Fortress hospital

Rambam has constructed the largest, most highly fortified underground hospital in the world.

Rambam hospital to be moved underground (photo credit: RAMBAM HOSPITAL SPOKESMAN)
Rambam hospital to be moved underground
Haifa’s Rambam Medical Center was caught unprepared in the summer of 2006. Some 90 Hezbollah rockets thundered overhead and crashed into the city within a couple of kilometers of the hospital, a major trauma center where many of the war wounded were being treated.
“We would hear a siren and know we have 60 seconds to two minutes until the rocket falls, and we’d wait to hear the explosion,” Rambam Director Prof. Rafael Beyar tells The Jerusalem Report. “Sometimes, it was far away and sometimes very close.”
One rocket landed close enough, some 20 meters from Rambam’s grounds, shaking its walls, sending a gray plume of smoke into the air. Haifa, Israel’s third-largest city, just 30 or so kilometers south of the Lebanese border, came under direct attack during the Second Lebanon War. The government hospital is positioned between two major strategic targets, the Israel Navy’s main base and Haifa Port.
Rambam’s emergency room, which treated some 800 wounded during the war, was vulnerable; any stray missile could have easily penetrated its walls. A neonatal intensive care unit was located high up in the exposed northern side of the hospital, and patients and staff were generally unprotected when the siren warned of incoming rockets.
Only four months on the job, Beyar had his baptism by fire. He closed the north- facing half of the hospital and moved some 200 patients – with IV drips and oxygen tanks – into corridors and down into a hastily cleared storage basement with bare concrete walls. Maintenance workers quickly hooked up electricity lines to power monitors that check vital signs. A cafeteria functioned as a ward for treating shell-shocked patients and helicopters kept bringing in soldiers wounded in Lebanon.
“It was an embarrassing situation; I had a pilot lying in the Intensive Care Unit after being brought in wounded from the front and he was vulnerable to missiles inside the hospital,” says Beyar.
The worst day was August 6, when a Katyusha rocket landed near Kibbutz Kfar Giladi, killing 12 reserve soldiers and seriously wounding 15 more. Towards evening, as the wounded soldiers were triaged and in surgery, rockets fell in the Haifa neighborhood of Wadi Nisnas, and within minutes civilians began streaming in.
Beyar is a realist. A future war in the Middle East is likely, if not inevitable.
“We all know the threats in the region and I’m hoping there will be no more war, but, unfortunately, every 10 years there is some kind of hostility,” he notes. “The situation in the Middle East is less stable than it was in the past and we have to be ready for the next time.”
The next war will find the hospital more than ready; it will find it a fortress. Rambam has constructed the largest, most highly fortified underground hospital in the world – 60,000 square meters – to be used in peacetime as a short-term parking lot, but quickly converted into a full-service, self-sufficient 2,000 bed emergency hospital. The multilevel facility is fortified with cutting-edge protection against conventional, chemical and biological warfare and is able to store enough breathable oxygen, drinking water and medical-gas supplies for up to three days.
THE SAMMY Ofer Fortified Underground Emergency Hospital has 40 centimeter thick reinforced concrete walls and ceilings, dozens of ventilation and air filtration units, equipped with carbon and HEPA filters to sieve out biological and chemical agents, and retractable soft-sided ducts, hidden away, can be pulled out to provide air-conditioning to the entire space.
It will take some 72 hours to transform the parking garage into a fully functioning hospital able to execute core medical functions, including dialysis units for close to 100 patients, a maternity ward, an oncology department, four operating rooms and a radiology unit. The logistics have been meticulously planned and drills will begin shortly.
“There is nothing like it in the world,” says Beyar with satisfaction, sitting in his office overlooking the Mediterranean just several meters away. He’s dressed in surgical gear, since the interview takes place on a Tuesday, his day to keep his surgical skills sharp in cardiac catheterization.
Beyar founded the Heart System Research Center at the Technion-Israel Institute of Technology and is the former dean of the Technion’s Rappaport Faculty of Medicine, where under his leadership, Professors Avram Hershko and Aaron Ciechanover were awarded the Nobel Prize in Chemistry, in 2004. Rambam is the major hospital serving northern Israel and the fifth-largest hospital in the country. Rambam just recently celebrated its 75th anniversary and received a $10 million donation from billionaire Warren Buffet to mark the occasion.
Rambam’s project is indicative of the bunker culture of Israel, a country whose citizens take it as a matter of course that their homes must have access to bomb shelters, fortified rooms that can be sealed off and equipped with water, food, radios, flashlights and government-issued gas masks. A nationwide siren system is used to warn of missile attacks on the civilian population. Surprisingly, the only other country with a network of bomb shelters and underground hospitals is Switzerland, which hasn’t known war on its territory for centuries. The Swiss began constructing them in the 1960s during the Cold War era.
Israel has also developed a tiered ballistic defense concept based on different types of defense missiles to intercept enemy projectiles, including Shahab missiles from Iran, Scud missiles from Syria and Hezbollah’s tactical ballistic missiles. Against artillery rockets fired from Gaza, Israel has deployed the Iron Dome missile defense system.
The only Israeli hospital that was ready for Hezbollah rockets in the 2006 war was the Western Galilee Medical Center in Nahariya. One can see Lebanon, just 10 kilometers away, from the hospital’s windows. Because Nahariya had suffered intermittent shelling over the years, the hospital’s former director decided to build an underground facility, much to the derision of many who claimed he was wasting public funds.
“In the summer of 2006, it took us one hour to move some 500 patients underground and we stayed sheltered for about five weeks,” says Dr. Arie Eizenman, head of the hospital’s medical emergency room.
In the third week of the war, a rocket smashed into the hospital’s Ophthalmology Department, completely destroying eight rooms that were fortunately deserted. The hospital’s various departments are linked by underground tunnels wide and large enough for an ambulance to drive through.
“By the time that we were happily safe underground without any fear, other hospitals such as Rambam found themselves completely unprepared and their patients were completely exposed,” says Eisenman.
Rambam isn’t the only hospital going underground. Others have learned the lesson of the Second Lebanon War. A 750- bed, underground emergency facility was completed in 2011 at Tel Aviv’s Sourasky Medical Center; and according to the Health Ministry, underground facilities exist at four other hospitals, including Hadassah Medical Center in Jerusalem, while others are in the works throughout the country.
ASSAF HAROFEH Medical Center, located 15 kilometers east of Tel Aviv, is converting two floors of its four-story underground parking into a 400-bed emergency hospital. There is no completion date due to the lack of funds, according to a hospital spokesperson. The cost of the project is 70 million shekels (20 million dollars).
“Our location in the central part of the country exposes our hospital to any possible direction considering the nature of modern conventional as well as non-conventional warfare,” says Anat Zecler Moriah, a hospital spokesperson. “The possibility of mass casualty events in our surrounding densely populated region is, unfortunately, very real.”
The first thing Rambam officials did after the 2006 war was to reinforce the above- ground emergency department, installing blast doors to seal it off from the rest of the building during attacks.
The 420 million shekel emergency subterranean hospital got its start with a 100 million shekel donation from the late shipping tycoon, Sammy Ofer. Rambam’s original plan called for a more modest 700-bed facility. However, the Home Front Command took a more strategic view and required that the plan be expanded to 2,000 beds to serve the entire northern part of the country and kicked in 160 million shekels. The rest came from other donations and from a bank loan to be paid by parking lot proceeds. The hospital is still 40 million shekels short to complete the project.
Surprisingly, one major stumbling block was the Vatican, says Beyar. The land was owned by a Catholic order. “The church never sells property,” says Beyar. “It took us a year to explain what we wanted to do and the decision to sell came from Rome.”
Another stumbling block was the location of the site just meters away from the Mediterranean Sea, which meant that several meters down bedrock yields to water. From an engineering standpoint, the underground facility was a nightmare, says Yehuda Horezki, Rambam’s project engineer. Ground water had to be pumped out at a rate of 12,000 cubic meters of water an hour from 90 wells in the center of the site for 24 hours a day. Once construction crews dug down deep enough to lay the foundations, 80 cement mixers completed 1,000 rounds carrying 7,000 cubic meters of concrete to the site for 36 hours straight.
“This is a once-in-a-generation project, one for the history books,” says Horezki, as he takes a reporter down the stairs two floors to a vast, cavernous, well-lit, colorful parking garage to which workers are still putting the finishing touches.
The first thing to notice is the high ceiling, unusual in a parking garage. It is needed to run pipes for air conditioning, oxygen lines for patients, and other hospital necessities. Separating every three parking spaces is a low wall. A discreet plastic cover hides sockets for essential support systems such as electricity, oxygen and medical vacuum pumps. Four to eight patients will fit into such a space. There are outlets for toilets and other plumbing concealed throughout the garage walls. Metal blast doors can slide into place to seal off sections of the underground garage from the outside world.
Beyar hopes the underground hospital will become a white elephant used only as the world’s most expensive parking garage, but he is not optimistic.“Our enemies are there. Some say it’s not a question of if, but rather of when.”