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The report finds that pharmaceutical production in Hyderabad continues to cause severe environmental degradation through the discharge of untreated wastewater containing heavy metals and industrial solvents. It highlights a critical link between these manufacturing practices and the spread of antimicrobial resistance (AMR), a global health threat. The document argues that Indian regulatory bodies are failing to enforce pollution controls and that the pharmaceutical industry's reliance on opaque supply chains allows companies exporting to the US and EU to avoid accountability for their environmental footprint.