissions are embedded at manufacture (Scope 3), and imported pharmaceuticals produced outside the region (Scope 3). Anaesthetic-gas reduction is the fastest, lowest-cost intervention. The binding constraint across all three is verifiable, activity-level measurement.

Key takeaways:

• Healthcare accounts for roughly 4.4% of global emissions, and a higher share in the Gulf, with the majority originating in indirect, upstream sources.
• Anaesthetic gases are a fast, low-cost Scope 1 reduction: phasing down desflurane and nitrous oxide lowers emissions without capital investment.
• Single-use devices embed most of their carbon at manufacture; reprocessing reduces both cost and emissions and remains underused in the GCC.
• Pharmaceuticals are the region’s largest hidden Scope 3 exposure, given that around 80% of Gulf medicines are imported.
• The binding constraint is verifiable, activity-level measurement rather than ambition.

A single hospital’s anaesthetic gases can release greenhouse gas emissions equivalent to approximately 1,200 cars operating for a year. This figure is rarely captured in facility-level sustainability reporting, because the majority of healthcare’s emissions originate outside the areas most teams monitor.

Healthcare is responsible for approximately 4.4% of global greenhouse gas emissions (2019 data), a footprint that would rank it as the fifth-largest emitter worldwide if it were a country. In the Gulf, sustained cooling demand and continuous operation in a high-temperature climate typically place the sector’s footprint above the global average.

For ESG and sustainability teams across the GCC, the more significant challenge is the location of that footprint. Three sources account for a substantial share, and each is easily overlooked: anaesthetic gases used in surgery, single-use devices used in procedures, and pharmaceuticals that carry embedded manufacturing emissions.

Why healthcare emissions are a strategic priority in the GCC

Regional targets are established. The Abu Dhabi Department of Health has set healthcare-sector goals to cut carbon emissions by 20% by 2030 and reach net zero by 2050. Saudi Arabia incorporates healthcare decarbonisation within Vision 2030 and the Saudi Green Initiative.

Under the Greenhouse Gas Protocol (GHG Protocol), emissions are classified into three scopes: Scope 1 covers direct emissions under a hospital’s control, such as anaesthetic gases and on-site generators; Scope 2 covers purchased electricity and cooling; and Scope 3 covers indirect value-chain emissions, including devices and medicines. This distinction is central, because the largest sources fall within Scope 3.

Measurement is beginning to align with these commitments. The UAE Ministry of Health and Prevention launched its Carbon Footprint Analysis in UAE Hospitals project, assessing facilities including Sheikh Khalifa Medical City in Ajman and Sheikh Shakhbout Medical City in Abu Dhabi. Its central finding is directly relevant to any reduction plan: the majority of emissions derived from indirect, upstream sources rather than from on-site boilers and generators. PureHealth, the country’s largest healthcare group, reports a 37% reduction in emissions intensity since 2022.

The predominance of indirect emissions is precisely what elevates the importance of anaesthetic gases, single-use devices, and pharmaceuticals. Each is examined below.

Anaesthetic gases: a concentrated Scope 1 source

Inhaled anaesthetics are potent greenhouse gases that are exhaled by patients and vented directly to the atmosphere. Nitrous oxide is less potent per unit but persists in the atmosphere for over a century, producing a substantial cumulative impact at clinical doses.

What makes anaesthetic gases significant is their concentration. They can account for a notable share of an acute hospital’s carbon footprint and a large portion of an operating department’s emissions, and because most of an inhaled anaesthetic is exhaled unchanged and vented, nearly the entire dose reaches the atmosphere.

This also represents one of the most cost-effective reductions available. A large private hospital group in Spain reduced anaesthetic-gas emissions by 54% within a single year by phasing out desflurane and nitrous oxide in favour of sevoflurane, intravenous anaesthesia, and regional techniques. Desflurane carries a higher cost than the alternatives with limited clinical advantage, aligning the carbon and financial cases. For GCC operating theatres, a desflurane and nitrous-oxide reduction protocol delivers a Scope 1 reduction with no capital expenditure.

Single-use devices: emissions embedded at manufacture

Single-use devices are carbon-intensive, and the majority of that carbon is embedded before the device reaches the patient. Disposable instruments have become the default across surgical suites in the Gulf, including scissors, trocars, forceps, gowns, and drapes. The operational convenience is considerable, but so is the associated footprint.

Medical devices account for an estimated 6-10% of a national health system’s carbon footprint, with single-use items driving a significant proportion. Approximately 95% of a single-use product’s environmental impact arises from manufacturing, well before clinical use, meaning the emission is committed at the point of procurement rather than at disposal.

Reprocessing, the cleaning and re-sterilisation of selected single-use devices to a regulated standard, is an established countermeasure. In 2025, hospitals and surgical centres across 18 countries used reprocessed devices to save approximately 495 million US dollars and avoid more than 125 million pounds of CO2, with reprocessed devices typically costing 30-50% less than new equivalents. Adoption in the GCC remains limited, which represents an opportunity: the region can implement a mature, evidence-based practice rather than develop one.

Waste that is not reprocessed requires disposal, increasingly via energy-from-waste in the Gulf. Coral’s analysis in Waste-to-Energy in Gulf Cities: Climate Solution or Incineration Greenwashing? examines that trade-off in detail.

Pharmaceuticals: the imported Scope 3 exposure

Pharmaceuticals represent a category that most GCC health systems have only begun to measure. Relative to the revenue it generates, the pharmaceutical industry is more carbon-intensive than the automotive sector, and the large majority of that footprint sits within Scope 3: the supply chain, spanning active-ingredient synthesis, packaging, and transport. In the UK, medicines alone account for approximately a quarter of the NHS’s total emissions.

For the Gulf, this footprint is almost entirely imported. GCC countries import around 80% of their medicines, meaning the manufacturing emissions behind nearly every medicine on a Gulf hospital shelf are generated abroad and fall within the region’s Scope 3. Global pharmaceutical emissions grew 77% between 1995 and 2019, and the trajectory remains upward.

This mirrors the structural challenge facing GCC construction firms, where the majority of the footprint is embedded in purchased goods and difficult to trace. Coral’s analysis in The Construction Emissions Disclosure Gap addresses Scope 3 Category 1 reporting where supplier data is limited.

Two developments are narrowing the scope for inaction. The first is regulation. The EU Corporate Sustainability Reporting Directive (CSRD) requires in-scope companies to disclose material Scope 3 emissions. While the EU’s 2025 Omnibus package narrowed CSRD’s scope and extended reporting timelines, large non-EU groups with substantial EU turnover may still fall within scope from 2028, and GCC providers or distributors within European supply chains can inherit the requirement through their customers even where not directly obligated. The second is localisation: Saudi Arabia and the UAE are investing substantially in domestic pharmaceutical manufacturing, transferring a portion of that offshore Scope 3 onshore and rendering it directly manageable.

Recommended sequence for GCC health systems

1. Prioritise the operating theatre. Implement a protocol to minimise or eliminate desflurane and nitrous oxide. This is a Scope 1 reduction requiring no capital expenditure, with measurable results within a quarter.
2. Pilot single-use device reprocessing for high-volume, high-cost items, where cost and carbon savings are greatest and the regulatory pathway is best established.
3. Incorporate pharmaceutical procurement into scope. Request product-level emissions data from suppliers, weight purchasing decisions toward lower-carbon and locally manufactured options, and account for medicine supply as the Scope 3 category it represents.
4. Benchmark against a credible target. Net-zero commitments in the Gulf increasingly follow the Science Based Targets initiative (SBTi) framework, which has shifted emphasis from ambition to delivery. Coral’s analysis of SBTi’s Net-Zero Standard Version 2 outlines the implications for GCC targets.

Measurement as the primary constraint

Each of these interventions depends on reliable data. A 2026 study of a Saudi tertiary hospital found that annual carbon reporting obscured the seasonal demand variations and operational inefficiencies on which decarbonisation planning depends. Anaesthetic-gas volumes, device-level lifecycle data, and supplier emissions typically reside in separate systems and formats, and in many cases are not recorded at all.

This is the gap Coral is designed to address: activity-level emissions data across Scopes 1, 2, and 3 that is verifiable, auditable, and suitable for submission to a regulator, lender, or assurance provider. In healthcare, where the majority of the footprint is upstream and indirect, the ability to trace and substantiate a Scope 3 figure is decisive. Coral’s analysis in The Trust Stack examines why ESG software must establish that trust before reporting can be relied upon.

FAQ

What are the largest sources of hospital greenhouse gas emissions?

For most hospitals, the majority of emissions are indirect (Scope 3) and reside in the supply chain rather than in on-site fuel use. Three sources are commonly underestimated: anaesthetic gases, single-use devices, and pharmaceuticals. Energy use for cooling and continuous operation is also material, particularly in the Gulf.

Is desflurane more environmentally damaging than sevoflurane?

Yes. Desflurane has a global warming potential of approximately 2,540 times that of CO2 over 100 years, around 20 times that of sevoflurane and 5 times that of isoflurane. Its lower clinical potency increases the volume required per case, compounding the impact. Alternatives such as sevoflurane, intravenous anaesthesia, and regional techniques reduce both emissions and cost.

What is single-use device reprocessing, and is it safe?

Reprocessing is the cleaning, testing, and re-sterilisation of selected single-use devices to a regulated standard for reuse. Where regulated and quality-controlled, it is an established practice across many jurisdictions. It typically reduces device cost by 30-50% and avoids the manufacturing emissions that constitute most of a single-use device’s footprint.

Why are pharmaceuticals classified as Scope 3 for GCC hospitals?

Because their emissions are generated during manufacture, which occurs outside the hospital and, for the GCC, predominantly outside the region. With around 80% of Gulf medicines imported, the associated production emissions fall within the purchased-goods category of a health system’s Scope 3 inventory rather than its direct (Scope 1) footprint.

How should a GCC hospital begin measuring its emissions?

Begin with sources for which activity data already exists: anaesthetic-gas purchase volumes, device procurement records, and pharmaceutical expenditure. Convert this activity data into emissions using recognised factors, maintain an auditable record, and expand coverage progressively. The primary challenge is consolidating dispersed operational data into a single verifiable record rather than the calculation itself.

Measure healthcare emissions across all three scopes

Coral supports GCC healthcare providers, distributors, and manufacturers in converting dispersed operational data into audit-ready emissions figures across all three scopes, including the Scope 3 categories that many platforms leave unaddressed.

Book a demo to see how Coral’s Emissions Management System addresses healthcare’s most difficult-to-measure sources.