America has built hospital ships since the Spanish-American War. But in the era of 2020 (and future) post pandemic budgetary constraints, are they going to be cost effective?

Comfort and Mercy were built to support a 1980s-era wartime playbook to serve as the biggest offshore combat trauma centers in the world. They’re also huge targets in a potential coming navy war with the People’s Republic of China. Does any reader believe that the Chinese People’s Liberation Army’s Navy (PLAN) would hesitate to sink a hospital ship? No, I didn’t think so.

The Mercy-class ships have several shortcomings, with the most vexing being that these world-class floating medical facilities have the offshore receiving capability of a small-town physician’s office. The ships lack a hangar and flight deck big enough to handle a surge of casualty-carrying helicopters. They are expensive to operate, can’t defend themselves, can’t safely receive injured by boat while at sea, and they are too large to operate in many areas of the world.

USS Red Rover

The USS Red Rover, entered service in 1862. During World War II, the Navy struggled to employ its baker’s dozen of Patrol Craft Escort (Rescue), or PCE(R)s, stubby little 185-foot boats crammed with 80 hospital beds. An informative review of these vessels can be found here.

PCE(R) Admirable Class (converted)

In the era of budgetary distress, the US Navy needs to think smarter about the future of hospital ships. Everybody wants to provide the best casualty care, but nobody wants to apply the lessons learned from the past three decades of hospital ship operations. Once the disaster-of-the-day is over, the hospital ships go into reserve status and become a problem for somebody else.

USNS Comfort

With the country beset by the COVID-19 pandemic, and the medical facilities in LA & NYC metropolitan areas in danger of overload, the President authorized the activation and deployment of the USNS Comfort and Mercy. Each ship is manned by civilian merchant mariners from the Military Sealift Command, with medical personnel drawn from Navy hospitals and the Navy Reserve, and has the capacity to handle 1,000 patients. In a press conference on 1 April 2020, the President stated, “This [deployment of the hospital ships] has worked out well so we’re looking at doing two brand new ones.”

The 2020 long-range shipbuilding plan projects the construction of two new hospital ships, one in 2033 and another in 2034, with delivery three years later. If anyone thinks that these will be built, raise your hand – and then slap your face with it.

There are two ways to look at hospital ships: They are either floating targets in a war, or they are disaster relief ships designed for peacetime operations in distressed locations. Each option requires a radically different design. If the Navy and the nation plans to replace these 44 years old behemoths, powered by obsolete steam plants, there are ways to go about it.

A FEMA Navy?

The Chinese Plague has destroyed the cruise ship industry and it won’t be coming back anytime soon. Certainly not soon enough to save the companies from insolvency. The fire sale that will follow the bankrupt cruise industry offers an opportunity to acquire cruise ships and convert them into “disaster relief ships”  (possibly paid for out of the FEMA budget, not out of the Defense Department budget) that are designed for point of care, not to survive in a combat environment. As these are refit, they can step into the role that the Mercy and Comfort now occupy, with the latter ships being held in reserve for combat casualty care until they can be replaced by more functional options.

Cruise ships have significant generator capability sufficient to power a large hospital, a robust water purifying and waste disposal systems to accommodate large passenger capacities, and the decks that are reinforced to support swimming pools can be used to support helicopter landing platform(s).

These disaster relief ships can win hearts and minds overseas and can be used to aid recovery efforts following domestic disasters such as hurricanes, earthquakes and the next pandemic. They don’t need to be as big or as sophisticated as the Mercy Class hospital ships, and they won’t pick the Navy’s pocket, though they could be captained and crewed by US Naval and National Health Service (who wear Navy uniforms) personnel.

Military Hospital Ship Concepts

Converting existing designs such as the Alaska-class tankers that was modified into the Lewis B. Puller–class expeditionary support base (ESB) platforms, could be used to construct “fighting hospital ships” capable of defending themselves against air threats, incoming cruise missiles, etc. Paint them haze gray and treat them like warships. Drop a hospital module into the space below the helicopter landing deck (see below). They’re never going to take the war to the enemy, but they’re smaller, and more deployable than the unwieldy Mercy Class ships. You could limit the bed space to 500 in much the way that the British Argus is configured. (see both ships below)

USS Lewis B. Puller, ESB-3
Royal Navy Casualty Receiving Ship – RFA Argus

Nobody knows when (or maybe “if”) there will be a shooting war with Communist China in the Pacific, but if there is, CASEVAC capacity will be needed. The sooner we start thinking in that way, the better off we’ll be.


  1. Some fine ideas there, LL. I especially like your cruise ship reuse plan. It seems some of the major design considerations include: large enough to be effective, small enough to go where needed, recognition of the need for some defensive capability. In my opinion, the Navy brass could be the greatest obstacle to an effective design. Also, an open war with China seems likely within the next twenty years. Interesting times….

    • The cruise ship option should be one that FEMA might consider. They have no watertight compartments and would be shamelessly easy for the Chinese to sink. US Naval Hospital Ships need a war-surviving design, need to be smaller, and could also be dual purpose ships as troop transports when they are not loaded with casualties. The current Mercy Class ships are as big as aircraft carriers and are dinosaurs. The Navy understands that.

      Look at how the USMC is reforming itself to fight expeditionary warfare on Pacific islands. It’s a remarkably prescient modification. They’re giving up their heavy armor, bridging units, etc. and are taking on land based anti-shipping missiles. The F-35B can VTOL from islands and provide local air cover for the Marines. I point this out because they’re planning to hold and defend against the Chinese. The same philosophy needs to go into the calculus of hospital ship programs. Of course, the future of the Navy and all this depends on who the next president – or vice president if the donkeys win – turns out to be.

  2. Several good solutions and I like the idea of the appalling cruise ships being put to good use. That aside, let’s hope they’re not needed.

    What’s your take on the ChiCom navy?

    • Maybe one cruise ship can be refit by FEMA. You don’t need a fleet.

      The PLA(N) has good platforms and a lot of them, with a navy that has a lot of experience in shallow, coastal, littoral water. The Chinese Coast Guard has a lot of experience ramming and sinking fishing boats, taking those boats on the high seas in international waters, and imprisoning the crews.

      Nobody knows how they will fight.

      • I would suggest 3 cruise ships. One on the east coast, one on the west and one in the gulf.

        • Three may be more than we can afford. At the moment we have East and West Coasts covered with the Comfort and Mercy, but they take a long time to spin up because they are USNS, not USS. They’re reserve ships, crewed differently. My sense was two or possibly one. A lot depends on how much money FEMA wants to spend on ships.

          I definitely think that we need to break away the FEMA mission from the US Navy mission. US Naval war/hospital ships can definitely perform humanitarian missions, but they need to train as a component of the Amphibious Ready Group (ARG) or Carrier Air Group, and possibly have a logistics mission as well as operating as dedicated floating hospitals only. No white slab sides, no red crosses, and defensive weapon systems manned by regular navy.

      • Good point, and the Private was talking about that in an army way today — the US Army’s been fighting since what, His Majesty Bush Ist. So it has experience. Who’ve the PLA fought a war against lately? Anyone?

        Saying that, when was the last time our Navy actually fought against warships.

        • The Marine Corps (naval infantry) has had a lot of trigger time but the last big navy war was the Second World War.

  3. I like your proposal but likely it’ll never fly. It makes too much sense and would likely save money.

    • In an era of shrinking/no budgets the only think that we’ll build in the short term are submarines and destroyers, and likely the new frigates. The big aircraft carriers may NEVER be built beyond the Ford.

    • As I mentioned to Jim, the USN ship building program can only survive in any way (beyond submarines, destroyers and frigates) if there there is an infrastructure spending bill that earmarks money for shipyards. They employ a lot of people and once left fallow, the critical skills necessary to build ships vanishes. That’s why some shipbuilding programs won’t be shut down. The start-up problems are legion.

  4. Hopefully we’ll never again need the capability to crank out large numbers of “throw away” ships like the Liberty and Victory class. At this point, we can’t crank out large quantities of ANY ship due to the fact we barely have any ship building facilities left. There’s nothing left in the L.A. area that can even service big ships, let alone build them. I think Todd Shipyards in Wilmington were the last active yard, and the Long Beach Naval Shipyard is just a fond memory, replaced by container yards owned by the CHICOMS. One of the best shipyards EVER, always on-time, under-budget, and extremely well run.

    And I agree about the Super-Mega-Awesome-Class carriers. I remember the first time I was on the Nimitz. The first thing that struck me was “GAWD….Whatta TARGET”, but I didn’t say anything because the F-14’s I was working with were there to protect the carrier and her battle group.

    I have no doubt the PLA(N) would sink a hospital ship without batting an eye.

    • The loss of the Long Beach Naval Shipyard was criminal. It will never be rebuilt. As you correctly point out, it’s a wholly owned Chinese Communist operation today. We could seize the facility and seize the CHICOM ships, but it’s not going to be a shipyard again.

      • They even filled-in the huge dry dock they had there. Huell Howser rightly raised one hell of a stink about closing the LBNSY, pointing out they’d just spent 10’s of millions to modernize it, it was the ONLY facility of it’s kind in all of Southern California, and had a sterling reputation.

        But with the gentrification of Long Beach, people didn’t want a smelly, dirty, MILITARY base on prime shorefront property, so his protests fell on deaf ears, except for people like us.

        Goodness…think of the children being exposed to military people and hardware!

        And I’m sure the shiploads of cash the CHICOMS spread around helped grease the skid…..

  5. A hospital ship is a prime enemy target. We need to make them look less like hospital ships and simply run them with the fleet. They shouldn’t need significant UNREP and need to be able to keep up with the warships.

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