In the Middle East, a great amount of effort has been organized around incorporating sustainable design strategies. Whether in the United Arab Emirates (UAE) or Saudi Arabia, facilities are looking at a variety of categories, including sustainable sites, water efficiency, energy conservation efficiency, occupant comfort, resource efficiency, and effectiveness.

In 2007, the government of Abu Dhabi created a master planning document called “Plan Abu Dhabi 2030” which, along with the Masdar Initiative and Estidama, sets the stage for building green. This was the government’s first comprehensive approach to master planning that addresses sustainable approaches and coincided with the creation of a new planning entity called the Urban Planning Council, which would oversee future developments within the Emirates and ensure compliance with the 2030 plan. Their vision includes numerous sustainable measures and a focus on smart growth and infrastructure, similar to the Burnham Plan that guided Chicago to its waterfront grace.

Healthcare owners in the Middle East are extremely interested in sustainability for two reasons. The first is that these design practices are at the core of creating healing environments and provide benefits to patients, visitors, staff, and the community, while reducing the cost of operations and maintenance.

Connections to nature can ease a patient’s anxiety and good air quality can enhance patient recovery and staff well-being. Daylighting strategies, such as creating light wells and optimizing window openings and orientation, have been shown to decrease occupational stress in healthcare workers, leading to improved productivity and performance as well as increased retention and recruitment rates.

The second reason for the growing focus on sustainability is the region’s extreme climate, which is known for its limited annual rainfall, hot temperatures, and significant energy needs to desalinize potable water. These factors make water conservation a priority for the region. However, healthcare facilities require large volumes of water for mechanical operation and occupant needs.

The implementation of water efficiency measures, such as high-efficiency plumbing fixtures and reclaimed greywater from lavatory, showers, and HVAC systems, can reduce vital potable water withdraws and provide cost savings. Sustainable water use also protects natural water bodies from contamination.

The UAE’s hot climate cycles—from hot, humid summers to warm, arid winters and the intense humidity—also create an opportunity for hospital design not offered in other regions. For example, the condensate from dehumidification at the HVAC system can be collected, treated, and stored with the rest of the greywater. The total greywater potential from a large healthcare facility can exceed the required need for a sizable irrigation system and water features, which play an important role in the healing context of a hospital landscape.

There’s also room for creative new solutions in exteriors and façades. HDR designed a double skin curtain wall façade at the new Cleveland Clinic Abu Dhabi. A 1.6m catwalk is situated between the inner and outer walls that feature a high-transparency outer skin with a high heat absorption performance characteristic cooling mechanism. Multiple laminated glass layers and laminated heat film help break down the long waves of UV light and reduce the overall heat gain coefficient.

Although this region has some of the highest solar potential in the world and initiatives have been created to invest billions of dollars in solar energy, we’ve found that low utility rates have made the initial payback for photovoltaics cost prohibitive. However, preference can be given to solar hot water due to the reduced first cost and a more efficient delivery of usable thermal energy.

The Arabian Gulf countries understand that while oil has brought considerable wealth to the region, it’s a finite resource. Their future depends on conserving and respecting natural and cultural resources and developing a renewable energy source. Designing sustainable healthcare facilities sets a new standard of design overseas—one that we hope others will follow as we collectively invest in our future.

James Atkinson

James J. Atkinson, AIA, LEED AP, EDAC, is vice president and managing director of healthcare design, HDR (Charlotte, N.C.). He can be reached at

For more on international design, check out:

Part Two: Designing Abroad: Planning For A Global Marketplace

Part three: Designing Abroad: Cultural Considerations In Evidence-Based Design