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 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 and community information submitted by the project sponsor as well as a site visit to the existing hospital facilities in the 6th of October City. The following potential environment, health and safety (EHS) and social/community impacts of the projects were analyzed: - The compliance of Dar Al Fouad Hospital’s existing and new facilities with Egyptian and IFC EHS requirements; - The commitment of Dar Al Fouad Hospital to quality and efficiency and to EHS performance including international certifications; and - Labor, community and social issues.

The sponsor, Dar Al Fouad Hospital, has presented plans to address these impacts to ensure that the proposed project will comply with the environmental, health and safety, and social/community requirements of Egypt as well as the IFC environment and social policies and the environmental, health and safety guidelines. - Compliance with Egyptian and IFC Environment, Health and Safety (EHS) Requirements Water is supplied to the hospital from the municipal water system in 6th of October City. While raw water quality is good, the hospital provides additional water treatment prior to use (i.e. filtration, softening, and disinfection). Wastewater from the hospital is discharged directly to the municipal sewer system where it receives primary and secondary biological treatment as well as chlorination prior to discharge to the environment. There are 2 small boilers which are now fired by fuel oil but in 1 month this will change to natural gas firing. Solid waste from the hospital is segregated at the point of generation to facilitate proper disposal. Municipal-type wastes from hospital operations is collected in color coded bags designed for that purpose, stored in appropriate containers, and regularly collected by the municipality of 6th of October City for disposal in a sanitary landfill. Health care radioactive wastes are collected, stored and handled according to the requirements of the Government of Egypt. Hazardous health care wastes are also collected in color coded bags by trained hospital staff, stored in appropriate containers, collected regularly, and sent to the University Hospital in Cairo for incineration. This incinerator is a Government of Egypt licensed medical waste treatment and disposal facility. Electrical power is provided by the grid with a standby backup diesel generator of adequate size. The hospital fully complies with IFC’s Life and Fire Safety Guidelines and incorporates proper access and egress, signage, fire hose reels, and smoke and thermal detectors. DAF also has detailed Policies on Patient Safety, Healthcare Quality Management, Environment (including waste disposal) as well as detailed Disaster and Emergency Response Plans. These policies and plans are supported by operating procedures as well as staff training, performance monitoring and reporting – the aim is continuous improvement of all phases of the hospital operations. Dar Al Fouad Hospital will adopt the same proactive approach to management of EHS issues in their new operations in Nasr City, Cairo and elsewhere in the region. - Commitment of Quality and Efficiency Dar Al Fouad Hospital has developed a world class system of polices and procedures that covers all aspects of hospital operations. DAF’s strategic alliance with the Cleveland Clinic has been extremely beneficial particularly in terms transfer of medical knowledge and of administrative systems. To maintain this relationship with the Cleveland Clinic, the Clinic completes a detailed audit each year and the hospital must complete Performance Reviews every 3 months and submit these to the Clinic. The international standards of DAF were recently recognized when the hospital received it’s accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), based on international standards specifically developed for the healthcare sector. Again to maintain this accreditation, the JCAHO carries out unannounced audits of the facilities, with a major re-accreditation exercise every 3 years. DAF has also achieved ISO 9001-2001 (Quality) certification in 2002. DAF places a very high priority of staff training and capacity building. New employees for instance are provided an orientation program in occupational health and safety with annual training provided thereafter. - Labor, Community and Social Issues Dar Al Fouad employs about 250 doctors and about the same number of nurses. While DAF has no problem attracting high quality and dedicated doctors to their staff, the hospital does experience some shortage in nursing and other skilled support staff. Typically for DAF, the hospital has adopted a forward thinking strategy to deal with these shortages – approaches include a very active career development program based on training and upgrading of skills, excellent salaries and benefits, and the opportunity and challenges associated with working in an environment dedicated to quality and first rate healthcare. Employees undergo pre-employment medicals as well as regular medicals each year. DAF has also developed an effective community program including the Charity Society (formed in 1999) which focuses on congenital cardiac problems in children (about 40 operations performed in the last 5 years). DAF provides training in the development and implementation of Mass Disaster Plans and is working with the Ministry of Tourism, Government of Egypt, in developing and implementing a plan to monitor food safety in Egyptian hotels. Dar al Fouad Hospital will adopt the same quality and performance standards for all their operations in Egypt and elsewhere in the Gulf Region.

This ERS contains the full environmental and social documentation prepared for the project.

Accordingly, IFC concludes that the proposed project will meet the applicable Egyptian and IFC environment and social policies and the environmental, health and safety guidelines.

IFC will evaluate the project's compliance with the applicable Egyptian and IFC environmental, health and safety and social 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.