We Need a Hospital Ship – Stat!

As the new Liberal Government seeks to redefine Canada’s role in world affairs, perhaps it is time to look at new alternatives to the way Canada has traditionally responded to international crises, particularly in the humanitarian role.

Acquiring a Canadian Government Hospital Ship capability would offer new options for Canadian response such as: enhancing Canadian soft power; improving Canada’s ability to respond to a natural disaster; providing increased health care services to Canadians located in remote Northern and coastal communities; and also in stimulating the economy.

Hospital ships are internationally protected in accordance with Protocol 1 of the Geneva Conventions of 1949. They are lit and marked to indicate their purpose as a hospital ship. They must not be used for military purposes and must be unarmed (beyond small arms required for security). They are subject to search by belligerents in a conflict and must not interfere with any combatant vessels.

USNS Mercy (1986) and Comfort (1987), the two U.S. Hospital Ships, were converted from San Clemente-class supertankers. Shown below, Mercy’s last mission was in 2013, when she arrived in the Phillippines area to ­provide aid in the aftermath of Typhoon Haiyan.

Hospital Ships are different from Casualty Receiving and Transport Ships (CRTS), which are typically warships with a secondary role of providing limited medical support to one side in a conflict. Examples of a CRTS would include vessels such as U.S. Navy amphibious ships, the French Mistral-class ships, and the proposed multi-role logistics support ship for Canada. Unlike hospital ships, these vessels are classified as combatant vessels. They are not internationally protected, are not marked as a hospital ship, are usually armed, and typically do not permit belligerents to board and inspect the vessel.

Modern hospital ships have all the services of a major hospital – everything from multiple operating rooms to Intensive care units, advanced diagnostic imaging, laboratory services, a blood bank, pharmacy, ophthalmology, physiotherapy, dental clinic, a medical warehouse, medical equipment repair services, and mortuary services. These ships vary in size from half a dozen to 1000 beds (the size of some of the largest hospitals in Canada). Several countries, including Brazil, China, Indonesia, Russia, Spain, Thailand, the United States and Vietnam, all operate vessels dedicated to providing medical aid and assistance. Some other countries operate military vessels that can accommodate and treat patients. Hospital ships are also operated by private charities, as in the case of the Motor Vessel (M/V) Mercy Africa. Canada had minimal maritime capacity for treating patients other than its own crew and now, with the paying off of HMCS Protecteur and Preserver, further eroding what limited capacity we had. Currently, capability in the Navy is limited to a single Physician’s Assistant on each of its Frigates.

Value and Flexibility
Perhaps the greatest single benefit of a hospital ship is its mobility. It is capable of deploying around the world, and is self-sufficient when it reaches its destination. Hospital ships have all the features of a modern hospital – and bring with them the service and resources necessary to support the medical staff assigned to that hospital ship (such as accommodation, food services, potable water, laundry facilities, medical warehousing, medical oxygen generation, and a clean working environment for medical equipment, staff and patients). Further, hospital ships enjoy a level of security and safety that many land-based field hospitals and treatment facilities do not. Access to the hospital ship is easier to manage, and control. Unlike a field hospital, a hospital ship (and embarked patients and staff) can easily be moved out of harm’s way in the face of a natural or manmade threat without interrupting the delivery of care and medical services.

During Harmonious Mission 2015, China’s Hospital Ship Peace Ark visited seven countries and regions around the Pacific Ocean (Australia, French Polynesia, the United States, Mexico, Barbados, Grenada, and Peru) for military diplomacy, medical exchange and cultural communication.
(USN PHOTO: MC1 Carlos Gomez)

Logistically, a hospital ship is easier to support than land-based field hospitals, in part because it typically carries all the supplies and spare parts it needs to sustain operations. A hospital ship has the option of moving to a safe, secure, and supportable location for resupply if necessary. Additionally, it can be pre-positioned (without an embarked medical staff) to areas such as the Caribbean during hurricane season, or conflict zones such as Syria and Libya (in the same way that the Canadian Government currently deploys warships).

Soft Power
A hospital ship is a potent instrument of international policy, diplomacy, humanitarianism, and soft power. It can provide disaster relief assistance during a natural disaster, humanitarian assistance and advanced medical care and treatment in developing countries, and can serve as a floating classroom and medical training facility both at home and abroad. Because it is internationally protected, a hospital ship can deploy to areas where the Canadian military might otherwise be viewed as a combatant.

Soft power has been defined as “getting others to want what you want through the use of culture, values and institutions rather than by the use of force”. The use of soft power to achieve desired political outcomes in international security and stability, social development, and public health can increase Canadian influence and stature on the international stage, and is a viable alternative to the use of military force. Providing good will, humanitarian assistance and international development is at the core of Canadian values and how we wish the rest of the world to view Canada.

The U.S. government sponsored a public opinion survey that was conducted in the wake of the US Naval Ship (USNS) Mercy mission to Bangladesh and Indonesia after the 2004 Tsunami. The results demonstrated very significant changes in local opinion of the United States. Clearly, the Mercy mission was very effective in changing anti-Western sentiments. In fact, USN humanitarian assistance deployments of USNS Mercy and her sister ship Comfort have enjoyed almost universal positive public opinion ratings with Americans versus a very polarized public opinion response to the use of U.S. military combat forces (Webb and Richter, 2010, p.165).

Domestic Operations
In addition to its versatility in conducting international disaster relief and humanitarian assistance roles, a hospital ship has the ability to supplement or replace existing Canadian medical infrastructure after a natural disaster. USNS Comfort deployed to New York City in the days following 9/11 to augment New York City medical facilities, treating 541 relief workers who had been injured during the recovery efforts. In 2005, USNS Comfort deployed to Pascagoula, Mississippi, and New Orleans, Louisiana, after Hurricane Katrina to provide trauma services, treating nearly 2000 patients in seven weeks.

In the event of a major natural or man-made disaster along any of Canada’s three coasts or in the Great Lakes, a Canadian hospital ship could augment existing medical facilities or act as a temporary replacement for damaged or destroyed health infrastructure.

Hospital ships can deliver medical services to remote areas that are under-served by traditional medical facilities. The Brazilian Navy operates three hospital ships along the Amazon River to deliver medical care to remote villages. A Canadian hospital ship capable of operating in Arctic waters could provide advanced medical treatment and facilities to many Northern communities and would provide an effective alternative to medical evacuation to southern Canadian cities.

The Russian Navy has three Ob’-class ships: IrtyshSvir, and Yenisei (built between 1981 and 1990). Each has 7 operating rooms, 100 hospital beds and a heli-pad. They are operated by civilian crews and staffed by naval medical personnel. Class leader, built in 1980, was sold to China in 2007.  

The isolation component of any vessel means a Hospital ship can act as an alternative medical facility for treatment of highly contagious pathogens. The UK deployed the RFA Argus to Sierra Leone in 2015 to provide support to international medical teams ashore and to act as a medical treatment facility for international medical staff. A Canadian hospital ship could provide alternate medical facilities for outbreaks such as SARS, helping to check the spread of such highly infectious diseases.

Construction and Operation
Many hospital ships began their lives in other roles. USN Ships Comfort and Mercy were originally built as US Navy oil tankers before undergoing conversion. While a new-build Canadian hospital ship is certainly within the capabilities of the Canadian shipbuilding industry, conversion of an existing commercial ship design might prove to be the most economical alternative. As the cruise ship industry has grown over the years, the drive for larger and larger cruise ships has led to the early obsolescence and replacement of a number of vessels that would make ideal hospital ships. Many of these vessels remain available for sale or lease.

Cruise ships have many design features that make them desirable vessels for conversion to a hospital ship. To begin with, they are designed to carry large numbers of people – a significant portion of the hull space set aside for passenger cabins and the service staff required to cater to them. Ship services such as fresh water making, heating, ventilation and air conditioning, electrical generation, black and grey water collection and treatment, laundry facilities, food services and cargo capacity are already capable of supporting medical treatment services. Further, many cruise ships are designed to travel into restricted harbours and waterways and therefore already have advanced navigation and propulsion systems allowing them to manœuvre in tight waters without the aid of a tug.

Russian Hospital Ship "Енисей" (Yenisei).

Canada’s National Shipbuilding Strategy had winners and losers for the shipbuilding industry. Some yards such as Port Weller and Chantier-Davie lost out on the opportunity to participate in construction of the next generation of Royal Canadian Navy (RCN) and Canadian Coast Guard ships. However, Chantier Davie created Project Resolve to address the gap between the retirement of Canada’s replenishment ships (HMC Ships Protecteur and Preserver) and their replacement by the Joint Support Ships HMC Ships Queenstown and Chateauguay (to be built by Vancouver-based Seaspan). Project Resolve will provide an interim resupply capability for the RCN by converting a commercial ship to act as an oiler and replenishment ship. This converted ship will be operated and maintained by Chantier-Davie and leased to the Navy.

A similar such conversion, operation, maintenance and leasing arrangement for a hospital ship would both reduce much of the upfront costs of acquiring a hospital ship and make the capital costs more palatable. Further, privatizing operation and maintenance of a hospital ship would minimize demands placed upon existing government repair facilities such as the Navy’s Fleet Maintenance Facilities. A contracted hospital ship capability need not involve the Navy at all. Such a ship could be funded by other federal government departments such as Global Affairs Canada.

Launched in 1929 as passenger liner Hikawa Maru, this 11.6-ton ship’s routes typically included Hong Kong, Shanghai, Hawaii, Victoria, Vancouver and Seattle. It was requisitioned by the Japanese Navy in November 1941, and conversion to a hospital ship began on December 1st at the Mitsubishi Zosen shipyard. Three weeks later, on 23 December 1941, she departs on her first hospital round-trip voyage under the command of naval surgeon Captain Kanai Izumi. In 1960, she was taken out of service and became a floating youth hostel, museum and restaurant at Yokohama, Japan.
(art by Ueda Kihachiro)

Several Canadian shipyards have the capacity to convert a cruise ship into a hospital ship, and a hospital ship project would create regional benefits for shipyards that did not receive any of the NSPS projects. Further, funding a hospital ship through Global Affairs Canada/International Development, and choosing a shipyard not involved in the NSS contracts would reduce or eliminate any potential impact on the construction of Canadian Coast Guard and RCN projects.

As Chantier-Davie demonstrated with the rapid ramp up of Project Resolve, a hospital ship project could be shovel-ready within a very short period of time, thus tying into the federal government’s intent to spend on infrastructure projects.

Crewing a Hospital Ship
As previously noted, crewing a hospital ship can be done on a contract basis such as the arrangement with Federal Fleet Services for the crew of the Project Resolve replenishment ship. The U.S. Navy keeps each of their hospital ships on a standby basis with a small crew of maintainers and technicians, and augments the rest of the crew and medical staff when the ships are activated. There are several options for medically staffing a Canadian hospital ship. Cooperative arrangements with other like-minded countries, coalitions of the willing, or international organizations such as Médecins Sans Frontières, the Red Cross, the UN High Commission for Refugees, international charities, Canadian provinces and health authorities, as well as CAF medical personnel are all viable options. Medical staff composition could be tailored for the mission as the situation dictates. A Canadian hospital ship could also fulfil the role as a floating classroom for Canadian and international medical students, giving many the opportunity to learn and work in a modern hospital environment.

The Humanitarian Gap
Given the inherent value of such a national asset – its capacity to project soft power, its ability to contribute to Canadian international development and humanitarian response, its utility in responding to disasters here in Canada and abroad, its affordability and potential for contributing to employment and prosperity – why doesn’t Canada have a hospital ship?

LCdr Tim McDermott is a recently retired Royal Canadian Navy Officer of 37 years. He is currently completing a Graduate Degree in Disaster and Emergency Management at Royal Roads University.