Building Dignity in War-Torn Sudan

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tamassociati designs a hospital as a place of peace, healing, and gathering within a refugee settlement

photography by Massimo Grimaldi and Raul Pantaleo

"A PROFOUND INFLUENCE ON THE HEALTH, WELL-BEING, AND VITALITY"

Picture this scenario — you and your closest relatives have just moved to a foreign area in your country. The promise of work, and the desperate search to find it, has lead you here in order to feed the people you care about most. With metal scraps, tree branches, and other materials that you scavenged from the roadside, you made a hut to provide shelter from the harsh environment—heat, wind, disease, maybe even some neighbors. As you walk to fill jugs from a distant well, clouds of dust make your eyes water and your throat scratchy, leaving a reddish coat on your clothes and skin. Inside some huts you pass, people lay on reed mats, alone and recovering from some sickness. Children weave in and out amongst neighboring shelters, kicking a soccer ball, coughing, hungry.

For some, this is the reality of living in Sudan.

Thousands of miles away in their cozy Venetian garden studio, a team of architects from tamassociati is working on a new hospital design for a community such as this. From organizing room adjacencies, drafting up plans and elevations, and selecting materials, their decisions will have a profound influence on the health, well-being, and vitality of this Sudanese community. And unlike some of their disconnected, first-world contemporaries, who’ve never seen or experienced such a place (like many projects sprouting up in Asia, Africa, and the Middle East), this consortium of architects is refreshingly unique.

Founded in 1996 by Raul Pantaleo and Massimo Lepore, tamassociati has been designing healthcare facilities since 2004 in some of the world’s most war-torn countries, including Sudan,Sierra Leone, the Central African Republic, Iraq, and Afghanistan. The firm has grown over the past fifteen years, keenly focusing on social-oriented design for the “third sector,” a term which loosely encompasses non-profits, non-governmental and voluntary organizations. The studio’s first healthcare project in Sudan came in 2004, when the Italian NGO, Emergency posted an opening for a site construction managerial position. “I made an application and then that started the adventure,” chuckled tamassociati partner and senior architect Raul Pantaleo. After being notified of his selection, Pantaleo moved to Sudan’s western Darfur region for six months in order to oversee the renovation of an operating theater. By working and living amongst the people served by the hospital, tamassociati and Emergency discovered they shared many of the same guiding principles, and a relationship was solidified.

The colorful clothing of the Sudanese people illuminates the waiting area of the clinic.

“WE BRING TO AFRICA A HOSPITAL THAT SENDS A MESSAGE [...]
THAT IS TO RECOGNIZE EQUAL DIGNITY AND EQUAL RIGHTS”

Emergency was founded in 1994, on the ethos of promoting peace, solidarity, and respect for all humans. The non-profit builds hospitals and trains local staff in providing free medical treatment to victims of war, land mines, and poverty. As one of the largest Italian NGOs, the organization operates in 16 countries and has served over 5 million people. Since their first project in Darfur, tamassociati found in Emergency a value-aligned partner with a shared vision about the power of architecture in its ability to transform people’s lives. “We bring to Africa a hospital that sends a message,” said Emergency’s Program Coordinator Pietro Parrino. “And that is to recognize equal dignity and equal rights.” Every Emergency health facility adheres to these two values, not to mention one other simple requirement that tamassociati satisfied with ease—quality design.

Near the end of the renovation project in 2004, Pantaleo was approached about designing Emergency’s second health center in Sudan, which came to him as a shock. “I had a meeting with the director and he asked me if I was able to design a heart center. I said, ‘Gino, look, I have never designed a hospital in my life.’ He said, ‘That’s perfect! It just has to be outrageously beautiful.’ That was the mandate.”

Now with seven healthcare facilities designed, built and fully operating around the world, tamassociati has established a thriving crosscontinental work methodology. This entails having one designer living onsite, absorbing the place, people, and needs, while a team in Italy translates the experience into the building’s design through drawings, modeling, and continuous feedback. “You have to live there, you have to be part of the organization… It’s not something that you can just apply to as an architect,” explains Pantaleo about the absolute need of an embedded presence on the project site. “You have to be aware of the people.You have to speak with the people.”

The large woven wooden screens provide ventilation and shading for the community.

A PLACE FOR HEALING IN A BUSTLING PORT CITY

tamassociati’s most recently completed healthcare facility continues to fulfill Emergency’s “outrageously beautiful” design mandate. Adopting typical Arab building principles and forms observed throughout Sudan, the gleaming white Pediatric Center, which provides free healthcare to children under 14 years of age, wraps around a central garden, providing a place of peace and rest to a rapidly emerging refugee neighborhood in Port Sudan.

The city sits on the edge of the Red Sea as Sudan’s main port, drawing tourists for scubadiving and sandy beaches, as well as devout Muslims for the once-in-a-lifetime “Hajj’ pilgrimage to Mecca in Saudi Arabia. In recent years, Port Sudan has been inundated with an enormous amount of refugees escaping surrounding areas fraught with conflicts, draughts, and instability, for the work available at the active port. This influx of residents has grown the population from 30,000 inhabitants in 2000, to nearly 500,000 in 2007—a population increase of just over sixteen fold in a matter of seven years.

In order to accommodate these new residents, makeshift refugee settlements sprouted towards the edges of the city, creating isolated, underserved suburbs of raw earth huts and not much else. “When we [went] there it was a very desperate situation. It was the middle of the desert. Nothing around. There was a school but [it was] very poor and desperate. It was great to design a hospital but it needed something more,” recalled Pantaleo.

The solution to address this deficiency was to create a public park around the Pediatric Center, along with a healing garden--a tamassociati trademark--and a sports field to fill in the 54,000 square foot site. As one enters the site through the public park, which contains some of the only trees in the surrounding area, the main entrance to the 8,400 square foot, single story facility greets visitors with a blend of familiar materials.

Four traditional materials - coral stone, brick, wood and bamboo - found in old and new Sudanese buildings, are composed like a three-dimensional quilt on the front facade. Fragments of coral stone, which have all but disappeared from local quarries, were repurposed from demolished buildings and used to complement the masonry cavity walls, constructed with locally manufactured bricks.

Sixteenth century Ottoman-era buildings found in the center of Port Sudan brought inspiration for large, wooden lattice screens, which were originally used to allow women to observe activity on the streets without being seen. These organic screens offset against the white monolithic masonry walls provide ventilation and privacy to the entrance hall.

As visitors move through the exterior hall and enter the building, they are met with serene white walls and a warm gray floor covered with a barrel vault ceiling painted in shades of blue, altogether creating a cool, calming effect in comparison to the arid, dusty desert outside. Patients traverse through a single circulation artery, which unfolds into rooms containing three outpatient clinics, a 14 bed inpatient ward, a 4 bed intensive care ward, diagnostic exam rooms, and a pharmacy. Although openings have been minimized to avoid sun exposure, the lightness and airy feeling within the spaces provide enough ambient light to minimize the need for electric lighting. The architects’ careful selection and combination of materials paired with an easily navigable spatial layout creates a sanctuary of restoration and rehabilitation—an oasis of calm in an area of chaos.

A UNIQUE, GENTLE SPIRIT JOINS THE TEAM

Along with the architecture team incorporating Sudanese architectural tradition through material selections and the building form, the burgeoning area’s recent history (largely transformed by the new hospital) was documented by a unique artistic partner who elevated the level of participatory design for the Pediatric Center.

Italian artist Massimo Grimaldi, an avid collaborator and supporter of Emergency’s efforts, saw the new hospital in Sudan as the perfect subject for creating a useful piece of art. He wrote in his artist’s statement, “My work explores the nature of what we call ʻartʼ, the way that it is perceived, judged, and understood. It is an ongoing investigation of the criteria used to produce and circulate images, the power and limitations of aesthetic speculation, the possibility of redefining it in an ethical way. My desire to rethink the basic utility of my role as an artist, in an art system that is so often self-absorbed and vacuous, has led me to collaborate with EMERGENCY…”

As Grimaldi’s fourth and largest collaboration with Emergency, the Pediatric Center in Port Sudan was the focus for his submission to the MAXXI Museum’s 2per100 Award—an annual competition that adheres to Italy’s ‘2% law’, which requires all public organizations who construct new buildings to devote a minimum of 2% of the construction costs to the production of artwork. Upon submission into the international competition, Grimaldi was awarded the top prize, which included an exhibition space on the museum’s main exterior wall and an award of €700,000--92% of which he donated to cover the cost of the hospital’s construction. Grimaldi then relocated to Sudan’s port city to join the team and photographed the entire design and construction process for the Pediatric Center.

The circular openings within the walls help to provide views, daylight, and ventilation.
The circular openings within the walls help to provide views, daylight, and ventilation.
The barrel vaulted ceiling, painted in shades of blue, creates a serene environment away from the desert.

Grimaldi’s generous gift and artistic eye were not his only contribution to the project. “He would talk to people, play with the children, take photographs, and participate in some activities, like gardening--he loves gardening,” Pantaleo reflected. “I was talking a lot with him while we were there on site. He wasn’t interfering [with] the aesthetics of the building but rather was focused on the concept. He was very involved in the idea of transforming the hospital into a public park.”

Construction began with clearing the site and leveling the ground. Once the area was prepped, it was immediately overtaken by local children playing a game of football (soccer). After seeing this reaction, Pantaleo and his team knew transforming the hospital’s site into a public garden, playground, and sports field was exactly what the local residents needed most, making the hospital just a small part of the bigger community space. And with Grimaldi leading the enthusiasm for gardening, the local community has created a thriving green area amongst a brown field of desert.

"MY DESIRE TO RETHINK THE BASIC UTILITY OF MY ROLE AS AN ARTIST, IN AN ART SYSTEM THAT IS SO OFTEN SELF-ABSORBED AND VACUOUS, HAS LED ME TO COLLABORATE WITH EMERGENCY"

“Along with health care, the studio’s roots in civic engagement and social issues has led them to examine new wa ys of living, how public spaces act as a collective identity, and what traditional economic metrics analyze”

DESIGNING FOR EFFICIENCY AND LONGEVITY

Because the site is in an arid climate zone where temperatures often exceed 120°F, the grassy play areas and garden surrounding the hospital are understandably out of the ordinary and require constant irrigation. The architects worked with engineers from Climosfera to devise a wastewater treatment system to irrigate the greenery surrounding the site. “That is the only green in all of Sudan because of the filtration system with wastewater,” said Pantaleo. “This has become a central part of the [greater city] area where people can meet and also because at night it’s the only place where people can get light.”

Along with extreme heat, Port Sudan’s extremely low humidity level and strong desert winds kick up exorbitant amounts of dust, creating enormous sand clouds fondly named “The Haboob.” Recognizing the limited resources and a sensitive operating budget for the hospital, the design team concentrated on the cooling, insulation and filtration systems to address these adverse environmental conditions while minimizing the building’s energy consumption and maximizing the occupants’ comfort level.

Opting first and foremost for passive techniques, the team began designing the building’s envelope. Thick masonry walls made of two brick layers set apart with an air gap accumulate heat during the day, allowing the heat to rise and be released in the evenings through the attic space created between the barrel vaulted ceiling and insulated metal roof. This alternating 12-16 hour air cycle within the wall cavity helps maintain a temperature equilibrium for the interior spaces.

The use of just these massive walls was not sufficient to ensure comfort, so the team shielded the intermittent exterior windows and walkways with braided bamboo screens to reduce solar heat gain. Again finding inspiration from the local area, the bamboo screens pay homage to fences used in the nearby refugee camps, becoming an important feature from both a cultural and functional perspective.

With temperatures maintained by the thick masonry walls and sun shades, the team returned to a successful ventilation system previously implemented 400 miles away at the Salam Center for Cardiac Surgery in Khartoum, Sudan—the traditional Iranian stack ventilation system, “badgir”. The badgir incorporates two 26-foot outdoor chimneys that poke above the building’s rooftop, pulling fresh air from prevailing North-South winds into the basement of the building. The air then weaves through a labyrinth of walls, slowing down in speed and depositing sand and dust onto the basement floors, before entering an adiabatic humidifier for treatment. The filtered air (previously at levels of 30%+ humidity) is now at a humidity of 5-10%, a temperature reduction of 10°F below the incoming temperature, and free from airborne particulates. The air then flows up to the interior spaces through small vents in the masonry walls. Finally, as the air warms, it rises up to the ceiling and exits through shorter return ventilation chimneys.

"THESE SIMPLE YET INNOVATIVE SYSTEMS FOR SUDAN REPRESENT NEW METHODOLOGIES THAT CAN BE EASILY IMPLEMENTED ACROSS SUB-SAHARAN AREAS"

The adiabatic ‘water cooler’ system combined with the ventilation chimneys ensures continuous outdoor air flow through the hospital--the ideal condition to prevent airborne diseases amongst the patients. Electric consumption for the air conditioning system is also at a staggering 70% reduction due to coupling with the passive systems. These simple yet innovative systems for Sudan represent new methodologies that can be easily implemented across Sub-Saharan areas.

With this modest yet powerful hospital design, Port Sudan’s Pediatric Center represents tamassociati and Emergency’s shared prioritization for well-designed, location-appropriate, and easily maintainable facilities that bring peace, harmony, and beauty to distressed communities. What’s the key to achieving this success? “One of the main things--that you can call a secret--is the participatory process that has been rooted in the way of thinking in this project,” reveals Pantaleo. “There is a community that is made with the doctor, the engineer, the architect, the site supervisor-- there is a group of people that believe in going that direction. That is the way to process a project with that complexity.”

A FUTURE WITH LOW COST, HIGH VALUE DESIGN

Since the completion of the Pediatric Center, tamassociati’s methodologies and projects are receiving increased recognition among the international design community, most recently being bestowed with an Aga Khan Award for Architecture and a Curry Stone Design Prize in 2013. With the award prize money, the studio, which operates as a “research team,”is focusing their efforts for 2014 around the theme “Low Cost, High Value.

”Deciding on the annual theme is an essential piece in driving the firm’s efforts. Each year, the entire office meets with a different partner or collaborator and develops a statement of research to frame each individual’s upcoming work. “It’s a way of putting together the research for the group. You have ten people trying to think in the same direction yet in total independence,” explains Pantaleo. Last year, the team focused on “Taking Care” as, “a precise will for architectural design rooted in mutual respect towards human beings and environmental tasks, as architecture concerns both of them.”

This year, “Low Cost, High Value” will heavily involve developing guidelines for low-cost hospitals in Africa based on the eight successfully operating health care facilities and four new projects upcoming in 2014. Team members will be relocating to Somalia, Uganda, Rwanda, and the Central African Republic to design and build four additional health care facilities, which will serve as ‘live’ case studies to test the guidelines as they are developed.

Along with health care, the studio’s roots in civic engagement and social issues has led them to examine new ways of living, how public spaces act as a collective identity, and what traditional economic metrics analyze. Two new co-housing developments will be realized in 2014, further expanding their diverse portfolio of built work, along with a new study into social profit metrics for industrial areas.

All of these upcoming built projects are capped with a dedication to building awareness about architecture’s importance to each person’s life, which the firm is exploring with print communications. Pantaleo and partner Massimo Lepore, who co-edited the European publication Utopica for three years while studying architecture at university, have returned to their roots in writing and publishing to create graphic novels that reflect on their 15 years of built work and the larger impact architecture has on communities around the globe. In collaboration with a journalist and photographer, the studio is embarking on their second graphic novel to capture tools that communicate architecture’s impact on the landscape.

Pantaleo explains how the “simple,” graphical format creates “a positive way to understand the value of architecture and shift the idea that architecture is not only about the big events but things that deal with daily life.”

Let’s return to your cobbled-together home in the dusty, baking desert. A strange man is approaching your shelter. He has soft eyes and a smile on his face. He wants to ask you a few questions about your living conditions, your family, and what you need the most. For some reason he makes you feel comfortable. Communicating with more hand signals than words, you tell him that you moved here to find better work so you can feed your family. The dust has been bothering your throat and your children are constantly coughing. He leaves after spending a few hours speaking with you and each of your neighbors, promising that the new site across the way will be a place for you and your family to get the treatment you need.

This is the impact tamassociati and their collaborators are making around the globe. From healthcare buildings, to economic metrics, to graphic communications, tamassociati’s range of poignant designs and commitment to ethical issues puts them at the top of leading international humanitarian firms of our generation.

CLIENT
EMERGENCY NGO Preliminary, detailed,
final design: tamassociati (Massimo Lepore,
Raul Pantaleo, Simone Sfriso with
Laura Candelpergher and Enrico Vianello)

PROJECT COORDINATOR
Pietro Parrino

PROGRAM COORDINATOR
Rossella Miccio, Pietro Parrino

MECHANICAL ENGINEERING
Marco Paissan, Climosfera

STRUCTURAL ENGINEERING
Francesco Steffinlongo, INGECO

SITE ENGINEERING
Roberto Crestan

CONSTRUCTION COMPANY
Autocostruzione

COVERED SURFACE AREA
780 sqm / 8,396 sf

SURFACE AREA
5000 sqm / 53,820 sf

TIME
June 2011- May 2012

COST (CONSTRUCTION AND FITTING)
€1,200,000 / $1,640,000

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