Sungai Buloh Leprosarium
Permanent Delegation of Malaysia to UNESCO
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The Sungai Buloh Leprosarium, officially known as the National Leprosy Control Centre (NLCC), is located at the valley of Bukit Lagong in the state of Selangor, 25km from the capital city of Malaysia - Kuala Lumpur. It was completed in 1930. The Sungai Buloh Leprosarium has been known as one of the exceptional models in the liberation of leprosy institutions in the 20th century and also one of best treatment centers for leprosy. On top of this, the Sungai Buloh Leprosarium was also one of the key leprosy research center in the globe where some of its research, trials and experiments have greatly contributed to the treatment of the disease. The Leprosarium originally covered an area of over 562 acres, comprising more than 600 buildings in three sections. At its peak period, the patients numbered 2,440. Hence, the Sungai Buloh Leprosarium is the biggest leprosarium in the British Empire in terms of the number of patients and empirically, it was deemed as the second biggest in the world after the Culion Leprosarium in the Philippines.
Justification de la Valeur Universelle Exceptionnelle
In the past, leprosy patients were ostracized and strictly segregated in prison-like institutions to prevent the disease from spreading. These inhumane methods were certainly against the basic human right of patients as ordinary citizens.
In 1923, Dr. Ernest Travers, the former Selangor state surgeon, mooted an enlightened policy to reform the management and planning of leprosaria. The purpose was to make a leprosarium a model human settlement to the outside world, with democratic, self-supporting and educative characteristics, emancipating from the stereotypical and regimentedly planned leprosaria. Free from any forms of confinement, the Sungai Buloh Leprosarium was an open human settlement with social amenities and modern medical facilities where patients could live independently and undergo their long-term treatment with dignity. The persuasive method of encouraging leprosy patients to enrol voluntarily into the Leprosarium worked exceptionally well and solved the problems of dealing with the moral quandary of human rights in the cause of long-term treatment of the disease. These approaches were bold and unprecedented attempts in dealing with leprosy control in the 20th century.
A few years after its inauguration, the Sungai Buloh Leprosarium had received strong endorsements from international medical experts and bodies, such as Bernhard Nocht, Herbert Windsor Wade and the British Empire Leprosy Relief Association, praising that the establishment was an important milestone in leprosy control.
The natural and fair atmosphere in the Leprosarium is akin to the outside world. It allowed patients to live as naturally as they did in their former villages, participate in the Leprosarium's daily operation and, in the same time, provide opportunities such as education, training and skill learning to enable every patient to explore their full potentials. This liberal approach is parallel with the social reform in the early 20th century in Britain and Europe.
To fulfil the complex, long-term social and medical necessities, the Sungai Buloh Leprosarium was organised as a modern self-sustained human settlement. The planning of the Leprosarium is akin to Ebenezer Howard's popular Garden City diagram which depicts clear zonings consisting of a central park, a central garden (a grand avenue), residential areas and a green belt.
The Central Park is where administrative buildings such as the administration office, the reception building, the post office and other premises are located. The Central Garden is similar to the Garden City's Grand Avenue where social facilities, such as a school, community clubs and a recreation park for the residents to enjoy open spaces and leisure activities, are situated. The residential areas are divided into two parts: residential enclaves where small domestic houses are built to house able-bodied patients and hospital enclaves with medical facilities such as the treatment center, the research unit and hospital wards to accommodate old and disabled patients. Behind the residential areas is the green belt, a huge farmland for the patients to cultivate vegetables, fruits and farm poultry on a larger scale. One of the most significant agricultural legacies is the horticulture industry which has been the core economic activity and the identity of the Leprosarium over the last few decades.
As a self-contained settlement, most of the jobs and employment in the Leprosarium were undertaken by the leprosy patients. In the Sungai Buloh Leprosarium, the patients participated as clerks, typists, teachers, nurses, carpenters, police officials, fire brigades, general workers and other roles. Some sort of semi autonomous . power was given to the medical superintendents to administrate the Leprosarium, from registering new births, marriages, and deaths, to the extent of sentencing punishments to offenders into the Leprosarium's prison. In the 1930s, the Sungai Buloh Leprosarium even issued its very own set of internal currency to prevent the money from circulating outside of the Leprosarium.
Since its opening, the Sungai Buloh Leprosarium had extended its roles to receive patients from the British colony of the Straits Settlements- Singapore, Melaka and Penang, the British protectorate state of Perak, and, later, other Malay States. Besides, the Leprosarium had also attracted foreign patients seeking refuge and treatments. The cross-territory admissions had further diversified the multi-racial population in the Leprosarium. This is clearly reflected in the Leprosarium's diverse cultural landscape from places of worship such as the mosque, the Hindu temple, the Buddhist temple, the Taoist Temple, the Christian and Catholic churches, to ethnic-based social and welfare clubs such as the Chinese Rehabilitation Club, the Chinese clan societies, the Eurasian community's Green Club and Ryrie Club, the India Mutual Aid Society, the Malay Club, the Indian Muslim Club.
The architecture of the Sungai Buloh Leprosarium reflects its utilitarian character. All of the buildings are single-story with plain facade and pitch roof. The residential areas dotted with small and non-decorated cottage houses illustrated the common house architectural identity. The low density, domestic scale and plain architecture had created a harmonious countryside atmosphere and a sense of belonging for most patients who used to live in villages without feeling being segregated in medical institutions.
The Sungai Buloh Leprosarium has been known globally as the key research centre of leprosy. The studies have been greatly contributed to the discovery of new drugs to cure the disease. One of the most exceptional contributions was that between 1964 and 1965, Dr. R. J. W. Rees and Dr. John H. S. Petit, in a collaborative research with the British Medical Research Institute in London, found a definite clinical evidence of Dapsone resistance in three patients in the Leprosarium, using the mouse footpad inoculation technique. Eleven years later, the first case of primary resistance was identified. Subsequently, an animal house was established in the Leprosarium to perform footpad investigations, the first of its kind in Asia.
The research collaboration was continued by the Malaysian Ministry of Health and the British Medical Research Unit. Until 1981, about 100 research papers were published in several scientific and medical journals by the researchers of the Sungai Buloh Leprosarium's Research Unit.
Criterion (ii): The multi-racial living environment further distinguished the Sungai Buloh Leprosarium from other leprosaria around the world. The Sungai Buloh Leprosarium signifies a small republic with a population from different backgrounds - Chinese, Malays, Indians, Javanese, Eurasians and a sprinkling of other nationalities.
These are vividly reflected on the Leprosarium's diverse cultural landscape from places of worship such as mosques, Hindu temples, Buddhist temples, Taoist Temples, Christian churches and Catholic churches. The graveyard compounds comprising various tombstones from different religious backgrounds also witness the harmonious multi-racial interactions in the Leprosarium. Besides, there were other social and welfare clubs such as the Chinese Rehabilitation Club and the Chinese clan societies, the Eurasian community's Green Club and Ryrie Club, the India Mutual Aid Society, the Malay Club, the Indian Muslim Club, and etc.
Criterion (iv): The Sungai Buloh Leprosarium represents the best testimony in the liberation of leprosarium in the 20th century. The open spaces, accessible public facilities and democratic participation of patients signify the concept of liberation that was parallel with the societal principles subscribed in the Sungai Buloh Leprosarium. These liberal principles emancipated the Sungai Buloh Leprosarium from stereotypical, regimentally planned leprosaria during that period.
To ensure that the Leprosarium was open and modern, the Sungai Buloh Leprosarium imitated Ebenezer Howard's popular Garden City diagram with the central park, gardens and open spaces as well as equipping with public and social facilities. The planning of the Leprosarium was not only conceptually successful according to Garden City's ideas but also practically functioned as a self-sustaining and self supporting human settlement.
Criterion (v): The intertwined and complex land-use planning of the Sungai Buloh Leprosarium created a unique institution typology - something between a human settlement, a medical institution and an agricultural colony. This multifaceted architectural synthesis provides the best catalyst-a self-sustained and humane solution to fulfil the complex and long-term needs for a self-contained leprosarium.
The Leprosarium was planned as a modern human settlement equipped with public amenities such as the post office, the police station, the school and social clubs. Open spaces such as the central park, the garden and the playing field illustrate the characteristic of democratic spaces in the Leprosarium. Nonetheless, the residential areas were organised in a way resembling a village consisting of small houses. These randomly organised single-story houses with simple facade created a familiar countryside atmosphere which most of the patients had been accustomed to.
As a medical institution to treat the disease, rehabilitate the patients and conduct research on the leprosy disease, the Leprosarium's medical zone is well equipped with modern medical facilities such as the treatment centre, the research laboratory, the animal house and hospital wards. The medical zone is strategically located between the residential area and public facilities to facilitate patients' access to treatments and the delivery of medical supplies to the Leprosarium.
As a self-contained settlement, the green belt or the huge farmland at the hill slope behind the residential area was allocated for the patients to cultivate vegetables, fruits and farm poultry on a larger scale. The horticulture industry has been one of the most important agricultural legacies and the core economic activity as well as the identity of the Leprosarium over the last few decades.
Criterion (vi): The event of leprosy, the segregation policies and institutions are important testimonies to a certain period of medical history, human rights and living practices which will never recur in future. The self-contained Sungai Buloh leprosarium is an exceptional representative of such living practices. The population comprises men, women and children, with different languages, religions and customs. They were isolated by law but bound by the common fetter of leprosy, living together in complete harmony.
The Sungai Buloh Leprosarium was governed by medical superintendents and every patient had been given a social responsibility in the Leprosarium. Medical superintendents registered births, marriages and deaths, and even sentenced punishments to minor offenders. The patients took part as teachers, nurses, police officers, farmers, and other roles. At the same time, opportunities such as education and training were provided to let all patients explore their full potentials. The huge farmland allows leprosy patients to cultivate crops or work in commercial vegetable and poultry farms. In the Sungai Buloh Leprosarium, the farmland not only helped to sustain the Leprosarium but also developed the place into one of the key horticultural hubs in the country.
Social activities and entertainment played a very important role in strengthening community bonds within the Leprosarium. Over the years, many societies such as a drama club, bands, Chinese opera clubs, and sports clubs, had been established. Various festivals, carnivals, funfairs, and stage performances were celebrated with the participation of guests and the public to reduce the stigma of the disease. Quarterly magazines were published by the community to record events and serve as a channel for the residents to unleash their creativity as well as an instrument to convey messages to the outside world.
The establishment of the Sungai Buloh Leprosarium is a significant evidence of living legacies in relation to the modem treatment and management of leprosy disease which will never happen again in future.
Déclarations d’authenticité et/ou d’intégrité
The Sungai Buloh Leprosarium comprises three sections. The first section is the Eastern Section or the main section, which was built in 1930. In 1932, the Eastern Section was expanded by incorporating a decrepit settlement located one kilometer to the west. The decrepit settlement was later known as the Western Section. In 1937, a new Central Section was built to connect the Eastern Section and the Western Section (the former decrepit settlement). These three sections were then merged into the Sungai Buloh Leprosarium. The merger allows the three sections to complement each other perfectly and further enhanced the idea and function as a self-sustaining leprosarium.
The Eastern Section is the main section of the Leprosarium where the idea of the enlightened policy was first implemented. The settlement portrays the planning of a Garden City that includes a central park, a central garden, residential zones, and a green belt. In 2007, two clusters of houses, the central garden, the laundry and the prison have been demolished to give way to the development of a medical school. Other than that, the rest of the buildings in the Eastern Section remain intact. In 2012, in order to protect the integrity and authenticity of the Leprosarium, the Department of National Heritage (DNH) has implemented conservation works on four buildings in the Eastern Section. These premises include the police station, the post office, the sewing house and the rice storage.
The Western Section's buildings are mainly in the typology of hospital wards and a few administrative blocks. This huge section serves and offers refuge to disabled leprosy patients. The entire Western Section is still very intact and well-preserved. Only a few buildings are slightly renovated to serve new purposes.
The Central Section was built in 1937 to house discharged patients who were ostracized by the society. The planning of the houses reflects the idea of human settlement of the Eastern Section. This Section is mainly to house the able-bodied patients. Later, this section became the most vibrant human settlement where the majority of social clubs, welfare societies and religious buildings are located. The horticulture industry remains to be the main activity in the Central Section where farming agricultural products and plants is part of the leprosy patients' economic activities.
Due to the decreasing population of leprosy patients, some of the houses in the Central Section have been abandoned and naturally collapsed. These simple and identical structures in the Central Section could be rebuilt to revive the visual integrity of the site. Overall, the setting and the authenticity of the buildings in the Central Section are still intact and can clearly express its original characters.
Comparaison avec d’autres biens similaires
This comparative study assesses Malaysia's most prominent and significant leprosarium - the Sungai Buloh Leprosarium. The focus of this comparative study is centred on the exceptional values which the Sungai Buloh Leprosarium is believed to possess.
The first exceptional value (OUV Criterion iv) is that the Leprosarium portrays an outstanding testimony of modern human settlement planning in response to the crucial worldwide leprosy prophylaxis in the 20th century. The second outstanding value (OUV Criterion vi) is that the self-contained Leprosarium follows a unique and exceptional set of living practices whereby the enlightened policies had reformed the way of treating patients humanely. The third criterion (OUV Criterion ii) is clearly illustrated in the Leprosarium's multi-racial living and built environment that is unique to the Sungai Buloh Leprosarium and the OUV criterion v is in relation to the complex land-use planning and usages in order to fulfil the multifaceted and long-term needs for the self-contained leprosarium.
Comparison with overseas leprosaria
There are several notable leprosaria established throughout the critical period of modern leprosy prophylaxis from the end of the 19th century to the mid-20th century. Based on existing literature reviews and the current heritage conservation scenes, there are three leprosaria comparable to the Sungai Buloh Leprosarium, namely Culion Leprosarium in the Philippines, Nagashima Aiseien Sanatorium in Japan, and Aimores Leprosarium in Brazil. These leprosaria are selected based on their significant historic positions, modern planning and self-contained living tradition.
Culion Leprosarium was one of the most recognizable and the world's biggest leprosarium. It was established shortly following the worldwide discourse advocating for a compulsory segregation policy on leprosy patients in 1897. It served as a key model for modem leprosy prophylaxis and has been a world renowned centre for leprosy research in the 20th century.
Similar to the Sungai Buloh Leprosarium, Culion Leprosarium was envisioned to be a modern township for leprosy patients. The intention was to civilize the natives so that they would embrace western sanitary practices and the American civic virtues. The colonial government basically removed the local inhabitants on the island, installed sanitary amenities, adapted reuse buildings, and built 100 houses and hospital wards made of thatch and bamboo prior to the admission of the first batch of leprosy patients in 1906. The patients' houses were mostly built on a hill slope in the sick zone. Beginning from 1909, premises at Culion Leprosarium such as the hospital buildings were gradually built in concrete for fire safety.
The modern town as proposed by Victor Heiser mostly focused on implementing sanitary measures such as water supply system and a proper road to connect the healthy zone and the sick zone. The application of modern town planning could only be observed in the later phase of the colony in the 1910s when new streets, plazas, houses built on gridiron plots were gradually added to the colony, including a model sanitary housing - the concrete tenements in 1919.
The success of the Sungai Buloh Leprosarium lies in its planned settlement where every aspect and needs have been incorporated in its planning. Instead of focusing on segregating and controlling leprosy patients, the Leprosarium provided an open and fair environment aimed to persuade voluntary admissions and encourage active engagement in community living, which is one of the core principles of the Garden City Movement in the late 19th century.
Nagashima Aiseien Sanatorium was founded in the same year as the Sungai Buloh Leprosarium. It was an outcome of a visionary Japanese leprologist, Kensuke Mitsuda, who aimed to eliminate all leprosy cases in Japan through a centralised leprosarium network across the country. The Japanese leprosy patients also underwent forced sterilization and abortion. The distance between the living area of leprosy patients and medical staff members expanded tremendously from the former public leprosaria, which conveys a stricter segregation attitude executed by the Japanese government.
The patients' houses at Nagashima Aiseien were arranged similarly to military barracks, regimentedly and orderly. There is an absence of any form of modern town planning principles in the leprosarium design, as the layout of buildings was fairly basic and prioritized on maximizing land usage. On the other hand, houses at Sungai Buloh Leprosarium are small cottages akin to rural houses clustering randomly in a concentric pattern with a market at the middle to encourage social interaction among patients.
Another military-like planning of leprosarium is observed in the Brazilian model colony, Aimores Leprosarium. It follows the template of the earlier Garden-City-inspired leprosarium, Santo Angelo Colony. Instead of a more humane solution to leprosy prophylaxis advocated since 1923, the whole complex resembles a massive detention institution made of pavilion wards. Even the eminent Brazilian leprologist, Souza Araujo, recommended abandoning the large pavilion form during its construction in 1931. Yet, the houses were arranged rigidly in a gridiron layout. In spite of the inspiration drawn from the Garden City planning, it did not implement the concept as faithfully and similarly as the Sungai Buloh Leprosarium.
In terms of self-sustainability and land-use planning, the Sungai Buloh Leprosarium deliberately demonstrated these features by integrating huge agricultural zones within the settlement. This planning element is generally absent in the Japanese and Brazilian leprosaria. Today, commercial agricultural activities have become the Leprosarium's identity and the patients' important means of livelihood. The Sungai Buloh Leprosarium was not only perfect, in principle, according to Garden City's clear zonings but also functioned practically as a self-sustaining and self-supporting human settlement.
The multiracial living environment is a very distinct feature in the Sungai Buloh Leprosarium as compared to other leprosaria around the world. Although there are several different ethnic groups in Kalaupapa and Culion Leprosaria, the ethnicity and religious backgrounds of their population and the multi-racial cultural landscapes are certainly not as diverse and complex as the Sungai Buloh Leprosarium. (Refer to Justification of Outstanding Universal Value)
Comparison with local leprosaria
In order to further understand and accentuate the unique and significant position of the Sungai Buloh Leprosarium, a comparison is made to two local leprosaria- the Pulau Jerejak Leprosarium and the Tampoi Leprosarium.
Pulau Jerejak Leprosarium
The Pulau Jerejak Leprosarium is located on Jerejak Island. The leprosarium was completed in 1867 and started operating in 1871 as the main leprosarium serving the British colony of the Straits Settlements Singapore, Melaka and Penang. From 1867 to 1935, the Pulau Jerejak Leprosarium has expanded from a single camp to five separate camps. They are Camp 1 (the old camp), Camp 2 (the new camp), Camp 3 (the Eurasian camp), Camp 4 and Camp 5 (the main camps).
Apart from functioning as a leprosarium, at some point in time, Jerejak Island also served as a quarantine station (1877 to 1940) to quarantine newly arrived immigrants and Muslim pilgrims returning from Hajj. After the World War II, a detention camp (1948 to 1951) was established on the island to confine political prisoners and, roughly during the same period, a tuberculosis sanatorium (the 1950s to 1969) was built. In 1969, a high-security prison was created to detain serious offenders until it was closed down in 1993.
The enlightened policy was first examined in the Pulau Jerejak Leprosarium (Camp 4 and later Camp 5) where the idea of replacing the regimentedly planned hospital wards with a human settlement was put into practice. The colonial government saw the project as an opportunity for them to examine their reformist social policies and modern planning principles. A few years later, the enlightened policy had been exceptionally implemented in the planning of the Sungai Buloh Leprosarium.
The evolution of Pulau Jerejak is a critical piece of puzzle in the modern medical and architectural history. The leprosarium had witnessed a complete typological evolution of leprosy institution, from a single ward into a hospital complex, and from concentration camps into a liberated, modern, planned human settlement.
Camp 1 and Camp 2 had been demolished but there are still a few historical remnants on the sites. Camp 4, which was planned under the enlightened policy, had been torn down to give way to a resort development but the same idea had been deliberately adopted to plan Camp 5, a more comprehensive human settlement model.
Camp 5 was the main centre of the Pulau Jerejak Leprosarium. Some historic buildings and ruins in Camp 5 are in a dilapidated condition but the overall setting is still intact and is able to demonstrate the meaning of the place. Fortunately, 85% of the buildings in Camp 5 are identical buildings which can be fully restored to revive the former robust living condition. In Camp 3, or the Eurasian Camp, the historic remnants such as housing blocks with separate rooms, detached latrines, a kitchen house, terraces, and other buildings are still able to clearly illustrate how Eurasian patients were treated differently from their Asian counterparts.
The most intact structure on the island is the prison complex built in 1930, comprising two blocks of prison cells, a small courthouse, the warden quarters, the latrines and the guardhouse. This prison complex is a very important property to complement the demolished prison complex in the Sungai Buloh Leprosarium.
The oldest surviving building is the Catholic Church, standing still in the oldest Camp 1. Most of the graveyards on the island are still intact. Different religious tombstones are arranged side by side. This noteworthy arrangement portrays the harmonious relationship among multi-racial residents in the leprosarium. In the quarantine station, some buildings such as three quarantine blocks, the old quarters and the main administrative building are still standing intact too. Although most of the existing buildings in Camp 2 have been cleared, some surviving historic buildings such as an operating theatre, a mortuary and an old jetty building could still be found. Besides, old infrastructures such as the underground water bunker, six water reservoirs, old jetties, seawalls, and routes have also added to the integrity of the Pulau Jerejak Leprosarium.
Even though the Pulau Jerejak Leprosarium's historic remnants are not as complete as those in the Sungai Buloh Leprosarium, but all these remaining historic buildings and structures on the island are still able to demonstrate the meaning of the leprosarium. Furthermore, the historic remnants in the Pulau Jerejak Leprosarium are older and some historic enclaves such as Camp 5, Camp 3 and the Prison Complex are critical parts to complement the demolished structures in the Sungai Buloh Leprosarium.
The Tampoi Leprosarium was established in 1928 in Malaysia's southernmost state, Johor. It is interesting to note that the layout of leprosy patients' houses and the allocation of land for agricultural purposes are almost identical to the Sungai Buloh Leprosarium.
The first structure constructed on the site was 10 blocks of houses, laid in two 'C-shaped' layouts. Each house has three rooms that can accommodate three patients each. This layout pattern is not seen in other former leprosy colonies established in British Malaya and it bears a resemblance to the leprosarium model proposed by Ernest Muir, the advocator of humane segregation approach.