Design standards for bio-climatic health centres in cold climates in Afghanistan

Afghanistan is a country that faces not only the challenge of redevelopment after almost 30 years of war, but as well the circumstances of a still battled political unrest, which shows in a critical security situation in most provinces. Infrastructure like roads, electricity or water supply, especially in rural areas, is still destroyed or not in place at all. Currently, the Ministry of Public Health (MoPH) of Afghanistan runs 1085 health clinics all over the country. More than 500 clinics have been built since 2002 with the help of international donors. In the next three years, 371 clinics are planned to be built according to the Afghan National Development Strategy (ANDS) for the health sector.

The clinics that have been built and that are in consideration to be built follow one standard design of the Ministry of Urban Development (MoUD), which is not appropriate for the specific circumstances in Afghanistan:

-     The architectural design does not address the different climatic zones, the clinics are not properly insulated either correctly oriented. GERES identified three climatic zones; very cold climate (3 winter months below 0 °C), cold climate (1 winter month around 0 °C); and hot desert climate. Our studied zone it is located in the first area.

-           The electrical supply system is insufficient and not sustainably manageable. A generator room is included in the design as well as the installation of the electrical system ( light and fans). The clinic is equipped with a diesel generator (typically 10 kW). The MoPH has a budget for the running costs of the electrical system, which is very limited, so usually, it is not sufficient for providing enough electricity or regularly maintenance.

-          The water supply and waste water system is not appropriate. Depending on the region and season, clean drinkable water supply is lacking. In winter times, water supply is not possible due to freezing of the pipes. Hot water is not available and there is no sufficient waste water system in place.

-          Especially for the cold climates, no space heating system is available. In winter times, temperatures inside the clinics can fall to 0° C and below.

The points above lead- beside other factors like underpaid doctors and nurses- to a miserable account of health services in Afghanistan.