Fortress of Light
Western Galilee Hospital-Nahariya serves as the main hospital for the people of northwest Israel. However, in addition to its daily order of business, the facility with a location just six miles from the Lebanon border also has been established as the primary treatment center for casualties resulting from volatility between the two nations.
In 2003, decades of lobbying for a safe location where hundreds of patients could be treated at any given time were answered with the completion of underground hospital facilities, says Masad Barhoum, MD, CEO of Western Galilee Hospital-Nahariya.
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In fact, during the 2006 Lebanon War (also known as the Second Lebanon War), Western Galilee was able to operate from this protected site despite being under direct fire from Hezbollah forces. However, there was one area of the hospital that remained vulnerable to the battle outside.
“Although physicians, nurses, and ancillary staff were fully protected in the underground facility, the entrance to the emergency department was totally exposed. During the Second Lebanon War, medical personnel who ventured outside the fortified shelter to receive patients in the ER were fully exposed to incoming rockets, over 800 of which landed in direct proximity to the hospital and the city of Nahariya,” Barhoum says.
In addition to the dangerous environment, Barhoum says the emergency department (ED) itself had long faced inadequacies.
“The ability to effectively treat patients had been overtaken by space restrictions and the limitations of outdated facilities. In preparation for the building of an entirely new emergency department, many design elements were evaluated,” Barhoum says. “Additional space and efficiency of patient care were top considerations.”
Functional changes in the new ED included:
- The safe, secure treatment of the population during times of war and peace.
- Medical units with their own specialized space: Pediatrics, Shock Room, Orthopedics, Gynecology, Internal Medicine, Surgical Trauma, and Walk-In.
- Care administered through a “case management” design, wherein each patient is overseen by a limited team of medical personnel who follow the patient from admission until release.
- Provisions for on-call ED staff including staff respite areas, as well as a room for senior ED staff who previously did not have offices.
- Emergency preparedness for mass casualty events, including a design that allows for an immediate expansion to 120 beds.
- Additional 200-bed capacity in the existing underground space, which is fully equipped to be self-sustaining for up to three weeks.
In terms of the safety component of the new department, the structure sits above ground—a fortress that can withstand conventional weapons, as well as chemical and biological attacks. However, its fortitude on the exterior contributed to a significant design challenge on the interior.
“All outside entrances can be sealed at a moment’s notice and feature blast doors to protect against impact. This means that there are no exterior windows, which, in turn, necessitated unique lighting solutions to alleviate the claustrophobic sensation of being in a bunker,” Barhoum says.
To combat the effects of what he terms an “above-the-ground submarine,” architect Yuval Geni of Tel Aviv-based Yuval Geni Architects Ltd., says the design not only had to address patients but staff as well in the 10,000-square-meter area that includes 6,500 meters of functional space.
Geni’s firm collaborated with Mansfield-Kehat Architects, also of Israel, on the architectural planning and interior design of the project.
“To palliate this mandatory condition, we created different typological spaces for the different main functions, using rounded, flowing forms along a main central diagonal circulation axis accented by a small interior patio in its apex, thus providing ease of orientation and local identification to all the components and its users,” Geni says.
Also integrated were illuminated sky panels on both walls and ceilings—“Definitely the success of the whole design of the interior functional spaces is the idea to integrate these illuminated panels,” Geni says.
Different landscape features were chosen to identify each of the five main treatment halls, with hot air balloons for pediatrics and general sky and landscape views for the main corridor.
“They complemented the space design and give the illusion of the outside with honesty and art,” Geni says.
Materials in lighter shades were used in the space, as well, including natural local stone floor tiles, accented with red and green marble that together form the base for the interior color palette. Furniture, cabinets, and workstations mirror that lightness, with some accented by decorative LED fixtures.
Another large component of the design project was creating distinctive environments between such differing places of care.
“Interesting—and moving away from the traditional layout where surgical patients are directed to different treatment areas from those who are considered internal medicine patients—is in this project we were briefed programmatically to develop a plan where all patients will be admitted to a treatment area with no need for previous determination of their category: Medicine is being brought to the patient, not the patient searching for it,” Geni says.
Visual aesthetics also were used to identify each unit. For example, obstetrics is located in an intimate corner of the building that is far from public view and the main turmoil of the facility, Geni says.
“Pediatrics is almost a place to come back to fo
r children, if it wasn’t a hospital,” he continues. “In their waiting area, they will have play stations with a decorative ceiling of bright colors in circular forms. Each treatment cubicle has flying balloons incorporated into the design of the separating curtains.”
The trauma unit has PVC flooring in light blue tones with all treatment positions arranged in a semicircular order, as they also are in pediatrics, in an effort to be less formal and more pleasant for such sensitive areas of the hospital.
In use today by Western Galilee, the new ED forges a path for future building projects at the hospital, which will follow the same protocol with structures reinforced against attacks and fully integrated into the existing underground facilities.
“The medical mega-structure underground with full access from all future medical departments is an entirely unique design worldwide and will advance the availability of healthcare for those most in need,” Barhoum says.
Geni says he hopes that the design, intended to answer the structure’s specific nuances, will be beneficial to patients as well as the staff who work there every day.
“My personal professional satisfaction will be accomplished when and if it will be proved that the unique environment we created for this facility enhances the quality of service patients receive, due to the calm and variety of the spaces in spite of the hectic character intrinsic to the activity involved,” Geni says.