On Hospitals in Ships

According to the International Red Cross, the history of hospital ships, at least in the west, starts in the 17th century, when navies began to routinely send ships intended for the care of wounded and sick sailors and soldiers in company with fleet actions. In the 17th and 18th centuries, naval authorities chose veteran combat vessels for hospital use. Typically these tired men-of-war served as warehouses for the sick and wounded–victims of the rigors and deprivations of long distance sailing, or of war. During the 19th century, the procedure of taking ships up from trade–contracting civilian passenger liners or cruise ships and converting them to hospital use–found increasing use among many navies. Even as recently as the war in the Falkland Islands, the British Royal Navy took SS Uganda up from her civilian service as an educational cruise vessel to serve UK and allied troops during that short but violent conflict.

British Hospital Ship Uganda, then returned to civilian service

By the twentieth century, while the vast bulk of ships serving hospital duty were taken up from trade, some nations–the United States in particular–began constructing purpose-built hospital ships, the first example being the USS Relief (AH-1), laid down in 1917 and commissioned in 1919. In World War II, the British, Australian, Canadian, New Zealand, Dutch, French and German naval services all boasted hospital ships taken up from trade and converted for hospital or sick-transport use. The U S Army commissioned 24 hospital ships, all in hulls converted from civilian use and manned by Navy crews and Army medical staffs. To this day, the vast bulk of ships serving a dedicated hospital role are commercial or transport hulls converted to hospital purpose.

USS Relief

In 1907, hospital ships received explicit international legal status with international legal protections from attack and seizure, under Article Four of the Tenth Hague Convention. In order to receive such international protection, the hospital ship must meet the following standards: they must carry on no military activities, including interference with navigation by enemy ships; they must be painted white and bear large images of the red cross, the red crescent, or the red lion and sun. In order to ensure their protection under the Convention, these ships may be illuminated at night and during periods of poor visibility in order to make their hospital ship status readily apparent. Ironically, it was the Russian Hospital ship Orel (Eagle) that, by being so illuminated, tipped off elements of the Japanese navy to the presence of the Russian Admiral Rozhesvensky’s fleet trying to sneak its way under cover of fog and dark through the Tsushima Strait to Vladivostok. This contact led directly to the 1905 epochal naval battle that devastated the combined Russian fleet, and confirmed the ascendancy of Japanese naval power.

Russian Hospital Ship Orel

In World War I, hospital ships continued their traditional role as transports of the sick and wounded, bringing them from far away points of combat back to their home country for definitive treatment. The same can be said for hospital ships in World War II, though by this time, increasingly sophisticated care could be provided aboard these ships. By the time of the Korean War, hospital ships could take the role of stationary hospitals simply located at sea. An example of this is the Danish hospital ship Jutlandia, which, operated by the Danish Foreign Ministry and staffed by Danish volunteers, and with agreement of the United Nations, anchored off the Korean city of Pusan, and later Inchon, to provide medical services to military and civilian casualties and sick alike for three years during the U N’s police action in that peninsular nation.

Today, only the U S (Mercy class), Chinese (Type 920)

Chinese Type 920 Hospital Ship

and Russian (Project 320 Ob’ Class) navies operate large hospital ships; these are almost inevitably hulls converted or adapted from other purposes. The Spanish Department of Labor operates a large purpose-built hospital ship to serve that nation’s commercial and fishing fleet, and many nations, including Argentina and Brazil, operate smaller hospital units afloat in their extensive river waterways to provide care to civilian populations. Given the trend toward delivering nearly definitive care to wounded soldiers very close to, or in, combat action zones, and the extensive use of air evacuation, many are questioning the need for large hospital ships. The American experience is instructive: since 2003, U S hospital ships have been absent in areas of U S combat operations; increasingly, they are seen as assets to provide humanitarian care in areas of natural disaster. The US, Chinese, British, and German navies increasingly use medical and surgical capabilities built into combat or combat support ships to provide at-sea medical support for operations distant from the home country. The US has extensive medical capability in amphibious warfare ships of the LHD, LHA, LPD and LSD classes; the British have the Royal Fleet Auxiliary (Aviation Training Ship) Argus, now designated as a Primary Casualty Receiving Ship) and the Germany navy counts two ships (with a third on order) in its Berlin Class of replenishment ships, designed to support German military forces away from their home ports.

German Berlin Class Fleet Support Ship

It would appear that while the nature of hospital facilities at sea are changing, there is little doubt that soldiers, sailors and Marines can look forward to receiving medical and surgical care “from the sea” for some time to come.

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Comments

  • Neil Louwrens, MD  On 30 Sep 2010 at 08:27

    I found this article very informative and wanted to direct you to two interesting other sources. I recently replied in a letter to the editor to the Annals of Internal Medicine on my experience aboard the M/V Africa Mercy as Crew Physician. This letter was in response to an article in the Annals of the USS Mercy experience in Haiti. This at least highlights the roles of humanitarian ‘non-governmental’ use of Hospital ships worldwide. Logistical maintenance is high of course, but Mercy Ships is probably a leader in provision of care, with cost containment and efficiency of operation expertise perhaps unrivaled anywhere else, with subsequent maximization
    of care to the poor.
    See: Annals of Internal Medicine, September 7th, 2010, Volume 153, Number 5. This was in response to ‘ Practicing internal medicine on board the USNS Comfort in the aftermath of the Haitian earthquake, Annals of Internal Medicine. 2010; 152:733-7.
    Sincerely,
    Neil Louwrens, MD, FACP
    Crew Physician – M/V Africa Mercy, April 2010

  • Alan Hawk  On 25 Oct 2010 at 12:06

    This is a continuation of a trend that began during the Korean Conflict. As aeromedical evacuation has become increasingly reliable with the development of long range transports, hospital ships gradually became more useful as floating hospitals rather than as patient transports. Miniaturization of hospital electonics has allowed for creation of Critical Care Air Transport Teams (CCATT) that provide ICU-level care on non medically equipped transport aircraft. While the value of floating hospitals has declined for treatment of combat wounded, they have proven extremely valuable for humanitarian operations in Military Operations Other Than War(MOOTW).

  • Neil Louwrens  On 02 Mar 2014 at 18:23

    Mercy Ships is currently building the first ever Hospital ship from the ground up, i.e. not a conversion. Can’t wait!

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