BİLKENT ANKARA INTEGRATED HEALTH CAMPUS PROJECT

Transcription

1 BİLKENT ANKARA INTEGRATED HEALTH CAMPUS PROJECT NON-TECHNICAL SUMMARY OF THE ESIA REPORT November 2014 ANKARA

2 BİLKENT ANKARA IHC PROJECT NON-TECHNICAL SUMMARY OF THE ESIA REPORT Version Revision Date Prepared by Reviewed by Approved by Draft A T. Huyuk Env. Eng. E. Kaya Sociologist G. Ertürer Env. Eng. D. E. Kaya Env. Eng. G. Özenirler Env. Eng, M. S. Final Draft B T. Huyuk Env. Eng. E. Kaya Sociologist G. Ertürer Env. Eng. D. E. Kaya Env. Eng. G. Özenirler Env. Eng, M. S. Revision Codes: A (Draft), B (Final Draft), C (Final) Project No.: 12/005 November 2014 Client: Consultant: Bilkent Ankara Entegre Sağlık Hizmetleri Yatırım ve İşletme A.Ş. Üniversiteler Mah Cadde No: 09 Çankaya - ANKARA/TÜRKİYE : +90 (312) : +90 (312) Mühendislik ve Danışmanlık A.Ş. Tepe Prime İş ve Yaşam Merkezi Mustafa Kemal Mahallesi Dumlupınar Bulvarı No: 266 C Blok Kat: 5 Daire: Çankaya / ANKARA / TÜRKİYE : +90 (312) : +90 (312)

3 TABLE OF CONTENTS 1 INTRODUCTION OBJECTIVES of the ESIA PROJECT DESCRIPTION Project Overview The Project Company and Lenders Project Location Project Facilities Area of Influence and Associated Facilities Traffic Arrangements Hospital Closures Project Alternatives Project Site Alternatives Technology Alternatives ESIA PROCESS AND APPROACH TO THE ASSESSMENT ENVIRONMENTAL AND SOCIAL IMPACT ASSESSMENT (ESIA) Impacts on the Physical Environment Impacts on Air Quality Noise Impacts Wastewater Impacts Impacts on Soil Quality and Groundwater Geo-hazards Project No.: 12/005 1 / 32

4 5.1.6 Waste Generation Traffic Ecology Impacts on the Social Environment Resettlement Population Influx Interactions with Workers during the Construction Phase Increase in Population during the Operational Phase Local Economy and Local Livelihoods Economic Impacts as a Result of Hospital Closures Community Health, Safety and Security Security within and around the Project Site during Construction and Operation Infectious Disease Control Emergency Event: Fire Safety Fire Safety During Construction Fire Safety During Operation Access to Services and Infrastructure Occupational Health, Safety and Working Conditions Cultural Heritage Cumulative Impacts ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN STAKEHOLDER ENGAGEMENT AND PUBLIC DISCLOSURE Project No.: 12/005 2 / 32

5 1 INTRODUCTION This document is the summary of the final draft Environmental and Social Impact Assessment (ESIA) report for the Ankara Bilkent Integrated Health Campus Project (hereinafter the Project ). It has been prepared by 2U1K on behalf of the Bilkent Ankara Entegre Sağlık Hizmetleri Yatırım ve İşletme A.Ş. (the Project Company). The Project Company is committed to full compliance with all Turkish EIA Regulations, the international lending Performance Standards of the International Finance Corporation (IFC), Performance Requirements of the European Bank for Reconstruction and Development (EBRD) and Equator Principles. Project No.: 12/005 1 / 32

6 2 OBJECTIVES of the ESIA The ESIA Report aims to describe the Project and the impacts it is predicted to have on the environmental and social baseline conditions. Furthermore, it aims to explain how the Project has been designed and how it will be implemented in order to minimize its adverse impacts and maximize its benefits. This document is a summary of the main ESIA Report. Project No.: 12/005 2 / 32

7 3 PROJECT DESCRIPTION 3.1 Project Overview The Project is to be realized on a 120 ha area plot of land in the District of Çankaya in the City of Ankara, Turkey. In addition to the construction of the health service buildings, plans have been made to integrate a Clinic Hotel, a commercial zone, and an administration building for the Ministry of Health (MoH) into this modern health campus. The IHC shall also include a forensic psychiatric hospital and a physical therapy and rehabilitation hospital. The campus shall benefit from the services provided by a tri-generation plant, which shall produce the electricity needs of the campus while reclaiming waste heat to meet some of the facility s heating and cooling needs. Ultimately, the Project will possess 3,704 bedscapacity. The construction of the Project has been projected to span 42 months, after which the Project Company shall implement its operation for a period of 25 years before handing it over to the Ministry of Health. 3.2 The Project Company and Lenders The Bilkent Ankara Entegre Sağlık Hizmetleri Yatırım ve İşletme Anonim Şirketi (Project Company) is the Special Purpose Vehicle (SPV), which was established by a consortium consisting of Dia Holding FZCO and İC İçtaş İnşaat Sanayi A.Ş. (the Consortium), has been awarded the contract for the construction and operation of the Ankara Bilkent Integrated Health Campus Project (the Project) by the Ministry of Health. During the 25 operation year term, the MoH will pay annual rent to the Project Company. Turkey has been implementing the World Bank s Health System Strengthening (HSS) Program since 2003, supported by the World Bank through a lending program and policy dialogue. As part of the HSS Program, the MoH initiated a process of reconstruction in A Public Private Partnership (PPP) Department was established in the Ministry of Health to manage investments in the health sector. The Bilkent IHC Project is being developed as part of the HSS Program and the wider Public-Private Partnership (PPP) Program in Turkey. The PPP program involves the development of approximately 30 new healthcare facilities with a total capacity of over 26,000 beds and a total investment cost in excess of USD 10 billion. The concept of this Project No.: 12/005 3 / 32

8 program is that the private sector finances the design, construction and supplementary facilities of the project and the MoH is responsible for providing clinical staff. Ankara has two Health Regions, Bilkent, as mentioned and one in Etlik. The Bilkent Region, or the 11 th Health Region, shall serve 4,513,150 people from the Ankara Province. It covers the Districts of Evren, Şereflikoçhisar, Nallıhan, Güdül, Beypazarı, Polatlı, Çamlıdere, Kızılcahamam, Haymana, Bala, Ayaş, Kazan, Gölbaşı, Mamak, Sincan, Etimesgut and Çankaya. In addition to the population of Ankara, the Bilkent IHC shall service the nearby provinces of Çankırı, Karabük, Kastamonu, Zonguldak, Bartın and Bolu. 3.3 Project Location The Project site is located in the Çankaya District of Ankara Province of Turkey. Figure 1 provides a location map of the Project site and a satellite image is provided in Figure 2. The Project Site is close to three of the most important universities in Turkey, namely Middle East Technical University (METU), Bilkent University and Hacettepe University. It is neighbored by a rehabilitation facility for the Turkish Armed Forces to the south, the Directorate of Religious Affairs and State Council to the north and the Ministry of Food, Agriculture and Livestock (MoFAL) to the northwest. The vacant land to the west of the Project Site is the property of the Directorate of the Atatürk Forest Farm. Project No.: 12/005 4 / 32

9 Project Site Source: Official website of TR General Directorate of Highways Figure 1: Location of the Project in relation to the City of Ankara and Turkey Project No.: 12/005 5 / 32

10 AFF Property Ministry of Food Agriculture and State Council Subway Station Property Livestock Directorate of Religious Affairs Rehabilitation METU Facility of Turkish Armed Forces State-Owned Civil Servant Dwellings Hacettepe University Bilkent University Property Source: Official website of TR General Directorate of Highways Figure 2: Establishments in the Vicinity of the Project s Location Locating the Project in Bilkent is a strategic decision. Bilkent is situated next to the Eskişehir highway providing easy access to those commuting from outside of Ankara. It is also relatively close to the highway that circles Ankara s perimeter. Bilkent is currently serviced by buses, minibuses and metro. Thus, this location is convenient for the citizens of Ankara as well. Finding such a large undeveloped plot of land in such a convenient location is difficult. 3.4 Project Facilities The Bilkent IHC is to be a large urban development situated on a tract of land sized 120 ha. The proposed Bilkent integrated health campus will host a total capacity of 3,704 beds which shall be distributed throughout its many facilities. Its core facility is to be its core diagnostic center, which will host the emergency services and will supply the diagnostic needs of the hospitals it services. A burns unit will also be housed in this core. Connected to this core diagnostic center will be six towers, each a different hospital specializing in a different area of medicine. These specialty hospitals shall include a general hospital, a women s hospital, a children s hospital, a Project No.: 12/005 6 / 32

11 cardiovascular surgery hospital, an oncology hospital and an orthopedic and neurological sciences hospital. In addition to the hospitals housed in the towers, a physical therapy and rehabilitation hospital and a high security psychiatric hospital (or forensic hospital) is also planned. In addition to these services, a 100-bed clinic hotel is planned in the context of the Project. Furthermore, an administrative building is to be built for the use of the Ministry of Health (MoH). A simplified layout of the Project Complex has been provided in Figure 3. Figure 3: Simplified General Design Layout of the Bilkent IHC. The Project is to produce some of its own power through the use of a tri-generation plant with an installed capacity of 39.0 MWt. The trigeneration plant will comprise four gas engines each with an installed capacity of 9.75 MWt. The remaining electricity shall be obtained from the national electricity grid. Furthermore, as part of the technical services provided at the Bilkent IHC, there will be a water treatment system which will supply water to the entire Bilkent IHC. It will use filters and active carbon to purify the water. During the construction of the Project, it is expected that 8,000 workers will be employed during the peak height in activity. In order to provide accommodation for the employees except the locals who live in and commute within Ankara, a labor camp will be established within the Project Site. Project No.: 12/005 7 / 32

12 Construction activities have commenced in September Currently, site offices and part of the workers accommodation area have been already mobilized and mobilization activities are ongoing. 3.5 Area of Influence and Associated Facilities The Area of Influence includes all hospital buildings and the commercial areas and associated facilities of the Project such as primarily Atatürk Training and Research Hospital and other institutions in the immediate surroundings. Area of Influence also includes the concrete batching plant and the municipal wastewater treatment plant, landfill and debris dump site, which will serve for the Project-related wastes. The Metropolitan Municipality is planning to construct a new parallel road to the north of Eskişehir Highway. Secondly, another road is planned to connect the eastern gate of the campus in order to bypass Eskişehir Highway. In addition to these, there are also plans for new roads that will connect the campus to newly developing settlement areas in the west of the city. These roads are planned within the scope of the city development plans. In addition, it is not clear at this stage when the construction will start and thus it is not certain whether the construction activities having similar adverse impact on the environment will coincide. Thus, these roads are not included in the Area of Influence. Etlik Integrated Campus Project, which is the second large-scale project to be developed in Ankara, is also included in the Area of Influence and cumulative impacts are discussed in the ESIA report and summarized in Section Traffic Arrangements A traffic assessment and modeling study has been made in order to arrange traffic in an efficient manner. It is planned to allow vehicle and pedestrian entrance to the hospital from two locations. Entrances are to be provided from the east and west for emergency vehicles and pedestrians. These spots have, at the same time, been designed as main entrances to the underground parking lot. Emergency vehicle and pedestrian entrance is also to be provided from the entry to the north. The internal parking lot will take up two floors. The project designs include no pedestrian roads/sidewalks around the building. 3.7 Hospital Closures Once the Project and the Etlik Integrated Heatlh Campus are operational, twelve existing state hospitals will be closed and the employees of these hospitals will be assigned to the Etlik and Bilkent Integrated Health Campuses. These hospitals include Sami Ulus Project No.: 12/005 8 / 32

13 Maternity and Child, Zekai Tahir Burak Training and Research, Altındağ Physical Medicine and Rehabilitation, Numune Training and Research, Türkiye Yüksek İhtisas Training and Research, Ulus State, Dışkapı Training and Research, Etlik Zübeyde Hanım Maternity, Gazi Mustafa Kemal State, Abdurramnan Yurtasan Oncology, Ulucanlar Eye Training and Research hospital and the Atatürk Training and Research Hospital. Time frames of these closures have not been provided by the MoH, but closures are expected to occur once the Project is operating. 3.8 Project Alternatives Project Site Alternatives About 76.7 ha of the land where the Project will be realized is the property of the Treasury, and was allocated to the Ministry of Health upon designation as a "health campus area" in the "1/25,000-scaled 2023 Master Plan of the Capital of Ankara". Additionally, 39.2 ha of the area is in the forest register, i.e. owned by the Ministry of Forestry and Hydraulic Works. The MoH obtained consent from the former and the Ministry of Environment and Forestry to use the site for a period of 49 years. The Project Site is advantageous in that respect - a property of the Treasury which partly houses another hospital and a very large plot for such a major development. The Project Site is also away from the crowded parts of the city. This site is considered further advantageous due to the fact that it possesses ease of public transportation. The site is located very close to a station along the new subway line. Its location is also close to a main artery of the city, Eskişehir Highway. There are, in fact, only two sites within Ankara that are large enough to hold such a facility, owned by the public and close enough to the city to be relevant. Yet, this other site is already planned to be used for the other Health Campus Project, in Etlik. Thus, no other alternative sites have been evaluated for this Project Technology Alternatives The Project Company intends to build a health campus, which is superior to previous health facilities in terms of energy efficiency. The health campus will also utilize high-tech medical devices for time efficiency in provision of health services. In other words, more patients will be served in a facility with almost the same bed capacity as the total of those to be closed. Examples of such high-tech devices are as follows: Robotic pharmaceutical preparation system; Da Vinci Robot (urology, women's health); MR device and accessories (intraoperative) 1.5 and 3 Tesla; Project No.: 12/005 9 / 32

14 Magnetic Navigated Coronary Angiography System; Magnetic Navigated Coronary Angiography System; Baby food preparation robot. In addition to these devices, proton therapy will also be used in the health campus. Proton therapy is an advanced treatment for cancer. It is more effective as compared to conventional x-ray therapy methods. In proton therapy, higher doses can safely be used since less damage is given to healthy tissues and vital organs with less side effects. Many energy-efficient systems will be employed in the health campus. These systems firstly include trigeneration plant. In this system, electricity, heat and cooling are produced simultaneously using natural gas as fuel. Traditional gas turbines typically operate at an efficiency of 35% whereas trigeneration systems operate up to 85% by converting 45% of the source energy to electricity, 40% to heating and cooling. Heat and line losses typically take up 13% and 2%. In addition to this, blower and exhaust fans as well as circulation pumps and pumps used in a part of the cooling system will be frequency-controlled to save energy. Use of frequency-controlled pumps will decrease annual total energy consumption by 25%. 4 ESIA PROCESS AND APPROACH TO THE ASSESSMENT The methodology for predicting impacts of the Bilkent IHC Project consists of a multistage iterative approach in order to predict and evaluate the potential effects the Project could have on the physical, biological, social and cultural environment. Measures are then identified that the Project will take to avoid, minimize, mitigate or compensate for any adverse impacts; and to enhance positive impacts where possible. Results continue to be revisited and modified as the assessment progresses and as Project effects are monitored. In summary, potential Project interactions with the environmental and social environment are identified and the significance of resulting impacts rated as Negligible, Minor, Moderate or Major. Once the significance of a given impact has been characterised, appropriate mitigation or enhancement measures are identified and the significance of resultant residual impacts assessed. Residual impacts are also rated as Negligible, Minor, Moderate or Major. It is important to note that the ESIA has been prepared taking into account the results of stakeholder engagement to date and review by the Lenders and their advisors. An Environmental and Social Management and Monitoring Plan has been prepared to cover all the mitigation measures identified to minimize potential environmental and social impacts that might result from the Project. Based on the gaps and the improvement areas identified during the ESIA process An Environmental and Social Action Plan (ESAP) has Project No.: 12/ / 32

15 been developed with which the Project Company must comply with to ensure that Lenders environmental and social requirements are met for the Project. Project No.: 12/ / 32

16 5 ENVIRONMENTAL AND SOCIAL IMPACT ASSESSMENT (ESIA) The ESIA Report is a public document that provides information to local stakeholders to help them understand the development and its potential effects. The ESIA assesses the baseline environmental and social conditions and applies several modeling studies and analyses for assessment of impacts and recommends mitigation measures against impacts identified. This Non-technical Summary presents a brief description of the Project and identifies and describes its potential environmental impacts. Copies of the NTS are available free of charge from upon written request or can be viewed on its website; Impacts on the Physical Environment Impacts on Air Quality Construction Phase Three major sources of potential impacts on air quality during the construction phase of the Project are the generation of dust from earthworks, concrete preparation and the movement of vehicles on unpaved surfaces in addition to the release of emissions from construction equipment and vehicles at the construction sites and workers accommodation. The exhausts from construction equipment, diesel-fueled units and vehicles will also result in the release of exhaust gases such as nitrogen oxides (NO X), sulfur dioxide (SO 2) and carbon monoxide (CO). Carbon dioxide (CO 2), which is a greenhouse gas, will also be released. Baseline survey of air quality for PM 10 was conducted at the four closest sensitive receptors (State Council-Directorate of Religious Affairs, Ministry of Food, Agriculture and Livestock (MoFAL) Lodgings, Military Rehabilitation Lodgings and Ataturk Research and Training Hospital.) and the area of concrete batching plant. The results indicated that PM 10 values at the site were below the local limits for this parameter. In order to predict the impact of the Project on ambient air quality, dispersion modelling was carried out for the Project. All modelled values are based on the worst-case scenario where geographic conditions have not been taken into consideration. In addition, it is assumed that all of the sources are working at the same time and same location.the results of this modeling indicated that the legal limits for PM will be exceeded at the MoFAL Lodgings and Military Rehabilitation Lodgings, whereas EU limit is exceeded at (MoFAL) Lodgings, Military Rehabilitation Lodgings and Ataturk Research and Training Hospital. However, since excavation works and main construction activities will not Project No.: 12/ / 32

17 coincide with each other and modelling results presents the worst case scenario, the lower concentrations are expected. A series of mitigation measures will be taken to suppress dust. A minimal number of vehicles will be used in areas close to the sensitive receptors. All inner roads (with the Project site) and areas where trucks move including excavated and leveled areas will be watered regularly under warm, dry and windy weather conditions. Material will be loaded and unloaded without sluing. A speed limit of 30 km/hour will be set and enforced on non-paved roads. The top of the trucks will also be covered while carrying the excavation materials to the landfill of the Metropolitan Municipality. The exhaust emissions of the heavy machinery will regularly be measured, controlled and recorded by site staff from authorized institutions. Pollution prevention measures pertaining to the concrete batching plant will be employed. The silo conveying systems will be totally enclosed. Following the implementation of mitigation measures the residual impacts on air quality during construction are assessed as negligible. Operation Phase There will be a tri-generation plant having four units of natural gas-fired gas engines. In addition to the tri-generation plant, five natural gas-fired boilers will also be established in order to satisfy heat and hot water demand of the Project. NO x, CO and greenhouse gas (GHG) emissions to be originated from tri-generation plant and boilers are considered as the major and continuous source of air emissions during operational phase. In order to estimate emission, modelling studies were carried out for NO 2 parameter for operation activities (for emissions from the tri-generation system and boilers) based on three scenarios. According to the results of this modelling study, it was concluded that the values obtained for all scenarios were significantly lower than the associated limits to be complied by the year 2024 which are set forth by the RAMAQ and IFC EHS General Guidelines limits. To mitigate air emissions originated from the stacks of gas engines and boilers, NOx emission control measures such as of dry-low NO2 burners and DeNOx system will be implemented. In addition, the trigeneration plant will be designed to comply with the relevant national and EU air emission standards and Stack heights for trigenaration plant and boilers will comply with the minimum height requirements set out the IFC EHS Guidelines. Project No.: 12/ / 32

18 With the implementation of this design, air emissions during operation are predicted to be within national limits and IFC limits, therefore the significance of the impact is assessed as minor. Annual GHG emissions to be possibly originated from the Project calculated as 119,814.4 tones CO 2eq make up 0.1% of the GHG emissions for Public Electricity Generation and Heat Combustion sub-sector in Moreover, calculated annual GHG emissions of the Project are approximately 0.03% of the total GHG emission of Turkey in According to the European Environment Agency records, the GHG emissions of Turkey make up about 0.4% of the total GHG emissions in the world, in comparison, the Project s GHG emissions will be approximately of the world s total Noise Impacts Construction Phase Construction phase of the proposed Project has the potential to create noise through the use of equipment and increased road traffic. Noise may cause temporary nuisance to the people living in the surrounding settlements. Limit value for environmental noise given in Appendix VII of the Regulation on Assessment and Management of Environmental Noise is 70 dba for construction sites. According to this regulation, construction activities can continue during evening and nighttime provided that necessary permission is obtained from the Local Environmental Committee through applying to the Provincial Directorate of Environment and Urbanization. In this case, limit values are 65 dba and 60 dba for the evening and nighttime, respectively. The IFC Environmental, Health and Safety General Guidelines (2007) require 55 db(a) during the day-time (07:00-22:00) and 45 db(a) for night. According to the IFC, the relative change in noise level at which noise abatement measures will be applied is identified as a maximum increase in background levels of 3 db(a). Turkish legislation has the same requirement at 5 db(a). Two baseline studies were performed. Background noise levels at the closest receptors were found to be between 38 dba to 53.5 dba depending on location and time of the day according to the first baseline study. According to the second baseline survey, hourly background noise levels at the MoFAL Lodgings and Military Rehabilitation Lodging ranged between 39.5 dba and 53.5 dba and between 47.6 dba and 62.4 dba, respectively. Noise modeling indicated that increase in the background levels are approximately 5.5 dba and 15 dba at the Atatürk Research and Training Hospital and MoFAL Lodgings, whereas the construction activities will not result in a maximum increase in background levels of 3 dba at the only Military Rehabilitation Lodgings. Project No.: 12/ / 32

19 According to results of noise measurements that will start in the context of environmental monitoring studies, noise curtains will be installed to reduce noise level due to construction activities below limit values ; and regular maintenance of the machinery will be made to reduce noise from the machinery. Following the implementation of these mitigation measures, noise levels during construction will be within the limits prescribed by Turkish legislation and the IFC EHS General Guidelines. Therefore the significance of the impact, post mitigation, is assessed as negligible. Operation Phase The main source of noise will be the engines in the tri-generation plant and the generators. Occasional noise will occur due to the emergency generators and helicopter movement. Acoustical performance of air inlet silencers, exhaust silencers, air outlet silencers and walls during to the operational phase will be maintained as necessary to comply with IFC standard for outdoor noise and Turkish standards for indoor noise. With the embedded design measures (i.e. four meter high noise barriers around the sources), the significance of noise impacts during operation are assessed as insignificant and proposed mitigation measures have been shown to be sufficient Wastewater Impacts Construction Phase Through all periods of the project water will be consumed and wastewater will be produced. During the construction phase of the Project, drinking and potable water will be required by the construction staff and for the cleaning of construction equipment. In addition, water will be used in construction activities such as dust suppression and concrete preparation. Domestic wastewater will be generated from personnel. In addition to domestic wastewater, silty wastewater will be generated at the concrete batching plant. Connection to the sewerage system will be made through the branch of sewerage system passing next to the Project site. Wastewater that will be discharged to the sewerage system will be conveyed to the municipal Tatlar wastewater treatment plant of the Metropolitan Municipality of Ankara. Hence, no adverse impacts, due to direct discharge of wastewater onto the soil are expected. Impact significance will be negligible if the aforementioned mitigation measures are employed. Project No.: 12/ / 32

20 Operation Phase During operation, total water consumption is expected to be around 2,200 m 3 per day, most of which will be converted to wastewater. There will also be contaminated wastewater discharged from medical wards, operating theatres, laboratories, pharmaceutical and chemical stores and x-ray development facilities. A portion of the wastewater that will come from the administration building of the Ministry of Health will be grey water, and it will be used for irrigation after proper treatment. Hazardous wastewater from laboratories will be treated in a treatment plant outside the hospital building before being discharged to the municipal sewerage system. A detailed design of this treatment plant has not been completed yet. The wastewater treatment plant will be designed to ensure compliance with the wastewater discharge criteria given in the Regulation of ASKI on Wastewater Discharge to Sewer. Besides impacts on water quality, the extra flow load that will be brought to the sewerage system is an important issue that has been considered and addressed by the Project design. Although the health campus will replace the existing hospitals, there may be an additional load due to high number of visitors. ASKI stated that a new large municipal wastewater treatment plant is to be constructed in two years, and put into operation. This new treatment plant shall lessen the load received by the Tatlar WWTP. Thus, no connection problem is foreseen. Impact significance will be negligible when the proposed mitigation measures are employed Impacts on Soil Quality and Groundwater The quality and stability of the soils and groundwater on site might be affected by earthworks, discharge of silty water from concrete batching and accidental leakage of chemicals to be used. The topsoil that is to be stored long term will be covered with a grass layer in order to prevent erosion. This topsoil will be used in landscaping activities later. The topsoil piles and all excavation material mounds will be stabilized in order to prevent accidents. There may be accidental spills or leakage of construction chemicals, fuel and other chemicals to be used in the site. Such spills or leakages may result in soil and groundwater pollution as stated above. In order to mitigate such impacts, measures will be taken such as secondary containment around chemical and fuel tanks, good housekeeping practices all over the site, etc. In addition, particular care will be given for oil changes and refueling to take place in designated locations on impermeable surfaces, Project No.: 12/ / 32

21 such as metal sheeting. In order to protect intrusion into groundwater, any soil that has been contaminated will be removed, with a reasonable buffer zone, and placed in the temporary hazardous waste storage area. This will later be taken to the hazardous waste landfill in Sincan. No significant impact is expected on soil quality at operation and construction phases, provided that good waste, chemical and wastewater management practices are implemented at the site Geo-hazards The most significant geo-hazard during both the construction and operational phase is the threat of an earthquake, and thus this was a focus for the design team. The structural design of all the buildings in the health campus will be made according to the criteria stipulated in the relevant legislation on earthquakes (e.g. the Regulation on Buildings to be constructed in Potential Earthquake Areas). Regarding this, the design team has also made the necessary arrangements for building evacuation and escape routes in case of such incidents. With the implementation of these design measures, seismic risks are assessed as minor significance Waste Generation Non-Hazardous Waste at Construction Phase Domestic solid waste and packaging waste will be produced by the construction staff at both the workers accommodation sites and the construction sites. The generation of construction waste, including cables, empty containers of various sizes, steel etc., is expected. There will be also worn-out tyres from the construction machinery and vehicles. It has been estimated that there will be approximately 8000 kg of domestic solid waste produced from construction workers on site. In addition, excavated material to be disposed off-site has been calculated by the design team as total of 64,480 m 3. Besides domestic solid waste, there will be packaging and recyclable wastes, e.g. steel, plastic and wood, from construction and the demolition of existing buildings. However, the quantity of these wastes is not known at this Phase. Separate collection of packaging waste is important since it may be recycled or recovered to gain additional economic benefits and reduce pressure on raw materials. Separating Project No.: 12/ / 32

22 this waste on site saves the energy of staff at the Sincan Landfill where separation is conducted on-site. Çankaya Municipality will collect the solid wastes generated at the construction site collected on a daily basis and transport it to the Sincan Landfill. Packaging wastes will be collected by the staff of a licensed packaging waste recycling firm. As the dumping of excavated material damages landscape, excavated material that will not be re-used at the site will be sent to the licensed disposal areas of the metropolitan municipality. Worn-out tyres will be changed by the authorized sellers in order not to allow generation of such wastes in the site. In addition, vegetable top soil will be stored in a separate part of the temporary storage area. Top of vegetable will then be used in landscaping works at the end of construction. As part of the Environmental and Social Management System, a robust site-specific waste management plan has been prepared, and implemented by the construction site management for separate collection of different types of wastes and temporary storage of wastes. Impact significance will be negligible with the proposed mitigation measures. Non-Hazardous Waste at Operational Phase Non-hazardous waste expected to be produced during the operation phase of the Project can be classified as domestic solid waste and packaging wastes. It has been estimated that approximately 14.7 tons non-hazardous wastes will be generated daily. There will be also worn-out tyres from the vehicles. Solid waste to be generated at the health campus will be temporarily stored at the waste storage area and collected by the Çankaya Municipality, and taken to the Sincan Landfill of the Ankara Metropolitan Municipality. Hence, adverse impacts of improper waste management such as soil pollution and odor are not expected to be observed. In addition, according to interviews of the ESIA team with the authorized people from Çankaya Municipality, additional load that will be brought about by the health campus is an amount that can be handled. Worn-out tyres will be changed by the authorized sellers in order not to allow generation of such wastes in the campus. The overall significance of the impacts that could be incurred because of solid waste during the operational phase have been considered and evaluated as being minor. Project No.: 12/ / 32

23 Hazardous Waste at Construction Phase These wastes include, but are not limited to, oily rags, used air and oil filters, waste fluorescents, used cartridges as well as waste oil, waste vegetable oil, waste batteries and accumulators. Given that there are several licensed collection and intermediate storage companies in Ankara, hazardous waste management is not expected to be problematic. This fact is further compounded by the fact that a new hazardous waste landfill has been constructed in Ankara. Hazardous wastes will be stored in a concrete-sealed, fenced and covered temporary storage area in order to prevent spill and leakages onto the soil and protect it from precipitation. Besides, hazardous wastes will also be taken to the nearby hazardous waste landfill in Çadırtepe which is operated by the ITC. Impact significance will be minor as the existing infrastructure is quite robust, mitigation measures are embedded in the Project and a waste management plan has been put in place. Hazardous Waste at Operation Phase As medical wastes are considered separately from hazardous waste in the ESIA Report, there will be a limited amount of hazardous wastes produced during the operational period. These hazardous wastes shall include, but are not limited to, empty containers of chemicals, used cartridges, fluorescent lamps, used batteries and oily rags or equipment resulting from maintenance works as well as waste oil, waste vegetable oil and waste batteries and accumulators. A waste storage area is to be built which will be surface-sealed and closed. It will not allow spills or leakages of hazardous wastes onto the soil. Hazardous wastes will be sent to the licensed recovery/disposal facilities by licensed transporters. Impact significance will be minor with the infrastructural arrangements and mitigation measures described above. Medical Waste at Construction Phase In the construction phase, medical waste will be generated at the infirmary that is to be established on-site, from routine medical assistance as well as from emergency response. Medical wastes that will be generated during first aid applications at the infirmary will be put in double layered red colored medical waste bag with the label Medical Waste, pursuant to the Medical Waste Control Regulation. Used injectors and other sharp edged materials in the infirmary will be put in closed containers made of hard plastic. Medical waste will be taken to the nearest health institution by the camp site doctor. Project No.: 12/ / 32

24 Impact significance is considered as minor provided that the proposed mitigation measures are in place. Medical Waste at Operation Phase In the operational phase, medical waste will include, but is not limited to, microbiological laboratory wastes, waste blood samples and objects contaminated with blood, used surgery clothes, dialysis wastes (wastewater and equipment), air filters containing bacteria and viruses, injector needles, laboratory cultures and broken glass and similar objects. It has been estimated that there will be approximately 8600 kg of medical waste generated in the health campus each day. Medical waste bins, suitable for the purpose of use, will be supplied in all clinics, polyclinics, diagnosis and treatment areas, medication preparation units and all other areas. Adequate amounts of medical waste bags, autoclave (i.e. sterilization) bags, waste labels and other consumable materials are kept available. Filled medical waste bags and sharp bins are collected and replaced regularly according to occupancy of the relevant unit. A waste storage building will be constructed and medical wastes will be temporarily stored in this area to prevent contamination. Medical wastes will be transferred to this building from waste collection spots to be established at the basement of each tower. After each use, the waste collection and handling tools (waste bins, transport containers, etc.) will be disinfected at the temporary storage area. As of the Medical Waste Control Regulation, medical wastes will be collected from the health campus by licensed vehicles of Greater Municipality of the Ankara Metropolitan and then taken to the incineration plant which has been recently erected near the hazardous waste landfill in Çadırtepe. This incineration plant is to be operated by the ITC on behalf of the Municipality. A Medical Waste Management Plan will be in place in the context of the Health Care Waste Management System (HCWMS) as per national legislation and IFC requirements. Impact significance is considered as minor provided that the proposed mitigation measures are put into place. Radioactive Waste During the operational phase, radioactive wastes including solid, liquid, and gaseous materials that have been contaminated with radionuclides shall be produced from various medical technologies and processes. Project No.: 12/ / 32

25 Radioactive waste will be stored in containers labeled with the radioactive symbol to limit dispersion. These containers will be stored behind lead shields. Management will be carried out according to national requirements and international guidelines. A radioactive substance management plan will be prepared prior to the operation phase. Impact significance is considered as minor provided that the proposed mitigation measures are put into place. 5.2 Traffic In the construction phase, major impact of the Project on the local traffic is due to movement of trucks bringing construction material into site and taking excavated material and demolition debris from the site. In addition to surroundings of the Project Site, increase in traffic load might also be seen near the excavated material disposal area. A dump site has been designated for both disposal of excavated material from both of the health campus projects. Trucks carrying excavated material will use different main arteries. Thus, the other project is not expected to add up to impacts on traffic. Construction and excavated material flow into and out of the site will be made from the streets with low traffic such as the southern and western streets. Morning and evening rush hours on week days will be avoided. Any stipulation of UKOME will also be taken into consideration. In operational phase of the Project, traffic load near the campus will increase due to ambulance movements, transportation of patients, visitors and other people visiting the campus by private cars in addition to public transportation. A traffic assessment study has been carried out by the design team to describe the existing traffic conditions in the surrounding arteries. Results of the survey were used to identify necessary traffic arrangements. As proposed in the Traffic Assessment Study, duration of traffic lights will be adjusted to prevent traffic congestion. The SPV will work together with the Greater Metropolitan Municipality of Ankara, which is conducting a joint project with Gazi University in order to produce a transportation plan for the city of Ankara. The Bilkent IHC Project has been taken into consideration of this plan, as have the thoughts of 45,000 survey participants. As a result of this study, the Main Transportation Plan for Ankara will be prepared. This plan is aimed to understand the needs of the transportation infrastructure and recommend necessary investments and arrangements to have a proper transportation system in the city. This project is believed to include significant measures to reduce negative impacts of the Project (and other proposed developments) on the local traffic. Project No.: 12/ / 32

26 By the implementation of various mitigation measures and collaboration with the Greater Municipality, although a significant traffic increase is expected, the residual impact is expected to be moderate. 5.3 Ecology It is expected that, there will only be limited impacts on both flora and fauna of the region during both the construction and operational phase due to the low biodiversity of the project area. No endemic or threatened plant species have been identified at the project site. Additionally based on the surveys, fauna species rarely visit the project site due to the current poor habitat quality and thus it is unlikely noise created by the facility will be a crucial disturbance factor for the inhabiting faunal community around the region. Post construction landscaping works will employ native species and measures will be in place to stop the accidental transfer of invasive species to the region. In order to reduce impacts on vegetation placed by the aforementioned landscaping works, an Integrated Pest Management system will be established in line with PR3 of the EBRD. With the mitigation suggested above in place, residual impact is estimated as negligible. 5.4 Impacts on the Social Environment Resettlement Atatürk Training and Research Hospital, six businesses of the Atatürk Training and Research Hospital, two occupied public dwellings, and a dairy farm will be resettled to a different residence or to a different place of employment. The details are given in the following paragraphs: i. The Atatürk Training and Research Hospital will continue to operate through the construction of the Project. The hospital is owned and managed by the MoH. When the Project becomes operational the Hospital will be closed and demolished. Medical and other MoH staff will be reallocated by the General Directorate of Health Services. ii. The canteens, restaurants and other shops in the hospital currently operating out of the Hospital will be closed as a result of the closure of the Hospital. The facilities are being leased from the MoH and privately managed. The contracts of these shops have expired and the MoH has not, and is not going to, renew their contracts. As the tender process for shops in the commercial area will be Project No.: 12/ / 32

27 transparent, the local shops and canteens of the Atatürk Training and Research Hospital will have the opportunity to apply to work within the Bilkent IHC. iii. The SPV compensated the first family s moving costs, one month s rent and the deposit of their new flat. Additionally, the SPV helped the family cover old debts related to the education of their children. The head of the family expects to receive a job from the Project. The SPV is planning to hire him as a gardener. The family currently lives in the Kazan district of Ankara. iv. The head of the second family continues to look after the dairy farm which was moved there. The SPV covered some of the children s education costs. The SPV also compensated the moving costs, one month s rent and the deposit of their new flat. The head of the family will be hired by the MoFAL as the civil servant. The family currently lives in the Sincan district of Ankara. The head of the family continues to work at the MoFAL. v. The owner of the goat farm was also moved to Kazan, in October 2013 with the assistance of the SPV. All moving costs of the dairy farm were covered by the SPV. The SPV also constructed a milking station, fence and concrete floor for the new dairy farm. With the implementation of all mitigation measures, negligible impacts are foreseen Population Influx Interactions with Workers during the Construction Phase During peak construction period up to 8,000 workers will be required. Temporary worker accommodation has been designed to house 6,000 beds. Therefore, at some time during the Project it is possible that 6,000 workers will live at the site. It is expected that construction workers will mainly come from within Ankara and neighboring cities. However, residents of the Universiteler and Beytepe Mahalles will most likely not be included within this workforce. Therefore, a significant increase in population is expected during the construction period. Stakeholders have expressed concern over construction workers causing social problems within the local communities and their impacts on safety and security. In this respect, a strict code of conduct will be developed and implemented for construction workers, outlining expected behavior with respect to their daily interactions with local residents and users of public amenities. This will be part of the labor force management plan to be developed for the project. The labor force management plan will also include requirements for induction and training on expected behaviors and on disciplinary procedures (including dismissal procedures for unacceptable conduct). Construction workers will be made aware of the Project No.: 12/ / 32

28 grievance mechanism and stakeholder engagement process, explaining that stakeholders have the right to register grievances through a formal procedure. Impacts are expected to reduce to negligible with the implementation of the described mitigation measures Increase in Population during the Operational Phase During the operation phase, it has been estimated that 5,000 medical staff will be directly employed with an additional 4,500 jobs being created from the medical and non-medical support services. Therefore, around 9,500 personnel will work at the campus. It is reasonable to postulate that many of these medical staff, especially those who are better off income-wise such as doctors, shall move to the Bilkent area for the sake of convenience. The Project could lead to a real estate boom as construction companies rush in to meet the housing demands of staff that are better off. Yet, Bilkent area truly is on the higher-end of the economic scale, thus, most workers will be unable to find affordable housing in the area. It is doubtful that even an increase in the supply of housing will be enough to lower the demand for housing enough to water down the prices. Thus, a significant influx of population to the Bilkent Mahalle in the form of residency is not likely. Only a significant influx of workers is expected. Key impacts associated with this influx in people are likely to be traffic noise, congestion and impacts associated with interactions with workers. All these impacts are discussed previously Local Economy and Local Livelihoods The arrival of this Project can potentially affect the local economy and local livelihoods in both positive and negative ways. However, it has been reasoned that the Project will predominantly result in benefits for the local economy and therefore the local people. These benefits are expected during both the construction and operational phases of the Project, but the operational phase shall render far more economic benefits than the constructional phase. The Bilkent IHC, including the hospitals, the commercial zone and the hotel will be a potential source for local jobs, particularly for students from the surrounding universities. The Bilkent IHC will have a Business Ethics Policy/Good Neighbor Policy that commits the Project to try and Buy Local as much as possible. The Project will also develop and implement human resources policies that will include requirements and targets regarding the hiring of local workers. In addition, there will be Project No.: 12/ / 32