This study's purpose is to evaluate the system management of medical hazardous wastes in Great Cairo governorates (Cairo, Qalubia, Giza) across the last two decades since issue of the Environment Protection Law No. 4 of 1994 and its executive regulation. Since then Egypt has become concerned with setting a sustainable integrated system for hazardous wastes management that includes all economic institutions and activities in different areas of the state. In this system, all ministries and multiple institutions, national and international organizations in Egypt cooperate which on top are Ministry of Environment Affairs, Ministry of Health and Population in addition to several universities. The activities of Hazardous Wastes Management in health care establishments have shown increasing commitment of health organizations towards principles, rules and procedures and the guidelines manual of secure for sound, secure and sustainable handling of hazardous wastes. However, there still several economic institutions and organizations don't apply safe integrated and sustainable handling system for hazardous wastes in the sound integrated environmental and health and economic management, which necessitates reviewing most of what related to this issue and to find out the alternative suitable solutions that achieve compromise with law and its conditions. Despite the efforts made by all institutions in the management of medical waste, there are many procedures that must be considered to address several challenges and shortcomings in the management of hazardous waste in health care facilities and to minimize the negative effects of these challenges. These challenges are related to the behavior of employees, suppliers and suppliers who deal with thousands of health care facilities and activities in most parts of the country. The researchers follow the descriptive approach in analysis of information and statistical data. The sample items (24) are distributed due to sex (male/female), education level (university and above certificate-medium- below medium), age stage, and the administrative level (higher management – medium – executive); including also three kinds of hospitals (governmental – private – and civil societies). The statistical method is used for testing measurement tools and checking validity of hypotheses statistical approaches and deducing results. The most important results are: There is a remarkable shortness in efficient incinerators for handling wastes and absence of proper style of use, operation, and maintenance. Hospitals in Great Cairo are missing the good management system of their wastes regarding collecting, transporting, and storing wastes. Study Most important recommendations: The necessity for finding out comprehensive integrated solutions for the problem of medical hazardous wastes in cooperation with all intended parties, particularly, Ministry of Health and competent authorities. The necessity to find out alternative techniques that will be proper environmentally and economically such as closed sterilization to avoid pollution.