IFC requires that this document is made available through the World Bank InfoShop and to the locally affected community no less than 30 days prior to project consideration by the IFC Board of Directors. The Summary of Project Information (SPI) also provides details of where the ERS has been made available to the locally affected community. The SPI must also be sent to World Bank InfoShop no less than 30 days prior to project consideration by the IFC Board of Directors.

This is a Category B project according to IFC’s Procedure for Environmental and Social Review of Projects because a limited number of specific environmental and social impacts may result which can be avoided or mitigated by adhering to generally recognized performance standards, guidelines or design criteria. The review of this project consisted of appraising technical, environmental, health and safety , as well as social/community information submitted by the project sponsor as well as site visits to existing Acibadem healthcare facilities in Istanbul and to the site of the proposed new hospital in Bursa. The following potential environment, health and safety (EHS) and social/community impacts of the projects were analyzed: - the compliance of Acibadem’s existing and new facilities with Turkish and IFC EHS requirements; - the commitment of Acibadem to quality and efficiency and to EHS performance including international certifications; and - community issues.

The project sponsor, Acibadem, has presented plans to address these impacts to ensure that the proposed project will upon implementation of the specific agreed measures, comply with the environmental, health and safety, and social/community requirements of Turkey as well as the IFC environment and social policies and the environmental, health and safety guidelines. Compliance with Turkish and IFC EHS requirements: Water will be supplied to the hospitals from the municipal water systems in Istanbul and Bursa. While raw water quality is good, each hospital will provide additional water treatment prior to use. Wastewater from the hospitals will receive some pretreatment prior to discharge to the municipal sewer – both Istanbul and Bursa provide primary and secondary biological treatment as well as chlorination prior to discharge of municipal wastewater to the environment. Solid waste from the hospitals will be segregated at the point of generation in the hospitals to facilitate proper disposal. Municipal-type wastes from hospital operations will be collected in color coded bags designed for that purpose, stored in appropriate containers, and regularly collected by the municipalities of Istanbul and Bursa for disposal in sanitary landfills. Health care radioactive wastes will be collected, stored and handled according to Turkish Atomic Energy Law #2690, July 1982. Hazardous health care wastes will be collected in color coded bags by trained hospital staff, stored in appropriate containers, and collected regularly by a government licensed waste management contractor. Disposal will be by incineration in a government licensed medical waste treatment and disposal facility. Electrical power is from the grid with backup generators and all boilers fired by natural gas. In accordance with IFC’s Life and Fire Safety Guidelines, Acibadem will prepare and implement a Life and Fire Safety Master Plan acceptable to IFC. Commitment to quality and efficiency: Acibadem has developed a world class system of policies and procedures that cover all aspects of hospital operation. Since October 2003 Acibadem has been affiliated with Harvard Medical International, a foundation supported by Harvard Medical School and 17 other training hospitals and institutes. The benefits of this cooperation include - executive professional development of medical staff, especially nurses; - development and strengthening of quality management related to healthcare services; - development of healthcare services and treatment protocols in oncological and neurological sciences; and - access to new and improved treatment models and services applied in Harvard and their associated hospitals. Medical services are organized through the US based Joint Commission International (JCI) accreditation standards, developed specifically for the healthcare sector, while the work for organizational standards is being carried out with the EFQM (European Foundation for Quality Management) Excellence Model. Acibadem also has achieved ISO 9001 (Quality) certification, has a policy on Patients Rights, and has extensive training for staff (e.g. technical skills development, professional training, on-the-job training). Community issues: The private sector has been providing an increasing level of quality healthcare in Turkey. Recent changes to the law mean that increasing numbers of Turks can avail themselves of higher quality healthcare services provided by the private sector. This is a trend that is likely to continue in the future. Acibadem participates in a wide variety of community outreach programs including the Acibadem Health and Education Foundation which focuses on public health education and supporting students studying in the healthcare sector. Acibadem has a particular focus on healthcare for children and provides healthcare services for the underprivileged in Istanbul and Bursa.

This ERS contains the full environmental, health and safety (EHS) and social/community documentation prepared for this project.

Accordingly, IFC concludes that the proposed project will meet the applicable Turkish and IFC environment and social policies and the environmental, health and safety guidelines upon successful implementation of the agreed mitigation measures.

IFC will evaluate the project's compliance with the applicable Turkish and IFC environmental, health and safety, and social/community requirements during the lifetime of the project by reviewing the annual monitoring reports (AMRs) prepared for the project covering ongoing performance of project-specific environmental, health and safety (EHS) and social/community activities. Periodic site supervision visits will also be conducted.