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The design and operation of wastewater treatment systems for hospital is a challenge for wastewater engineers. In this study, a pilot-scale system integrated anaerobic-aerobic fixed film reactor for hospital wastewater treatment was constructed and its performance was evaluated. The aim of the study was the elimination of organic compounds and a significant reduction of bacteria. The system had been operated for 90 days. The results show that the system efficiently removed 95.1% of the chemical oxygen demand (COD) from a hospital wastewater with the influent COD of 700 mg L^-1, leaving 34 mg L^-1 COD in the effluent. The significant removal of pathogenic bacterial has been do after operating of the system. The advantages of the treatment system studied for small wastewater flows include: (I) simple operation and maintenance; (II) efficient removal of COD and bacteria; and (III) low-energy consumption