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Hospital Ship History

The use of ships for the care of sick and wounded naval personnel is not new or unique to our time. As early as 400 B.C. there is record of a trireme in the Athenian fleet, called Therapeia, that served as a floating hospital. Later, floating sanctuaries, called "immunes" accompanied the galleys that transported Caesar's legions to the "edge of the earth." These vessels were kept free from combat duty, and their special status, for the most part, was recognized and respected. It was there that the concept of the hospital ship as a protected place set apart from the travails of war and dedicated to the care of the sick and injured, came into being.

The US Navy's history with hospital ships can arguably be dated to years of the Tripolitan War. In June 1804 the armed 60 foot ketch Intrepid, fresh from a daring sortie into the fortified harbor of Tripoli, was fitted out as a hospital ship and received the sick from the USS Enterprise. Since then, at least 26 ships have been used by the U.S. Navy for the care of sick and wounded.

The US Navy's Bureau of Medicine and Surgery was created by Congress on 31 August 1842. The first hospital ship, a converted side-wheeler Red Rover, was commissioned on Dec. 26, l862. The medical complement included 30 surgeons and male nurses, as well as four nuns. Red Rover sailed the Mississippi River during the Civil War, treating 2,947 patients over a three-year period. She was sold at public auction in 1865.

The Additional Articles Relating to the Condition of the Wounded in War of 1868, which was never ratified, set forth basic precepts that continue to inform the law of armed conflict relative to hospital ships. Principal among them is that "vessels not equipped for fighting which, during peace the government shall have officially declared to be intended to serve as floating hospital ships, shall . . . enjoy during the war complete neutrality, both as regards stores, and also as regards their staff, provided that their equipment is exclusively appropriate to the special service on which they are employed." Although it was not in legal force, belligerents in both the Franco-German War of 1870-71 and the Spanish-American War of 1898 agreed to accept and abide by the 1868 accord.

During the ill fated operation by Great Britain against Turkey at Gallipoli in 1915, the great number of Commonwealth casualties practically stopped operational activity on the beaches. At least twenty-two hospital ships, twenty troopships, and also transports and merchant ships had been set aside for the reception of sick and wounded, but fear of Turkish coastal artillery and German submarines prompted many of these vessels to lie off shore or in port some distance away. From the beaches, casualties were towed seaward in small craft, each carrying thirty patients, often in a frantic search for a ship that would accept them. As troopships landed their complements on the beaches or transports unloaded their cargoes, they were at once filled with casualties. These "carriers" then moved to the hospital ships or other vessels lying off shore and transferred the casualties at sea, under occasionally difficult, even dangerous, conditions. At a later stage, minesweepers partially fitted for medical purposes were brought into use for evacuating casualties, and the British Red Cross Society provided six motor launches specially equipped to tow barges from the Gallipoli beaches. The large number of casualties at Gallipoli led to overcrowding, rendering some ships unsuitable as base hospitals. They became in essence casualty- clearing stations, receiving and providing interim, often only token, treatment of patients and transferring the more serious ones to distant shore bases.

In 1917, the Central Powers of World War I declared, in disregard of international law, that hospital ships, no matter how prominently marked in compliance with Geneva and Hague Convention accords, were no longer protected as neutral vessels. Such ships were denied immunity from attack in the English Channel, parts of the North Sea, and the Mediterranean, even if the belligerents had been notified of their identities. Overall, the British lost fifteen hospital ships, most from mines and torpedo attacks. Similarly, during World War II, Germany, and later Italy, showed complete disregard for the Hague Convention.

During World War II, in the final phases of the Pacific campaign, tactical doctrine for employment of Navy hospital vessels changed, allowing them to function as mobile, definitive-care combat hospitals rather than as transports only. Specially designed ships of the Haven (AH 12) class were also built to support this concept. At Leyte Gulf, however, it became apparent that floating hospitals were urgently needed at the objective, especially during the night, when hospital ships were under orders to retire. Two arriving APAs were summarily designated as casualty receiving ships and stationed offshore to provide hospitalization at night. Small escort patrol craft, PCE(R)s, were also used as ad hoc transports for casualty evacuation.

Two intermediate steps in the evacuation process came into their own during the Korean War, use of hospital ships and aerial evacuation. Prior to the Second World War, hospital ships were used only to transport badly wounded men home. During World War II, however, hospital ships could often be found waiting off the landing beaches to provide a safe haven for treating casualties incurred during the opening rounds of amphibious operations. In Korea it was common practice to keep at least one hospital ship nearby at all times. These Haven- and Comfort-class vessels mustered about 150 officers and more than 1,000 enlisted men to man the operating rooms and healing wards which could accommodate several hundred critical short-term patients at one time.

This practice, combined with the increasing use of helicopters for medical evacuations, ensured rapid advanced medical treatment was available. Several Haven- and Comfort-class hospital ships rotated station watches during the spring of 1951, and the USS Consolation (AH 15) was fitted with a helicopter landing pad-an adaptation that soon thereafter became standard practice.

Many view the advent of rotary-wing aircraft as the most important aviation innovation during the Korean Conflict. Inevitably, the nimble helicopters soon became an important means of medical evacuation because they could fly directly to the forward areas, pick up wounded men from previously inaccessible locations, then deliver them to an advanced care facility within a matter of minutes rather than hours or days. Helicopters could land atop the mountains and ridges that dotted Korea eliminating the rough handling and long movements necessary for overland evacuation.

Unfortunately, the Sikorsky HO3S-1 could carry only one stretcher case at a time (and the patient's lower extremities would have to extend out the rear hatch), limiting their utility as an evacuation machine. By the spring of 1951, the bubble-topped Bell HTL, which mounted a pair of stretchers on each side and could carry a sitting evacuee as well, augmented these older machines. Eventually, even more capable evacuation helicopters (Sikorsky HO5S and HRS) made their way to Korea. Fixed-wing observation aircraft were sometimes pressed into service for emergency evacuations as well. Twin- and four-engine fixed-wing transport planes were used to deliver men to in-country theater-level facilities, hospitals in Japan, or to take the badly wounded back to the States.

The Vietnam War provided an ideal geographic setting and combat scenario for hospital ships - intermittent low-level warfare with the combat zone adjacent to the sea, in a long, narrow country with a substantial length of coastline. In addition, because of the air superiority enjoyed by U.S. forces, the helicopter was used extensively - the ideal medical evacuation system for hospital ships. The enemy lacked, or refrained from using, artillery or rockets to interdict the two red cross-marked U.S. hospital ships Sanctuary and Repose. They sailed freely, immediately offshore, seemingly immune from hostile activity.

During Vietnam, Hospital Corpsmen were assigned aboard ships of various kinds, providing offshore medical support to U.S. forces. The largest commitment here was on the hospital ships USS Repose and USS Sanctuary. Some 200 Hospital Corpsmen, representing the gamut of technical specialties, worked on each ship. USS Repose was commissioned for the third time in 1965 and outfitted with a 750-bed hospital. During four years in Southeast Asia, USS Repose treated more than 9,000 battle casualties and admitted a total of more than 24,000 patients. Repose was joined by USS Sanctuary in 1967. USS Sanctuary remained in Vietnam, once spending a record 121 days on the line. She left Da Nang Harbor for the last time in April 1971 and was decommissioned in 1974. She was the first U.S. Navy ship to house a mixed male-female crew and was the Navy's last hospital ship until the current USNS Mercy and USNS Comfort joined Military Sealift Command. The current hospital ships are USNS, rather than USS and are the third ships to carry the name Comfort and Mercy. After more than 20 years of commissioned service spanning three wars, USS Repose left Vietnam in March 1970 and was decommissioned two months later. She earned 28 battle stars for action in Korea and Vietnam.

For more than a dozen years -- from the end of the Vietnam era to the launching of USNS Mercy (T-AH 19) and USNS Comfort (T-AH 20) in 1986 and 1987 -- the U.S. Navy sailed without a hospital ship. The history of the hospital ship had been one of ebb and flow. Rarely have hospital ships been maintained in peacetime. In the late 1970s, military planners saw a need for mobile medical assets to deal with so-called brush fire conflicts. The Iranian hostage crisis underlined the lack of such facilities, resulting in a hospital ship program that produced USNS Mercy and USNS Comfort.