Urban healing: a maternity and children's hospital has an impassive urban presence concealing a rich interior life

Architectural Review, The, May, 2005 by Carla Bertolucci

To a geographic diversity that encompasses such disparate locales as Stockholm, San Sebastian and Los Angeles, Rafael Moneo can now add programmatic diversity. Best known for an impressive repertoire of arts and religious buildings (for instance, LA's new cathedral, AR March 2003) that stir the soul through the contemplation of human creativity or divine mysticism, his latest building, a major new maternity and children's hospital in Madrid, responds to the more messy realities and demands of the corporeal. It also marks a return to his native country and the city in which he both studied and taught. Madrid itself is currently embarking on an ambitious programme of urban transformation (partly prompted by its candidacy for the 2012 Olympics), with projects by Richard Rogers (airport), Cruz & Ortiz (stadium expansion), Wiel Arets (housing) and Toyo Ito (urban park) in the pipeline. Moneo is also overseeing the renovation of the famous Prado Museum--certainly more familiar territory than designing a hospital, but the qualities and subtleties of his architecture are not lost in the more pragmatic nature of a healthcare programme.

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The new building forms part of the campus of Gregorio Maranon, a major teaching hospital in the heart of the city. Like many older healthcare institutions, the hospital had evolved in a piecemeal, accretional fashion into a haphazard jumble of structures. The oldest buildings dated back to the early part of the twentieth century and the most recent from the 1980s. As well as designing a new facility, which replaces an obsolete maternity hospital on the site, Moneo's task was to rationalise the campus.

The main challenge was how to humanise what is a very large building (46 500sqm), with exacting technical and functional demands. The programme combines two separate but interrelated institutions, each with their own wards, operating and outpatient provision, backed up by shared diagnostic, emergency and general services. On paper, the brief has the potential to be a soulless and disorientating institution, but Moneo's strategy is to break down the building into a series of smaller and more manageable units each arranged around a courtyard. Such permeability draws on the historic tradition of the Iberian patio, which brings light and air into deep-plan buildings.

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Another strong Iberian tradition is the impervious, inscrutable exterior, which here finds contemporary expression in a skin of milkily translucent horizontal glass panels that wraps, seals and homogenises the exterior (shades of the Kursaal concert hall in San Sebastian, AR May 2000). Mirrored on the inside face, with etched glass on the exterior, the 20mm thick panels reflect the changing light and climatic conditions, creating a sense of calm impassiveness and slight mystery. Panels of cast aluminium form a base at ground level, preventing direct contact between pedestrians and the glass. Where necessary, windows are simple slots and slits, but the impression is that of a building that deliberately turns away from the street, shielding its occupants from the outside world and enclosing a secluded inner realm that in its complexity and scale resembles a small, self-contained, city.

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The exception to this introversion is a section of clear glazed wall that runs the full height of the building, flaring out at its base to form a protective canopy over the main public entrance to the maternity hospital. Tasteful superscale graphics proclaim the legend 'Maternidad'; the entrance to the children's hospital on the diagonally opposing side of the block (but one floor up because of the 3m difference in level across the site) is similarly distinguished.

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Ground level contains maternity outpatient services, with paediatric outpatients above. The second floor houses technical services, with paediatric, gynaecological and obstetric departments stacked up in ascending layers. The topmost level contains facilities for doctors on call. The emergency department at lower ground level is shared by both hospitals, and potential emergency cases arriving by ambulance or car are funnelled down a long ramp to a subterranean admissions bay. Also below ground are the radiology department, mortuary, clinical records and laboratories. An underground passageway connects the new building with the rest of the site.

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In practice, rather than the notion of breaking down and fragmenting a large mass, the project could be said to begin with the design and organisation of smaller units that are then built up into a larger whole. Individual patient rooms face on to courtyards, but never overlook other patient rooms. Instead, patients have views of glazed corridors beyond the courtyard that allow them to feel in contact with hospital life while retaining their privacy. Folding maple wood shutters can close off views completely and also help to diffuse the sun's glare. Working with design company Tecno, Moneo also designed the non-clinical furniture, such as patient armchairs, rocking chairs, meal trays and bedside tables, so that his elegant, humanising vision is carried through to the smallest detail.