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Abstract: Hospital wastewaters contain a large number of chemical pollutants such as disinfectants, detergents, and drug residues. A part of these pollutants is not eliminated by traditional urban waste water treatment plants, leading to a major risk for the aquatic ecosystems receiving these effluents. After having formulated a specific methodology in order to assessment ecotoxicological risk for such a situation, we applied it to the project to build a new hospital shared by several towns in the French Alps. This methodology is based on the ecotoxicological characterisation of the hospital wastewater using a battery of three chronic bioassays (Pseudokirchneriella subcapitata, Heterocypris incongruens and Brachionus calyciflorus) and of genotoxicity tests (Ames fluctuation assay on Salmonella typhimurium, and a Fpg-modified comet assay on the trout liver cell line RTL-W1). The formulated methodology highlights a moderate risk of the hospital wastewater for the organisms of the water column of the river concerned. Nevertheless, this discharge contributes significantly to the global ecotoxicological risk when taking into account all the releases of the watershed into the river. This leads to recommending the implementation of a specific treatment system in the urban WWTP, or upstream to it, in view to protecting the aquatic organisms. [Copyright &y& Elsevier]