A Nigerian eye hospital redefines climate-smart design

The rain had cleared by the time we arrived along University Road in Nsukka, leaving behind a cool afternoon and a soft, blueish hue across the sky. Inside the waiting lounge of The Eye Specialist Hospital (TESH), light pours in from above.

Through wide, open windows, the damp post-rain air moves in a natural breeze, sweeping away the heavy heat that usually settles over public spaces in south-eastern Nigeria.

In its central hall, metal waiting chairs stand beneath a high, curved translucent roof. Outside, palms, flowering shrubs and trees surround wicker chairs in an outdoor waiting area that feels closer to a garden cafe than a hospital.

For Professor Nkiru Kizor-Akaraiwe, an eye surgeon who started the clinic, the room is a huge change from the stuffy, low-ceilinged boxes common in modern Nigerian healthcare spaces: “Hospitals are places where people usually dread to go to; often an unpleasant environment. When I entered there after the panelling, it was spontaneous. I said, ‘Wow, this is amazing.'”

The designer behind that change is her daughter, Crystal Kizor: an architect, interior designer, and founder of Studio COKA.

At thirty-one, Kizor belongs to a growing group of West African designers questioning the reliance on hot, energy-hungry Western building styles. In a country where electricity is unpredictable, and the cities grow hotter, her work offers a clear answer: building homes and spaces that stay cool naturally, use daylight, and feel like home.

“The biggest design decisions, I would say, were two things,” Kizor said. “First of all, bringing in the translucent roof. That was big because, even as we went there today and the lights were on, they can actually put off the lights and they will still be able to function.”

The second was elevating the roof structure to allow natural ventilation

Nsukka remains warm for most of the year. Measurements at a local climate-observation station illustrate how hot individual days can become. A study using observations from 2011 and 2012 recorded maximum air temperatures above 36°C during the dry season and a peak of 37.67°C in March 2012. Even in the wet season, monthly maximums were around 30°C.

The hospital grew from an unmet need for specialist eye care. Kizor-Akaraiwe initially operated in Enugu but noticed that patients were travelling from Nsukka for treatment. Despite Nsukka’s size and status as a university town, she said it had no resident ophthalmologist.

Many available properties were residential flats unable to accommodate consultations, waiting areas and surgery. The hospital initially operated on the outskirts before its founders found an old building on University Road, closer to the university and residents.

Kizor believed the old residential structure could be retained and transformed. A more experienced architect handled structural work, including strengthening its pillars, before she developed its architectural and interior features. She then moved to Nsukka for about six months to supervise the project.

Kizor-Akaraiwe had initially been shown a conventional renovation proposal, but her daughter urged her to consider another approach. Her brief was simple: create something that would surprise people entering the hospital.

Kizor’s approach grew from questions she had asked since childhood. She remembers noticing crooked building edges on her way to school and wondering why they were not more carefully made. Dark, stuffy interiors affected her mood, while a hotel built around an open hall with large trees showed her how architecture could change how a person felt.

Kizor said the unusual building attracted people from the surrounding community, some of whom became patients. Its central location may also have contributed; the previous premises received fewer visits.
The idea that surroundings can affect patients has a longer research history. In a widely cited 1984 study published in Science, environmental psychologist Roger Ulrich found that surgical patients with views of nature had shorter postoperative stays and used fewer doses of strong pain medication than those facing a brick wall.

The need for buildings that remain comfortable without continuous air conditioning extends far beyond the hospital. Sustainable Energy for All estimates that 114.9 million Nigerians, 53% of the population at the time of its analysis, were at high risk because of high temperatures and inadequate access to cooling.

Across Lagos, Abuja and Enugu, concrete-block houses with low ceilings and windows that open only partly can trap heat and leave families dependent on air conditioning. Festus Adibe, an architect at Flexi-Space, said orientation, windows, roofs, shading and vegetation can reduce the need for artificial cooling.

“If you do your work well, you could work your ventilation so that you don’t need air conditioning at all, all year round,” he said.

Passive design uses cross-ventilation, trees, roof overhangs and shaded openings to limit heat and move warm air out. A 2022 study of residential design in Nigeria found that orientation, windows, shading and insulation can affect comfort and cooling demand.

“Any solution we have through design that keeps the sun away, the interiors will remain cooler, and so you won’t need to use AC as much,” Kizor said.

Adibe said solar panels should come after design has reduced energy demand.

“If you’ve done your job well, you won’t need as many solar panels and as many batteries because you’re not going to be needing to generate a lot of energy anyway.”

Adibe identified small windows, dark exterior surfaces and poor orientation as common causes of heat becoming trapped in Nigerian buildings.

“Tiny windows make it very hard for your ventilation to really work,” he said. “When heat enters the room, it gets trapped in the room.”

Nigeria has incorporated some of these principles into policy. The National Building Energy Efficiency Code, introduced in 2017, sets minimum requirements for new buildings, including solar shading and roof insulation. However, a 2023 assessment found limited implementation and enforcement.

Some design choices are driven by small plots, cost and security concerns. Others follow styles imported from different climates.

“Somewhere we saw minimalism online, or wherever, and it became a thing,” Adibe said. “When we’re copying minimalism, we’re not really following the principles. We’re just doing boxes and boxes and tiny windows and black buildings.”

Cost remains an obstacle. Larger windows, specialist design and solar systems can raise initial expenses. Local materials such as compressed earth blocks are not always readily available, while builders trained to use them can charge a premium.

“Access is a major factor,” Kizor said. “These materials and the technical skills aren’t widely available, so whoever knows how to use them charges a premium.”

Kizor encourages clients to spend on orientation, shading, overhangs and suitable windows before decorative columns or pillars. The important comparison, she said, is between construction cost and lifetime cost. A building that appears cheaper initially may require decades of spending on air conditioning, electricity, generator fuel and maintenance.

“It’s probably expensive in the beginning,” Adibe said. “But then it saves you the cost over a long time.”

For Kizor, the future also lies partly in recovering knowledge displaced by imported construction styles.

“For a long time, we went away from traditional. We saw traditional as poor, as backward,” she said. “We’ve lost a lot: identity, pride, and longevity. How do we define Nigerian architecture? The richness of a place is in its stories, its history, its people. When we lose something as concrete as architecture, what is telling our stories?”

Older African buildings often used locally available materials and features suited to heat and rain. Adibe said those practices can be adapted using contemporary construction knowledge.

“We have better technology to work with mud,” he said. “We can do earth buildings. We can do some rammed-earth buildings and have something really good, and even preserve it better than our forefathers could.”

Kizor has also had to establish her authority as a young woman on construction sites.

“It’s been tough to be taken seriously. You’re fighting different things: you are female, you are young,” she said. “I realised early on that technical competence is impossible to deny.”

That pressure drove her to research and refine her work, she said.

Adibe expects household finances to push more clients in that direction. Rising electricity tariffs and the cost of running generators make wasteful buildings increasingly difficult to afford.

“What pushes people is not necessarily what is better; you can’t convince someone with words as effectively as you can with their pockets,” he said. “It’s going to be more of an economic thing than an ideological thing that pushes us towards sustainability.”

The Nsukka project does not remove the upfront costs of thoughtful design. It shows how an existing structure can respond to its climate and users, making sustainability tangible through comfort, light and air.

“I would love to see thoughtful architecture, not copy and paste,” Kizor said. “I’d love to see beauty come back to Nigerian architecture, where our built environment is not just for living and working, but is also a beauty to behold.”

Written by Toochi Gabriel, for bird story agency