Interest in sea-based health diplomacy is growing. Admiral Stavridis, SOUTHCOM commander and fellow USNI blogger recently argued for the creation of Navy Humanitarian Service Groups to project US smart-power abroad:

“What I am thinking about specifically is centering a group around a hospital ship and then including in that group several smaller ships that bring training capability with them”.

A major challenge with the type of mission Adm. Stavridis is suggesting is logistical: getting patients to the hospital or vice versa. The US Navy’s only two hospital ships are ill equipped for this task. Converted supertankers, both have deep drafts, no well decks, and limited airlift capabilities.

The ideal ship would be the LPD-17, which has a well deck, significant on board airlift capability, and a shallower draft. In fact, the LPD-17 forms the center of Navy Commander Henry Hendrix’ proposed Influence Squadrons. Augmented with a module akin to a field hospital, the LPD-17 could provide a flexible platform for disaster relief and health diplomacy.

Some question the feasibility of operating a field hospital on board transport ships. These critics contend that field hospitals require significant resources (power and water) and supplying adequate amounts onboard would be impossible. However, more than a decade ago the Chinese designed a system to do just that.

China-Defense-Mashup.com

Ship 865. Credit: China-Defense-Mashup.com

China-Defense-Mashup.com

Ship 865. Credit: China-Defense-Mashup.com

In the mid-90s PLAN developed a “ship-used medical module system” consisting of a series of interconnected shipping containers (similar to many modern field hospitals). The system allows cargo vessels to be employed as hospital ships. China’s little known Ship 865 (pictured) is an example of the medical module system in action, providing a medical facility, landing pad, and even an air control tower.

While the exact capabilities of Ship 865 and PLAN’s medical module system are not known, they provide a meaningful proof of concept. A Navy medical module, combined with the LPD-17, offers the capability and flexibility needed in future humanitarian missions.




Posted by Christopher Albon in Navy, Soft Power
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  • http://www.jimdolbow.blogspot.com Jim Dolbow

    Chris, outstanding post! welcome aboard USNI blog!

  • Fouled Anchor

    Chris, great topic, and yes, welcome aboard. Jim Dolbow knows first hand the value of missions like the COMFORT. The rest of the Navy and the nation are starting to get acquainted with the benefits. Two things are need now: educating people on the benefits of these important missions, and planning how to improve them. Your post is helping on the second point.

    This is a subject that needs to be talked about more…and I believe we’ll hear and see more of these missions as Admiral Stavridis moves on.

  • Chap

    Great to see you on here!

    Might be worth talking to the Maritime Civil Affairs Group folks. They have some interesting lessons learned.

  • Scott B.

    Another very interesting concept to provide a flexible platform for disaster relief and health diplomacy is the Danish ABSALON flexible support ship, which can be fitted with a containerised modular hospital on the flex deck. This modular hospital has a throughput capacity to treat 40 emergency patients a day or up to ten major surgical operations.

    With a unit cost of about $230 million, the US Navy could get 6 Absalons for the price of one LPD-17 ($1,479 million per unit).

  • Scott B.

    (sorry for double post above; please delete first one)

    The purpose-designed concept for GFS proposed by NSWC Carderock in February 2008 was not an LPD-17 derivative, but a general cargo ship design with a loaded displacement of about 6,500 tons, modified to include a well deck, helicopter landing pad and hangar.

  • http://www.militaryairships.blogspot.com campbell

    Gentlemen, all:

    A primary goal of mine for over 28 years now, has been to use large rigid shelled airships as “flying hospitals”.

    While I do have a commercial airship business (Turtle Airships); it is our absolute determination to also manage a non-profit organization (TurtleDove Airships) that will field large airships that can serve to deliver the types of medical/humanitarian needs now being so well done by USS Comfort and crew. We have always published our intent to make these craft available for use by International Red Cross, UNICEF, WHO, Red Crescent, and other humanitarian organizations.

    Large rigid, solar powered AIRSHIPS (not blimps) offer a potential airlift capability that is unequalled; with the ability to deliver humanitarian personnel/supplies directly to remote locations where needed, by-passing the traditional airlift or shipping methods, or local transport via helicopters or land vehicles. This can make delivery of help more versatile and effective; and at less cost. It would also enable relief efforts to avoid all to common interruption from theft along transport lines.

    Use of airships can become an immensely important part of the U.S. Navy “soft power” projection misssion.

    [email protected]

  • http://warandhealth.com/ Christopher Albon

    Jim, Fouled Anchor, and Chap: Thanks! Good to be here.

    Scott B.: The ABSALON is another good proof of concept. The key is to design a system so that the transport ship can be supporting OIF in the Persian Gulf one deployment, and doing health diplomacy in Peru the next. Flexibility, flexibility, flexibility.

    Campbell: Airships are not the answer. Politically and economically, building a dozen LPD-17s is more likely than a single operational hospital airship.

  • http://www.militaryairships.blogspot.com campbell

    Mr. Albon

    Indeed, airships are not “the” answer; as I posted, they can become an important “part”.

    As you say, politically, airships are less likely to be built than other vessels. It is a sad thing, that such a good supplement to current platforms should be so disregarded.

    Hopefully, future concerns over high shipbuilding and fuel costs will bring about a needed change.

    In the meantime; thank you for your posts about ANY of the missions,personnel, ships, or tech involved in this type of Naval humanitarian work.

  • Scott B.

    Christopher Albon said : “The key is to design a system so that the transport ship can be supporting OIF in the Persian Gulf one deployment, and doing health diplomacy in Peru the next. Flexibility, flexibility, flexibility.”

    Don’t forget Affordability, affordability, affordability.

    Which is one of the reasons that makes LPD-17 a rather poor choice.

    The best option is to combine :

    1) a large number of small (war)ships (6,500 tons sounds about right) which can be configured as hospital ships for health diplomacy purposes. Ideally, these ships should be versatile enough to cover most (if not all) the spectrum of low end contingencies. This is more or less the idea behind the February 2008 design proposed by NSWC Carderock I mentioned earlier. And when it comes to covering a wide variety of contingencies (not just low-end), a flexible support ship like the Danish Absalon seems ideal.

    2) a smaller number of large-sized Field Hospitals (FH) to cope with major disasters. An interesting concept studied by NSWC in April 2007 was to place such a large-sized containerised modular FH on the deck of a commercial heavy lift ship to act as a temporary hospital in major combat or disaster relief operations. This type of large-sized containerized modular FH would have the ability to be adapted to any type of commercial heavy lift ship, eliminating the need for the US Navy to construct a dedicated large hospital ship.

    In other words, to paraphrase CMDR Hendrix, (1) + (2) = Buy Ford, Not Ferrari

    Last but not least, a very warm welcome to the USNI blog !

  • Benjamin Walthrop

    The deep draft approaches mimic the design of the current crop of hospital ships. The key is not trying to figure out how to put a field hospital in containers, and the containers on a ship. The key is the ship to shore connector that will be able to get the patients to the ship in the first place.

    Scott B’s solution has some advantages in that it will probably be able to get closer to shore or access more harbors than the current (or Chinese proof of concept) solution. The disadvantages of the deeper draft solutions could be mitigated with appropriate connectors, but at what cost? Leesea would probably have more insight in this field that I do at the moment.

    That said, given the relatively limited throughput of the Absalom solution, a business case would have to be made to compare apples to apples in this case. When I hear that the Absalom solution is only $230M per copy, but the plan would be to build a large number I get just a little bit nervous. Four would get you to the $1B LPD solution, but might (and this is a very big might) buy you more flexibility depending on the mission.

    By no means is the business case the final deciding point, but it would have to be an important consideration.

    As modularity is truly adopted throughout the fleet, perhaps a two tier solution could be adapted.

    V/R,

  • Byron

    Ro-Ro.

  • Scott B.

    Ro-Ro ?

  • Byron

    “The key is the ship to shore connector that will be able to get the patients to the ship in the first place”

    Roll-on, Roll-off ships.

  • Scott B.

    Benjamin Walthrop said : “The deep draft approaches mimic the design of the current crop of hospital ships.”

    Commercial *heavy lift* doesn’t necessarily mean deep draft. For instance, two of the ships studied by NSWC Carderock in April 2007, M/V Explorer (Dockwise) and M/V CombiDock (Combi Lift) have less draft than an LPD-17 :

    * for M/V Explorer : summer draft = 4.84 meters
    * for M/V CombiDock : summer draft = 6.60 meters
    * for LPD-17 (hospital ship variant) : draft, full load = 6.80 meters

    *Heavy Lift* ships with more deck space, for instance Dockwise Super Servant 4 (4,672 square meters of DS) or the future Combi Lift Deckcarrier (6,000+ square meters of DS + helicopter deck) would still offer *reasonable* drafts, i.e. 5.38 meters (summer draft) for Super Servant 4 and 7-8 meters (summer draft) for Deckcarrier.

  • Scott B.

    Benjamin Walthrop said : “That said, given the relatively limited throughput of the Absalom solution, a business case would have to be made to compare apples to apples in this case.”

    Some quick comments here :

    1) Like I said earlier, the Average End Cost for the San Antonio-class LPD is $1.5 billion according to the FY2009 Budget documentation (see 14-1).

    2) The LPD-17 Hospital Ship variant studied in April 1997 of 250 patients per day. A standard LPD-17 with a modular hospital would probably offer less capacity.

    3) $1.5 billion gets you 6 Absalons, each with a capacity of 40 patients per day, i.e. an aggregate 240 patients per day.

  • Benjamin Walthrop

    I am starting to go down the rabbit hole of potentially arguing apples and oranges, but the USNS Comfort has about 1000 beds total. 240 patients per day seems like it is not in the same league.

    As far as draft, Scott B. may be (and probably is) right. I’m try to dig up report I have seen in the past from NOAA on Aftrican ports to see how many can support a 4.84m summer draft ship pierside.

    V/R,

  • leesea

    MSC has been chartering sealift ships to preposition Fleet Hosptials since the SS Letitia Lykes in the late 1980s. I worked on that project. The MPF-Enhanced were bought specifically with Fleet Hospital lift rqmts in mind.

    The Navy has known for years that the T-AH 19 class is too big for HA/DR missions, but they are unwilling or unable to afford a smaller replacement.

    The Chinese have stolen my idea for an affordable hospital ship (there they go again LOL) based on the two LKA conversions I worke on in the late 90s.

    Scott B have you been reading the links I mentioned to DockWise? What seems to be missed here is that HEAVY lift ships are NOT needed for container and vehicle transportation. Heavy lift ships and Flo/Flos needs very deep draft to submerge in order to discharge their loads. The CombiShips are a highly specialized barge carrier which does not fit the bill but is shallower draft.

    LPD17 design has NO significant container capability and its wet well docks detracts from available space for MTF and other needed lift rqmts such as Seabee vehicles, building materials and as not discussed FH vehicles and support equipment. There is NO need for a wet well to launch the size boats/lighterage used in hospital ship missions. Go look at Kvichak MPF lighters which are launched by ships cranes. Simply using LCM-8s would be a slow solution.

    But I digressed, the hospital ships indeed do need to be smaller aka handy sized. They do need larger flight decks. They do need more boat assets. They do need more cranes to handle cargo/containers over the side. None of which is available currently in either the T-AH19 class or the LPD17 class. But IF a warship design were to be used the Absalon would be on the high end of the list. An Araphao system would be on the low end of the design an only a few notches up from the Chinese Navy ship of the subject.

  • http://informationdissemination.blogspot.com/ Galrahn

    When I hear that the Absalom solution is only $230M per copy…

    When I see this, I think of $220 million littoral combat ships.

    This is one of the most propagated inaccurate statements in the naval blogosphere. I have asked every possible credible person who estimates US shipbuildnig, and from Tim Colton to Eric Labs the consensus is that $230m number is completely unrealistic.

    And Tim Colton notes that comparing US and European shipbuilding costs is very dangerous, costing is much different and there are a lot of government substities involved, among many other things.

  • http://www.militaryairships.blogspot.com campbell

    Just to be contrary a bit, I’ll make a note about Hospital Airships…and then leave it alone.

    RE: “draft”……..Amphibious hospital airships in mind would have less than 3 meter draft (water)
    and less than 6″, landing on an empty grass/shrub field.

    What is the cost of building something like a 747? less than $150 million a copy, since that is what they SELL for. (100) bed flying hospital airships can be constructed for that amount.

    we can build “more” solar powered airships for the same cost as surface vessels; and, while it’s true that they can’t carry as much in tonnage, we can gain huge advantages in versatility (water or land ops/ no fuel) and speed

    Just had to add that ;)

  • Scott B.

    Galrahn said : “This is one of the most propagated inaccurate statements in the naval blogosphere.”

    I’ve already posted several links, for instance at your own website, that confirm the figure of $230 million for one Absalon.

    For instance, this datasheet available on the Danish MoD website :
    http://www.forsvaret.dk/sitecollectiondocuments/smk/projekter/fs/pr%C3%A6sentation_af_fleksibel_st%C3%B8tteskib.pdf

    Page 2, 2nd paragraph :

    In Danish : “Den samlede pris for de to skibe med udrustning er ca. 2.5 mia. kr. og skibene planlægges at være fuldt operative med udgangen af 2007.”

    In English : “The overall price for the two ships complete with equipment is about DKK 2.5 billion and the ships are planned to become fully operational by the end of 2007.”

    Current Exchange Rate : 1 USD = 0.187 DKK

    Which means That means $468 million for two ships, i.e. $234 million per ship.

  • Scott B.

    Galrahn said : “And Tim Colton notes that comparing US and European shipbuilding costs is very dangerous, costing is much different and there are a lot of government substities involved, among many other things.”

    Now this is one of the most propagated inaccurate statements in the naval blogosphere.

    For instance, in the NATO SLC Study that was discussed many times at your own website in the past, it was found that the overall correlation of U.S. Coast Guard and Netherlands shipyard production costs (WBS Group 100-700 inc.) was strong, as follows :

    600-ton SLC : NL = 1.0 / US = 1.153
    2000-ton SLC : NL = 1.0 / US =1.024
    600-ton OPV : NL = 1.0 / US = 1.093
    2000-ton OPV : NL = 1.0 / US = 0.826
    Overall correlation : NL = 1.0 / 1.0394

    Same strong correlation was found between NL and US at the WBS Level, e.g. for the 2,000-ton SLC :

    WBS 100, Structure : NL = 1.00 / US= 1.00
    WBS 200, Propulsion : NL = 4.88 / US = 4.60
    WBS 300, Electrical : NL = 5.64 / US = 5.97
    WBS 400, Electronics : NL = 2.34 / US = 2.75
    WBS 500, Auxiliaries : NL = 4.32 / US = 4.33
    WBS 600, Outfitting : NL = 5.00 / US = 5.48
    WBS 700, Armament : NL = 0.90 / US = 1.30
    WBS 900, Admin : NL = 0.34 / US = 0.53

    What it means is that, for the four designs analyzed in the NATO study :

    1) Shipyard costs at aggregate level (WBS100 -> WBS 700) were very similar between the NL and the US.

    2) Cost structure (i.e. cost broken down at WBS level) was very similar between the NL and the US.

  • Scott B.

    One more comment on costs :

    The Dutch Air Defense and Command Frigates (De Zeven Provincien) cost a little less than Euro 1,600 million in total, i.e. about Euro 400 million per frigate, i.e. about $560 million per frigate.

    For comparison purposes, LCS-1 cost $637 million and LCS-2 cost $704 million.

  • Scott B.

    leesea said : “What seems to be missed here is that HEAVY lift ships are NOT needed for container and vehicle transportation.”

    Lee,

    The reason why they went for heavy lift ships and not containership is this :

    The containers that consitute the modular hospital would be loaded pre-assembled on to a mobile causeway system or a barge, which would then be floated to the heavy lift ship.

    The expected benefits are that :

    1) The modular hospital could be pre-assembled before the heavy lift ship arrives, which would speed up deployment.

    2) The modular hospital could be floated off the deck of the heavy lift ship float after reaching the desired mission location (meaning the heavy lift ship could be used for transportation only).

    There are other benefits, like the ability to put tanks inside the body of the barges for increased potable water storage, etc…

  • leesea

    ScottB, you have obviously never loaded either a semi-submersible ship or a fleet hosptial. I have, I stand by my comments.

    Also why are you ASSUMING that the fleet hospital needs to be afloat? 500 bed FH’s take up 22 acres ashore. Smaller versions can be assembled ashore easily using helos and vehicles by Seabees. A medium sized ConRo with flight deck added and sufficient cargo gear would work fine as a handy sized hosptial support ship. Which I thought was the point of this post?

    Chris sorry but an LPD17 cannot do much to help get an FH or its subsets ashore inland. Its a popular myth kicking around the web and in the minds of some not so knowledgeable Marines (who really only want another exquisite ship!)

    Also go look up Fleet Hospital prepo ships (yes there have been several) and see how they were discharged ashore as in Desert Storm.

  • Scott B.

    leesea said : “Also why are you ASSUMING that the fleet hospital needs to be afloat? 500 bed FH’s take up 22 acres ashore.”

    1) I am not assuming anything, merely reporting what’s in the 2007 study by NSWC Carderock.

    2) Total deck area used for the modular hospital in the Black Marlin configuration is 4,798 square meters (i.e. a little more than 1.1 acres) for a capacity of 216 patients per day.

  • Scott B.

    leesea said : “Which I thought was the point of this post?”

    I may be wrong, but I believe the point of this post was not how to transport a FH that would subsequently have to be assembled on land, but to discuss *affordable* options for a Hospital Ship replacement.

  • leesea

    There is a difference between deck area required and land area needed to setup a FH or one of its subsets. You people need room to walk around? Generators and HAZMAT has to be away from ORs.

    Like I said MSC has already sealifted fleet hospitals before. Did NSWC study mention that? Did they mention the several FHs setup far inland during Desert Storm? Did they mention the dedicated Seabee support vehicles and equipment needed?

    I didn’t read the studies. I saw what a FH was composed of and put it a ship or two. Just because some idiot in NSWC says heavy lift or some other ship type is THE right one, does not impress me. Afterall they are also the ones who came up with the MLP monstrosity.

    Did you check those other sites?

  • Scott B.

    leesea said : “There is a difference between deck area required and land area needed to setup a FH or one of its subsets. You people need room to walk around?”

    The modular hospital proposed by NSWC Carderock for the heavy lift ships is fully enclosed through a network of corridors.

    In the CombiDock configuration, these corridors alone account for more than 20% of the deck area utilized (i.e. 360 sq. meters out of 1,747 sq. meters).

  • Scott B.

    leesea said : “Like I said MSC has already sealifted fleet hospitals before.”

    Again, what the NSWC study is talking about is a Modular Hospital Ship, which is not the same as a sealifted field hospital.

  • Scott B.

    leesea said : “I didn’t read the studies. (…) Just because some idiot in NSWC says heavy lift or some other ship type is THE right one, does not impress me.”

    I don’t think there is any kind of benefit to be had with this kind of criticism, that’s completely disconnected from the substance of the study and solely based on what organization its authors may belong to.

    However, it would be more constructive if you could take a close look at the study, make an informed opinion on what’s in there, and then share some of your findings with the audience.

    Here are the references of the study, should you eventually decide to take a look at it :

    Title : Use of Heavy Lift Ships as Modular Casualty Receiving Ships

    Author : David Jurkiewicz

    Organization : Naval Surface Warfare Center, Carderock Division

    Date : 30 April 2007

  • leesea

    Go read something other than NAVSEA studies, you will see that what is needed is a handy sized ship to transport smaller existing fleet hospitals, move them and there personnel ashore and then support them for a long period while they are ashore. That is a good operational rqmt.

    The premise that heavy lift ships are needed to transport a modular aka containerized hospitals is erroneous at the start.

    Met those guys and still not impressed.

    No more on this topic

  • http://s296.photobucket.com/albums/mm200/fsorensen/ Hvidtfeldt

    For those interested in pictures of the Absalon including drawings of the internal lay-out:
    http://s296.photobucket.com/albums/mm200/fsorensen/Ships/Absalon/?start=all

    I will gladly send original photos by mail on request:
    My mail address is NEPTUNUS1960(at)HOTMAIL.COM (please substitute at with proper character :-) I am away most of August, so pleaase be patient.

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