Emergency Urbanism and Preventive Architecture

Emergency Urbanism and Preventive Architecture Hilary Sample Modern cities and their architecture have largely developed as a result of man-made rules and regulations associated with maintaining the public’s health.1 The evolution of these rules, particularly as they pertain to protecting collective health during unexpected disease outbreaks or epidemics, challenges the order and freedoms such rules were to uphold.2 In turn, rules for urban development have thus been shaped by the effects of both chronic and communicable disease events. Modern history has shown that the greatest disturbance to the urban status quo occurs during communicable disease outbreaks, in part because the speed by which disease spreads results in the destabilization of public space and life-sustaining infrastructures.3 Modern epidemics from typhoid, tuberculosis, cholera, influenza, polio and legionnaire’s disease to the more recent HIV/AIDS as well as SARS, Avian flu and H1N1 viruses have each affected the cities they surfaced in, causing spatial guidelines to be reworked – and have since led to reforms of the built environment.4 Today’s epidemics are increasingly unpredictable due to never before seen anomalies in viruses and new superbugs. If rules and regulations are to provide a means of treating the built environment, urban health crises quickly upend those rules and undo established freedoms.

To understand how these design conventions are thwarted in extreme cases, it is productive to examine the physical change to cities that is brought about by contemporary urban epidemics.

Healthy city, sick city

At any given moment there are always at least two cities within any one city: a healthy city and a sick city. This innate division is most evident when a public health crisis occurs. Not only is a physical distinction between healthy and afflicted individuals recognizable by bodily appearance – consider the wearers of face masks during the 2003 SARS outbreaks, or the withering forms of AIDS patients who came to media attention at the beginning of the HIV/AIDS crisis – but it is also possible to see physical repercussions of illness in the public body mirrored in the city’s architecture and its public spaces. Epidemics affect the ways in which cities and their buildings perform; having been designed, built, organized, controlled and maintained according to policies, plans and protocols formed before any contemporary epidemic could be predicted. In the face of crisis – such as the 2003 SARS outbreaks – a normally functioning city is drastically altered and subsequently controlled via entirely new and unexpected urban conditions, for example, the forced closure of hospitals, the emptying of street cars and subways due to voluntary quarantines, 231

or the shuttering of bath houses at the beginning of the HIV / AIDS epidemic.

These unpredictable and disruptive physical changes to urban space produce a greater distinction between the healthy and the sick. The urban transfor­mations that occurred during SARS were first conducted on the scale of a single building. Small shifts associated with a building’s function can radically change its performance, that building’s subsequent performance on a block, the block on a larger urban area and eventually the reconfiguring of the city as a whole. The city’s image thus becomes recalibrated from the inside out – one recalls the collapse of Toronto’s tourist industry due to the outbreaks. During SARS the most visible changes took place in building typologies with a direct impact on health cure or care.

Our civic health has long been associated with one building type: the hospital – an environment designed to be permanent and constantly accessible to the public. Under normal circumstances the sick associate with a certain public ( doctors, nurses, pharmacists, clinicians, public health officials ) and occupy those spaces affiliated with these care providers: hospitals, clinics, pharmacies. But this image of a single, central place for health is no longer relevant, as was made evident by the SARS outbreaks. Civic health is now less exclusively reliant on the hospital; the idea of the hospital as a cure-all space outdated. Previously, the hospital was understood to be a civic architecture with an urban presence that housed experts on the treatment of the body. The image of the urban hospital as a place to avoid in the eighteenth and nineteenth centuries would be reversed by the twentieth century through progressive projects such as James Gamble Rodgers “ air castles ” at New York 2 Sammy Ofer Hospital Tel Aviv, 9 March, 2011

The hospital was built to be protected and fortified against chemical and biological warfare. The parking garage can be converted into a 1750-bed emergency underground facility.

Photo: Jack Guez, AFP / G etty Images, 109887575

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City’s Columbia-Presbyterian Hospital ( 1921 ) that exemplified the new modern, healthy place for care. Today, the outbreak of war and the emergence of superbugs have transformed the hospital once again, into a site where the individual is at greater risk of an episode of harm. The hospital has recently been a battlefield from Iraq to Libya,5 whereas during the Gulf War, Tel Aviv’s main hospital was retrofitted – literally shrink-wrapped – in a protective layer that physically sealed windows shut, encasing air that was continuously filtered ( figure 2 ). Throughout the SARS outbreaks, Toronto’s Spring of Fear Report described its hospitals to be as dangerous as mines or factories, thus unsafe for both workers and patients: “ Before SARS no one was prepared for the possibility that a hospital might need to be closed to contain an infectious disease outbreak. ”6 Since the SARS outbreaks it seems that there is a concerted effort, or trend, in both the United States and Europe, to respond to an increase in disease by creating a new string of health-related programs; these are no longer built in suburban industrial parks but instead are constructed in urban settings.

Spaces within the city are being built to accommodate research, laboratories and office space for associated services ( intellectual property law ) and so on.

By extension, the idea that the public is affected not only by increasing certain types of programs but also by the visibility of these programs is the new civic way. Research laboratories – some garnering the title of “ Nobel Factories ” — health administration headquarters, government health agencies and pharmaceutical companies such as Roche and Novartis, who have shifted their stake in the competition to produce not only the most advanced drugs but also avant-garde architecture, is without a doubt reshaping the image of the city.

Urban health buildings have acquired new additions – built onto existing and historic hospitals too old to function at contemporary standards. Oncedistinctive buildings are now composed of many wings, atria, towers and so on, making the hospital one of the densest and greatest consumers of square footage of any building in the city today ( figure 3 ). 7 Directly on the heels of planning these buildings are the marketing strategies that reframe the city as a key medical and biological centre or destination.8 Of course the purpose of clustering services and programs is to strengthen physical health, but also the health of its image. But it’s too early still to know whether such strategies are effective, and how.

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3 Hilary Sample and Matt Zych Comparison of Health Headquarters Building diagrams, 2011

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Historically, cities have separated the sick from the healthy by large urban 0’ 0’0’ 200’200’ 1000’ 1000’ 200’ 1000’ forms known as cordon sanitaire. In Alison and Peter Smithson‘s little book, Urban Structuring, the modern architects dwell on these episodes of urban form, pointing out that in the city of Turin, the “ fortifications with its cordon sanitaire occupy more space than its built-up area. ”9 As urban disease and especially epidemics are on the rise – and able to emerge with little to no notice – conditions have been created that leave cities vulnerable to outbreaks and transmissions. Where the cordon sanitaire, as the Smithsons point out, occupied an equal area as was dedicated to built area, urban cities today seem to lack the necessary space for the ill. Once a physical and necessary protective perimeter that provided a buffer between the healthy and the sick, the cordon sanitaire is no longer such a large physical presence. Instead the urban hospital, particularly in a post-SARS context, continues to cluster more and more programs around it to fortify its image, and to provide for greater stability in the especially unstable time of an epidemic.

Many cautionary tales can be told about contemporary urban epidemics, almost all of them intersecting with the built environment and architecture.

The first episode here presents conditions of isolation versus quarantine during the period of SARS outbreaks ( 2003 ), and the second unfolds the history of global health headquarters by examining the UNAIDS administration building, completed twenty five years after the emergence of the HIV/AIDS epidemic ( 1983– ) – contrasting a world-class image of governance with that of conditions on the ground.

The “ atypical pneumonia ” that became known as severe acute respiratory syndrome ( SARS ) virus made the two cities of illness and well-being immediately apparent.10 Early stages of the outbreak were confusing; SARS’ first visible sign appeared as a fever, while the media hastily referred to the outbreaks as 234

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“ super toxic ” and “ incurable. ” Pulitzer Prize-winning journalist Laurie Garrett has frequently described the numbers of fever checks she was subjected to while reporting on SARS from Beijing.11 Largely found in South East Asia and particularly in China, the virus’s point of origin was traced to the wildlife markets of Guangzhou. It rapidly spread to other cities via air travel, most notably from Hong Kong to Toronto and other cities around the world.12 Like earthquakes, diseases too are measured. In a chart known as the Richter Scale for Global Viral Diseases, SARS ranks just under three, while HIV / AIDS remains close to the top, near a seven ( figure 4 ).13 Although the magnitude of the SARS outbreak was not as severe as the HIV/AIDS epidemic, it nonetheless significantly affected the public and urban life-support infrastructures, use of public buildings and spaces within a very short period of time. The rapidity of the virus’s arrival to each city produced a series of phenomena that were equally as devastating to the urban economy as the virus itself.

The arrival of the SARS virus to any city immediately generates a ghost town in its aftermath: streets and public spaces abandoned and empty. The degree of the evacuation and subsequent economic crisis resulted in no small part from the media’s promotion of the physical dangers of the virus. Nobel Prizewinning Professor David Baltimore named this phenomenon the “ media virus, ” claiming that the media exacerbated public fears by stimulating overreaction, in reports that threatened to “ outpace the risk to public health from the actual virus ” and potentially do more damage to the public than the virus itself.14 “ It felt like the Great Depression had hit. People were afraid to shop, to go out.

I stayed in a hotel where only one other person was staying. It was absolutely devastating to the economy. And at the crux of it all was whether one had a fever or not. ” 15 In Taipei, officials used the media as a tool against public fear by establishing SARS TV, broadcasting virus-related television programs throughout the day and creating a twenty-four-hour toll-free hotline for enquiries about information on SARS. The television broadcasts detailed the mundane 235

tasks of hospital staff cleaning tools and surfaces with bottles of rubbing alcohol, to reporting on elevators being disinfected once per hour.16 What had been banal and routine chores were suddenly life-sustaining procedures.

The urban forms most affected by SARS were public, and these included the public building types most frequently providing urban life support including hospitals, airports, schools, clinics and public transit. The life-support systems of society would become vulnerable to the point of failure, some temporarily and others permanently. The distribution of the SARS crisis created similar conditions in cities around the world, each sharing the same problems of surveillance, control and treatment – problems which affect the performance of buildings, thus rendering a new layer of history atop a previous one. If these new histories, though temporary, change the way architecture performs, then they are as important as what was intended, and thus worthy of study. The entanglement of crisis is as significant to a building’s history as its design, particularly when that crisis is short-lived.

Isolation occurs within a hospital, and quarantines occur within the city.

This is an important distinction to be made, particularly because isolation produces stricter measures and requires confined, controlled, and fixed spaces. Isolation refers to the separation of a sick patient within a hospital to prevent her or him from transmitting germs to other patients. The first isolation hospital was established on an island near Venice during the plague, at Lazzaretto Vecchio. Islands have played a large role in the control of contagious diseases throughout history. In industrial New York City, a cook carrying 4 A ‘ Richter Scale ’ for

global viral diseases measured as approximate numbers of deaths in 2003, from Robin A. Weiss and Angela R. McLean, “ Emerging Infections: What Have we Learnt from SARS, ” Philosophical Transactions: Biological Sciences, Volume 359, No. 1447, 29 July, 2004, The Royal Society, 1137–1140.

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typhoid was held in isolation in a cottage on North Brother Island in the East River for two decades. She is remembered as Typhoid Mary, and lived in isolation until her death. Between 1915 and 1938, in a more recent yet equally extreme case of separation, a young boy with a compromised immune system was compelled to live in a bubble – eliminating all interaction with others.

For twelve years he remained inside a plastic bubble built especially for him at Texas Children’s Hospital. In 1977, NASA designed a customized miniature space suit, or Mobile Biological Isolation System, which kept the air inside it germ-free and enabled him to walk about and eventually leave the hospital.

But after only six outings, he became too terrified to wear the suit, afraid that the germs outside would destroy him.17 Contemporary standards for isolation are more civil and confine a sick patient to a carefully controlled environment, with air ventilation systems calibrated to kill and keep germs from spreading through the main ventilation system to the hospital’s larger population. Isolation rooms are procedurally more like a safety laboratory than a typical hospital patient’s room, fitted with negative pressure rooms, and the most up-to-date technologies. During the SARS outbreaks, some hospitals created special departments known as fever wards.

Hospitals in Toronto and Hanoi were effectively transformed into contemporary isolation hospitals, closed to the public and allowing no visitors ( figure 5 ).

In Toronto’s hospital corridor along University Avenue, exterior entrances were severely restricted and perimeters cordoned off with yellow caution tape, forcing pedestrians to cross to the opposite side of the street – effectively creating a barrier between the hospital entrance and the sidewalk. Emergency 5 North York General Hospital Toronto, 29 May, 2003 A security guard wearing SARS protective gear patrols the closed entrance to the emergency ward.

Toronto was the source of a second cluster of SARS cases, where 7,000 residents were kept in precautionary quarantine.

Photo: J. P. Moczulski, AFP / G etty Images, 2039101

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exits were blocked with chairs and scribbled notes of warning. The intention was to protect the general public but also to keep desperate family members from entering the hospital. Visible police protection also heightens the visualization of the hospital, to the level of a crime scene. In Vancouver, one hospital set up a screening station in a parking lot across the street to create a still larger barrier between the hospital entrance and those who might be infected.

Depending upon their answers to routine questions, potential patients would be diverted for further screening. Similarly a hospital in Taipei set up a screening pavilion in the form of a party tent located on the site perimeter, which potentially infected individuals and workers had to pass through before entering. Because the city had what was later determined to be a weakened public health infrastructure, there were no other places for screening to occur.

This realization prompted the government to order the building of several infectious disease hospitals and to establish a new epidemic prevention system including clinics for infectious disease.18 Despite the context of the urban boom in Beijing, the virus transformed the city into a ghost town; with students quarantined in their dormitories and migrant workers on mass exodus via city train stations. Several People’s Liberation Army hospitals contained some patients, although these were shuttled around the city at times when the World Health Organization ( W HO ) conducted inspections, so as to reduce the total number of reported cases.19 Once it acknowledged the growing numbers of infected, the government ordered the emergency construction of a hospital with 1,000 beds, which was completed by the army within seven days. Isolation in contemporary practice exists but requires a greater level of containment than quarantine, and is never voluntary.

Unexpected side effects

While most cases of virus transmission occurred in hospitals, public housing projects were the next most affected building type. During the SARS outbreaks, the misunderstanding and naive interchange of isolation with quarantine by the media led individuals to be more afraid of the outbreaks, particularly with regard to episodes which took place in large-scale public housing projects. New modes of mapping were used to generate statistical surfaces which revealed daily changes in disease hot spots.20 In these hot spots – designating clusters of sick individuals, infected as the result of a super spreader – quarantine was often employed. A super spreader is a highly infectious person who unknowingly spreads a virus to many other people, such as Typhoid Mary in the early twentieth century. Quarantine refers 238

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not only to the separation of people from one another but also objects from the general public, for instance, ships held in port for observation purposes, or aircraft with foreign cargo needing to be searched for disease carrying agents. In the case of disease, quarantine is undertaken to monitor individuals who may show no symptoms, but are held during the incubation period to monitor visible changes in the body.

In Taipei, the Hua-Chang Public Housing Complex required its residents to be quarantined and relocated to the Ji-he Housing Estate while the city established a command centre and officials disinfected afflicted units.21 Among the mandates outlined by Taipei authorities – a common response by the administrations of affected cities – were the maintenance of public facilities, the use of air-conditioning at a maximum setting ( or opening windows for ventilation when no air-conditioner was available ) and avoiding elevators in favour of stairs. An X-ray bus was immediately deployed to a business after an employee returned from Beijing via Hong Kong and felt ill. Yet according to a post-SARS report, the establishment of a contingency centre to support governance surrounding the disease could have happened much sooner in Taipei.

In Hong Kong’s Kowloon District, the site of one of the largest clustered SARS outbreaks, a hot spot occurred in the residential towers of the Amoy Gardens Housing Estate ( figure 1 ). Leaky plumbing risers and drainage systems located in proximity to internal open air shafts, designed to take advantage of the chimney effect, were blamed for the spread of the disease through specific towers.22 Residents were found to be more infected the higher up they lived in the building, confirming the chimney effect air circulation pattern.

The flow of air within the towers, which should have provided healthful benefits of fresh air and sunlight, rather produced the opposite by becoming the very channel of viral transmission.23 Dried-up U-shaped water traps, water vapour and bathroom exhaust fans vented to the air shaft were seemingly responsible for the upward vertical spread of the virus through one residential tower alone.24 Amoy Gardens and other Hong Kong estates were built under British rule to provide public housing, according to similar policies for public housing projects completed during the reconstruction of post-war London. The lack of maintenance at Amoy Gardens would eventually be blamed for facilitating the spread of the disease; such extreme containment procedures were taken as, for example, the isolation of Block E in entirety for a period of ten days, during which no one could leave the building or have visitors.

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In a kind of modern day lazaret, the residents suspected of infection and their families were evacuated from the Amoy Gardens towers and sent to three government quarantine centres typically used as holiday camps: Lady MacLehose Holiday Village, Sai Kung and Lei Yue Mun Park. During the isolation period, infected individuals were evacuated by means of policeescorted buses. Run by Hong Kong’s Leisure and Cultural Services Department, Lei Yue Mun Park and Holiday Village is described as offering fine views and fresh air, having been modelled after early-twentieth-century European buildings with open-air terraces, though the complex once functioned as a military barracks. Individuals were completely isolated within the holiday camp, with meals delivered three times per day. Despite the outdoor setting, quarantine at Lei Yue Mun was described by one individual who had been brought there as “ sitting in a prison ”; no swimming and no interaction with the horses on the island was allowed, for fear of spreading the disease to animals and other wildlife. Families of the sick were sent to another camp to keep them from also getting sick. In 2009, these camps would again be activated during a swine flu outbreak that also required the transport of those suspected of infection by commercial coach bus to locations designated for quarantine.

Also furthering the SARS outbreaks were the 5,400 units of Hong Kong’s Lower Ngau Tau Kok Housing Estate ( 1969 ), similarly classified as a superspreading event. As at Amoy Gardens, massive maintenance campaigns ensued that entailed cleansing and disinfecting every surface, corner and crevice. While those infected were evacuated from Amoy Gardens, at LNTK one building was converted into an ad hoc quarantine centre, and later into temporary working quarters for front-line medical staff when the situation was better controlled.

After hospitals and housing estates, other public buildings were possible sites of virus contamination. In Toronto, schools, churches and even funerals were places that produced clusters of the sick. In total, 23,000 individuals were in quarantine. Although the majority of these were voluntary, and in fact the actual number of SARS cases never reached the numbers reported for other diseases, the outbreaks still impacted the masses. This resulted in travel restrictions and the cancellation of many events which, at the height of the season, had ruinous effects on tourism to the point of destabilizing Toronto’s economy.25 In an effort to prevent further spread of the disease but also as a strategy to recoup a healthful image, cities employed full-scale maintenance practices.

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In an effort to restore a sense of urban cleanliness in Taipei, the military pursued a campaign to disinfect streets and hospitals.26 Other cultural and public facilities were closed for internal cleaning, and once reopened required each visitor have their body temperature taken before entering, according to government policy. In the case of Hong Kong’s LNTK, one infected person resulted in the subsequent maintenance of eight hundred housing units.27 The commercial message of “ 1/99 ” – the bleach-to-water ratio recommended for disinfecting surfaces – was frequently played on television to encourage cleaning within individual households as part of a mass campaign to disinfect the whole city against further spread. A survey of the airports at this time would reveal the universal concern over personal protection with posted signs about wearing face masks and washing hands, along with descriptions of symptoms. Paranoia went so far as to suspect elevator buttons as a potential site of virus transmission among hotel residents; residents who would eventually board planes for other destinations and result in the arrival of the virus to Toronto. In response to the rapid spread of the virus from Hong Kong to Toronto, airports quickly became important surveillance sites.

From Singapore to New York to Toronto, airports set up check points with thermal scanning devices to detect fever, one of the symptoms of SARS. In some cases these detection stations have since become permanent fixtures.

At the new international airport in Beijing designed by Foster and Partners, passengers stream underneath a sweeping roof past a bank of thermal cameras before going through immigration. Although no further cases of disease outside of the laboratory have been confirmed since, the aftermath of the SARS outbreak has produced a series of permanent changes to the city, of which Beijing Airport’s thermal scanners are but one example. Other larger-scale effects can be felt in the building of new infectious disease control hospitals, primarily in South East Asia.

Throughout the outbreaks, the story of the SARS virus at times drew com­ parisons to the early days of the HIV/AIDS pandemic, with some speculating that the virus was here to stay and not the temporary event it turned out to be. This reaction was the underlying reason for Chinese Premier Wen Jiabao’s unprecedented public declaration of the need to treat AIDS patients with “ care and love. ” Wen thus broke a long-standing taboo by which prominent party leaders distanced themselves from the disease.28 The fear that SARS could be as devastating as the 1918 Influenza or 1983 HIV/AIDS pandemics 241

was very real, and governance by the WHO quickly trumped all laws, policies and politics from the local to national level.

Health governance and responsive architectures

Unlike HIV/AIDS, the SARS coronavirus is visible under a microscope, and was both discovered and identified with “ unprecedented speed. ”29 In comparison, the human immunodeficiency virus ( H IV ) took much longer to identify, and resulted in one of the worst modern pandemics. The collaboration of independent laboratories around the world under the leadership of the WHO provided an efficient infrastructure to rapidly decode the SARS virus.

Although the success of containing the virus so quickly was attributed to the strong intervention of the WHO, there were controversial moments when the WHO opposed the authority of local, regional and federal governments, enforcing travel bans and restrictions for weeks at a time to further exacerbate failing economic conditions. What the SARS outbreaks revealed is that health is no longer a local, regional or federal concern, but a global one.

Anyone anywhere can be infected, and regulatory practices and governance may not only be local or national.

This is only half of the story of the WHO, for in fact, world health governance associated with communicable diseases has been organized since 1948 from a headquarters in Geneva. Today the WHO is dedicated to the governance of HIV/AIDS, malaria and TB.30 Because, as Alex De Waal has argued, the HIV /AIDS epidemic “ is being managed, not solved, ” 31 and its management 6 Baumschlager & Eberle UNAIDS Headquarters Geneva, Switzerland, 2005

Photo: Eduard Hueber

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has grown increasingly more organized from a newly completed headquarters: the WHO / U NAIDS Secretariat.32 Located in Geneva, a city renowned for its aggregation of world governing body headquarters focused on health and economics, the WHO / U NAIDS building houses administrators but also serves as a tangible symbol for the efforts to improve global health in the face of the HIV/AIDS epidemic.33 In close proximity to other World Health Organization administrative buildings, the International Red Cross, and the European headquarters of the United Nations ( located in the former League of Nations headquarters, the Palais des Nations ), its Swiss site provides a stark contrast to those regions most critically affected by HIV/AIDS in Sub-Saharan Africa. The UNAIDS headquarters ( and by extension the WHO ) in distant Europe also represents the uncomfortable separation between the global sick and healthy. In AIDS and Its Metaphors ( 1989 ), Susan Sontag described the epidemic as spreading in “ slow motion ”: “ The virus invades the body; the disease ( or . . . fear of the disease ) is described as invading the whole society. ” 34 In 2002, the Austrian architects Baumschlager & Eberle won the international competition for the new offices of the World Health Organization ( W HO ) /Joint United Nations Programme on HIV/AIDS ( U NAIDS ), presenting a design for the building as emblematic of important health operations but one that also questioned the long history of formal architectural ideas for world health headquarters ( figure 6 ). 35 While formal analysis of the UNAIDS building is worthwhile, the project’s true merit lies in its rethinking of a previously heavy-handed UN mandate for aesthetic sameness, uniformity and control of health by means of traditional standards and conventions.

The United Nations headquarters in New York City ( completed 1952 ), with an administrative block housed in a glass secretariat tower and a stone assembly hall to accommodate its worldwide constituents makes a strong statement that symbolizes global governance and power. Reyner Banham described the tower’s glass as a “ world-wide symbolic material of clarity, literal and phenomenal ”; at the UN headquarters it is “ universally delivered in crisp rectangular formats . . . impervious to local accidents and customs. ” 36 Banham concludes: “ [ Glass ] was therefore appropriate to all the aspirations of the founders of the United Nations, who gave it canonical form in their headquarters tower in New York. ” The combination of the two elements, secretariat and assembly, had such a stronghold on the imagination of UN commissioners that these were mandated in the 1959 brief for the WHO headquarters, which were essentially to be built in the image of the UN building in New York.37 243

Among the fifteen architects of international stature to propose designs were Eero Saarinen, Kenzo Tange and Jean Tschumi. Those schemes that diverged from the criteria of the competition brief were the first to be eliminated, including Tange’s curved, swooping concrete towers which converged at their tops; whereas Saarinen’s scheme for a two-hundred-foot clear span tower lifted above an open-air entry plaza ( with assembly hall buried beneath ) garnered second place. Since the New York building, the UN had sought to repeat the forms of the tower and the cube in its many satellite projects, particularly in the development of the WHO headquarters and its six offspring, all established before 1965. Jean Tschumi won the international competition for the WHO headquarters ( 1959–66 ) with a design that fully complied with the competition mandates – complete with tower and assembly cube – although several stories shorter than the New York building as a result of Switzerland’s height restrictions ( figure 7 ). Tschumi’s design wrapped the secretariat in an aluminum brise-soleil façade that enclosed the administration staff within ( figure 8 ). This flexible interiority could better accommodate the purpose of the headquarters, which needed to be able to respond to any emerging disease crisis in the world at any time and provide the space for teams to grow or shrink. Tschumi’s secretariat could house over 1,000 people.

Embodying the WHO’s mission statement at the time, the headquarters were constructed such that no other headquarters would need to be built again. But of course, the emergence of the HIV/AIDS virus would quickly alter that vision.

The new WHO / U NAIDS Headquarters ( 2005 ) is a low and massive form surrounding a centrally placed open-air courtyard. Lining the courtyard perimeter 7 Jean Tschumi World Health Organization Headquarters Geneva, Switzerland, 1966 Building under construction with the League of Nations Headquarters in the foreground Photo: Tibor Farkas, WHO / Tibor Farkas

8 Jean Tschumi

World Health Organization Headquarters Geneva, Switzerland, 1966 Employee lounge Photo: Jean-Philippe Charbonnier, WHO / Jean-Philippe Charbonnier

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are administrative offices stacked neatly atop one another, but unlike the WHO headquarters across the street, without a unifying or distinctive secretariatlike form. The building’s most important room – considering the debates, votes and political resolutions which take place there – is similarly unarticulated.

In other words, the forms found in both the UN and WHO headquarters as two-component object-like buildings are simply contained within the interior of the low mass at WHO / U NAIDS.38 The physical form of the WHO / U NAIDS building is designed to counter the image of the UN and the WHO, and instead of recreating the individual elements of secretariat and assembly, it places both programs within a single glazed skin. The design thus brings together disparate parts to make one whole. Even the furniture of WHO / U NAIDS headquarters assembly room supports this metaphor: A simple series of linear tables and plastic chairs are configured into the shape of a square. There is no speaker stage, no auditorium seating, no hierarchy – it is a simple democratic arrangement. While the WHO / U NAIDS building is still in the family of the UN and the WHO, it is very clearly a break with the weighty secretariat and assembly combination of forms which were once mandated for replication as world-class design. The WHO / U NAIDS building suggests new thinking with regard to global health, or at least to the organization of global health surveillance, monitoring and governance. It is perhaps too easy to suggest that the building’s low and horizontal form ( as opposed to tall and vertical ), implies that its “ world-class ” architecture here stands for the deliberate action of expediently managing and supporting the fight against HIV/AIDS on the ground.

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In AIDS and Power, Alex de Waal writes that African governments, civil society organizations and international organizations have proven remarkably effective at managing the HIV/AIDS epidemic in such a way as to minimize political threat. In Sub-Saharan Africa where one in six persons will contract HIV in their lifetime – causing the prominent journalist Laurie Garrett to refer to the disease as the “ Black Death ” – the threat of AIDS overturning African society seems to have little political cachet. Instead, there is a “ smooth and coordinated functioning of their own institutions ” and because of these efforts, with a “ few important exceptions where different, intersecting stresses come together, AIDS is unlikely to cause socio-political crisis. ” 39 Management of the epidemic is efficient enough that “ society is neither collapsing nor being transformed in revolutionary ways. ” The Commission for Africa produced the 2005 report “ Our Common Interest, ” which outlined characteristics of HIV/AIDS-patient environments in Africa, and the rate at which the disease travels across the continent: infecting one person per second.40 Compounding the situation is the painful growth of cities ever increasing in poverty and burgeoning slums, euphemized by De Waal as chaotic urbanization.41 In these conditions, 22.5 million individuals live with HIV/AIDS in Sub-Saharan Africa – compared to the roughly 1.5 million in North America – yet there is a single facility that provides treatment and care, and these in extreme conditions. Al Jazeera’s documentary series Saving Soweto ( 2009 ) presented the day-to-day operations of the Chris Hani Baragwanath Hospital, known as Bara, in Soweto, Johannesburg, the largest acute hospital in the world set on 173 acres ( 70 hectares ) with nearly 3,200 beds. Despite the UNAIDS aim of “ Zero New HIV Infections, Zero Discrimination, Zero AIDSrelated deaths ” as published in the 2010 Global Report, South Africa’s epidemic remains the greatest in the world.42 In Bara’s medical admissions to Ward 20, for example, nearly sixty percent of the deaths are HIV/AIDS-related.43 Built from an abandoned British army barracks, Bara’s buildings and infrastructure are severely outdated and its connection to urban infrastructure equally despairing. Electrical shortages in the Soweto area frequently cause rolling blackouts; at the same time, although new buildings have been added to the campus, no new electrical services have been provided since its inception.

Bara’s dilapidated structures include the twelve-storey nurses residence, labour ward, neonatal intensive-care unit, mortuary cold room, bulk water storage, intensive care unit, doctors’ residences, and paths and walkways between buildings.44 In addition to these problems, conditions have been so poor that the staff has resorted to acts of sabotage: disrupting laundry 246

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equipment ( reducing the supply of sanitary linens ), tampering with gas and generators, delaying treatments and forcing operating theatres and wards to shut, in order to draw further attention to Bara’s deficiencies in the hope of a fix.45 The proposed solution is to reduce the number of patients by half and create a network of six “ mega-hospitals, ” of which Bara will be just one. Yet the fulfillment of this intention remains uncertain.

The lesson to be learned from both SARS and the HIV/AIDS epidemics is that in the current age, disease cannot be controlled through one fixed location: Neither the hospital nor the headquarters alone can provide a cure. Where modernism created utopian spaces filled with light and air and open, continuous space, today we understand space quite differently, to be in fact filled with particles, pathogens and other invisible matter. While buildings are a setting for treatment, they do not directly treat disease on their own. But in combi­ nation, these buildings together with smaller-scale clinics, pharmacies, research laboratories and others establish a necessary means of managing health, and defending the city.

Urban disease is not neat, but messy, and requires technical solutions as well as amateur fixes. As urban health events emerge more frequently, it seems that deliberate acts of planning must increasingly address issues of emergency more as norm than exception.46 What this means for architecture is not a loss of formal, cultural or aesthetic project, but rather the opposite; and poses the question of how architecture can absorb these contemporary performance issues. Modern architects were unafraid to think about health as a provocation for new forms of the city. And if the city will always be at least partly sick, architecture too requires deliberate strategies with health in mind.

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1 From 1851 to 1938, a series of annual international sanitary conferences were held in major European cities.

With cholera overrunning Europe, the first International Sanitary Conference was held in Paris to produce international sanitary conventions. Each year additional themes were dealt with from cholera to plague to smallpox and typhus, to trade along the Suez Canal, to the war time era and aerial navigation. At the time the conventions began there was no world-governing agency to oversee public health emergencies. In response to these conventions and conferences, national health agencies were born where none had existed, and eventually the 1874 Rome Convention saw a unanimous vote to create an international health body to collect, monitor and research information related to epidemics. This body was known as l’Office International d’Hygiène Publique ( O IHP ). World governance of public health would lead to the production of a set of conventions and standards for monitoring disease, but also more recently, conventions for disease prevention. These conventions would be adopted by national and local health agencies and cities to produce safer and healthier cities. The development of health headquarters here traces a history of international human health conferences and conventions desiring a permanent place from which to conduct worldwide disease surveillance. France and the United States had the first organized agencies; national bodies also tasked with overseeing international problems. The League of Nations eventually built a health administration wing that remained operational until the United Nations came to power in 1948; by 1966 the health department located within the League of Nations Health Administration wing would be relocated to the new WHO headquarters.

2 Alex Lehnerer, Grand Urban Rules ( Rotterdam: 010 Publishers, 2009 ).

3 Richard Matthew and Bryan McDonald, “ Cities under Siege: Urban Planning and the Threat of Infectious Disease, ” Journal of the American Planning Association 72, no. 1 ( Winter 2006 ): 109.

4 London’s cholera epidemics in the 1850s revealed key failures in the existing waterworks infrastructure, which led to new designs for receiving water into the house.

5 Kate Forbes, “ Libya Crisis: Medics Flee Gaddafi Airstrikes, ” BBC News, March 11, 2011, www.bbc.co.uk/ news/world-africa-12720402 ( accessed September 8, 2011).

6 Archie Campbell, Spring of Fear: SARS Commission Executive Summary 1 ( Toronto: SARS Commission, 2006 ), 9.

7 Cor Wagenaar, ed., The Architecture of Hospitals ( Rotterdam: Nai Publishers, 2006 ).

8 Hilary Sample, “ Biomed City, ” Verb Crisis ( Barcelona: Actar 2009 ), 68–77.

9 Alison and Peter Smithson, Urban Structuring: Studies of Alison & Peter Smithson ( London: Studio Vista, 1967 ), 76.

10 SARS, a coronavirus, resembles a halo in its form, and was sequenced within two weeks of discovery. Sequencing revealed the virus had its own branch of the genetic tree thus confirming it had never been seen before. David Baltimore, “ Viruses, Viruses, Viruses, ” Engineering and Science ( Pasadena: Caltech, 2003 ) http://eands.caltech.edu/ articles/LXVII1/viruses.html ( accessed September 5, 2011).

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11 Laurie Garrett, interviewed by the author, July 28, 2005.

12 “ It was reported that Dr. Liu, a respiratory expert in a Guangzhou hospital, traveled to the Hotel Metropole in Hong Kong from where he would spread the disease to 8,422 cases and 916 deaths in 29 countries. ” See Kevin Chan, “ SARS and the Implication for Human Rights, ” Case Study, Kennedy School of Government at Harvard University, Carr Center for Human Rights Policy, 2004. www.hks.harvard.edu/cchrp/pdf/SARS.CaseStudy.( Final ). pdf ( accessed September 14, 2011 ); Clifford Krauss, “ The SARS Epidemic: The Overview; Travelers Urged to Avoid Toronto Because of SARS, ” The New York Times, April 24, 2003.

13 Robin A. Weiss and Angela R. McLean, “ Emerging Infections: What Have We Learnt from SARS? ” Philosophical Transactions: Biological Sciences 359, no. 1447 ( July 29, 2004 ): 1137–1140.

14 David Baltimore, “ SAMS – Severe Acute Media Syndrome? ” The Wall Street Journal, April 28, 2003, 12.

15 Laurie Garrett, “ SARS and Other Emerging Diseases in a World Out of Balance. ” Paper presented at the Jill and Ken Iscol Distinguished Environmental Lecture, Cornell University, Ithaca, NY, June 16, 2003.

16 Yi-Chen Wu, “ Risk Communication During the SARS Outbreak in Taiwan: What Did We Do and What Have We Learned? ” Fu-Jen Catholic University, Taiwan, submitted to SARS Control Research Programme ( Rotterdam: Erasmus Medical Centre, 2006 ). http: // survey.erasmusmc.nl/SARSControlproject/picture/upload/ WP6%20final%20report%202( 1 ).pdf ( accessed May 5, 2010 ).

17 Randy Dotinga, “ Sad Story of ‘Boy in the Bubble,’ ” Wired ( October 4, 2006 ) web. See also related multimedia slideshow. www.wired.com/entertainment/theweb/multime dia/2006/04/70622?slide=7&slideView=3 ( accessed June 10, 2011 ).

18 Chiu Yu-tzu, “ Epidemic Prevention Gets Financial Shot in the Arm, ” Taipei Times, July 16, 2003: 2, www.taipeitimes. com/News/taiwan/archives/2003/07/16/2003059605 ( accessed July 14, 2007 ).

19 Richard Kraus, “ China in 2003: From SARS to Spaceships, ” Asian Survey, XLIV, no. 1 ( January–February, 2004 ): 148.

20 Laura Alderson, “ The Big Picture: Mapping SARS in Hong Kong, ” Environmental Health Perspectives 112, no. 15 ( November 2004 ): A896.

21 “ Taipei Housing Block Sealed Off Over SARS, ” Asian Economic News ( May 13, 2003 ), www.thefreelibrary.com/ Taipei+housing+block+sealed+off+over+SARS.a0101643782 ( accessed July 15, 2007 ).

22 P. C. Lai, et al., “ Understanding the Spatial Clustering of Severe Acute Respiratory Syndrome ( SARS ) in Hong Kong, ” Environmental Health Perspectives 112, no. 15 ( November 2004 ): 1550–1556.

23 S. H. Lee, “ The SARS Epidemic in Hong Kong, ” Journal of Epidemiology and Community Health, 57, no. 9 ( September 2003 ): 652–654.

24 Ibid., 653.

25 Archie Campbell, “ Interim Report: SARS and Public Health in Ontario ” The SARS Commission ( April 15, 2004 ), https: //ospace.scholarsportal.info/bitstream/ 1873/6381/1/243127.pdf ( accessed August 2, 2007 ).

Emergency Urbanism and Preventive Architecture

26 An architecture student who had been in Taipei during the outbreaks later suggested that tinted glass windows in high rises might be replaced with ultra-clear glass to let more sun infiltrate, as ultra-violet light is effective in killing germs.

27 Hong Kong Housing Department, “ Safeguarding Clean Housing Estates, ” Civil Service Newsletter ( July 21, 2003 ), http://www.csb.gov.hk/hkgcsb/csn/csn57/57eng/e14-15. html ( accessed September 15, 2011 ).

28 Kraus, “ China in 2003, ” 150.

29 “ B .C. Lab Cracks Suspected SARS Code, ” CBC News ( April 13, 2003 ).

30 Laurie Garrett, “ SARS and Other Emerging Diseases in a World Out of Balance. ” Paper presented at the Jill and Ken Iscol Distinguished Environmental Lecture, Cornell University, Ithaca, NY, June 16, 2003; Hilary Sample, “ Uberagencies, Design and Disease in the Contemporary City. ” Lecture presented at the CCA Study Centre seminar, Montréal, July 19, 2007; Hilary Sample, “ Uncovering Urban Patterns at the Daniels School of Architecture and Landscape. ” Lecture presented at the Architecture, Therapeutics, Aesthetics seminar, University of Toronto, February 27, 2010.

31 Alex De Waal, AIDS and Power: Why There is No Political Crisis – Yet ( New York: Zed Books, 2006 ), 3.

32 The UNAIDS agency was established in the mid-1990s and focuses on HIV/AIDS viruses. In Africa, the HIV/AIDS epidemic is further complicated by communicable diseases such as malaria and tuberculosis.

33 World Health Organization Media Centre, “ Beginning of Construction Work On New WHO / U NAIDS Building, ” ( June 28, 2002 ), www.who.int/mediacentre/news/releases/ release53/en/index.html ( accessed July 14, 2007 ).

34 Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors ( New York: Picador, 2001 ), 153–154.

35 WHO Media, “ Beginning of Construction. ” Ten architectural firms from seven countries were selected to participate in the competition, organized by FIPOI, a private not-for-profit foundation established by the Swiss Confederation and the canton of Geneva in 1964 along with the Federal Office for Construction and Logistics ( O FCL ). The project brief specified a moderately priced building not only in terms of construction, but also in terms

of annual operating costs and maintenance. Baumschlager Eberle’s submission was chosen for its “ highly contemporary, abstract and spacious design. ” See also http: //wien.baumschlager-eberle.com/en/office/projects/ who-unaids-administration-building.

36 Reyner Banham, “ Grass Above, Glass Around, ” in A Critic Writes ( Berkeley: University of California Press, 1996 ), 209.

37 These two strong, distinct forms – secretariat and assembly – first appear at Oscar Niemeyer’s Rio de Janeiro Ministry of Education and Health ( influenced by Le Corbusier ) which served as a model for the later UN headquarters in New York City.

38 Its low form and organization are more similar to Marcel Breuer’s US Department of Health and Human Services, Washington, DC ( 1977 ).

39 Alex De Waal, AIDS and Power, 3.

40 Bob Geldof, “ Our Common Interest, ” The Commission for Africa ( London: Penguin Books, 2005 ), 26. Also available as a free download: http://ocpa.irmo.hr/ resources/docs/Commission_for_Africa_Report-en.pdf.

41 Ibid., 83. Growth most frequently occurs through informal as opposed to formal and organized economies.

Seventy-two percent of the total urban African population lives in the slums. See also Alex de Waal, AIDS and Power, 3, which refers to chaotic urbanization.

42 Joint United Nations Programme on HIV/AIDS ( U NAIDS ), Global Report: UNAIDS Report on the Global AIDS Epidemic ( Geneva: UNAIDS, 2010 ), 3, 30. http: //www.unaids.org/globalreport/documents/20101123_ GlobalReport_full_en.pdf.

43 See also www.lefthandfilms.co.za/soweto. Chris Hani Baragwanath Hospital is the largest hospital in the world ( http://www.chrishanibaragwanathhospital.co.za ).

44 Nicholas Bauer, “ R150M Upgrade For Downscaled Chris Hani Baragwanath, ” Mail & Guardian Online ( August 16, 2011 ). http: //mg.co.za/article/2011-08-16-r150mupgrade-for-downscaled-bara.

45 Nonku Khumalo, “ Bara Sabotage an Inside Job, ” Soweto Live ( July 13, 2011 ), www.sowetanlive.co.za/ news/2011/07/13/bara-sabotage-an-inside-job.

46 Elaine Scarry, Thinking in an Emergency ( New York: W. W. Norton, 2011 ).

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