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The Navy announced on Feb. 14 that the hospital ship USNS Comfort (T-AH 20) will shift its layberth from Baltimore, Md., to Naval Station (NS) Norfolk to save $1.7 million in the initial year and $2.1 million for following years. Although this is significant savings to help reduce our defense budget, a larger question is, “is keeping hospital ships still worth it?” Eventually the Navy will decide this question but here are a few issues for the Navy to consider:

Does medical diplomacy work? One can argue medical diplomacy improves strategic relations with foreign countries by providing free medical care “to win hearts and minds.” The most visible medical diplomacy is using hospital ships such as the USNS MERCY and the USNS COMFORT. In response to the 2004 Tsunami, USNS MERCY deployed and provided medical care to tsunami victims inIndonesia and other affected areas. A more recent example is the USNS COMFORT deploying toHaiti to help earthquake victims.

In “Let’s have a Fleet of 15 Hospital Ships” LT Jim Dolbow argues the U.S. enjoyed a huge favorable swing in public opinion after MERCY’s 2005 humanitarian mission. According to Terror Free Tomorrow  following MERCY’s visit, a remarkable 85 percent of Indonesians and 95 percent of the people of Bangladesh were favorable to MERCY’s mission. Because of such positive response, the United States conducts biannual deployments with its hospital ships for theatre security cooperation missions. Hospital ships support a larger maritime strategy by enabling the Navy’s expanded core competency of “humanitarian assistance and disaster response.”

On the other hand, in “The Decline of America’s Reputation: Why?” it states following the 2004 tsunami, ratings only increased from 15 to 38 percent. There was not a similar rise in Pakistan after U.S. earthquake relief in 2005. This is quite a contrast compared to the Terror Free Tomorrow poll. In 2007, the Pew Research Center wrote “the impact of this humanitarian assistance should not be overstated – most of the same misgivings aboutAmerica seen throughout the Muslim world can be found inIndonesia andPakistan, and solid majorities in both countries continue to have a negative impression of the U.S.”

What are some costs of hospital ship medical care? In “Advancing Humanitarian Aid: Infusing the era of hope with a dash of accountability”, Professor Leslie F. Roberts argues much of the aid has little influence. Roberts notes “between 21 January and 11 March, the [COMFORT] with its 10 surgical theatres served 871 patients. Data presented by a senior USAID official suggested, excluding medical personnel costs, this highly visible relief effort cost >US$30,000 per patient. While this may be typical of the costs for similar surgeries in Western Europe or North America, it is orders of magnitude over expected surgical costs in humanitarian settings, or hospitals in Port-au-Prince.” Per the Daily Caller, “The Navy spent 2 million gallons of fuel treating fewer than 1,000 people – if it’s using marine fuel which is roughly $4 a gallon, that’s $8 million in fuel. That’s roughly $9,184 per patient, just to keep fuel in the tanks.” This seems like a lot of money to spend when theUnited States citizens have difficulty paying their own medical bills.

What if the United States Government got rid of hospital ships? If there were no hospital ships, other countries would not expect theU.S. to deploy one to give out free medical care. Warships can conduct humanitarian assistance and disaster relief. Amphibious ships such as the USS BOXER and aircraft carriers such as the USS NIMITZ have robust medical facilities and have superior boat and helicopter transport. Money saved by getting rid of hospital ships can be diverted to improving medical facilities on regular warships already forward deployed around the globe.

Do hospital ships provide benefits that a warship cannot? When the tsunami hit Indonesia in 2004, it took approximately a month for MERCY to arrive in Indonesia. The arrival was too late to treat initial wounds. U.S. Navy ships such as the Abraham Lincoln were already on station within days. In “Developing Soft Power Using Afloat Medical Capability”, CDR Salamander pointed out, “a study conducted by Center for Naval Analyses on host nation impact based on the recent T-AH and LHA/LHD 21 humanitarian assistance deployments reveals that ‘it does not matter whether it was a hospital ship or an amphibious ship as both ships functioned equally well in terms of positive impact to the host nations.’ . . . Speed of response is the most critical element of a successful humanitarian assistance and disaster relief operation. The ability to move people, equipment, and supplies throughout the operational area determines whether the operation is a success. Both hospital ship and amphibious ship are the right platforms for humanitarian missions, with the latter having an advantage on disaster response due to speed and global forward presence.”

No matter the results of this decision, the Navy will continue its expanded core competency to provide humanitarian assistance and disaster relief close to our shores and abroad.