HOSPITAL ARCHITECTURE BEYOND THE ‘WEST’


Sara Honarmand Ebrahimi

Church Missionary Society (CMS) hospital in Kerman © the author

Since March, besides being worried and reading and writing in between, I have been thinking about the term ‘Eurocentrism’ more than ever. COVID-19 has brought a wide array of discussion and reflection on various topics, including previous epidemics, hospital visiting, care, and health/care environment. At the beginning, I read many blog posts and some articles, but, as times went by, I stopped. I did not stop because the articles I read were not important, but because they were Eurocentric. 

Of course, this judgement is not all-inclusive. I came across many of those posts and articles via my Twitter page. I have also been limited by my language abilities. I am sure that many non-Eurocentric articles have been written in non-European languages, but whether or not they reach a wide audience is the question, and the problem for that matter. I can say with some degree of certainty that many of them do not. In this blog post, I wish to highlight some of my thoughts on this, which are, of course, open to criticism and correction.

I would like to take hospital architecture as an example. We know about the development of hospital architecture in Britain in detail: Florence Nightingale’s Notes on Hospitals is believed to had revolutionised hospital architecture in the nineteenth century; scholars have also examined archived journals such as The Builder and English-language publications on the history of hospital architecture such as the four-volume Hospitals and Asylums of the World.[1]

Let us consider similar publications on healthcare architecture in a country like Iran. The first book published in Farsi (Persian) on healthcare architecture by the German-trained Iranian architect, Nouradin Kianouri, in 1949 has completely been neglected, if not forgotten all together. Indeed, we know nothing about the history of healthcare architecture in twentieth-century Iran. In other words, we do not know ‘how we got here’.[2] This is rather surprising given that around 150 hospitals were built across the country between 1925-1979.[3] A similar argument is applicable to other countries in the region, as among a handful of books that deal with hospital beyond the ‘West’, only a few discuss architecture.[4]

The reasons for such a neglect are, of course, varied. Perhaps this is partly due to an emphasis of the field of global architectural history on encounters, connections, and transactions rather than building types. This is being done for a good cause: to damage ‘the largely Western narrative spun in standard architectural histories’ by bringing to the fore the agency of unconventional (non-Eurocentric) actors.[5] However, such an emphasis on one over the other might have an opposite effect in the long run, at least when it comes to hospital architecture.

Returning to healthcare environments and recent reflections on past epidemics: hospital visiting is a topic of personal interest to me. It is a multi-sensory experience that is affected (encouraged or governed) by the built environment. 

In their opinion article, Hospital Visiting in Epidemics: An Old Debate Reopened, Graham Mooney and Jonathan Reinarz state that rules governing hospital visiting ‘have differed from nation to nation and from institution to institution, depending on the prevailing cultures of care, the type of diseases or illnesses, and the attitudes of health care professionals.’ I have found examples of such diversity in my work on mission hospitals in early twentieth century. As visits from family and friends were increasingly being policed in British hospitals, missionaries of the Church Missionary Society (CMS) allowed patients to have tea parties with their family members and smoke water pipe in the Kerman hospital (southern Iran) (Figure 1).[6] 

Figure 1. A 3D model of the Church Missionary Society (CMS) hospital in Kerman. Drawn by the author. © the author

If such practices were not enough, they designed a hospital building in Peshawar (North-western British India, now Pakistan), consisting of a set of 30 identical rooms around three sides of a courtyard, similar to a caravanserai – an inn for travellers built along routes in the Middle East and Central Asia. Missionaries put each room at the disposal of a ‘whole family’ and this system became known as the ‘serai system’ (Figure 2).[7]

Figure 2. The CMS missionaries used a caravanserai as the hospital in Yazd. The serai building in Peshawar had a similar room arrangement. Source: Mrs. Napier Malcolm, Children of Persia (Edinburgh and London: Oliphant, Anderson and Ferrier, 1911), 90.

Michelle Renshaw has made a similar observation concerning patient visitors to American mission hospitals in China. Renshaw further makes a comparison between ‘family-centred’ care in children’s hospitals in today’s America and those of mission hospitals in China, referring to the later as ‘manifestations of the American hospital from which the family was never excluded’.[8] It is unlikely that American hospitals today drew on mission hospitals of the nineteenth century, but Renshaw’s comparison is tantalising. Without it, one might pin the development of ‘family-centred’ care in the ‘West’. 

It cannot suffice to analyse developments and experiences in the ‘West’ when discussing ‘how we got here’ and, by extension, what we can learn from the past. As the current Covid-19 pandemic brings spaces of healthcare to the fore, it seems more important than ever to take the topic of healthcare architecture beyond the ‘West’ seriously.


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Sara Honarmand Ebrahimi is a Research Associate at the Humanities Institute, University College Dublin (UCD), where they completed their PhD in 2018 (IRC doctoral scholar). Between September 2019 – February 2020, Sara was a visiting researcher at the University of Edinburgh on a Paul Mellon Centre Postdoctoral Fellowship. Besides completing a monograph on mission hospitals in Persia and North-western British India, 1865-1914, Sara is developing a project concerning transnationalism and healthcare architecture in twentieth century Iran. 


[1] Henry C. Burdett, Hospitals and Asylums of the World: their Origin, History, Construction, Management, and Legislation, 4 vols (London: J. A. Churchill, 1891); See for example, Jeremy Taylor, Hospital and Asylum Architecture in England 1840-1914: Building for Health Care (London and New York: Mansell Publishing Limited, 1991); Jeremy Taylor, The Architect and the Pavilion Hospital: Dialogue and Design Creativity in England 1890-1914 (London and New York: Leicester University Press, 1997); Harriet Richardson, (ed), English Hospitals, 1660-1948: A Survey of their Architecture and Design (London: Royal Commission of the Historical Monuments of England, 1998).

[2] Annmarie Adams, “Canadian hospital architecture: how we got here,” Canadian Medical Association Journal 188, no. 5 (March 2016): 370-1, DOI: https://doi.org/10.1503/cmaj.151233

[3] Based on materials available at the National Library and Archive of Iran (NLAI).

[4] Fabrizio Speziale, ed., Hospitals in Iran and India, 1500-1950 (Leiden and Boston: Brill, 2012); Mark Harrison, Margaret Jones and Helen Sweet, eds., From Western medicine to Global Medicine: The Hospital Beyond the West (Hyderabad: Orient BlackSwan, 2009); Jiat-Hwee Chang, A Genealogy of Tropical Architecture: Colonial networks, nature and technoscience (London and New York: Routledge, 2016), Chang discusses the translation of pavilion plan hospitals in the tropics in chapter 3; Samuel D. Albert, “Egypt and Mandatory Palestine and Iraq,” in Architecture and Urbanism in the British Empire, ed. G. A. Bremner (Oxford: Oxford University Press, 2016), Albert only refers to one mission hospital built in Jerusalem in this chapter; Preeti Chopra, A Joint Enterprise: Indian Elites and the Making of the British Bombay (Minneapolis and London: University of Minnesota Press, 2011), Chopra discusses hospitals and Lunatic Asylums in chapter 4. 

[5] Sibel Zandi-Sayek, “The Unsung of the Canon: Does A Global Architectural History Need a New Landmarks?” ABE Journal [Online], 6 (2014), DOI: https://doi.org/10.4000/abe.1271

[6] Florence M. James, “Kerman Then and Now,” The Mission Hospital 42, no. 482 (1938): 62.

[7] “Items: Home and Foreign,” Mercy and Truth 13, no. 146 (February 1909): 38. 

[8] Michelle Renshaw, “’Family-Centred Care’ in American Hospitals in Late-Qing China,” in Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting, eds., Graham Mooney and Jonathan Reinarz (Amsterdam and New York: Rodopi, 2009), 56.


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