Space Performance Assessment of a Relocatable Health Facility: Mosul Hospital as a Case Study

Abstract

Relocatable buildings are commonly spread around as an alternative method of construction. To consider it a successful practice, it should perform its function similarly to a traditional way. Assessing a building after its operation determines the rate of its success and decides the possibility of repeating its type. This study aimed to provide a comprehensive knowledge base related to space evaluation of the building through spatial assessment. This study investigated the functional efficiency and dimensional requirements of a relocatable hospital in Mosul, in the south of Iraq. This study compared the dimensional requirements of eight hospital departments to the standard, followed by functional efficacy analysis based on space syntax theory and compared the results to examples used in standards books. The results showed that departments in the relocatable buildings have good plan integration. We concluded that hospitals constructed with containers could achieve functional efficiency.

1. Introduction

Destruction caused by ISIS in Mosul, in the south of Iraq, resulted in fast-paced demographic changes, which pose different challenges to that region. Cities are in a hurry to recover and develop new buildings to meet new space demands. Recently, interest in modular and relocatable buildings has increased significantly during the 2010s, especially in the public sector. In particularl, the school and healthcare sectors have used temporary modular solutions, primarily due to booming renovation needs and migration between regions [1]. Relocatable buildings were described by Abuin as buildings that can be transported in parts but which are assembled at the site almost instantly into a usable form. They are practically carried but sometimes have a portable system built into their structure and can be reused in another location for another function. Relocatable buildings are leveraged from the prefabrication process, helping to curb costs and time resources required to speed up the construction process. This is particularly useful for large-sized and high-volume building demand. The benefits of relocatable buildings include rapidity and quality of construction, sustainability, adaptability, and multi-functionality. At the same time, their challenges are rigid design, dimensional restrictions, and poor image [2]. A relocatable building is made of many containers; an intermodal container is a large, standardized shipping container designed and built for intermodal freight transport, meaning these containers can be used across different modes of transportation—from ship to rail to truck—without unloading and reloading their cargo [3]. Based on size alone, up to 95% of intermodal containers comply with ISO standards [4].

In 2006, the Architect Peter DeMaria designed the first two-story shipping container home in the U.S. as an approved structural system. Several architects, such as Adam Kalkin, have built original homes using discarded shipping containers for their parts, using them in their original form, or a mix of both [4]. In the same year, the Urban Space Management firm completed the project called Container City I in London. The firm went on to complete additional container-based building projects, with more underway. In 2006, the Dutch company Tempohousing finished, in Amsterdam, the biggest container village in the world: 1000 student homes from modified shipping containers from China [4]. In 2010, German architect Stefan Beese utilized six 40′ long shipping containers to create a large viewing deck and a VIP lounge area [4].

In the health sector, relocatable modular buildings have many benefits and provide a viable option for cities struggling to meet their fluctuating space demands. Relocatable modular buildings could solve the challenges posed by quickly changing demographics in different types of regions and deliver both usability and circularity [1]. The requirement of a complete diagnostic capacity hospital can be met with a relocatable building solution. In the healthcare sector, relocatable buildings constitute a suitable solution in case of a lack of construction budget or time limitations [5]. Figure 1 shows the steps involved in creating buildings with containers.

Regionally, construction in the healthcare sector has been growing continuously, and the need for using the relocatable building is evident. Hospitals, as a type of building, are disinterested in the external appearance of the building, focusing, rather, on its functional efficiency. Space performance is the main factor of functional efficiency in hospitals and can only be evaluated through the space syntax tool. Thus, the study aimed to provide a comprehensive knowledge base related to spatial assessment of the building through the dominant tool, space syntax. According to the container size used for this type of building, the designer is restricted to a specific grid dimension and has to design a highly functionalized building with the size of containers, which is limiting. Thus, the research question was as follows: do containers’ fixed dimensions affect the performance of the spaces in health care buildings? The objective of this study was to assess the potential of relocatable buildings in terms of their functional efficiency and dimensional requirements according to universal standards to address these challenges. In this study, Mosul hospital was selected as a notable case of a relocatable hospital. The case study was evaluated using a dimension and space syntax tool comparison with standards. Its endeavor to apply two methods is with the purpose of increasing reliability by measuring the ability of buildings to perform in a way similar to traditional ones in terms of spaces.

2. Literature Review

2.1. Relocatable Hospital Development

Kukil Han showed an example of a relocatable hospital, which he designed to provide immediate aid in hard-hit disaster-stricken areas. Modularized container medical treatment centers can either function individually or as larger modular units. Deliverability of the units by ground or via helicopter provides a shorter response time to emergency areas [6]. Another example was shown by Hord Macht and Spevco, who eliminated the need for a standard hospital. In their design, 58 trailers provide a fully operational, fully mobile 48-bed hospital. The trailers include every aspect of a hospital, from waiting for spaces to surgical suites, pharmacies, and labs. The design constitutes the future of how health care will travel. It is a system that effectively transforms health care for entire regions and countries over time, letting the hospital and care come to the patient [7].

Despite the spreading nature of relocatable building usage, scientific studies about it are minimal. Kyro is the only researcher who focused on the relocatable building when he searched about the possibility of relocatable buildings to deliver usability, which is defined as the potential of the building to meet the needs of the specific users. The study provides a framework for a modular relocatable building that could deliver both circularity and usability. The primary data included semi-structured interviews, whereas additional data comprised site visits, observation, and written documents [1].

In this context, it was found that there are very limited studies dealing with the topic of relocatable hospitals from a very limited standpoint, which ensures the importance of this study.

2.2. Space Assessment in Hospital

Space syntax in the design process is based on a configurational theory of space and attempts to decode spatial formations and their impacts on human activity [8]. Its main interest is the relationship between human beings and their inhabited areas. Space syntax considers that distinctive characteristics of societies exist within spatial systems, and their knowledge is conveyed through the organization of spaces. Since the late 1990s, space syntax has increasingly been applied to the study of healthcare facilities [8]. Space syntax is theorized as an appraising tool for health facility buildings in several studies. Arslan and Koken evaluated the 130 healthcare buildings that are affected by earthquakes and which needed renovation by using the space syntax method to analyze the pre-and post-strengthening projects. Visibility graph analysis (VGA) was conducted, and then permeability graph analysis was compared with it in terms of the connectivity, integration, and mean depth value [9]. In the same regard, Pramanik presented space syntax methods for analyzing the activity and flow of spaces in the hospital. A clinic as a case study in the construction phase was used to develop the integration procedure and then compared with the actual case analysis [10]. Another study about evaluating spatial configuration in hospital buildings was carried out by Setola. A study was conducted in three hospitals in Italy and demonstrated how the spatial configuration of a hospital’s public spaces influences the interfaces between patients and medical staff. Social surveys and space syntax analyses were used [11]. Regarding the assessment of a specific department in the hospital such as outpatient, Chen investigated the relationships between the wayfinding system of the outpatient areas and the patients’ behaviors in the hospital by using space syntax at Cheng Ching Hospital in Taiwan. They integrated axial mapping and isovist analysis to provide suggestions on the location, format, and content of the wayfinding system [12]. Furthermore, Setola focused on the spaces connection system concerning public flows. Space syntax was chosen as a possible tool to show the potential of an evidence-based approach combining the social and spatial aspects concerning the people’s movements. The case study was performed at the Careggi University Hospital in Florence [13]. Moreover, Khan described the genotype of 250-bed hospital layouts in Bangladesh by analyzing six hospitals within a cultural tradition. An integration measure in space syntax was used to discover the department’s difference factor value [14]. Additionally, Beck and Turkienicz concluded, in their study, that spatial usage had a higher relationship with visibility compared with a short distance by analyzing the visibility and permeability relations of three defined routes in a hospital [15]. Additionally, Sadek examined the potential influence of the spatial configuration of a new emergency department on the effectiveness of visual surveillance, movement, and communication [16].

Depending on the literature review, studies that use space syntax provide reasonable evidence for assessing the spatial configuration of healthcare facilities. However, the knowledge gap is derelict in evaluating the usability of the relocatable hospital, while this type of hospital is used worldwide. Furthermore, the research is studying the space performance of the relocatable hospital through the dimensional requirement and the functional efficiency through several factors such as wayfinding and accessibility. The limitation of this study is the space aspects that are related to planning, such as space dimensions, shape, boundary, circulation, and the relationship of shapes.

3. Space Performance

3.1. Dimensional Requirement

This study followed two leader standards in the field of architecture and healthcare facilities. The first is The Guideline for Design and Construction of Hospitals and Outpatient Facilities, which intends to keep pace with evolving healthcare needs and in response to requests for up-to-date guidance from healthcare providers, designers, and regulators. Prescriptive measurements, when given, have been carefully considered relative to generally recognized standards [17]. The second is the Neufert, Architects’ Data which is a reference book for spatial requirements in building design. The book is conceived to help the initial setup of buildings by providing extensive information about spatial requirements [18].

3.2. Functional Efficiency

3.2.1. Wayfinding

The term “wayfinding” can be traced back to the 1960s when it was first mentioned by Kevin Lynch in his book The Image of the City. Lynch used wayfinding to explain people’s cognition and analytical capabilities toward the urban environment. He defined paths, edges, districts, nodes, and landmarks as the essential elements that support one’s image of a place [19]. Hospitals share many attributes of cities and urban planning. A clear hierarchy of circulation (primary, secondary streets, and back alleys) is essential for complex hospitals as is in cities’ urban paths. Nodes and landmarks similarly serve as reference points along paths. For instance, well-designed departmental entries, nurses’ stations, and courtyards can operate as important nodes and landmarks. Eventually, distinguishing departmental and functional zoning can act equivalently to city districts and edges to facilitate legibility [16]. There are several reasons why people have problems finding their way in hospitals; hospitals often are complicated environments, people are first-time visitors, and the names of units on the signs are often long, difficult, and similar to each other [20]. Improving the wayfinding feature is a sophisticated problem that is influenced by multiple factors [16]. Although wayfinding is the main function of the sign system in hospitals, architectural space design also plays a significant role. Carpman demonstrated that signs alone are not sufficient to guide wayfinding behavior in large complex environments such as hospitals [21]. Architectural design of spaces is one of the critical factors to wayfinding in large hospitals, as Mollerup considered pre-visit information, architecture, and the naming of places as three main factors in wayfinding [20]. Carroll noted that floor plan complexity significantly affected wayfinding behaviors [22]. O’Neill suggested a close relationship between building plan complexity and the number of times people become lost. The sizes, forms, relationships among spaces, and the irregularity of floor plans are the leading causes of this complexity. Moderate and straightforward route planning in space will help reduce the problems of wayfinding. However, too many route intersections will increase the number of decision points, making users more easily confused [23].

Field of view in the entry point and corridor integration is an essential predictor of exploration and wayfinding. In other words, an integrated analysis of a hospital plan is a powerful indicator of which corridors visitors can be expected to walk in and have a better memory of. Moreover, the syntax value of Isovist analysis in the entry space affected wayfinding and indicated which entry poses more wayfinding difficulties [24]. According to International Health Facility Guidelines, an understanding of the reasonable progression of space and the relationships between them will contribute to determining the circulation system for its importance in creating an existing wayfinding system [17].

3.2.2. Accessibility

Healthcare accessibility is one of the most significant factors for overall patients inside the hospital. Accessibility is defined by Cambridge Dictionary as “the characteristics of something that makes it possible to enter, use or approach” [25]. The physical architecture of hospital departments should provide quick access to staff equipment and supplies [26]. To ensure the safety of patients, healthcare departments should have an apparent architectural layout that allows staff to readily access patient rooms and promote clear vision for continuous observation. To improve care delivery, healthcare systems experts often implement accessibility analysis, focusing on the patients’ activities with flexible movement [26]. Flexibility in accessibility refers to applications that include spatial proximity relationships among different functional sectors, patient–staff relations, circulation hierarchy, path differentiation, the transportation of equipment, the legibility of access, journey times, and entrance control [13].

The aim is to keep circulation organized and straightforward to a user by decreasing the number of decision points and maximizing visual access. The wayfinding in the case study was measured by two indicators: the entry point of view and the corridor integration, as shown in Figure 2. According to accessibility, this study focused on two indicators within the accessibility: first, the patient–staff relationship, and second, the plan complexity, as shown in Figure 2.

4. Research Method

The research used a two-level method to assess the space performance of the relocatable building. The first evaluated the dimensional requirements of the hospital, which is about comparing hospital space areas and dimensions with standards. As mentioned, the standards used were as follows: Guidelines for Design and Construction of Hospitals and Outpatient Facilities, 2018; and Neufert, Architects’ Data, 2019.

The second level of the method is about evaluating the functional efficiency of the hospital by using space syntax, DepthmapX software with version X-0.8.8. In space syntax, visual information is described by the isovist, which is the set of all points visible from a given vantage point in space. When performing the spatial analysis, space syntax provides the ability to investigate both visibility and accessibility situations [16]. Isovist analysis was chosen to measure the field of view in entry spaces and then indicate the wayfinding in the hospital. In addition, the axial map analysis was selected to measure the corridor integration in hospitals and indicate the wayfinding value in hospitals, as shown in

Table 1. Space syntax methods used in the study.

Functional Efficiency	Factors	Indicator	Space Syntax Map	Space Syntax Indicator
	Way Finding	Entry field of view	Isovist	Isovist Area
		Corridors integration	Axial map	Integration
	Accessibility	Patient-staff relation	VGA	Connectivity
				Integration
		Plan Complexity	Convex Map	Depth

.

Visual graph analysis VGA was used to measure the connectivity and integration of the hospital departments, which indicating the patient–staff relationship and then measuring the accessibility of the plan. Space syntax measurements of connectivity (the number of direct connections to other spaces) and integration (how well one space is connected to all other spaces) allow for representing the layouts’ configurational properties and the degree of their complexity [16]. Convex map analysis was carried out to measure the depth of the hospital departments and then the complexity of the plan and accessibility in the hospital was calculated, as shown in Table 1.

5. Case Study

From 2014 to 2017, Mosul and Nineveh suffered severe devastation due to the control of the Islamic State (IS) terrorist militia over the city. They heavily damaged the healthcare buildings such as Al ‘Salaam hospital, which used to be the biggest hospital in the area before it was destroyed in 2017, as shown in Figure 3. Since being liberated from IS in July 2017, the western part of Mosul, in particular, has suffered from the large-scale destruction of public and private infrastructure. Social services such as health care are limited [27]. Recovery and Rehabilitation in Mosul, as a program of the GIZ organization, supports the reconstruction of a relocatable health care facility. The first relocatable hospital in Mosul consists of 150 beds and accommodates up to 1500 outpatients and 150 inpatients a day to receive adequate primary and special medical treatments [27]. Figure 4 shows the hospital in the construction process.

In July 2017, Mosul city was liberated from ISIS. The relocatable hospital was constructed by GIZ (German Agency for International Cooperation GmbH), the main German development agency, in partnership with the Ministry of Health. The relocatable hospital in Mosul was built on the same site as Al ‘Salaam hospital on a single floor and contains more than 600 containers, as shown in Figure 5 and Appendix A Figure A1. Two types of containers were used; first, a high cube of 13.09 m² area, 2.90 m height, and second a high cube of 26.77 m², 2.90 m height, as shown in Figure 6, was used. To analyze the case study, eight departments of the hospital were chosen (Emergency, Dialysis, Pediatric, Outpatient, Radiology, Endoscopy, Laboratory, and Wards).

6. Results

6.1. Results Related to Dimensional Requirements

To determine if the building performs its function in terms of size and dimensions of its space, all department spaces were compared to the minimum standards. Each department was detailed by all spaces in comparison with standards as shown below.

The emergency department in Mosul hospital is about 1211 m² in area and comprises 75 containers as shown in

Table 2. Dimensional requirements of the emergency department compared to standards.

Emergency Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Single-bed Patient Room	11.15 m2	13.09 m2	1.94+
	Multiple-bed Patient Room, Per bed	9.29 m2	19.58 m2	+10.29
			15 m2	+5.71
	Ambulance Ent. Width	1.83 m	2.3 m	+0.47
	Trauma Room	23.23 m2	48.24 m2	+25
	Treatment Room	11.15 m2	13.34 m2	+2.19
	Consultation Room	11.15 m2	13.34 m2	+2.19
	Clearance around stretcher.	1.52 m	2 m	+0.48
	Operating Room	30 m2	48.24 m2	+18.24
	Nurse Work Ares	25 m2	26.15 m2	+1.15
	Staff Rest	15 m2	9.12 m2	−5.88
	Clean Room	10 m2	6.41 m2	−3.59
	Corridor	2.25 m	2.25 m	0
	Service Corridor	1.5 m	2.18 m	0.68

and Figure A2. The dialysis department is about 325 m² in area and comprises 22 containers, as shown in

Table 3. Dimensional requirements of the dialysis department compared to standards.

Dialysis Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Examination Room	11.15 m2	18.23 m2	+7.08
	Treatment Area, Per Chair	7.44 m2	9.89 m2	+2.45
	Clearance Between chairs	1.22 m	1.5 m	+0.28
	From Nurse Station to Chair	1.83 m	1.9 m	+0.07
	Isolated Room	9.29 m	13.09 m2	+3.8
	Nurse Work Area	15 m2	18.9 m2	+3.9
	Staff Rest	15 m2	13.09 m2	−1.91
	Clean Room	10 m2	8.76 m2	−1.24
	Corridor	1.5 m	1.8 m	+0.3

and Figure A3. All treatment and patient spaces are in larger spaces than minimum standards, leading to the ability to perform their function. However, failures in the area are in rooms related to staff rest and service spaces.

The pediatric department in Mosul hospital is about 487 m² in area and comprises 27 containers. As shown in

Table 4. Dimensional requirements of the pediatric department compared to standards.

Pediatric Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Single-bed Patient Room	9.29 m2	19.67 m2	+10.38
	Multiple-bed Patient Room, Per bed	7.43 m2	11.42 m2	+3.99
	Treatment Room	11.15 m2	8.76 m2	+2.19
	Nurse work Ares	15 m2	17.27 m2	+2.27
	Staff Rest	15 m2	8.76 m2	−6.24
	Clean Room	10 m2	13.09 m2	+3.09
	Corridor	2.25 m	2.25 m	0
	Service Corridor	1.5 m	1.8 m	+0.3

and Figure A4, all spaces are in larger rooms than minimum standards, which leads to the ability to perform their function, except for the area for staff rest.

The outpatient department in Mosul hospital is about 443 m² in area and comprises 30 containers. As shown in (

Table 5. Dimensional requirements of the outpatient department compared to standards.

Outpatient Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Consultation Room	11.15 m2	13.09 m2	+1.94
			18.28 m2	+7.13
	Treatment room	11.15 m2	18.24 m2	+7.09
	Examination room	7.43 m2	13.09 m2	+5.66
	ENT	20 m2	18.09 m2	−1.91
	Clean Room	10 m2	8.78 m2	−1.22
	Laboratory	15 m2	13.09 m2	−1.91
	Corridor	2.25 m	1.8 m	−0.45

) and (Figure A5), all main spaces including consultation rooms, treatment, and examination spaces are in larger spaces than minimum standards, which leads to the ability to perform their function. However, failures in the area are in spaces related to the laboratory, clean room, ENT, and corridors.

The radiology department is about 207 m² in area and comprises 21 containers. As shown in

Table 6. Dimensional requirements of the radiology department compared to standards.

Radiology Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Ultrasound Examination or Procedure Rooms	11.15 m2	13.35 m2	+2.2
	X-Ray	20 m2	27.27 m2	+7.27
	Consultation Room	11.15 m2	13.09 m2	+1.94
	Control	10 m2	13.09 m2	+3.09
	Storage	10 m2	14.66 m2	+4.66
	Service Corridor	1.5 m	1.12 m	−0.38

and Figure A6, all spaces such as the ultrasound examination or procedure rooms, x-ray, consultation room, and control are in larger areas than minimum standards, which leads to the ability to perform their function. Only the service corridor is smaller than required.

The endoscopy department in Mosul hospital is about 177 m² in area and comprises 12 containers. As shown in

Table 7. Dimensional requirements of the endoscopy department compared to standards.

Endoscopy Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Procedure Room	11.15 m2	27.27 m2	+16.12
	Clearance at each side, head, and foot of the stretcher	1.07 m	1.35 m2	+0.28
	Pre-Procedure, Per bed	5.58 m2	5.6 m2	+0.02
	Pre-Procedure clearance.	1.52 m	1.2 m	−0.3
	Post-Procedure, Per bed	7.43 m2	8.03 m2	+0.6
	Post-Procedure clearance.	1.52 m	1.2 m	−0.32
	Sterilization	10 m2	13.09 m2	+3.09
	Consultation Room	11.15 m2	13.09 m2	+1.94

and Figure A7, all spaces such as the procedure room, pre-procedure room, and post-procedure room are in larger space than the minimum standards, which leads to the ability to perform their function. However, there are failures in the clearance at the side, head, and foot of the stretcher in the pre-procedure and post-procedure rooms.

The laboratory department in Mosul hospital is about 135 m² in area and comprises nine containers. As shown in

Table 8. Dimensional requirements of the laboratory department compared to standards.

Laboratory Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Taking Blood samples	5.76 m2	10 m2	+4.24
	Laboratory Work	35 m2	70 m2	+35
	Storage	10 m2	6.74 m2	−3.26

and Figure A8, spaces such as bloodwork and laboratory work are larger spaces than minimum standards, which leads to the ability to perform their function. However, there are failures in the storage area.

Wards in Mosul hospital have about a 3408 m² area divided into three parts and 126 containers; most of the container wards are the large type. As shown in

Table 9. Dimensional requirements of the wards compared to standards.

Ward Plan	Dimensions Details
	Description	Standard	In Plan	Def.
	Single-bed Patient Room	11.15 m2	16.85 m2	+5.7
	Multiple-bed Patient Room, Per bed	9.29 m2	11.41 m2	+1.85
			12.62 m2	+3.33
	Clearance multiple-bed	1.52 m	1.78 m	+0.26
	Ward Corridor	2.25 m	2.25 m	0
	Service Corridor	1.5 m	1.9 m	+0.4
	Nurse work Ares	25 m2	26 m2	+1
	Procedure Room	11.15 m2	10.16 m2	−0.99
	Staff Rest	15 m2	10.48 m2	−4.52
	Clean Room	10 m2	10.03 m2	+0.03

and Figure A9, the main spaces such as the patient room, isolated patient rooms, corridors, and clean rooms are in larger areas than minimum standards, leading to their ability to perform their function. However, there are failures in staff rest and procedure rooms.

6.2. Results Related to Space Syntax

The space syntax results were obtained by analyzing the architectural layout plan for each department of the case study and comparing the same department in the standards. Examples were selected according to the size and component of the case study department.

Table 10. Examples used in the space syntax analysis. Adapted from ref. [18].

Emergency	Dialysis	Pediatric	Outpatient
Helios Clinic, Gotha, Arch.: Worner+ Partner.	Hellos Clinic, Gotha, Arch.: Worner+ Partner.	Velbert Municipal Hospital.	Oskar-Ziethen Hospital, Arch.: Deubzer Architekten.
Radiology	Endoscopy	Laboratory	Wards
St Johann Nepomuk Catholic Hospital, Arch.: Thiede Klosges.	Beizig Hospital Arch.: Thiede Klosges	Soltau Distric Hospital. Arch.: Poelzig + Biermann	St Elisabeth Hospital, Halle. Arch.: U + A Weicken

shows the models used in all space syntax analyses.

Table 11. Examples used in the space syntax analysis.

Department	Area (Case Study)	Ares Example (Nufert)
Emergency	1208 m2	750 m2
Dialysis	324.8 m2	522 m2
Pediatric	486.5 m2	566 m2
Outpatient	443 m2	532 m2
Radiology	310 m2	466 m2
Endoscopy	180 m2	160 m2
Laboratory	134.5 m2	177 m2
Ward	1137 m2	914 m2

shows the comparison in the area between the case study and the examples used.

6.2.1. Wayfinding Results

Isovist provides data on the coverage of the viewing area from a certain point within each department plan. Isovist was measured from the public space (lobby). The Isovist analysis was conducted only at the entrance point because wayfinding is related to the decision points and entrance is the main decision point that appears in all departments. The highest value of the Isovist area represented the highest value of wayfinding. A high Isovist value means high visual access at a point in the entrance, which leads to high wayfinding at that point. Visitors to the entry point of a department can have high visual access, which helps them find their way.

Table 12. Isovist area values and graphs of case study departments compared to examples.

Departments	Isovist Area
	Relocatable Hospital	Examples	Def.
Emergency
	155	136.1	+18.9
Dialysis
	102.2	93.7	+8.5
Pediatric
	95.7	121.4	−25.7
Outpatient
	111.8	31.2	+80.6
Radiology
	73.2	62.9	+10.3
Endoscopy
	45.4	26.7	+18.7
Laboratory
	55.6	36.6	+19
Wards
	182.1	140.9	+41.2
Coverage of the viewing area from a point in the entrance

shows the Isovist area values and graphs of case study departments compared with examples from Neufert. The results showed that the deferent in value of Isovist areas from the entrance of all departments was positive in the relocatable hospital (case study) except the pediatric department. This indicates that the angle of view in the entrance point was higher in the case study than in the examples, leading to a better wayfinding value.

Corridor integration is shown in the results of the axial map integration analysis (

Table 13. Axial Map/Integration values and the graphs of case study departments compared to examples.

Departments	Axial Map/Integration
	Relocatable Hospital	Examples	Def.
Emergency
	5.32	5.25	+0.07
Dialysis
	9.76	8.37	+1.39
Pediatric
	5.79	6.6	−0.81
Outpatient
	6.85	4.8	+2.05
Radiology
	5.51	6.19	−0.68
Endoscopy
	8.13	6.52	+1.61
Laboratory
	8.03	5.62	+2.41
Wards
	5.85	7.46	−1.61

). The red color is the highest integration value and represents a higher value of wayfinding than the blue line, which means a lower degree. The results showed that the integration value of all departments was higher in the relocatable hospital (case study) than in examples except the pediatric department and ward. The highest degree of integration is in the radiology department of the case study. This indicates that in most departments, plans of the case study are well integrated compared with the example departments.

6.2.2. Accessibility Results

Visibility graphs analyze the range of any point in the spatial layout that is visible from other points. A graph also measures and calculates the points that are not directly visible by testing how many intervening points are needed for a point to see others [28]. Connectivity in the syntax visibility graph showed the highest rates on dialysis and emergency (766.4, 765.5), respectively, and were more prominent than examples (

Table 14. Visual graph analysis/connectivity values and graphs of case study departments compared to examples.

Departments	VGA/Connectivity		Def.
	Relocatable Hospital	Examples
Emergency
	765.5	555.5	+210
Dialysis
	766.4	487.5	+278.9
Pediatric
	471.9	522.4	−50.5
Outpatient
	548.9	271.5	+277.4
Radiology
	323	633.8	−310.8
Endoscopy
	355.3	481	−125.7
Laboratory
	538.2	308.8	+229.4
Wards
	742.6	573.5	+169.1

), where the warm colors (red, orange, yellow) indicate high visibility and cold colors (blue, dark blue) show the low-visibility spaces (the cold colors negatively affect the result and give low readings), and lower VGA values than the examples for pediatric, radiology, and endoscopy departments. A well-connected plan represented a good relationship between patient and staff spaces, strengthening the accessibility.

Integration in the syntax visibility graph measures the patient–staff relationship; the high integrated plan means a strong connection between patient spaces and staff spaces, leading to good care offered to patients. The results showed the highest rates for laboratory and dialysis departments (12.95, 9.3), respectively, and were more prominent than the examples (

Table 15. Visual graph analysis/integration values and graphs of case study departments compared to examples.

Departments	VGA/integration
	Relocatable Hospital	Examples	Def.
Emergency
	5.29	5.52	−0.23
Dialysis
	9.3	6.38	+2.92
Pediatric
	5.07	6.67	−1.6
Outpatient
	6.49	4.45	+2.04
Radiology
	5.42	7.72	−2.3
Endoscopy
	8.11	7.11	+1
Laboratory
	12.95	6.12	+6.83
Wards
	6.69	6.55	+0.14

). The rate of plan integration is bigger in case study departments than in examples, except for emergency, pediatric, and radiology departments, where the value of plan integration was lower than in the example. ore integrated plan indicated higher accessibility.

Plan complexity is another indicator of accessibility measured by the depth of convex map analysis. Each space in plan is converted into convex polygons and connected to sounding spaces. It is used to consider the configuration relationships among spaces. Convex depth is used to express how deep the plan is [28]. Higher depth in the plan reflects a more complex plan and a lower accessibility rate. The convex map represents a graph system in which each node matches a convex space, and each line relates the connection between them; in this situation, the depth is utilized to represent the number of spaces that must be crossed to proceed from one location to another. The depth in the corridor (main circulation) space is the lowest level (no crossing space). All other spaces were measured according to the number of spaces they should across to reach. Spaces that have a direct connection with the corridor measure as having more depth than the corridor itself. So, a plan which has many crossing spaces is considered high depth. The results showed that most of the departments in the case study had larger planned depth than in the example. However, some departments had less depth than, for example, outpatient (1.88 vs. 2.79), endoscopy (2.2 vs. 2.78), and laboratory departments (1.93 vs. 2.6), as shown in

Table 16. Convex map analysis/depth values and graphs of the case study departments compared to examples.

Departments	Convex Map/Depth
	Relocatable Hospital	Examples	Def.
Emergency
	4.89	2.95	−1.94
Dialysis
	2.88	2.18	−0.7
Pediatric
	2.82	2.63	−0.19
Outpatient
	1.88	2.79	+0.91
Radiology
	3.67	2.1	−1.57
Endoscopy
	2.2	2.78	+0.58
Laboratory
	1.93	2.6	+0.67
Wards
	3.46	2.54	−0.92

.

The difference between case studies and examples represents the rate of efficiency in each plan. The deferent numbers in the Isovist area and VGA connectivity were converted from (100 to 1) to be similar to other analyses and be easy to compare; for example, 210 was converted to 2.1.

Table 17. Overall deferent rate in all space syntax analyses.

Departments	Functional Efficiency
	Way Finding		Accessibility
	Entry Field of View	Corridors Integration	Patient-Staff Relation		Plan Complexity
	Isovist	Axial Map	VGA		Convex Map
	Isovist Area	Integration	Connectivity	Integration	Depth
Emergency	+0.19	+0.07	+2.10	−0.23	−1.94
Dialysis	+0.08	+1.39	+2.79	+2.92	−0.7
Pediatric	−0.25	−0.81	−0.51	−1.6	−0.19
Outpatient	+0.8	+2.05	+2.77	+2.04	+0.91
Radiology	+0.10	−0.68	−3.11	−2.3	−1.57
Endoscopy	+0.19	+1.61	−1.26	+1	+0.58
Laboratory	+0.19	+2.41	+2.29	+6.83	+0.67
Wards	+0.41	−1.61	+1.69	+0.14	−0.92

shows the overall deferent rate in all space syntax analyses.

The overall results show that departments such as outpatient and laboratory are performing their function well when their rate of deference in all analyses is positive. Dialysis and endoscopy are also well-functionalized performances, followed by emergency and wards. However, the pediatric department obtained negative results in all analyses.

7. Conclusions

Building healthcare facilities with relocatable buildings has become a present need. Designers face many challenges dealing with relocatable buildings beginning with the restrictions related to the size of containers to the poor exterior appearance. This study assists the space performance of relocatable buildings in terms of wayfinding and accessibility. Based on a comparison with standards, the study concluded that spaces in healthcare buildings constructed with containers are efficient in size and dimension. The size of containers has not negatively affected the size of spaces. Therefore, relocatable hospitals are performing their function according to the dimensional requirements.

Moreover, the performance of relocatable buildings is assisted according to wayfinding as a functional efficiency factor. The space syntax analysis concludes that all relocatable hospital departments should have a clear view of the entrance and integrated plans that lead to a good wayfinding feature. Wayfinding is an indicator of efficiency in hospitals constructed as relocatable buildings. Besides, accessibility as another factor of functional efficiency is assessed in relocatable buildings. The visual graph analysis concluded that all departments in the relocatable building had good plan connectivity and integration compared with the example plans. This indicates that the relationship between patients and staff is more robust, and accessibility in the relocatable hospital department is achieved. Planning in the relocatable building can be designed at a reasonable level according to the complexity, which smoothens the accessibility in the building. The study concluded that healthcare buildings constructed with containers to be relocatable could achieve functional efficiency. Designers can overcome the restrictions related to the size of containers in relocatable buildings. Thus, this type of building can be adapted more based on its advantages.