RCN Needs a Hospital Ship - STAT

BY TIM McDERMOTT
© 2016 FrontLine Defence (Vol 13, No 4)

As the new Liberal Government seeks to redefine Canada’s role in world affairs, perhaps it is time to look at new alternatives to the way Canada has traditionally responded to international crises, particularly in the humanitarian role.

Acquiring a Canadian Government Hospital Ship capability would offer new options for Canadian response such as: enhancing Canadian soft power; improving Canada’s ability to respond to a natural disaster; providing increased health care services to Canadians located in remote Northern and coastal communities; and also in stimulating the economy.

Hospital ships are internationally protected in accordance with Protocol 1 of the Geneva Conventions of 1949. They are lit and marked to indicate their purpose as a hospital ship. They must not be used for military purposes and must be unarmed (beyond small arms required for security). They are subject to search by belligerents in a conflict and must not interfere with any combatant vessels.

USNS Mercy (1986) and Comfort (1987), the two U.S. Hospital Ships, were converted from San Clemente-class supertankers. Shown below, Mercy’s last mission was in 2013, when she arrived in the Phillippines area to ­provide aid in the aftermath of Typhoon Haiyan.

Hospital Ships are different from Casualty Receiving and Transport Ships (CRTS), which are typically warships with a secondary role of providing limited medical support to one side in a conflict. Examples of a CRTS would include vessels such as U.S. Navy amphibious ships, the French Mistral-class ships, and the proposed multi-role logistics support ship for Canada. Unlike hospital ships, these vessels are classified as combatant vessels. They are not internationally protected, are not marked as a hospital ship, are usually armed, and typically do not permit belligerents to board and inspect the vessel.

Modern hospital ships have all the services of a major hospital – everything from multiple operating rooms to Intensive care units, advanced diagnostic imaging, laboratory services, a blood bank, pharmacy, ophthalmology, physiotherapy, dental clinic, a medical warehouse, medical equipment repair services, and mortuary services. These ships vary in size from half a dozen to 1000 beds (the size of some of the largest hospitals in Canada). Several countries, including Brazil, China, Indonesia, Russia, Spain, Thailand, the United States and Vietnam, all operate vessels dedicated to providing medical aid and assistance. Some other countries operate military vessels that can accommodate and treat patients. Hospital ships are also operated by private charities, as in the case of the Motor Vessel (M/V) Mercy Africa. Canada had minimal maritime capacity for treating patients other than its own crew and now, with the paying off of HMCS Protecteur and Preserver, further eroding what limited capacity we had. Currently, capability in the Navy is limited to a single Physician’s Assistant on each of its Frigates.

Value and Flexibility
Perhaps the greatest single benefit of a hospital ship is its mobility. It is capable of deploying around the world, and is self-sufficient when it reaches its destination. Hospital ships have all the features of a modern hospital – and bring with them the service and resources necessary to support the medical staff assigned to that hospital ship (such as accommodation, food services, potable water, laundry facilities, medical warehousing, medical oxygen generation, and a clean working environment for medical equipment, staff and patients). Further, hospital ships enjoy a level of security and safety that many land-based field hospitals and treatment facilities do not. Access to the hospital ship is easier to manage, and control. Unlike a field hospital, a hospital ship (and embarked patients and staff) can easily be moved out of harm’s way in the face of a natural or manmade threat without interrupting the delivery of care and medical services.

During Harmonious Mission 2015, China’s Hospital Ship Peace Ark visited seven countries and regions around the Pacific Ocean (Australia, French Polynesia, the United States, Mexico, Barbados, Grenada, and Peru) for military diplomacy, medical exchange and cultural communication. (USN PHOTO: MC1 Carlos Gomez)

Logistically, a hospital ship is easier to support than land-based field hospitals, in part because it typically carries all the supplies and spare parts it needs to sustain operations. A hospital ship has the option of moving to a safe, secure, and supportable location for resupply if necessary. Additionally, it can be pre-positioned (without an embarked medical staff) to areas such as the Caribbean during hurricane season, or conflict zones such as Syria and Libya (in the same way that the Canadian Government currently deploys warships).

Soft Power
A hospital ship is a potent instrument of international policy, diplomacy, humanitarianism, and soft power. It can provide disaster relief assistance during a natural disaster, humanitarian assistance and advanced medical care and treatment in developing countries, and can serve as a floating classroom and medical training facility both at home and abroad. Because it is internationally protected, a hospital ship can deploy to areas where the Canadian military might otherwise be viewed as a combatant.

Soft power has been defined as “getting others to want what you want through the use of culture, values and institutions rather than by the use of force”. The use of soft power to achieve desired political outcomes in international security and stability, social development, and public health can increase Canadian influence and stature on the international stage, and is a viable alternative to the use of military force. Providing good will, humanitarian assistance and international development is at the core of Canadian values and how we wish the rest of the world to view Canada.

The U.S. government sponsored a public opinion survey that was conducted in the wake of the US Naval Ship (USNS) Mercy mission to Bangladesh and Indonesia after the 2004 Tsunami. The results demonstrated very significant changes in local opinion of the United States. Clearly, the Mercy mission was very effective in changing anti-Western sentiments. In fact, USN humanitarian assistance deployments of USNS Mercy and her sister ship Comfort have enjoyed almost universal positive public opinion ratings with Americans versus a very polarized public opinion response to the use of U.S. military combat forces (Webb and Richter, 2010, p.165).

Domestic Operations
In addition to its versatility in conducting international disaster relief and humanitarian assistance roles, a hospital ship has the ability to supplement or replace existing Canadian medical infrastructure after a natural disaster. USNS Comfort deployed to New York City in the days following 9/11 to augment New York City medical facilities, treating 541 relief workers who had been injured during the recovery efforts. In 2005, USNS Comfort deployed to Pascagoula, Mississippi, and New Orleans, Louisiana, after Hurricane Katrina to provide trauma services, treating nearly 2000 patients in seven weeks.

In the event of a major natural or man-made disaster along any of Canada’s three coasts or in the Great Lakes, a Canadian hospital ship could augment existing medical facilities or act as a temporary replacement for damaged or destroyed health infrastructure.

Hospital ships can deliver medical services to remote areas that are under-served by traditional medical facilities. The Brazilian Navy operates three hospital ships along the Amazon River to deliver medical care to remote villages. A Canadian hospital ship capable of operating in Arctic waters could provide advanced medical treatment and facilities to many Northern communities and would provide an effective alternative to medical evacuation to southern Canadian cities.

The Russian Navy has three Ob’-class ships: Irtysh, Svir, and Yenisey (built between 1981 and 1990). Each has 7 operating rooms, 100 hospital beds and a helipad. They are operated by civilian crews and staffed by naval medical personnel. Class leader Ob, built in 1980, was sold to China in 2007.

The isolation component of any vessel means a Hospital ship can act as an alternative medical facility for treatment of highly contagious pathogens. The UK deployed the RFA Argus to Sierra Leone in 2015 to provide support to international medical teams ashore and to act as a medical treatment facility for international medical staff. A Canadian hospital ship could provide alternate medical facilities for outbreaks such as SARS, helping to check the spread of such highly infectious diseases.

Construction and Operation
Many hospital ships began their lives in other roles. USN Ships Comfort and Mercy were originally built as US Navy oil tankers before undergoing conversion. While a new-build Canadian hospital ship is certainly within the capabilities of the Canadian shipbuilding industry, conversion of an existing commercial ship design might prove to be the most economical alternative. As the cruise ship industry has grown over the years, the drive for larger and larger cruise ships has led to the early obsolescence and replacement of a number of vessels that would make ideal hospital ships. Many of these vessels remain available for sale or lease.

Cruise ships have many design features that make them desirable vessels for conversion to a hospital ship. To begin with, they are designed to carry large numbers of people – a significant portion of the hull space set aside for passenger cabins and the service staff required to cater to them. Ship services such as fresh water making, heating, ventilation and air conditioning, electrical generation, black and grey water collection and treatment, laundry facilities, food services and cargo capacity are already capable of supporting medical treatment services. Further, many cruise ships are designed to travel into restricted harbours and waterways and therefore already have advanced navigation and propulsion systems allowing them to manœuvre in tight waters without the aid of a tug.

Canada’s National Shipbuilding Strategy had winners and losers for the shipbuilding industry. Some yards such as Port Weller and Chantier-Davie lost out on the opportunity to participate in construction of the next generation of Royal Canadian Navy (RCN) and Canadian Coast Guard ships. However, Chantier Davie created Project Resolve to address the gap between the retirement of Canada’s replenishment ships (HMC Ships Protecteur and Preserver) and their replacement by the Joint Support Ships HMC Ships Queenstown and Chateauguay (to be built by Vancouver-based Seaspan). Project Resolve will provide an interim resupply capability for the RCN by converting a commercial ship to act as an oiler and replenishment ship. This converted ship will be operated and maintained by Chantier-Davie and leased to the Navy.

A similar such conversion, operation, maintenance and leasing arrangement for a hospital ship would both reduce much of the upfront costs of acquiring a hospital ship and make the capital costs more palatable. Further, privatizing operation and maintenance of a hospital ship would minimize demands placed upon existing government repair facilities such as the Navy’s Fleet Maintenance Facilities. A contracted hospital ship capability need not involve the Navy at all. Such a ship could be funded by other federal government departments such as Global Affairs Canada.

Launched in 1929 as passenger liner Hikawa Maru, this 11.6-ton ship’s routes typically included Hong Kong, Shanghai, Hawaii, Victoria, Vancouver and Seattle. It was requisitioned by the Japanese Navy in November 1941, and conversion to a hospital ship began on December 1st at the Mitsubishi Zosen shipyard. Three weeks later, on 23 December 1941, she departs on her first hospital round-trip voyage under the command of naval surgeon Captain Kanai Izumi. In 1960, she was taken out of service and became a floating youth hostel, museum and restaurant at Yokohama, Japan. (art by Ueda Kihachiro)

Several Canadian shipyards have the capacity to convert a cruise ship into a hospital ship, and a hospital ship project would create regional benefits for shipyards that did not receive any of the NSPS projects. Further, funding a hospital ship through Global Affairs Canada/International Development, and choosing a shipyard not involved in the NSS contracts would reduce or eliminate any potential impact on the construction of Canadian Coast Guard and RCN projects.

As Chantier-Davie demonstrated with the rapid ramp up of Project Resolve, a hospital ship project could be shovel-ready within a very short period of time, thus tying into the federal government’s intent to spend on infrastructure projects.

Crewing a Hospital Ship
As previously noted, crewing a hospital ship can be done on a contract basis such as the arrangement with Federal Fleet Services for the crew of the Project Resolve replenishment ship. The U.S. Navy keeps each of their hospital ships on a standby basis with a small crew of maintainers and technicians, and augments the rest of the crew and medical staff when the ships are activated. There are several options for medically staffing a Canadian hospital ship. Cooperative arrangements with other like-minded countries, coalitions of the willing, or international organizations such as Médecins Sans Frontières, the Red Cross, the UN High Commission for Refugees, international charities, Canadian provinces and health authorities, as well as CAF medical personnel are all viable options. Medical staff composition could be tailored for the mission as the situation dictates. A Canadian hospital ship could also fulfil the role as a floating classroom for Canadian and international medical students, giving many the opportunity to learn and work in a modern hospital environment.

The Humanitarian Gap
Given the inherent value of such a national asset – its capacity to project soft power, its ability to contribute to Canadian international development and humanitarian response, its utility in responding to disasters here in Canada and abroad, its affordability and potential for contributing to employment and prosperity – why doesn’t Canada have a hospital ship?

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LCdr Tim McDermott is a recently retired Royal Canadian Navy Officer of 37 years. He is currently completing a Graduate Degree in Disaster and Emergency Management at Royal Roads University.

Preventing the Use of Children as Soldiers: A critical new operational capacity for the CAF

By: Dr. Shelly Whitman and Darin Reeves, CDA Institute 

CDA Institute guest contributors Shelly Whitman and Darin Reeves, the Executive Director and Director of Training at the Romeo Dallaire Child Soldiers Initiative, respectively, comment on how the CAF can be better positioned to address child soldiers as part of a conflict mitigation strategy. This is based on their submission to the Halifax Defence Policy Review round-table.

The Canadian Armed Forces (CAF) should build upon its recent, proven experiences within the broad spectrum of operations conducted at home and around the world, bridging uniformed military and civilian defence workers, civilian aid agencies and the governments of Canada and Canadian partners, with a re-​conceptualization of the human security frontier.

Working together with other Canadian diplomatic, humanitarian, and developmental assistance efforts, the CAF should as part of its “whole-​of-​government” approach be empowered to make the protection of children and youth a priority, as was seen when Canada hosted the first international conference on war-​affected children in 2000. This approach recognizes Canada as a middle power to whom all states, from the least developed to the most powerful, can rely upon as “honest brokers”; emphasizes Canada as a champion for the promotion of human rights; and permits us to reclaim a special place in the world of human security.

Realistic, contemporary threats to Canadian security have emerged both from domestic and international sources. A common theme shared among these threats has, unfortunately, been the exploitation of children and youth by those with ill-​intent, whether taking advantage of porous borders and ethnic strife, failing political institutions, economic disparity or extremism. The recruitment and use of these children, whether as child soldiers or as part of a criminal enterprise, has exploited children not in spite of their age – but because of it. In addition, the recruitment and use of children is an early warning indicator for mass atrocities that has yet to be fully recognized by the international community. This recognition by Canada presents a very unique opportunity to promote tangible action that can contribute significantly to overall conflict mitigation.

This reality is no longer confined to failed and failing states abroad, but has reached back and affected Canadian households and Canadian interests. Assessing and addressing the effect of this recruitment and use of children as soldiers and members of criminal enterprises on Canadian defence policy is a complex issue, one that engages the whole of the Department of National Defence (DND) and the CAF across their spectrum of responsibilities – defence of Canada and continental North America, the advancement of national interests, and support to peace and security operations internationally and law enforcement agencies domestically.

However, this issue is also broader than DND and the CAF, engaging Canadian law enforcement, border services, and other concerned federal and provincial agencies. By recognizing the unique challenges posed by children and youth recruited and used as soldiers and in criminal enterprise, training to address these challenges, and working cooperatively with concerned agencies and partners, the CAF will be uniquely poised to confront this issue at its earliest stages abroad, support and build capacity at home, and take a lead humanitarian role in the protection of children and human rights around the world.

It is also critical that we begin to see how better to utilize Canadian Police expertise both for international missions as well as to resolve domestic threats that have international linkages and consequences. Deployment of Canadian police personnel to peacekeeping operations has steadily declined to an all-​time low. Yet the contributions that can be made by Canadian police officers to help build capacity in conflict zones, to train, mentor and lead by example in both Francophone and Anglophone contexts has not been truly understood. Corruption in many police forces around the world, combined with the very nature of police operations that requires more contact with civilian populations, means there is a critical juncture to impact change by well trained and vetted Canadian police personnel.

The recruitment and use of children as soldiers internationally has been shown to share many commonalities with the recruitment and use of children in criminal enterprise. In being prepared to support Canadian law enforcement and civilian authorities, the CAF must be ready to face this phenomena. This readiness, honed around the world and across the spectrum of conflict from the earliest days of peacekeeping through to the subsequent period of peacemaking and full combat operations within an environment of “whole-​of-​government” engagement, will enable the CAF to take on a multitude of roles in support of contemporary operations, including:
As trainers and capacity builders to other forces in a prophylactic approach to regional and domestic violence and instability by instructing in the effective, lawful and humanitarian establishment of security conditions and the protection of civilians through a child-​centric approach;
By focusing on the demonstrated link between the recruitment of child soldiers and subsequent outbreak of the worst forms of violence, Canadian intelligence, empowered and knowledgeable in the phenomena of child soldiers, will be well suited to foresee conditions leading to regional instability. By seeing the early warning signs of impending violence, conflicts that historically have employed the worst forms of humanitarian abuse can be prevented or contained, leading to earlier resolution of conflict and reduced humanitarian need.

It should also be noted that resource or personnel constraints need not be a hindrance to advancing this new niche for theCAF. It is entirely possible that experienced CAF veterans, who are looking to stay engaged in meaningful work, can be a resource to compliment the training and capacity building role of CAF in this realm. As an example, based on the work of our own organization, the Roméo Dallaire Child Soldiers Initiative (“the Dallaire Initiative”) is partnering with Wounded Warriors Canada to train CAF veterans in a skills transition program that is specifically designed to assist the Dallaire Initiative’s training and doctrinal outreach around the world. This could be equally extended to retired Canadian police personnel.

In working within the contemporary world of UN peace operations, operations in support of Canadian interests at home and abroad, and other missions to counter threats to international peace and security, CAF personnel are increasingly being exposed to the very worst forms of violence and abuse of the most vulnerable members of any society – children. Studies have demonstrated a significant link between exposure to children in armed conflict by soldiers and subsequent rates of associated operational stress injuries. By educating and training CAF personnel in recognizing and constructively addressing the phenomena of child soldiers, they are better prepared to face this psychologically and emotionally corrosive reality. To quote our founder, LGen Roméo Dallaire (ret’d), “The abuse of youth as instruments of war is a reality that can’t be resolved on the day you face them in the field.”

The Canadian government has now very publically stated its desire to reengage at the United Nations. It is important that Canada has a clear strategy for what this reengagement may look like. Given the CAF roles outlined above combined with civilian expertise in Canada, we have an opportunity to align ourselves with key priorities of the United Nations while also claiming our niche in the world. The UN Secretary-General’s commitment to a “Rights Upfront” approach can be augmented with a “Child Rights Upfront” approach that is championed by Canada.
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Dr. Shelly Whitman is the Executive Director of the Romeo Dallaire Child Soldiers Initiative based at Dalhousie University. Darin Reeves is the Director of Training for the Romeo Dallaire Child Soldiers Initiative based at Dalhousie University. (Image courtesy of National Defence and the CAF.)

US Official: CAF Needs to Examine Roles for Future Disaster Aid

By Elliot Ferguson
The Whig

Canada and the United States may need to be willing to re-examine the role of the military in their societies as part of the preparations to deal with major natural disasters, says an American military expert.

Prof. Bert Tussing, director of the Homeland Defense and Security Issues Group at the U.S. Army War College, said preparations need to be made to respond to a "catastrophic incident" that would cause large numbers of deaths and injuries and destroy infrastructure over a large geographic area.

"You want to plan and prepare for the worst and pray that the worst never happens," Tussing said while addressing the 11th annual Kingston Conference on International Security at the Residence Inn Kingston Water's Edge.

Tussing said the role of the armed forces in times of natural disaster is to support civilian agencies in their response, not assume control.

In recent cases in the United States where the military was called in -- after the 1992 Los Angeles earthquake and in 2005 after hurricane Katrina -- the operations were short and the military withdrew quickly when its help was no longer needed, Tussing said.

Tussing used the New Madrid earthquakes of 1811 and 1812 as an example of a natural disaster that could threaten the stability of the country.

Three earthquakes in late 1811 and early 1812 -- all registering more than 7.3 on the Richter scale -- caused damage across 600,000 square kilometres and temporarily reversed the flow of the Mississippi River.

Rebuilding after that disaster took several months, at a time when there was little infrastructure.

Tussing said a similar earthquake now would cause widespread devastation. He added that it would take about 18 months to restore critical services, such as electricity and water.

In that time, local law enforcement agencies would be hard-pressed to maintain social order and it may fall to the armed forces to keep society together.

Tussing said governments need to put in place plans that give the military and civilian agencies clear roles during times of widespread and enduring disaster.

"It's time for us to plan now," he said.

This year's conference examines how militaries change and adapt to new situations during war and peace.

Conference participants looked at the "grey zone" between war and peace populated by non-governmental organizations, private corporations armed groups and states.

"It is hard to grasp, define, put borders and boundaries around it," said Maj.-Gen. Jean-Marc Lanthier, Canadian Army Doctrine and Training Centre.

"If we define the problem too narrowly, we will miss the solutions because the complexity of the problem makes it necessary to analyze it in the broadest sense."

This year's conference was meant to bring together military, academic, private sector and non-governmental organizations to discuss different issues.

Joining Tussing on the first discussion panel on Tuesday morning were Andrew Carswell from the International Committee of the Red Cross, Almero Retief from the mining company Rio Tinto, and Diego Ruiz-Palmer, an economics and security adviser to the NATO aecretary general.

"As an academic doing security and defence research, I really cherish those opportunities to have members of the armed forces, people from government and even the private sector react to the kind of research I am doing," said Prof. Stefanie von Hlatky of the Centre for International and Defence Policy at Queen's University.

"It usually takes the discussion in unexpected places."

Project Resolve: iAOR to Provide Strategic Humanitarran Assistance and Disaster Relief

News Release from Project Resolve

As failed states, conflict, natural disasters, famine and epidemics continue to plague the globe, Canada will increasingly be called upon to render Humanitarian Assistance and Disaster Relief (HADR) to those affected.

The Resolve-Class Auxiliary Oiler Replenishment ship will play a key role in the Royal Canadian Navy’s HADR efforts from 2017. While the primary role of the Resolve-Class AOR is to conduct underway replenishment for the Canadian Task Group and other allied warships, a significant number of design elements have been incorporated into the ship’s design to support the HADR mission.

An Artists Rendition of the iAOR Asterix aiding in a Rescue at Sea

The specific HADR capabilities include:

• A humanitarian processing area for triage and care of evacuees/survivors
• A large medical facility for up to 60 patients in two separate wards
• Emergency accommodation for up to 350 people (in addition to the ship’s current 150 persons capacity)
• A ship-shore airlift capability via the two embarked Cyclone CH-148 helicopters
• A significant small craft capability that includes up to 8 boats with quick launch and recovery capabilities
• The ability to sustain the delivery over 400t/day of Fresh Water and up to 7000t of Fuel Oil, as well as significant power
• The transportation and self-sufficient loading and unloading of light vehicles, sea containers and general cargo that are essential for HADR missions.

Spencer Fraser, CEO of Project Resolve today commented “We are extremely proud to be able to fill the current gap and provide Canada with a strategically enabling naval asset for HADR missions. We incorporated HADR requirements into the ship’s design from the very start and we are confident that the ship and its Canadian crew will successfully meet the Government of Canada’s goals of providing effective and responsive humanitarian and disaster assistance where and when called upon.”