Middle East: Culture and care
Following the economic dramas of the last year, the Middle East healthcare market is showing encouraging regional signs of maturity and vision for the future. Veronica Simpson looks at what might lie ahead.
The global economic meltdown has claimed many casualties, and few as spectacular as Dubai, a city bristling with grandiose commercial (and architectural) schemes, many of whose financial foundations have recently turned out to be, literally, built on sand. But as the dust from the most spectacular crash clears, the region is showing itself to have pockets of stability and resistance, plus a sound long-term view on the importance of high-quality local healthcare.
“It’s gone quiet but it hasn’t gone silent,” says David Derr, principal at Ellerbe Becket – about a market he’s been active in for the last 30 years. Although a huge percentage of the schemes that were on the drawing board even a year ago are still currently ‘on hold’, the projects that are under way, and highlighted here, give clear evidence of a growing sophistication and integration of expertise that bodes well for the region’s healthcare industry in the longer term.
Shaikh Mohamed Bin Khalifa Al Khalifa Cardiac Centre, Bahrain
Ellerbe Becket has designed a 30,000m2 cardiac centre for the government of Bahrain to replace an existing facility within the Bahrain Defence Forces Hospital. To reflect the health issues of the region, where diabetes is often one of the underlying problems for heart patients, the new 120-bed centre will combine state-of-the-art cardiac care with a renal transplant unit. Run by one of the Gulf states’ leading heart surgeons, Dr Resan Badran, the centre is billed as a ‘five-star’ facility. The seven-storey building will have four operating rooms and four cath labs. Single patient rooms are divided up into two 15-bed units per floor. Each floor will have a VIP room with a VVIP suite at the top. “The main circulation spine is on the ground fl oor and we’ve tried to make it as simple as possible to use,” says Ellerbe Becket’s David Derr. An outpatient clinic sits to the left of the entrance, which has a two-storey lobby and high-class cafeteria nearby. All the outpatient and clinical functions are combined on this floor, including labs and imaging. The operating suites use an ‘integrated interventional platform’ devised by Ellerbe Becket so that cath labs are adjacent to the operating theatres, with all patients being fed through the same prep and recovery areas. “It’s the same nursing staff that treats you on the way in,” Derr explains. “People going home go to the stage-two recovery area and the patients who are staying will go to the PACU and then to their rooms.” Luxurious but locally sourced materials are used throughout, including marble and granite, as well as wood. High-quality fabrics and furnishings add to a sense of warmth and comfort. Situated in Alwali, on the south edge of Manama, the area is largely residential, so the building, while rising above most of the surrounding houses, aims to minimise its mass with its bulk divided into three segments, each oriented to maximise light while minimising solar gain. The 17-acre site has been masterplanned for the possible future addition of a hotel for family members and residential housing for staff.
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Client: Government of Bahrain
Area: 30,000m2 on 17-acre site
Architect: Ellerbe Becket
Schedule: two-year construction programme, likely to start September 2009 |
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Regional and climatic sensitivities
Healthcare architecture has evolved significantly since the first flush of demand for ‘state-of-the-art’ hospitals that largely imitated western models without adding to the local visual/architectural culture or customs. Furthermore, rather than fly in international consultants to take care of medical planning and infrastructure of new healthcare systems, many healthcare organisations are opting to get much more closely involved with the whole design and decision-making process in order to absorb the insights and experience into their own healthcare infrastructure.
In stark contrast to the energy-guzzling glass and steel towers that typified the first phase of the Middle Eastern construction boom – especially in Dubai – there is growing interest throughout the region in sustainability and a willingness to invest more upfront in measures that will pay off long term.
Nadia Tobia, principal in charge of Middle East healthcare projects at Perkins Eastman, says the interest in sustainability is now very strong. For the Al Maktoum Accident and Emergency Hospital in Dubai (see case study), the practice is holding sustainability workshops for the Dubai government’s environmental health and safety (EHS) department, in order to try to achieve LEED silver certification for its design. Planned measures include the use of high-performance glass and drought-resistant planting; local sandstone, which provides excellent heat-sinking and cooling properties, which will be used extensively throughout. “The client [the Dubai Government] is very supportive and very much on board,” says Tobia.
Sheikh Khalifa Specialist Hospital, Ras Al Khaimah, UAE
The Sheikh Khalifa Specialist Hospital in the tiny emirate of Ras Al Khaimah – it boasts a population of just 300,000 people – is a 65,000m2 248-bed medical facility, with speciality units comprising oncology, cardiology, a trauma centre and emergency department. Perkins Eastman’s six-storey proposal incorporates the latest international design and medical planning solutions, and is intended to reflect the culture and customs of the region as well as sit comfortably in its dramatic natural environment. There are plans to eventually expand the facility to 400 beds. “We do medical planning at the same time as architecture and interior design to ensure flexibility for the future, as well as creating a hospital that is friendly and non-institutional,” says Nadia Tobia, principal in charge of Middle East healthcare projects at Perkins Eastman. “We tried to work up the site to minimise environmental impact, visually and functionally. It’s a little bit outside of the city in a very beautiful red desert. There’s no development around it at the moment, surrounded by red sand dunes and a national park to the north.” The sloping site facilitated a design that offers entrances on several levels to boost natural light, accessibility and privacy. “The movement of the dunes has influenced the shape of the buildings without affecting the clinical functionality,” comments Tobia. “It even continues in the floor pattern from one side to the other, so that you feel aware of the surrounding desert even as you walk through the hospital.” While the exterior contrasts with the surrounding natural tones through the use of limestone, glass, and metal, the interiors reflect the desert palette with the addition of some bright colours.
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Client: Executive Committee for Developing Rural Areas/Ministry of Public Work, Dubai
Area: 65,000m2
Architects: Perkins Eastman with Al Bayaty Architects
Schedule: completion 2011
Interior design: Perkins Eastman
Structural, civil and MEP engineering: Al Bayaty Architects and Engineers
Lighting design: Consullux Consultants/Crossey Engineering |
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Though many projects have slowed or stalled – HKS estimates that it has 32 outstanding projects in the region – from a population and demographic point of view, the case for continued investment is too strong. As HKS principal Steve Jacobson says: “The need is there and the demand is there.”
HKS’s new King Hussein Cancer Center in Jordan (see case study) will serve as a beacon for cancer treatment in the area. Says Jacobson: “Many of the patients from the Gulf region would have found treatment in the US. Now the goal would be that they can receive that same quality of care closer to home.” Although designed as architectural landmark, the facility’s appearance draws on that of local buildings to ensure that it will have a more harmonious relationship with its surroundings.
One of the floors is dedicated to a range of extremely sophisticated labs and treatment facilities – including a ‘cord bank’ (where umbilical cords can be stored and their cells harvested for treatment). “That function doesn’t currently exist in the region,” says Jacobson. “This is a very well established institution providing a much needed service within Jordan.”
Jacobson identifies three clear categories of ongoing investment activity. “The first is the higher end, for people who can afford to pay for treatment, wherever it is. Secondly is the building of the healthcare infrastructure for the local population and demographics – existing government-owned and -run hospitals have to be updated and replaced. These are being funded. The third category is more speciality-type hospitals that may be providing for niche services or as revenue resources or investments.”
HKS’s Danat El Emarat hospital in Abu Dhabi, a 160-bed women’s and children’s hospital with orthopaedic speciality (as featured in the January 2009 issue of WHD) fits this mould.
King Hussein Cancer Center (KHCC), Jordan
HKS has designed this facility – which promises to be the premier cancer research and treatment centre for Jordan and the region – as an architectural landmark, projecting an image that is progressive and contemporary while drawing inspiration from the local landscape and its history. It will have 152 adult and paediatric inpatient rooms, diagnostic and treatment facilities and outpatient clinics.
The existing facility was founded in 1997 and has links to many other cancer centres around the world, particularly in the US, but this new building represents an expansion of services, with a particular focus on outpatient care. Phase 1 of the redevelopment will focus on outpatient clinics. Phase 2 will include the inpatient rooms with diagnostic, treatment and outpatient services and Phase 3 will move all of the remaining inpatient and support services to the new cancer centre site. Phase 1 construction will begin in early 2010 and is due for completion in 2012. Using a concrete frame as the structure, the facility is designed as two connected towers of 12 and 14 storeys, representing 90,000m2 of clinical and patient space. The shorter, glass-faced tower is where the outpatient functions take place, and the taller tower will be where inpatient beds, diagnostic and treatment facilities are sited. The high-performance-glass curtain wall system above allows daylight to penetrate into six floors of inpatient beds, and the faceting of this glass is intended to represent a jewel, set in stone. Roof gardens will be planted with indigenous vegetation.The facility will provide complete, state-of-the-art cancer care for adults and children. “The main focus was to provide flexibility and growth capability for outpatient clinics and services,” says HKS principal Steve Jacobson. “What we’ve done is arrange on each fl oor a very fl exible, multidisciplinary clinic design or model such that it can accommodate both their needs now as well as being fl exible for future growth or as cancer care changes.” The facility is also intended to be an uplifting and healing environment. HKS senior designer Enrique Greenwell says: “We looked for visual inspiration to the city itself to try and create a building that belongs to the area, not something alien to the local culture and building techniques. We’ve made one side very open, with large expanses of glass that enable views of the new Amman but used Jerusalem stone to clad the side which faces the old town. Windows punctuate this solid wall in a stepped pattern that mimics the hills and buildings in the distance. Public areas such as the bridge, atrium and family lounges are exposed, with glass promoting openness. Its transparency displays the lifesaving activities occurring within the building.”
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Client: KHCC
Size: 90,000m2
Cost: 96 million JOD
Schedule: 2010-2012
Architect: HKS
Consultants: Sigma-Consulting Engineers
(local architect and engineer) |
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Local and international attention Turkey, though on the margins of the Middle East – and seemingly less hit by the economic tsunami – has also seen substantial investment, specifically from the Acibadem Healthcare Group, which has been upgrading its facilities across the country with an eye to the international healthcare tourist as well as the local population.
In many cases, the design and architecture skills have come from local practices. For example, the renovation of the private International Hospital in the prime holiday location of Yesilkoy is on a par with the best facilities in the west, with interior designer Zoom TPU maximising natural light and the use of high quality local materials. The use of local materials and vernacular architectural styles in the 20,000m2 extension to Kayseri Hospital also helps to achieve a building that complements and enhances the historical design of the original – designed by Lina Architecture with Zoom TPU.
As a region, there is every reason to hope, by the time it has stabilised, that there will be a substantial portfolio of excellent facilities for the local and the private market. But when is that likely to be? HKS’s Jacobson predicts 2010 or 2011 for the more stable economies of Kuwait and Abu Dhabi, though Dubai may take a little longer. Ellerbe Becket’s Derr feels Bahrain is relatively stable now, with Abu Dhabi and Qatar maintaining the pace of their healthcare investments.
Al Maktoum Accident and Emergency Hospital, Dubai
Perkins Eastman was chosen by the Dubai Health Authority DHA to design the most sophisticated accident and emergency hospital of its kind in the United Arab Emirates (UAE). Capable of providing immediate care for minor- to high-level trauma accidents and emergencies, the 300-bed, 95,000m2 facility includes a five-storey nursing unit and a separate three-storey clinical services component with an emergency department which will be capable of handling up to 75,000 visits annually. Rooftop and ground-level helipads and an ambulance receiving area are directly linked to a surgical trauma operating suite and a diagnostic imaging unit with MRI, CT, and X-ray capabilities. Additional spaces for diagnostic imaging, surgery, endoscopy, lab functions and an outpatient clinic are also included. Acknowledging the importance, culturally, of facilitating the presence of large family groups in emergency situations, there are generous waiting areas provided within the atrium-roofed central spine of the hospital, plus coffee shops and retail outlets. Medical departments are located along the spine and the unique L-shape of the inpatient units allows for greater flexibility in the allocation and separation of rooms according to patient gender, as local custom would require. Perkins Eastman is aiming for a LEED silver certificate for the project, although key elements still have to be approved.
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Client: Dubai Health Authority DHA and Department of Health and Medical Services
Area: 95,000m2
Architect: Perkins Eastman
Schedule: completion 2012 |
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Budgets are obviously tightly managed, but that is hardly anything new to architects, says Perkins Eastman’s Tobia: “They always have a budget, and you do costings at every stage. These hospitals may look highly designed, but it’s a hospital budget, not a luxury budget. And if the public areas seem luxurious (in comparison to government facilities in the West), it’s because the use of high-quality materials in public areas is absolutely the norm in this region.”
All in all, Derr believes the region is in good shape to achieve its desired aim: the marriage of the highest standards of clinical care with the sensitive treatment of cultural issues.
Veronica Simpson is an architectural writer
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