As a result of the growing interest in environmental issues in the Syrian environment, more precisely in the health service sector, companies in various sectors are facing the problem of measuring and analyzing environmental costs, and disclosing environmental costs in their financial statements. This research explores the role of measuring and classifying environmental costs in decision-making in the health sector. A case study was conducted in the General Authority of the Basel Hospital in Tartous in Syria. Data was collected using observations and analysis of hospital documents and reports, and personal interviews with managers and heads of departments and accountants in the hospital. The research aimed at finding a proposed model for classifying environmental costs in the hospital based on Shapiro's model. The results showed that the cost of acquisition, supply cost, training and qualification, storage costs, obsolescence costs, disposal costs, maintenance costs are considered appropriate to make environmental decision-making. The study also showed that the lack of knowledge and awareness of the administrative and accounting staff about concepts and terminology of environmental accounting adversely affect the process of tracking and measuring the environmental costs and hence the quality of environmental decisions. The results showed also that the hospital is almost committed completely to sort and separate medical and non-medical waste in all divisions and sections.