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HA Humanitarian Assistance

As a secondary mission, hospital ships (with appropriate tailoring of manning, medical material/equipment, and provisions) are capable of providing mobile surgical hospital service for use by U.S. government agencies involved in disaster or humanitarian relief, or of limited humanitarian care incident to these missions or to peacetime military operations.

U.S. Navy Hospital Ships are a powerful instrument of U.S. national will that provide both physical and psychological presence and directly support the security cooperation plan. Additionally, Hospital Ship deployments provide key medical personnel operational training opportunities, while providing assistance to the host nation's populace.

Peacekeeping, disaster relief (DR), and humanitarian assistance (HA) operations are integral to two US military strategy foundations: (1) forward presence, and (2) crisis response. The Health Service Support requirement is a major factor in these circumstances, and Navy medical units are required to make rapid deployments to varied geographical areas-often where the medical infrastructure of a host nation's (HN) may be overwhelmed or in chaos. Planned HA missions have been and continue to be a part of geographic combatant commanders' theater security cooperation plans (TSCPs), but the hospital ships' use in this role is new. How to plan for and respond to humanitarian assistance and disaster relief (HA/DR) missions is a complex issue since planners and logisticians strive to maintain operational readiness.

Combatant Commanders and subordinate Joint Task Force Commanders could consider the employment of these underutilized assets to provide assistance to nations in need of humanitarian assistance. The demand for international humanitarian assistance has increased over the last decade and, concurrently, U.S. military involvement in humanitarian assistance operations has increased. The failure to use available assets, such as the hospital ships, may prevent achieving the optimal desired end-state.

The manning levels and equipment/supplies are designed for the primary mission of combat casualty care. When an HA mission is deployed, planners are left without clear guidelines as to how best to staff the hospital ships. This is further complicated by the cooperative nature of working with NGOs, since it is difficult to predict how many providers and what specialties will supplement the US military medical staff. If the hospital ships are to be used for routine HA, staffing requirements specific to this type of mission need to be established. This is especially true where medical staff are in high demand due to the stress of other military commitments.

Capacity-building activities can have a lasting impact on the communities and populations served. They tend to be somewhat overlooked as an HA mission goal, since the work and results are not dramatic or easily quantifiable. The impact of education and physical improvements to the existing infrastructure will continue to serve the population long after the HA ship has departed, and will improve the overall health of the community. Because the HA missions are very short-term, it is important to provide as much capacity-building assistance as possible.

Hospital ship outreach can include facility and equipment improvements and repair, general and preventative medicine training classes, and environmental health assessments. General health classes can be given on topics such as nutrition, obstetric emergencies, neonatal advanced life support, pediatric advanced life support (PALS), physical therapy, community health, patient safety, infection control, pediatrics, venipuncture, EKG, diabetes, IV, and wound care. Preventive Medicine training courses can cover disease vector control, water sanitation and testing, infection control, personal hygiene, malaria, and laboratory procedures.

The advantages of using hospital ships for humanitarian assistance and disaster relief operations include their high level of capability, versatility, mobility, and their strong symbolism of American goodwill. These benefits outweigh the disadvantages of concerns for safety, financial burden, and manpower issues. Hospital ships are valuable assets to consider in the planning for joint, interagency, andmultinational medical missions to benefit the world's potential humanitarian assistance recipients.

The chief advantages of deploying a hospital ship are to reduce the possibility of being inundated by host-nation patients like shore-based facilities, providing a more secure environment for medical resources, and reducing requirements for shore- based logistical support.

Possibly the most significant reason to incorporate hospital ships into HA/DR operations is their strong symbolism of American goodwill. Due to their distinctive bright white hulls with prominent red crosses, the hospital ships provide a presence in an operating area that leaves a lasting impression. This visibility extends American influence overseas in a non-invasive manner and promotes peace and stability in particular regions.

The US Navy is planning future humanitarian cruises, which have three advantages. First are the obvious improvements in soft power, as seen by the post-deployment survey. These deployments can create or maintain a positive attitude with neutral and benign populations, again isolating terrorists and making their competing message harder to hear and accept. Second are the partnerships the US military gains with nongovernmental organizations. Third, such deployments give military medical personnel practical experience. The hospital ships offer a platform with a wide range of medical capabilities for medical HA or DR, which are their secondary missions. Because the hospital ships are considered for more routine HA missions, delivering effective assistance is the goal. Direct patient care can positively affect the patients seen, but the hospital ship platform can also support capacity-building projects. These projects have positive long-term implications for HNs and are a cost-effective method of delivering substantive medical care.