The Genius of Threat-Invention

"We were standing there, listening to rockets falling all around us walls were shaking and our own staff were being brought in with injuries", stated Dr. Michael Halberthal, a Rambam emergency physician. The hospital, after all, happens to be located directly beside a major military target. Rambam Health Care Campus is northern Israel's largest hospital. It found itself located precisely within range of a Hezbollah rocket barrage during the 2006 conflict between the IDF and the terror group.

And next to it, in Haifa, not far from the border with Lebanon, is located Israel's main naval base. By war's end in August of 2006 some 60 rockets had smashed into Haifa within kilometres of the hospital which exists as a major trauma centre where war wounded are treated. Some of those rockets landed mere metres from Rambam's grounds. Eventually a makeshift sick bay was set up in the basement, with room for a small number of patients.

Picture of Rambam Health Care Campus by Pioter Fliter

The hospital has since graduated. "Today it's very peaceful, but tomorrow or the next day, someone could start shooting. You never know. We are used to that, we live with that", said Shimon Reisner, a cardiologist, Rambam's deputy director. The seaside hospital is now more prepared for emergency wartime response than it was in 2006.

It has undergone an interesting transition, to become the world's largest fortified underground hospital. Complete with three below-grade storeys -- representing 20,000 square metres of specialized space that can be converted into a full-service general hospital with ample room for 2,000 beds. In the interim it is used as a peacetime parking lot.

How that is possible is another minor engineering miracle proving that desperate need is capable of ingenious solutions. Oxygen and other gas lines, suction tubes and electricity are installed in the walls. Their presence enables a swift makeover. Beside each parking space there exists locked plastic covers that hide sockets for those services until such time as they are needed.

Outlets for toilets and other plumbing remain hidden throughout the walls. Along with cutting-edge technical protection against chemical or biological warfare. All, obviously, is not as it seems. What is seen at first glance does not even begin to represent what this hospital is capable of swiftly converting to. This quick-change, protective and functional solution to constant threats bespeaks a country and a nation grown accustomed to siege.

Israeli law mandate that homes have access to a bomb shelter and rooms that can be sealed in case of a chemical attack. Over 100 bus shelters in Sderot, constantly bombed over the Gaza border, have been reinforced for refuge to pedestrians should an attack occur. Millions of gas masks have been distributed by government agency. Yet another hospital, in Tel Aviv has a smaller underground facility, and another is in the planning stages near Gaza.

Rockets fired from Lebanon killed 44 Israeli civilians. "We were sitting here and it was Sunday morning, 9 o'clock and I started counting: 'One, two, three, four' Katyusha missiles. They have a very specific sound -- a whistle and boom ... I said, "The war has started'." said Professor Reisner. "I spent many years in the army and I know how Katyusha rockets sound."

At that time, in 2006, with few exceptions all staff showed up for work at the hospital, irrespective of race or creed, Professor Reisner said. Among his workforce at the Rambam hospital, 25% of the doctors and many department heads are Arab. A Muslim prayer room exists right next to the hospital synagogue. After the Israeli commando raid on the Turkish Mavi Marmora attempting to breach the Gaza blockade injured Israeli soldiers and Turkish activists were treated side by side at the hospital's trauma bay.

After 2006, Rambam reinforced its emergency department to withstand a heavy war barrage. It installed blast doors to seal it off from the rest of the building when attacks occurred. It set aside other expansion projects to build an underground mirror of its above-surface services. Patient-care utilities are threaded through the walls of the underground space, and an Israeli company installed state-of-the-art ventilation capable of maintaining the underground wards free from chemical and biological weapon attacks.

On conversion to hospital presentation the underground facility has an intensive-care unit, four operating rooms, space for 94 kidney-dialysis patients, and delivery rooms. The project came in at $350-million. "...we are always ready ... If we look at the Middle East, it's quite possible we will use it one day", said David Ratner, a hospital spokesman.

Necessity, it is true, is the mother of invention.