I wrote the following in the February 2008 edition of Proceedings (pre-blog)….

Nobody asked me, but…

By Lieutenant Jim Dolbow, U.S. Coast Guard Reserve

Let’s Have a Fleet of 15 Hospital Ships

Each one of the Department of Defense’s five regional combatant commands should have three hospital ships permanently assigned to their respective areas of responsibility. Why so many, you ask?

It’s so simple that it can be summed up in two words: medical diplomacy. Former Health and Human Services Secretary Tommy Thompson (who coined that term) was right on target when he said, “medical diplomacy is the winning of hearts and minds of people in the Middle East, Asia, Africa, and elsewhere by exporting medical care, expertise, and personnel to help those who need it most.” Moreover, according to Thompson, “What better way to knock down the hatred, the barriers of ethnic and religious groups that are afraid of America, and hate America, than to offer good medical policy and good health to these countries?”

Between Secretary Thompson’s wisdom and the fact that the Navy’s two hospital ships, USNS Comfort (T-AH-20) and Mercy (T-AH-19), have proved themselves to be outstanding ambassadors of good will during their recent deployments, I say the Navy should go to the Office of Management and Budget and Capitol Hill and ask for the funds to begin laying the keels for an additional 13 hospital ships. The pros strongly outweigh the cons on this issue. For example:

•It would be a great boon for the shipbuilding industry that so desperately needs some work to remain afloat;

•There’s no shortage of hearts and minds to win in any of the regional combatant commands;

•Joint Chiefs Chairman Admiral Mike Mullen said when he was CNO that he’d hand a part of his budget to the State Department “in a heartbeat,” assuming it was spent in the right place. These additional platforms in a medical diplomacy role would remedy the need to transfer funds from DOD to bolster the diplomacy efforts of the State Department;

• The wrath of Mother Nature is not projected by the experts to lessen any time soon. Additional hospital ships would speed up the U.S. response to natural disasters around the globe, saving lives in the process. Gone would be the lengthy transit times from San Diego or Baltimore. (emphasis added)

Unfortunately, the same people who several years ago wanted to decommission both the Mercy and the Comfort have now been diagnosed with advanced bureaucratic arteriosclerosis. Besides needing some follow-up care after reading this article, they will most likely use some red herrings to argue against expanding the size of the Navy’s hospital fleet, including: money is tight, other assets could perform the same mission, and there is not enough personnel to sail them. To borrow a line from U.S. Army Brigadier General Anthony G. McAuliffe of Bastogne fame, I say “Nuts.”

First, for less than one day’s cost of the wars in both Iraq and Afghanistan, a tanker could be built and equipped to be a state-of-the-art floating medical facility. The potential dividends would be similar to the huge favorable swing in public opinion enjoyed by the United States after the Mercy’s 2005 humanitarian mission. According to Kenneth Ballen of Terror Free Tomorrow, “nationwide polls of Indonesia and Bangladesh conducted in August 2006, following the Mercy’s visit, suggest that a remarkable 85 percent of Indonesians and 95 percent of the people of Bangladesh were favorable to the Mercy’s mission.” No small feat indeed.

Second, manning the ships will not be a problem given proper recruitment and retention efforts. The new ships could sail with an expanded hybrid crew of civilian mariners, joint forces and coalition medical personnel, non-governmental organizations, and civilian volunteers to include retired military personnel. Also, instead of reducing the Navy’s end-strength as currently envisioned, some Sailors could be retrained as corpsmen. Contractors could also be hired. Headhunters could recruit plenty of doctors that would want to serve their country while at the same time getting a reprieve from insurance paperwork, TRICARE, and Medicare, etc.

“Let’s roll” by building a fleet of 15 hospital ships. We have some hearts and minds to win.

Posted by Jim Dolbow in Navy

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  • Second the motion! And, I’ll add in some more…..
    (excerpt from my book “Helium Phoenix” 1996)

    “…Solace was a one hundred bed hospital that could fly.

    Fly anywhere; land; and deliver comprehensive, immediate medical help to the most remote places on the planet. She could carry over sixty tons of foods, clean fresh water, emergency generators and other equipment to stranded peoples or survivors of natural disasters; land and take them on board as needed for emergency medical care, then fly the most needy to faraway cities and other hospitals.

    Solace had her beginnings in the mid 1950’s; back in the post Korean War days when the Military Sea Transport Service had still docked up at pier 39 in Seattle; when Turtle Airships president Darrell Campbell had been a boy; and while visiting his seaman fathers’ MSTS freighter at the docks, he had first seen the hospital ship HOPE.

    It was an impressive thought to the boy; that a hospital could move about the world and take help and hope to those that had none. That image stayed with him all his life; and became part of his vision for Turtle Airships’ future.

    How magnificent it would be; to create a fleet of airships that were flying hospitals; able to go where roads might have been washed out, or where airplanes couldn’t land, or where there simply were no helicopters available to save lives.

    Why not airships?

    They were roomy enough to have staterooms; why not operating rooms? Instead of carrying hundreds of tourists; why not carry hundreds of patients? Free from the constraints of the sea; this new kind of ship could travel inland; to any place. Unlike airplanes, it could land any place. Unlike helicopters, it would cost little to fuel; and could lift more.

    Why not build hospital airships?……..”

  • Chris

    I say we take care of our own heathcare needs first. With millions of Americans unable to get decent healthcare, don’t you think that would be a better idea?

  • 15? No.

    4 new-construction, modern ones to replace the MERCY and COMFORT? Sure, though just 2 would be fine as well.

    We cannot and should not build a fleet to serve as a floating Médecins Sans Frontières. Hospital ships should be based and designed primarily to meet expected wartime requirements with a secondary peacetime “soft power” missions and disaster relief as needed.

    If there is a desire by many to build a fleet of hospital ships to cruise the world trying to save it all – then those people should get in touch with the Bill Gates Foundation or other philanthropic organizations and do so as a NGO and private citizens.

    Our Constitution was not designed, and our taxpayers should not be forces to bear the burden, of expending large amounts of money, time, and resources performing functions that should be done by other sovereign nations for their own people.

    This nation’s military has a long and very proud history of stepping in both domestically and internationally for humanitarian assistance on a short term, immediate need basis – and we should continue to do so as a secondary mission within means and capabilities – until civilian organizations quickly step up to the plate and we go home.

    As we cannot meet the primary national security requirements – maritime or otherwise – as it stands right now; to divert funds to building 15 hospital ships would be ……… to be blunt as only one pal can to another, in a nice way with no hostility ……. feel-good folly.

    In summary; secondary mission – within means and capabilities. If want more, start a NGO.

  • Chuck Hill

    Does seem like having enough to keep one active on each coast would be a good idea.

  • Chap

    Can we do it? Sure.

    Should we do it? Well, that’s not exactly defense, so maybe USAID can have it. Except: is that where the government wants to be?

    How many hospital ships’ worth of people and equipment came to Haiti on its own as part of charitable need? How much less would go there on their own if they’re taxed so the government can Do Good in their stead (not so farfetched; studies of charitable giving in countries that mandate such via taxes tend to be less individually giving).

    You’re convinced, I’m sure, but I’m not convinced that this is an idea that should come via the taxpayers to the United States Government. Folks are doing stuff like this now all by themselves–I know one church setup where they have a merchant they fill up and send places in need, for instance–and that I argue is the more effective method.

    Besides, the doctors have to volunteer, or be hired specially. It’s not as though there are too many doctors aboard for one hospital ship.

    Then, you have one more problem. Let’s say you build those things. Freedonia gets all its major med care and emergency capacity from these visits. How, then, does Freedonia build its own capacity? We saw during the SOUTHCOM visits of Comfort that the massive medical influx killed local medical providers-they went out of business or lost money or went nuts providing the wave of post-op medical care needed when the ship went away.

    Can we do this? Oh sure. Should we do this? I don’t think so.

  • Jay

    Fifteen is a tall order. Especially for adequately staffing the medical billets. We could very likely build a handful (5ish?) from non-SCN funds — and have MSC operate them, but funded by…Dept of State? Some UN funding?

    Not the same size as the current two larger ones, but smaller, and perhaps permanently deployed — one each in the regional Combatant Commander’s areas, except for Northcom?

    It is an issue worth exploring, even if it ends up not being executed. No need to build them to anything other than commercial specs — pending USN flight deck cert. Some sort of robust small boat (shallow draft) capability as well.

    Partner heavily with NGOs — to preclude putting local medical efforts from going under and/or aid being wasted — perhaps include them on the staff?

  • leesea

    This suggestion completely ignore the realities of two things. First there is NO support for more hospital ships in the SCN. And the USN needs more handy-size medical ships which have most of the other support capabilities built into them. Just as I proposed years ago converting two T-LKAs for that purpose (for less than the cost of one new construction JHSV)

  • B.Smitty

    Why not build 15 multipurpose, modestly-sized GFS station ships that have the ability to carry containerized hospitals or other capabilities as needed?

    Then, if you want to do “Construction Diplomacy” you load construction equipment and crews. If you wanted to do counter-piracy, you could carry small craft and crews. And so on.

  • Chuck Hill

    One of the problems with the existing ships is that their helo facilities are so limited.

  • Spade

    How about more amphibs with somewhat expanded medical capabilities?

  • B.Smitty


    LPD-17s are over a billion each. LHD/LHAs are a LOT more than that, and they still don’t come close to the hospital facilities of a dedicated vessel.

    We can buy modified commercial vessels for a lot less and have the same or greater capability.

  • At Mercy Ships, we represent those who want to make a difference through hospital ships that are strategically deployed to serve in areas of health care needs. Recently, our services are increasingly focused on capacity building – training and medical infrastructure development. The strategy is particularly effective as we are “non-threatening” to local health care providers. We do not compete with their efforts to provide services and we strengthen their efforts through capacity building. Most of our field staff – even surgeons and nurses are volunteers. Check us out on the web: http://www.mercyships.org.

  • Julie Feinsilver

    I am delighted to see some debate about the use of medical diplomacy. It is a great idea, and something I have studied since 1979, and written about on and off and supported since 1989. There is no doubt that medical diplomacy does much to change people’s attitudes about the U.S. or, for that matter, any country that practices it. However, the U.S. government should seek the best way to provide it in a coordinated and cost-effective fashion. Although each agency, service branch, or institution may wish to go it alone, the effect is optimized and transaction costs reduced both for the aid recipient and the U.S. government if there is coordination. Better yet would be a government-wide strategy in which each agency, service branch, or institution had a piece of the action. Public-private partnerships with both the non-profit and for-profit sectors could further enhance the beneficial results and may even reduce their costs. Therefore, I would advocate for a government-wide strategy. And, by the way, Tommy Thompson did not coin the term “medical diplomacy.” It was in use already in the Carter administration, and probably before that. My own first published article using the term was in 1989, long before Tommy Thompson supposedly coined it.

  • Mike Carroll

    I’d say 15 seems a bit much. However, we are at a particularly auspicious moment for such a large action. Both COMFORT and MERCY began life as Single Hull Tankers that NASSCO converted to their present missions, to include moving the bridge to the bow. Single Hull Tankers are going to scrap. If the USN were really serious about this (and seabasing), they could probably acquire all the hulls they could use at scrap cost and convert them to AH and other soft power missions requiring big decks and massive volumes, and keep a couple of US shipyards busy for a couple of years.

  • Pascal Stalder

    The choice of building more or different USNS hospital ships should first be governed by DoD strategy, priorities and requirements. It is a fortunate side effect that we can gain goodwill when we use these assets, as we use aircraft carriers, amphibs, other USNS assets, etc., for humanitarian missions.

    If there is a definite cost-benefit gain to having such ships, it is (unfortunately?) up to the State Department and Congress to come up with the funding and then give the mission to an appropriate mission manager (in my book the most qualified would be the USCG with HHS support; seamanship and medical knowledge/organization combined).

  • eastriver

    Well, it is always up to Congress for funding, now and forever. But let’s consider that we can use these domestically in emergency, too.

    I think four or five would suffice; fast, relatively shallow (13 – 15 ft). Scatter three or four around the US coast, and one or two maybe in Guam or Japan. Great helo capability. Well deck. Retired amphibious ships might do the trick. Keep them on 24-hr notice to get underway. The med staff can come from the highly-developed HHS emergency response teams, which we already fund.

    The ships should be run out of DoD and/or Marad. With respect to CDR Salamander’s curious statement: “Our Constitution was not designed, and our taxpayers should not be force(d)…” this is some of the best PR that we as a nation can do. Our taxpayers are not forced, and the Founding Fathers could never have considered the advances in emergency medicine we have enjoyed, let alone internal combustion propulsion. If one insists, take it out of the Public Diplomacy budget.

    Consider, if you will, the vast investment that this nation makes in fire and rescue resources. Is each and every one used to it’s maximum potential? Not a chance. But… what if? We are wealthy enough to do this, and moral enough to do it, too.

  • Chap

    @Eastriver: You’re hitting right on the objection I have. The government’s got the capability, and the idea to have a solution like this is a nice one.

    The problem I have with this solution, even before addressing the practicalities of this particular solution, is this: People should be doing this, not government. After a certain point the governmental effort will push out individual giving…and this is counterintuitive for many folks, but in the United States private charity is orders of magnitude bigger and better than government largess. Somebody brought up Mercy Corps, a great example. Look at the mobile field hospitals Doctors Without Borders already set up in Haiti.

    This nation does make a vast investment in fire and rescue resources. It makes it with taxes when the cities get too big, but the biggest investment is the volunteer fire departments and the other volunteer first responders, supporting their own community, their own neighborhoods, of their own volition, not going three states over due to government fiat. This system works, and works better than it would if everything were done through taxation.

    Only after this objection is settled could I move on to other objections to Jim’s idea: where the doctors come from, how this fleet would change the medical infrastructure of other countries, what actual defense goes away in order to support this fleet, what this does to overall foreign aid handed out by USG, et cetera.

  • Jim Dolbow

    @all many thoughtful and informed responses. Much appreciated and here I was worried no one read my posts. May have to agree to disagree with some words which is fabulous b/c I dont like to be surrounded by “yes” people.

    I was limited to 700 words for the original Proceedings article and if i could have had additional space I could have alleviated some concerns.

    And for the record I still support a 600 ship Navy. It is just a matter of political priorities and courage…

    Thanks again!

  • Matthew S.

    I think 2 is enough. The USN should not function as the world’s free medical provider. If anything we need more submarines.

  • Chuck Hill

    I remember when I cam into the Coast Guard we had at least 36 large cutters and when they sailed for Ocean Station, they had a Public Health Service Doctor on board. Sure would have been nice if the cutters that showed up early had had doctors on board.

  • eastriver

    Chip, thanks for pointing out what I left unsaid in my post. I’m only advocating a system for emergency response, not medium- or long-term care. It is unconscionable to me that people should die because bones cannot be set, wounds cannot be cleaned, and a few lousy penicillin tablets are not available 590 nm from the Miami sea buoy. After the situation is stabilized, I’m all for Doctors Without Borders, Mercy Corps, etc. taking up the slack.

    (I think you’ll find that most volunteer first responders have their major equipment funded at least in part through taxes and government grants. $500k-plus for an engine is out of the reach of many communities. In my state, fire districts are municipal units that have the power to tax to fund the equipment necessary, which are manned in large part by volunteers. And in my city, in September 2001, many municipalities from two other states sent their taxpayer-funded equipment staffed by both volunteers and professionals to back up the FDNY, as FDNY was a bit busy for a few days.)

  • leesea

    I believe that BUMED awhile back studied and recommended a replacement for the T-AH 19 class. I don’t know the details but ANY hospital ship MUST be smaller than the existing one, and it should NOT be based on a expensive warship hull as some have proposed. The essential attributes for a hospital ship do NOT include a wet well dock system! While converting old amphibs may be expedient, it is also costly and those ships cannot be seen as amphib assets. The inevitable fact of life is that the warships WILL leave Haiti long before the naval auxiliaries and sealift ships do.
    IF one waits for the “system” to generate rqmts we will be whistling dixie. It takes naval leadership to get another ship construcion program going. Any hope?

  • Jay

    Jim — Not sure the “600 ship Navy” ever really had any more firm plans (and funding) than a lovely PR statement…

    Leesea — A well deck might be a decent idea on a “civilian” hosptial ship — especially if it can accomodate all kinds of small craft (not be LCAC centric). Might make patient transfer eaiser (once the doors are up…water pumped out) and reduce the need for helo landing spots).

    All — yes, Congress is always the funding hurdle — but this doesn’t *have* to be Navy or SCN funding at all.

    Now — if only (dead issue, I know…) we could buy foreign hulls…or at least give them the ability to really compete with U.S. shipyards.

  • UltimaRatioReg

    “Not sure the “600 ship Navy” ever really had any more firm plans (and funding) than a lovely PR statement…”

    Between 1982 and 1991 the US Navy had an average of 566 warships in commission. This included an average of 60 amphibs. For a four year stretch after the 600-ship goal was announced, the average number in commission was 590. That is one hell of a lot closer than we are currently to 313.

    Jim is right. There was a firm plan and it was executed. And maintained until the big cuts from 1993-2000, when the US Navy shrank from 454 ships to 318. What we lack is will power. To fix shipbuilding and build ships.

  • eastriver

    Leesea — maybe a well deck is overkill. Lots of gear and maintenance. But could you suggest some arrangement by which small craft, maybe local ones, could come to the ship and handle stretcher cases with a larger margin of safety and efficiency than an accommodation ladder alongside?

  • Jim Dolbow

    @Salamander one man’s feel good folly is going to be one of my future accomplishments as SECNAV. You will be too busy blogging about all my other accomplishments that you will hardly notice. In the interim, I have the domain name reserved for my NGO. Will keep you in the loop

    @leesea. SCN hardly has $$$ to build warships. Last I look, shipyards need some stimulus $$$ too. A new fund perhaps modeled after the national defense sealift fund.

    @ Chuck Hill – most appreciative of your comments and insights as always

    @ Chap – interesting observation about the impact on local doctors. While aboard COMFORT last year, I only noticed local providers receiving training from COMFORT personnel so thanks for the rest of the story. The need for medical care is so great that I doubt they were out of business too long.

    @Dr. Feinsilver, many thanks for commenting. It is an honor to have a medical diplomacy scholar-practitioner like yourself comment on my posts. Thanks for the fact check. I have also read some of your writings and would like to interview you for a future post.

    @Grant MacLean mercyships.org rocks! keep up the good work.

    @Pascal great thinking. see my co-article about the USCG’s role in medical diplomacy:


    @ B Smitty i think you just coined the term “construction diplomacy”

    @ Campbell hospital airships sounds like an interesting Proceedings article

    @eastriver @Jay @Mike great job of asking questions and advancing the debate on this important issue

    @URR 600 ship navy or bust

    Thanks again everybody

  • leesea

    There is absolutely no need for a wet well dock on an hospital ship. The system takes up valuable interior space, add significant construction costs as well as OM&N costs. The number of boats which are needed for patient transportation and ship support can easily be lifted in davits or by crane something the T-AH19 class was not fitted with! I prefer the Kvichak MPF lighter which just finished a production run and can be lifted by ships crane. High speed beachable and covered.

    There was a patient litter lift system orginally installed aka star wars trapeze. I don’t know if they still use it?

    Lets not forget that most patients come in by helo and the T-AH19 does NOT have sufficient helo M&R installed with its medium size flight deck. How about a bigger flight deck with proper hangar?

    NDSF could be the funding source for replacement hosptial ships, but who is the program/funding sponsor? Assuming a naval auxiliary hull as baseline NDSF could work. Assuming an amphib baseline it would be SCB and a non-starter IMHO.

  • Julie Feinsilve

    Glad to hear you have read some of my work. I would be delighted to discuss medical diplomacy with you. Just send me an email and we can set up a time. As you may have realized, I am in DC.

  • Chap

    @Jim: Ask NECC’s Maritime Civil Affairs guys for their opinions and lessons. They’ve got some, apparently.

  • Grandpa Bluewater


    “could you suggest some arrangement by which small craft, maybe local ones, could come to the ship and handle stretcher cases with a larger margin of safety and efficiency than an accommodation ladder alongside?”

    Double wide WTD P & S at a sideport whose bottom edge is a fathom above the water line; with an extensible gang way, rigged with pins at the pie plate at the ship’s end and dolly casters on the seaward end; will mate nicely to a pontoon barge with about a half fathom of freeboard; made up to dutch bollards fwd and aft of the side port.

    Include stanchion and padeye sockets at the deck edge of the port to make up a standard international pilot ladder and Bob’s your uncle.

    Rig an extensible rail in the overhead to extend out the port; hang the gangway by bridles on two dollied electric chainfalls on the rail, and two men can rig it in five minutes once the pontoon is made up alongside.

    Watch “Victory at Sea” to see how to rig and lift litters out of boats on to the pontoon with a deck crane on the main deck above.

    As for putting boats and a pontoon on deck or in the water alongside, use a heavy duty crane with a single whip, and bridles to lifting eyes on the water craft. A single whip and tag lines are faster, more flexible and more safe than lifeboat davits, which have an execreble safety record.

    You can stow the pontoon and boats on the hatch cover of a hold, that way the crane can plumb the hold and grab pallets of relief and medical supplies for shipment ashore easily.

    You can argue about what kind of boat to use, but you got to love a Mike 8 for utility work. Steel hull, of course. Don’t forget the boat shop.

  • eastriver

    Grandpa — That works, and could handle “local” craft, to boot. Agree on davits. With the single whip crane and pontoon, only other thing needed is the welcome mat. Thanks.

  • Harold Hutchison

    I do have one question for the author of this piece… in parts of CENTCOM, AFRICOM, and PACOM, piracy is an issue. How do propose that we ensure that these ships don’t get grabbed by pirates – or worse?

  • Build more hospital ships Get people jobs.This country was built on refergies.We are BLESSED by the LORD.The would depends on us.Lets give back. NOW

  • Dana Brown

    I think medical diplomacy is a much better idea than any other kind.
    A few questions to ponder.How many ships (especially LSD type) does the US have in storage or waiting to be scrapped that can be converted? These ships have the helo capability, can lower back door and receive boats ,and are quite large enough for this purpose.

  • Dana Brown

    An LSD does not have to flood the well deck to open the back bay door.I was stationed on one,we would lower the door and swim off the back.It would be easy to modify an LSD to use more of the well space for something else.

  • Byron

    I’ve asked this before and haven’t seen an answer: Who will pay for this? DoD budget that’s stressed already? State Dept.?