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Gizli Ve Güvenli; Yer Alti Hastaneleri

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Gizli Ve Güvenli; Yer Alti Hastaneleri Review / Derleme GİZLİ VE GÜVENLİ; YER ALTI HASTANELERİ HIDDEN AND SAFE; UNDERGROUND HOSPITALS Nurcan BIÇAKÇI1 , Mehmet ULUTAŞ2 1Tekirdağ Namık Kemal Üniversitesi Sağlık Yüksekokulu, Acil Yardım ve Afet Yönetimi Bölümü, Tekirdağ, TÜRKİYE. 2T.C. Adalet Bakanlığı Adli Tıp Kurumu, İstanbul, TÜRKİYE. Öz Abstract Underground hospitals are sheltered health structures Yer altı hastaneleri savaşlar, salgın hastalıklar, afetler gibi which built under the surface of ground or obtained by insan sağlığı üzerinde yıkıcı etkiler oluşturabilen transforming existing underground areas to ensure that durumlarda hastanelerin güvenlik açısından tehdit altında hospitals continue to provide health care even though they olmalarına rağmen sağlık hizmeti sunumunu devam are threatened in terms of security when situations that ettirmeleri için kullanılan, yer yüzeyinin altında inşa edilmiş can have devastating effects on human health such as ya da yer altında var olan alanların dönüştürülmesi ile elde wars, epidemics and disasters. Many classic examples of edilmiş korunaklı sağlık yapılarıdır. Yer altı hastanelerinin underground hospitals built in the twentieth century due to yirminci yüzyılda savaşlar nedeniyle inşa edilmiş birçok wars have survived to the these day. Today, some klasik örneği günümüze kadar ulaşmayı başarmıştır. underground hospitals, which were created with the Günümüzde de klasik ve modern teknoloji sentezi ile synthesis of classical and modern technology, continue to oluşturulmuş bazı yer altı hastaneleri çeşitli amaçlarla serve for various purposes. Today's underground hospitals hizmet vermeye devam etmektedir. Günümüz yer altı are mostly organized to protect against possible hastaneleri daha çok olası konvansiyonel, kimyasal, conventional, chemical, biological, radioactive and nuclear biyolojik, radyoaktif ve nükleer saldırılardan korunmak ve attacks and to provide specialized care for these karşı karşıya kalınan bu durumlar için özelleşmiş bakım situations. The importance and necessity of having safe sağlamak üzere organize edilmiştir. Ülkemizin içinde hospitals for our society is increasing due to the strategic bulunduğu stratejik konum, komşu coğrafyalarda devam location of our country, the ongoing hot war in neighboring eden sıcak savaş, küresel silahlanmadaki endişe verici geographies, the alarming increase in global armament artış, terör gruplarının kitle imha silahlarına kolaylıkla and the fact that terrorist groups can easily access and use ulaşıp kullanılabilmeleri gibi nedenlerle toplumumuzun weapons of mass destruction. For this reason, it is güvenli hastanelere sahip olmasının önemi ve gerekliliği important to check the security levels frequently with the giderek artmaktadır. Bu nedenle ülkemizdeki hastaneler necessary analyzes for the hospitals in our country. In için gerekli analizlerle güvenlik seviyelerinin sık sık kontrol addition, underground hospitals should be available to edilmesi önemlidir. Bunun yanında yer altı hastaneleri de meet the needs of our society in strategically important mevcut hastane yapılarının yetersiz kalabileceği ya da locations in cases when existing hospital structures may sağlık hizmet sunumunu gerçekleştiremeyeceği durumlar be insufficient or can not provide health services. This için, stratejik önemi olan konumlarda, toplumumuzun article is planned to explain the importance and examples ihtiyaçlarını karşılayabilmek için hazırda bulundurulmalıdır. of underground hospitals that do not have active samples Bu makale ülkemizde aktif örneği bulunmayan yer altı in our country. hastanelerinin önemi ve örneklerini açıklamak üzere planlanmıştır. Key words: Hospital, underground, safe hospital. Anahtar kelimeler: Hastane, yer altı, güvenli hastane. GİRİŞ rehabilitasyon gibi sağlık hizmetleri veren, hastaların uzun ya da kısa süreli tedavi Sağlık sistemi içerisinde hastalıkların teşhis ve edildikleri yataklı kuruluşlar” olarak tedavisine yönelik çok çeşitli faaliyetlerin tanımlamıştır2. Günlük rutin işleyişte yürütüldüğü, çok sayıda ve birbirleriyle yakın kullanılabilecek bu tanımlamaya afetler ve acil ilişkide bulunan birimlerden oluşan karmaşık durumlar gibi olağandışı durumlarda verdiği sosyoekonomik sistemlere hastane hizmeti sürdürebilen ve toplumun o anki sağlık denilmektedir1. Dünya Sağlık Örgütü (DSÖ) hastaneleri; “Gözlem, tanı, tedavi ve Corresponding Author / Sorumlu Yazar: Article History / Makale Geçmişi: Nurcan BIÇAKÇI Date Received / Geliş Tarihi: 20.03.2019 Adres: TekirdağNamık Kemal Üniversitesi Sağlık Date Accepted / Kabul Tarihi: 23.10.2019 Yüksekokulu, Acil Yardım ve Afet Yönetimi Bölümü, Tekirdağ, TÜRKİYE. Namık Kemal Tıp Dergisi 2019; 7(3): 291 - 298 E-posta: [email protected] Bıçakçı ve Ulutaş. Namık Kemal Tıp Dergisi 2019; 7(3): 291- 298 bakımı ihtiyacına yanıt verebilen, güvenli bazı durumlarda yer üstüne göre tercih alanlardır ifadeleri de eklenebilir. edilmesine neden olan bazı özellikleri vardır5; Hastaneler sağlık hizmeti sunumunun her • Yer altı ortamı, zemine kurması zor, koşulda kesintisiz olarak sürdürülmesi gereken imkânsız, çevre açısından istenmeyen yerlerdir. Bu yüzden hastanelerin yapısal (örn. veya daha az kârlı olan faaliyetler veya hastane lokalizasyonundan kaynaklanan), altyapılar için uygun bir alan sağlar. yapısal olmayan (örn. güç kaynağı, su ve • Yer altı alanı, yer altına yerleştirilenlere sanitasyon hizmetlerinden kaynaklanan) ve doğal bir koruma sağlar. fonksiyonel (örn. güvenlik ve lojistik sistem • Yer altı yapıların yarattığı koruma, hatalarından kaynaklanan) her türlü tehdide yüzey ortamını belirli faaliyet türlerinde karşı güvenli yapılar olmaları esastır3. Güvenli doğabilecek risklerden / hastaneler acil durumlar, krizler ve afetler rahatsızlıklardan korur. sırasında ve hemen sonrasında, aynı alt yapı • Yer altı alanı opaktır: bir yer altı yapısı içerisinde hizmetleri erişilebilir ve çalışır sadece yüzeye bağlandığı noktalarda durumda kalan sağlık tesisleridir4. Güvenli dışarıdan görülür. hastaneler bu olağan dışı durumlarda tıbbi bakım, hemşirelik bakımı, laboratuvar gibi kritik İnsanların yer altına yapı oluşturma gerekçeleri hizmetlerin kesintisiz olarak devamını de kültüre ve bulunan coğrafyaya göre sağlarken, içinde bulunan sağlık personeli, değişmekle birlikte genel olarak şu şekilde 5 hastalar ve hasta yakınlarını fiziksel tehlikeler, sınıflandırılabilir ; salgın hastalıklar ve emniyet zafiyetleri gibi her • Arazi kullanımı ve yer nedenleri türlü riskten korur ve artan talebi • İzolasyonla ilgili gerekçeler karşılayabilecek dalgalanma kapasitesine • Çevresel koruma sahiptir4. Aynı zamanda güvenli hastaneler acil • Topografik sebepler durum planlarının uygulanması ve acil durum • Sosyal alışkanlıklar bilgi ağının işleyişinin devam ettirilmesi için sağlık işçilerinin eğitilmesini de sağlar4. Güvenli Yer altı hastaneleri bu gerekçelerin herhangi biri hastaneler oluşturulmasının gerekliliği nedeni ile oluşturulabilir ancak en çok izolasyon neticesinde gündeme gelen çok sayıda ile ilgili gerekçeler nedeni ile yeraltı kavramlardan biri de yer altı hastaneleridir. Bu hastanelerine başvurulmuştur. çalışmada yer altı hastanelerine örnekler Yer Altı Sağlık Yapıları verilerek, bu hastanelerin özelliklerinin ve Yer altı hastaneleri, savaşlar, salgın hastalıklar, önemlerinin açıklanması amaçlanmıştır. afetler gibi durumlarda hastanelerin güvenlik Yer Altı Yapıları açısından tehdit altında olmalarına rağmen Yer altı insanlar tarafından çok eski sağlık hizmeti sunumunu devam ettirmeleri için zamanlardan günümüze kadar, kendi elleriyle kullanılan, yer yüzeyinin altında inşa edilmiş ya ya da doğa tarafından oluşturulan alanlarda çok da yer altında var olan alanların dönüştürülmesi farklı amaçlarla kullanılmaktadır. Yer altının ile elde edilmiş korunaklı sağlık yapılarıdır. Günümüze kadar yer altında sağlık hizmetleri 292 Bıçakçı ve Ulutaş. Namık Kemal Tıp Dergisi 2019; 7(3): 291- 298 sadece özel dizayn edilmiş yer altı edilmiş, kalın betonarme ya da ahşap iskelete hastanelerinde değil binaların yer altında kalan sahip olmakla birlikte, ek güvenlik katmanı bodrum katları ve mağara hastanelerinde de oluşturmak için koruyucu zemin dolgu ile verilmiştir. kaplanmış yapılardır. Bu modelin bodrum kat ve mağara hastanelerine göre avantajı ihtiyaçlar Bodrum Kat Hastaneleri doğrultusunda kullanılan alanın Bodrum kat hastaneleri sağlık hizmet genişletilebilmesidir. Bununla beraber tamamen sunumunu yer altında devam ettirmek amacıyla yeni bir yapı inşası olduğu için maliyeti yüksektir en fazla kullanılan yer altı sağlık yapılarıdır. ve yapılışı uzun süre gerektirmektedir6. Genellikle ani gelişen durumlarda, hazırlık yapılmaksızın o anki saldırının etkisini azaltmak Yer Altı Hastanelerinin Tarihçesi amaçlı kullanılırlar6. Yeni bir yapı inşa etmek Yer altı hastanelerinin kayıtlı tarihçesi orta çağa yerine boş olan okul, fabrika veya diğer kadar uzanmaktadır. Günümüzdekilere benzer; binaların bodrum katlarının yeniden dizayn savaşlardan, salgın hastalıklardan korunma, edilerek sağlık hizmeti verilebilecek alanlara tedavisi henüz bulunmayan bazı hastalıklar için dönüştürülmeleriyle oluşturulurlar6. Zemin tedavi araştırılması gibi nedenlerle insanlar orta üzerindeki yapılar kum ve çimento kullanılarak çağda da yer altı hastanelerinden güçlendirilebilir6. Bodrum kat hastaneleri faydalanmışlardır. Bu dönemin günümüze mevcut yapıyı taban olarak kullandığı için kolay kadar ulaşan örneklerinden biri İtalya Pistoia’ ve ucuz, güvenlik açısından ise en savunmasız daki “The Spedale del Ceppo” hastanesidir. Bu yer altı sağlık yapılarıdır. hastane o tarihlerde “Kara Ölüm”
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