BEYOND THE REFUGE BOOK 3 MEDICAL CENTRE
SITE The case studies in the development of the proposed medical center have been on Al Zaatari (pop. 84,000), a Syrian refugee camp in Jordan and Dadaab (pop. 450,000) , a Somalian camp in Kenya. However it aims to be able to adapt to multiple environments and cultures. UNHCR (United Nations High Commission for Refugees) regulates these camps and imposes a series of restrictions in order to control their development. These include restrictions on building materials and limiting buildings to single storey. However UNHCR does not consider the protracted lifespan of camps at a policy level, and hence after the initial 6 month period, no additions or improvement of services are required. Accordingly, they can deteriorate over the lifespan of the refugee camp, which currently averages at 25-30 years. This medical center offers a solution to multiple issues. Standard UNHCR tents have a lifespan of 6 months at which point they are not fit for reuse. The SHS (Square Hollow Section) steel frame of the designed medical center tent is robust enough to be reused multiple times, and is easily constructed and dismantled with out heavy machinery, hence is more sustainable and a better investment for the UNHCR. However, should the camp last substantially longer than initially expected, as is unfortunately the trend, the steel frame acts as a base structure for more permanent cladding and roofing. The adaptability of the frame means this can be done by users at minimal to no cost to the UNHCR or host country. Existing Medical Centre
ŠThe adaptability of the frame means permanent cladding and roofing can be done by users at minimal to no cost to the UNHCR or host countryŠ
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THE DESIGN CONCEPT The project is a polemic on the lack of sustainability in the humanitarian aid industry. Its unintentional tendency to promote aid dependency as opposed to ‘relief from relief”. The adaptability of the design is meant to be an enabler, allowing those on the ground an opportunity to shape their environment, both refugees and NGO staff. Not every camp has an architect or a planner, so by giving those without professional spatial training a tool kit of structural parts, and a guide book of good design rules they can make the best use of the limited resources available to them. The guide book has been written by drawing from case studies of successful public spaces and buildings from a wide range of countries and cultures. The medical center is the most prescriptive of the structural tool kit for refugee city building. This being driven by the specificity of the program. Patient journeys rule the circulation paths, while providing spaces to limit the feeling of ‘being processed’. Separation of genders and minors is taken in to consideration as well as the treatment of both chronic and emergency situations. Clerestory openings allow for light and ventilation without compromising privacy. All of these aims are met while staying within the restrictions of the UNHCR, regarding height and permanence and speed of construction.
©Patient journeys rule the circulation paths, while providing spaces to limit the feeling of ©being processed©©
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HEALTH
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THE PLAN The plan was informed by studying the problems associated with existing medical centres in camps. Staff are frequently a low resource so must be capable of being as efficient as possible. As such many of the nurses stations over look two areas. Whilst spacing it out more can limit the spread of infectious diseases, quarantined isolation is not realistically achievable in early stage camps. The frame is constructed from 80mm SHS Steel, with 40mm SHS steel angled roof beams. It is braced vertically and horizontally at key junctions with 5mm steel tension cables attached via welded loops. (NOTE: Polypropylene Strips are a common waste product in refugee camps as they bind all winterisation packs, sanitation packs and family tent kits. These are extremely durable and can replace steel cable as a bracing material if an ultrasonic welder can be made available. These operate at low heat hence are relatively safe however an electricity supply is required to run them.)
ŠStaff are frequently a low resource so must be capable of being as efficient as possible. As such many of the nurses stations over look two areasŠ
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Medical Centre Plan- 1:200
Feeding Station Shaded area Triage Childrens Out-patients Adults Out-patients Dispensary Bloods Drug Storage Machinery Storage Staff area Anti-natal Post-natal In-patients Labour Ward Surgery High Dependancy Unit Adult In-patient Childrens In-patient Gas and Air Storage
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THE CIRCULATION It has been critiqued intensely by a current NHS Doctor Kat Phillips who has previously worked in refugee camp centres. This ensures patient journeys are as smooth as possible with limitations on overlooking and disturbance to other patients. Sanitation and safety are taken care of by separating from main complex. Gas and air can explode hence it has a separate structure with sturdy walls and a light roof. Passageways are established so that deceased persons can be removed from the building with very minimal exposure to other patients.
ŠPatient journeys are as smooth as possible with limitations on overlooking and disturbance to other patientsŠ
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Patient Journey Adult with minor shrapnel wound, requires stitches and blood test.
Child entered for feeling unwell, requires substantial treatment for dehydration.
Staff processes blood sample for anti-natal patient then goes for break
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Pregnant woman, complications in labour, requires C-section then post-natal care
Medical Centre Isometric - 1:200 Note: At any phase the UNHCR canvas covering can be substituted for a locally available building material.
Phase 3 - Full Centre Triage/A&E Outpatient Treatment Inpatient Wards
Surgery HDU Maternity Suite
Staff Area
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Phase 1 - Basic Centre Triage/ A&E Outpatient Treatment
Phase 2 - Medium Centre Triage/ A&E Outpatient Treatment Inpatient Wards
Phase 4 - Extra Centre Triage Outpatient Treatment Two Inpatient Wards
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Surgery HDU
Surgery HDU Maternity Suite
Staff Area Separate A&E
STAFF AREA
Front Elevation - 1:100
TO MATERNITY
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TRIAGE
OUTPATIENTS
INPATIENTS
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CHILDRENS INPATIENTS
Rear Elevation - 1:100
ADULT INPATIENTS
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TO SURGERY
HIG
GH DEPENDENCY UNIT
LABOUR WARD
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Left Elevation - 1:100
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LABOUR WARD
POST-NATAL INPATIENTS
STAFF AREA
TRIAGE
SHADED AREA
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SHADED AREA
Right Elevation - 1:100
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CHILDRENS OUTPATIENTS
ADULTS OUTPATIENTS
TO SUREGRY
INPATIENTS
nurses station
Left to Right Section - 1:100
LABOUR WARD
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nurses station
SURGERY
TO WCs
ADULT INPATIENTS
nurses station
CHILDRENS INPATIENTS
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Medical Centre Entrance and Courtyard DAY 1 - UNHCR canvas covering
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Triage and exit through Out-patients YEAR 1 - CGI Panels replace some walls
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Maternity Ward YEAR 3-5 - Solid walls and CGI roofing
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THE UNIVERSAL CONNECTION FRAME
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Exploded Isometric - 1:500 Steel frame with canvas covering
TRIAGE 1:200
J5
J6
OUT-PATIENT 1:200
Due to the cellular nature of the frame, we will focus on the Triage area and briefly on an out-patient unit. These demonstrate the majority of the connections and pieces seen throughout the medical center.
J1 J2 J3 J4
THE JOINTS 1:10 The post to beam joint is a 6mm steel welded hanger with a fixing bolt. The hanger itself uses the offcuts of its assembly as reinforcement. The rotation joint is folded from one piece of sheet steel. This is stronger than welding.
ROTATION DIAGONAL JOINT
POST/BEAM HANGER
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THE PIECES 1:50 In order to have the ability to create multiple shapes but with straight forward assembly, the frame system has been designed with a limited number of segments with universal joints, making them able to attach to any other segment. The diagonal segments of the frame exist to ensure light and ventilation to every bay in addition to sufficient water run off.
BASE PLATE
POST 1
POST 2
POST 4
POST 5
EXTENSION POST
BEAM 1 - 6M BEAM 2 - 5M BEAM 2 - 4.2M BEAM 3 - 3M BEAM 4 - 2.5M BEAM 5 - 1.6M
CROSS BRACING The SHS Steel frame is braced in three dimensions with steel cabling. However it has been suggested in discussions with engineers that a braced bay can support the bays on either side of it. All posts have bracing ring connectors so additional bracing can be added if the structure is like to be subjected to above average wind loads.
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Primary Joints 1:20
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Base Connection Section - DENSE STABLE GROUND CONDITIONS
Cross Bracing connector Post Base Beam Base Plate Securing stakes
BASE PLATE The base plate slots inside the posts so they can be stabilised separately. 500mm stakes are driven through pre-drilled holes. This can be done by hand with a sledge hammer, alternatively a jack hammer with a pile driving fitting is commonly used for similar bases in large trapeze and circus structures.
Base Connection Section - LOOSE UNSTABLE GROUND CONDITIONS
Cross Bracing connector Post Base Beam Base Plate Rubber movement joint Cast in screw bar and bolt Rough concrete foundation
If ground conditions are very unstable, it may be necessary to cast screw bar in a rough concrete foundation which the base plate can then be bolted to. Care must be taken to taper the concrete foundation so that water doesn’t pool.
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Cross bracing plan 1:10
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THE MODEL The weakest point is the longest span, a 6mx6m bay (which doesn’t occur in the design but could be altered on site to exist from the supplied elements.
The model, constructed at 1:2, aimed to examine the ease of manufacture and assembly of joints. The lengths were shortened to preserve materials, however the joints are exactly proportionate.
The 80mm SHS specified has been checked via the TATA Steel Blue book and the largest span would easily take 1kN of down force before reaching bending moment. This is equivalent to a 102kg kilogram roof, which is light but less than can be rationally predicted to occur on site where CGI sheets and tarpaulin are the most common.
SHS (Square Hollow Section) Steel is the material of choice as it is lighter weight, (all elements can be handled and placed by no more that two men, with the heaviest segment (6m beam) weighing 56kg.
14mm beams would take 2kN of downforce (approximately that exerted by standard roof construction) however this would make them difficult to handle due to the segment weight, and the limitation of no longer having universal joints. This weight capacity can be easily improved by adding additional supports.
Using SHS instead of traditional steel elements can lead to a 20% reduction in the use of steel. It is also easier to customise, requiring only basic tools to cut and drill it if necessary. Its hollow nature mean there its the potential in very long term situations to fill the posts with concrete, the SHS acting as reinforcement and the possibility of a second storey.
The posts are twice the size needed to take the axial compression of 1kN of down-force of the largest bay so there is no concern of them buckling. In addition, as there are stepped levels to the design, the higher posts can take bowing pressures in two directions making the extra strength beneficial.
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THE FOCUS AREAS AND ALTERNATIVE BUILDING METHODS
As previously mentioned, refugee situations are developing longer and longer life spans. With this in mind, the frame aims to be a base for users to add and adapt to their needs. This is normally done using locally available materials and low to mid level building skills but high ingenuity. The following are imagined scenarios demonstrating the ability of the designed frame to assist other forms of construction. The three areas of the world with the highest numbers of refugees, both origin and current settling places are South East Asia, the Middle East and Central Africa. Accordingly the scenarios examine common vernacular building methods and common locally available low cost materials.
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ayHelicopter Dropped - 1:50 Waterproof canvas covering, Secured at beams and posts with velcro ties
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Scenario 1 - South East Asia Bamboo Construction 1:50
Cement Impregnated fabric truss joints
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Representation of bamboo construction on frame
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BAMBOO WALL/ROOF SECTION 1:10
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1- Folded overlapping eucalyptus leaves ‘stitched’ with peeled bamboo bark to split bamboo battens. (NOTE: Eucalyptus leaves will require replacement every 3-5 years. Pissava straw or palm thatch can be substituted) 2 - 70-100m mature bamboo truss with cement impregnated fabric joint bonds. Truss attached to diagonal steel frame beam via 4mm J-bolt (NOTE: Ideal bamboo - Dendrocalamus or Oxytenathera. Cement impregnated fabric wrap joints remove the need for higher level bamboo carpentry skills, decommission tent canvas is appropriate here.
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3 - 70-100mm mature bamboo beam rests on steel hanger, fixed to SHS beam with 4mm J- bolt. Attached at corners to perpendicular beam with straight 4mm bolt with pre-drilled holes. (NOTE: Bamboo culms will reach structural strength in 3 years, full maturity in 5-6) 4 - Mosquito mesh sewn around split bamboo frame to defend light and ventilation opening. Once assembled, frame is tacked to outer facade. 5 - Outer skin, halved bamboo culms, tied to bamboo beam with peeled bamboo bark or available alternative. 6 - Inner facing clad with woven shaved bamboo mat. Space between facings can be clad with appropriate insulation though not always necessary in S.E. Asia climate. 7 - In absence of J-bolts, bamboo beams can be secured directly to steel frame though it is best not to add additional holes to tubular products.
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©Cement impregnated fabric wrap joints remove the need for higher level bamboo carpentry skills, decommission tent canvas is appropriate here© 36
BAMBOO FLOOR/FOUNDATION SECTION 1:10
1- Outer skin, halved bamboo culms, tied to bamboo beam with peeled bamboo bark or available alternative 2- Inner facing clad with woven shaved bamboo mat. 3 - Preexisting cross-bracing and connector 4 - One of three 10mm bolts to secure post to extended base plate
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5 - Three ply split bamboo flooring
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6- Flooring joist, potentially palm wood as opposed to bamboo. (NOTE: When working with palm wood all fixings must be galvanised not iron as the timber is naturally acidic and will corrode fixings at high speed)
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7 - 70-100mm mature bamboo beam rests on steel hanger, fixed to SHS beam with 4mm J- bolt. Attached at corners to perpendicular beam with straight 4mm bolt with pre-drilled holes.
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8 - Extended base plate
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9 - Perpendicular bamboo beams cross tied with peeled bamboo bark or available alternative. Also used to tie down split bamboo flooring. 10 - Bamboo post for additional stability as weight of structure increases.
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11 - Partially embedded box of rocks and large particles acts as foundation for bamboo post to slow deterioration of bamboo. 12 - Drainage holes 13-Tapered slope to assist water run off
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ŠPartially embedded box of rocks and large particles acts as foundation for bamboo post to slow deterioration of bambooŠ 37
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Scenario 2 - Middle East Earth bag and Recycled/Waste materials Construction 1:50
NanoIron - Road surface before and after treatment
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Representation of recycled/waste construction on frame
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EARTH BAG AND RECYCLED/WASTE MATERIALS WALL/ROOF SECTION 1:10
1 1- CGI (Corrugated Galvanised Iron), minimum 120g/m2 zinc coating. Closure strips and 0.2mm polyethylene waterproofing membrane. Overlap by minimum 4 corrugations. 2- Recycled plastic insulation (bottles, plastic bags. (NOTE: Camps produce huge quantities of plastic refuse due to common aid supply packaging) 3 - Polypropylene Strips to tie layers together, ultrasonic welded. (NOTE: Every UNHCR aid package is wrapped in this extremely strong material) 4 - J- bolt connecting bottom CGI sheet to diagonal beam. (NOTE: Connect through peak of corrugation to prevent leaks)
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5 - Aluminum flashing 6 - J-bolt fixing CGI sheet cladding to SHS post 7 - Corrugation closure strip 8 - Acrylic and timber window unit. (NOTE: Acrylic has lower embodied energy than glass, is easier to recycle, is more break resistant, allows the transference of more light and is more workable than glass.)
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9 - Tapered block to assist water run off
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10 - Polypropylene strip, ultrasonic welded to rubber movement joint, affixing window to SHS beam
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11 - Tapered earth bag to assist water run off 12 - Barbed wire course between earth bags to tie wall 13 - Barbed wire wrapped SHS post to bond to earth bag wall and give extra stability. 14 - Sulphur and lime render (NOTE: Sulphur is a waste material of the petroleum industry among many others. It is uncommon but has multiple potential uses in the building industry. It melts at 119°C and when heated can replace water and partial cement in concrete mixes. It deters insects, which will assist in the preservation of the earth bag wall. With dicyclopentadiene added it become fire resistant.)
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©Sulphur melts at 119C and when heated can replace water and partial cement in concrete mixes. It deters insects, which will assist in the preservation of the earth bag wall. © 40
EARTH BAG AND RECYCLED/WASTE MATERIALS FLOOR/FOUNDATION SECTION 1:10
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3 1- Barbed wire wrapped SHS post to bond to earth bag wall and give extra stability. 2 - Barbed wire course between earth bags to tie wall
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3 - Sulphur and lime render 4 - Barbed wire tying earth bag wall to gabion foundation
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5 - Gabion foundation, steel mesh cage filled in place with rocks from site.
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6 - Gabion cross ties, to prevent warping 7 - 0.2 polyethylene waterproofing membrane 8 - Rubber interlinking flooring system. 9 - Staked base plate foundations in earth stabilised with nano iron. (NOTE: a 3-5% ratio of nano iron in any earth foundation will dramatically improve its stability. ”I ”. nanotek.ws.)
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©Nanoiron modifies the characteristics of soil, controlling and reducing abrasion effects produced by water.© 41
Scenario 3 - Central Africa Rammed Earth and Ferro-cement Construction 1:50
Litre of Light
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Representation of Earth and ferrocement construction on frame
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RAMMED EARTH AND FERRO-CEMENT WALL/ROOF SECTION 1:10
1 2 3
1- Litre of light, sealed with putty to 300x300mm ferro-cement square, tied with cast in wire connectors. (NOTE: By putting 50ml of ammonia in a bottle of water and placing it in a hole in the ceiling, the ammonia reflects and transfers the light to match a 40 watt bulb. This can be combined with a basic solar connector to provide light at night also. See precendents)
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2 - 25mm Ferro-cement interlocking roofing panel with RHA (Rice Husk Ash) cement substitute. (NOTE: The roofing panels can be made on the ground and then placed with a zinc style overlap. This means the difficulty of plastering overhead is removed 3 - Galvanised steel wire cast in to roofing sheet in order to tie to steel frame. 4 - Uncovered opening, the overhanging roof will protect interior from elements.
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5- Tapered edge to assist water run off 6 - Form work layering 7 - Banana mix coating (NOTE: Boiling banana leaves and stalks in water produces a paste, this paste when applied to earth walls makes them waterproof and resistant to cracking and abrasion.
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8 - Galvanised wire anchor to steel beam 9 - Adobe render (NOTE: Adobe can regulate humidity)
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10 - Galvanised wire anchor to steel post 11 - Rammed earth construction (NOTE: Lateritic soils are the ideal for rammed earth, with a high sand content. These are relatively common in central Africa)
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Š50ml of ammonia in a bottle of water, placed in a hole in the ceiling, reflects and transfers the light to match a 40 watt bulb Š 44
RAMMED EARTH AND FERRO-CEMENT FLOOR/FOUNDATION SECTION 1:10
1 2 3 4 1- Rammed earth construction 2 - Form work layering
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3 - Adobe render 4 - Galvanised wire anchor to steel post 5- Banana mix coating 6 - Timber flooring, secured to steel frame with J-bolt, wrapped in DPM to protect from moisture in rammed earth wall. 7 - 100mm course of min 5% stabilised soil, cement or equivalent. (NOTE: This prevents termites reaching timber elements via the earth wall which may go unseen.)
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8 - Bitumen felt to protect rammed earth foundation from moisture
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9 - Steel hanger and floor joist 10 - Tapered slope to assist water run off away from foundation. Surrounding soil treated with banana mix coating.
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11 - Infilled and stabilised soil 12 - RHA concrete footing
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ŠBoiling banana leaves and stalks in water produces a paste, this paste when applied to earth walls makes them waterproof and resistant to cracking and abrasionŠ 45