As hospitals turn to tents, architects see promise in shipping containers

A rendering shows how CURA pods could be deployed to fit temporary hospital expansions. (Courtesy Squint/Opera and CURA)

This article appears on CityMetric courtesy of Blueprint magazine.

In mid-March, Italian authorities began setting up tents outside hospitals to handle an influx of patients with Covid-19. Other places soon followed suit: A 14-tent field hospital opened in New York’s Central Park on 1 April, built in just 48 hours. The same day, London’s St Thomas’ Hospital started erecting its own tent to expand its capacity to treat coronavirus cases.

With the virus continuing to spread rapidly around the world, governments and medical facilities are scrambling to keep up with the growing demand for intensive care facilities and ventilators, and these tents are part of the response.

They're a quick solution, but an inadequate one, says the Italian architect and MIT professor Carlo Ratti, because it is impossible to effectively contain pathogens within the open structures.

"Biocontainment is very important for Covid-19 as it traps the virus and creates a less dangerous environment for health care professionals," says Ratti, founding partner of CRA-Carlo Ratti Associati.  

He has been working as part of an international group – including the architect Italo Rota, Humanitas Research Hospital, Policlinico di Milano and the US engineering firm Jacobs – to develop an alternative: a series of compact, 20-foot-long, self-contained modules built out of shipping containers. 

The units are called CURA Pods, an acronym for "Connected Units for Respiratory Ailments" that also means "cure" in Latin. Each of the pods is equipped with a ventilation system that creates a negative air pressure within them: air can only flow inwards, which means the virus cannot escape. The designers say the units comply with the standards required of airborne infection isolation rooms, which prevent cross-contamination between hospital rooms for patients with contagious airborne diseases. The pods would come with all the medical equipment needed to treat people battling coronavirus. 


Interior designs for a single CURA Pod. (Courtesy Squint/Opera and CURA)

Shipping containers are often lambasted for being a knee-jerk architectural response disguised as a sensitive, sustainable solution – offered by many designers as a literal one-size-fits-all building block for everything from housing to co-working spaces to industrial and commercial units, regardless of whether their boxy, airless nature is desirable or suitable for the purpose. 

In this instance, however, those very qualities are most valuable, not only allowing for biocontainment, but enabling the units to be combined together easily in a modular formation using inflatable corridors, so that hospitals around the world can rapidly scale up and down their capacity during this time of crisis. The idea is that the pods could be attached to hospitals – perhaps set up in their parking lots – or as standalone facilities in open spaces, configured to suit the space available, offering just four beds or more than 40. 

In keeping with the rapid spread of the virus, the designs were developed at speed, coming together in just a couple of weeks. This was partly due to to a conscious effort not to reinvent the wheel. "We didn’t aim to invent something new – rather, we want to improve the efficiency of existing solutions in the design of field hospitals, tailoring them to the current emergency," Ratti says. 

Nonetheless, working on the project in the era of social distancing was a problem in itself. "One of the main challenges was not being able to meet in person," Ratti says. "Remote working isn’t always easy to manage, especially when it comes to co-designing with more than 100 people from different countries and continents."

At the time of writing, the first operational CURA Pod has just been installed at a temporary hospital in Turin and funded by UniCredit. The team estimates each unit can be produced for about €75,000 per bed. The idea, however, is for the initiative to take on a life of its own. The designs are being shared for free online, in the hope that they will be copied around the world. 

For the sake of speed and given the current restrictions on movement, not to mention environmental impact, this seems a more appropriate solution than shipping ready-made modules. Still, local manufacturing will no doubt be difficult in many places, given the disruptive impact that coronavirus has had on global supply chains.

Ratti is hopeful, however, that CURA Pods will help smooth out some of the logistical roadblocks that stand in the way of curbing the pandemic. "We hope that our work can be of inspiration for more people around the world to take action."

Debika Ray is a writer living in London.


In South Africa's cities, evictions are happening despite a national ban

An aerial view shows a destroyed house in Lawley, south of Johannesburg, on April 20, 2020. The city has been demolishing informal structures on vacant land despite a moratorium on evictions. (Marco Longari/AFP via Getty Images)

On the morning of 15 July, a South African High Court judge ruled that the city of Cape Town’s Anti-Land Invasion Unit had illegally evicted a man when it destroyed the shack where he was living.

That afternoon, the Anti-Land Invasion Unit was out again, removing shacks in another informal settlement.

Evictions were banned in South Africa for nine weeks, after the national government placed the country under a strict Covid-19 lockdown in late March. At present, eviction orders are automatically suspended until the country moves to a lower “alert level” and can only be carried out with a special order from a judge.

Yet major cities including Cape Town, Johannesburg and eThekwini (created through the merger of Durban with several surrounding communities), have continued to use municipal law enforcement agencies and private security companies to remove people from informal housing. In many cases those operations have been conducted without a court order – something required under regular South African law.

Around 900 people were evicted from three informal settlements in eThekwini during the eviction ban, according to the Church Land Programme, a local NGO. Its director, Graham Philpott, says it’s also aware of evictions in other informal settlements.

While evictions aren’t a “new experience” in these communities, the NGO released a report on lockdown evictions because they were “so explicitly illegal”. “There was a moratorium in place,” Philpott says, “and the local municipality acted quite flagrantly against it. There’s no confusion, there’s no doubt whatsoever, it is illegal. But it is part of a trend where the eThekwini municipality has acted illegally in evicting the poor from informal settlements.”

Evictions also took place in Cape Town and Johannesburg during so-called “hard lockdown” according to local activists. In eThekwini and other municipalities, the evictions have continued despite restrictions. In Cape Town, authorities pulled a naked man, Bulelani Qholani, from his shack. That incident, which was captured on video, drew condemnation from the national government and four members of the Anti-Land Invasion unit were suspended. 

The cities say they’re fighting “land invasions” – illegal occupations without permission from the land owner.

“Land invasions derail housing and service projects, lead to the pollution of waterways, severely prejudice deserving housing beneficiaries and cause property owners to lose their investments over night,” Cape Town’s executive mayor, Dan Plato said in a statement. (Plato has also claimed that Qholani did not live in the shack he was pulled from and that he disrobed when municipal authorities arrived.)

South African municipalities often claim that the shacks they destroy are unoccupied. 

If they were occupied, says Msawakhe Mayisela, a spokesman for the eThekwini municipality, the city would get a court order before conducting an eviction. “Everything we’re doing is within the ambit of the law,” Mayisela says. But “rogue elements” are taking advantage of Covid-19, he added.

“We fully understand that people are desperately in need of land, but the number of people that are flocking to the cities is too much, the city won’t be able to provide housing or accommodation for everyone overnight,” he says. 

While eThekwini claims to be a caring city, local activists say the evictions show otherwise.

In one case, 29 women were evicted from shacks during the hard lockdown. With nowhere to go, they slept in an open field and were arrested by the South African Police Service for violating the lockdown, Philpott says.

“These evictions are dehumanizing people whose dignity is already compromised in many ways,” says S’bu Zikode, the president of Abahlali baseMjondolo, a community organization whose Zulu name translates to “the people of the shacks”. 

“It has reminded us that we are the people that do not count in our society.”

Municipal law enforcement and private security contractors hired by cities regularly fire rubber bullets, or even live ammunition, at residents during evictions. Some 18 Abahlali baseMjondolo activists have been killed since the organization was founded in 2005, Zikode says, most by the eThekwini Land Invasion Unit and Metro Police.

(Mayisela says that if city employees have broken the law, Abahlali baseMjondolo can file a complaint with the police. “There is no conclusive evidence to the effect that our members have killed them,”  he says.)

Other Abahlali baseMjondolo activists have been killed by what Zikode calls “izinkabi,” hitmen hired by politicians. Two eThekwini city councillors were sentenced to life in prison 2016 after they organized the killing of Thuli Ndlovu, an Abahlali baseMjondolo organizer. A member of the Land Invasion Unit who is currently facing a charge of attempted murder after severely injuring a person during an eviction remains on the job, Zikode says.

South Africa’s 1996 constitution is intended to protect the public from arbitrary state violence and guarantees a right to housing, as well as due process in evictions. But for Zikode, the South African constitution is a “beautiful document on a shelf”.

“For the working class and the poor, it’s still difficult to have access to court. You’ve got to have money to get to court,” he says. 

The actions by municipal law enforcement are breaking down social trust, says Buhle Booi, a member of the Khayelitsha Community Action Network, a community group in the largest township in Cape Town.

“There’s a lack of police resources and those very few police resources that they have, they use to destroy people’s homes, to destroy people’s peace, rather than fighting crime, real criminal elements that we see in our society,” Booi says.

For him, it’s a continuation of the practices of the colonial and apartheid governments, pushing poor people, most of whom are Black, to the periphery of cities.

Around one-fifth of South Africa’s urban population live in shacks or informal dwellings, according to a 2018 report by SERI. Many more live in substandard housing. City governments maintain that the shacks destroyed during anti-land invasion operations are unfinished and unoccupied. But Edward Molopi, a research and advocacy officer at SERI, says that this claim is an attempt to escape their legal obligations to get a court order and to find alternative accommodation for affected people. 

The roots of the current eviction crisis go back to apartheid, which barred non-white people from living in cities. Between the 1940s and 1970s, tens of thousands of people were forcibly relocated from neighbourhoods like Johannesburg’s Sophiatown and Cape Town’s District Six to remote townships.

In the 26 years following the end of apartheid, deepening economic inequality and rampant unemployment have limited access to formal housing for millions of South Africans. Government housing programs have mostly focused on building small stand-alone homes, often on the peripheries of cities far from jobs and amenities.

While these well-intentioned projects have built millions of homes, they’ve failed to keep up with demand, says Marie Huchzermeyer, a professor at the Centre for Urbanism & Built Environment Studies at the University of the Witwatersrand in Johannesburg. Government-funded housing projects “will never on it’s own be enough,” she says. “It has to be accompanied by land release.”

Government policies call for the “upgrading” of informal settlements and the formalization of residents’ occupation. But “there are still very, very, very few projects” of that nature in South Africa, Huchzermeyer says. “Even if it’s an informal settlement that’s been around for 20 years, there still seems to be a political wish to punish people for having done that.” The government wants people to go through the formal process of being given a house, she says – and for them to be thankful to the government for providing it.

At the municipal level, change will require “real leadership around informal settlement upgrading and around ensuring that land is available for people to occupy,” she says. 

Despite the end of enforced racial segregation, spacial apartheid remains a factor in South Africa. There are few mixed-income neighbourhoods. Those who can afford to often live behind walls in sprawling low-density suburbs, while the poor live in overcrowded slums and apartment buildings.

The creation of the apartheid city “didn't happen by chance,” says Amira Osman, a professor of architecture at the Tshwane University of Technology. “It was a deliberate, structured approach to the design of the city. We need a deliberate, structured approach that will undo that.”

Since last fall, Johannesburg’s Inclusionary Housing Policy has required developments of 20 or more units to set aside 30% of those units for low-income housing.

The policy, which faced significant opposition from private developers, won’t lead to dramatic change, says Sarah Charlton, a professor at the Centre for Urbanism and Built Environment Studies, but it is “an important and significant step.”

Zikode isn’t optimistic that change will come for shack dwellers, however.

“People in the high positions of authority pretend that everything is normal,” he says. “They pretend that everyone is treated justly, they pretend that everyone has homes with running water, that everyone has a piece of land – and hide the truth and the lies of our democracy.”

Jacob Serebrin is a freelance journalist currently based in Johannesburg. Follow him on Twitter.