Nine Design Considerations for the Middle East

The Middle East is steeped in rich heritage and cultural subtleties, and designing the region’s next generation of healthcare facilities requires a nuanced approach. Design considerations range from the cultural differences to climate extremes. Below, we showcase different ways that we address key Middle Eastern elements in our award-winning healthcare designs.

With temperatures hovering at 40 degrees Celsius (104 F) in the shade for more than half of the year, a building’s orientation is one of the first considerations. The site location of Kuwait Children’s Hospital restricted our design team, requiring patient windows to face east and west. Solar studies were performed to create sophisticated shading systems on both sides of the building, not only to reduce solar gain, but to reduce glare and enhance comfort within patient rooms. Catwalks on every other floor allow easy cleaning of the windows and shading systems after humid dust storms characteristic of the region. Canopies over outdoor respite areas are necessary for a large portion of the year and HVAC systems need to be powerful, durable and efficient to minimize energy consumption.

Because much of the region relies on desalination plants to provide water, irrigation is strictly regulated. Through the use of regional plant life, such as Ghaf trees, we provide xeriscaping to minimize water usage. On site water recycling plants are utilized to efficiently irrigate green spaces.

During transportation, water is warmed by intense heat, and must be cooled before use. Brutal sunlight means that roof storage isn’t an option for cooling. Some jurisdictions, like in Kuwait, require water to be stored in subterranean tanks or cooling towers before it is distributed. Pumps are then required to move water to its destination. Further, the use of large water features is discouraged due to the high evaporation ratio year-round.

We develop architecture and interiors that identify with local heritage, while also providing a functional purpose. The sea is an established theme among coastal countries like Kuwait. In harmony with this theme, large marionettes of aquatic creatures are used in Kuwait Children’s Hospital as wayfinding points, among other uses such as a theater. From the outside looking in, the hospital has the appearance of a massive fish tank, providing relevance to Kuwaiti fishermen and pearl divers, while also entertaining children.

Buildings, like the Saudi German Hospital in Jeddah, take design cues from traditional wood shading devices known as mashrabiya for protection from the sun. The design of King Fahad Medical City’s proton beam center is inspired by date palm leaves and utilizes the sculptural form as a symbol of hope and healing.

Some clients prefer traditional architecture to help patients feel comfortable. Healthcare facilities like Prince Sattam University Hospital in Al Kharj, KSA are in conservative agricultural areas, outside of urban centers. Sensitivity to the local community is important, so the team focused on developing a design that utilizes local stone for the exterior facades. To reduce the sense of anxiety, while providing familiarity to the agriculture community, the project was organized around a wadi, or valley, including natural elements that blend into the lobby’s space. Prayer rooms for men and women, and sometimes even mosques, are incorporated into convenient locations of our designs.

From the outside, the Middle East can appear to be one large desert, but each country has specific cultural interests that need to be represented respectfully. Some countries are more conservative than others, and thus, understanding the level of separation in all the different flows throughout the hospital is important. Differences can include separate waiting rooms for men and women in parts of the region. In some facilities, emergency rooms have a single entrance, but split in different directions for men and women.

Health care is a sensitive topic in the Middle East and many patients don’t want to expose any health issues. Substance abuse and mental health border on taboo, creating a challenge at facilities like the National Rehabilitation Clinic (NRC) in Abu Dhabi. The NRC was designed for the local Emirati community with conservative, vernacular architecture to ease anxiety.  Sensitivity in separation of patients that are being admitted, vs out-patients or visitors, is very important. In many healthcare facilities, discussions about patients are guarded more closely than in western facilities. Doctors maintain desks and offices in exam rooms, increasing privacy.

Families tend to be larger in the Middle East than in western countries and, rather than one or two visitors, a patient might receive six or eight at a time. Patient rooms are designed with patient, caregiver and family zones, and public areas are designed to accommodate multiple families.

Incorporating amenities in public spaces is a priority. Kuwait Children’s Hospital five-story atrium stretches nearly 1,500 feet and includes a hollow whale where movies are played, cafés and other elements blending healthcare, hospitality and retail. We developed outdoor courtyards for Prince Sattam University and the NRC to allow families, or even patients, to walk away and take a break from the hospital.

Rising energy costs and a harsh climate mean that sustainability is being pushed to the forefront of the region’s unique challenges. Dubai for example, requires a sustainability checklist when submitting building permits, and other countries require a minimum of LEED Silver equivalent design for government hospital projects. Our exterior design for Prince Sattam provided energy studies, creating a 30% in energy savings. Designers must continue to encourage clients and peers to support energy efficient initiatives.

The Middle East has a large middle-income class with growing expectations, and HKS is creating the next generation of health care facilities that meet the region’s needs. Cities like Dubai have almost quadrupled in size over the last 20 years, and healthcare investment is struggling to keep pace.

Private providers are beginning to invest in new facilities. Hospitals like Danat Al Emarat, a private Maternity hospital, are successful examples of a very efficient and financially responsible project meeting the needs of Abu Dhabi. HKS has been involved with several teaching hospital campuses, like CAPITALMED Medical City in Egypt and Prince Sattam University Hospital, in the ongoing challenge to meet the region’s demand for experienced physicians.