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.
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.
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.
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)
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.