Mar 24

The History of Hospital Ships

Tuesday, March 24, 2020 11:05 AM

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Did you know that the USNS Mercy (T-AH-19) arrived in Los Angeles, California earlier today? The Mercy and her sister ship, the USNS Comfort, are both hospital ships operated by the United States’ Military Sealift Command, and both have a long history of aiding combatant forces as well as civilians in need of disaster and humanitarian relief. Seeing the Mercy on the news, however, lit a question in my archival brain: just what is the history of hospital ships?

USNS Mercy leaving San Diego Bay, California. U.S. Navy Photograph

While we do not have concrete evidence, there is a possibility that hospital ships have existed since ancient times. The Athenian Navy had a vessel named the Therapia – which in Greek means to treat medically – and the Roman Navy had a ship named after the Roman god of medicine, Aesculapius. These names have led historians to deduce they were likely hospital ships for the ancient peoples.

Our first tangible example of a hospital ship, though, comes from the Royal Navy. The vessel Goodwill accompanied a Royal Navy squadron to the Caribbean in 1608, with the intent that the vessel would house the sick from the squadron’s ships. This task was short-lived, however, as within the year the Goodwill was assigned other duties and dropped her convalescences off at the nearest port. It took until the mid-seventeenth century for the Royal Navy to formally designate two vessels as hospital ships. They chose elderly sixth rate ships for the duty, removing the internal bulkheads and adding ports cut through the deck to create more room and internal ventilation.

What was it like on these early hospital ships? Well, in addition to the sailing crew, seventeenth century hospital ships were assigned a surgeon and four surgeon’s mates. Patients were provided a bed – or rug – and a pair of clean sheets, along with what is reported to be abysmal rations. At this time, hospital ships were intended to only house the sick, not those wounded in combat, though this would quickly change.

By the 1680s, soldiers wounded on land were being transferred to hospital ships. The earliest example of this is the evacuation of English Tangier in 1683. Samuel Pepys, an eyewitness, documented how 114 invalid soldiers and 104 women and children were evacuated via the hospital ships Unity and Welcome. This is also the first example of hospital ships being used to evacuate civilians as well as combatants.

A newspaper article on the HMS Melbourne, displaying the modern editions to this hospital ship that served in the Second Opium War. The Illustrated London News.

Through the eighteenth century, Royal Navy hospital ships increased their medical personnel, though it was not until the nineteenth century that true progress in hospital ships was made. Thanks to the medical advancements of the nineteenth century, hospital ships became places not just to house the ill, but to treat the sick and wounded. The first ships to be equipped with genuine medical facilities were the HMS Melbourne and the HMS Mauritius. They both provided spacious accommodation for patients, as well as a dedicated operating theatre. By this time, other countries also began designating vessels as hospital ships. The USS Red Rover, the U.S. Navy’s first hospital ship, treated the wounded from both sides during the American Civil War. And it was the sighting of the Russian hospital ship Orel that led to the decisive Japanese victory during the Battle of Tsushima of the Russo-Japanese War (1904-1905).

Starboard side view of the USS Red Rover, the U.S. Navy’s first hospital ship. U.S. Navy Photograph

It was not until the World Wars that the next evolution in hospital ships occurred. This was the first occurrence of hospital ships being utilized on a massive scale. Many passenger liners were converted for this purpose, one of the most famous examples being the RMS Aquitania. This was also the period that the U.S. began purposefully building hospital ships, rather than simply converting other vessels. The first of these was the USS Relief, which was commissioned in 1921.

Aerial starboard side view RMS Aquitania underway.

During the World Wars, hospital ships served a number of purposes, including evacuating civilians, treating the wounded, and evacuating to hospitals. These purposes could not only differ by country, but also by branch of the military. For example, U.S. Navy hospital ships were fully equipped hospitals which could treat casualties straight from the battlefield, as well as serve as logistical support to front line medical teams on shore. U.S. Army hospital ships, on the other hand, were not equipped or staffed to handle large numbers of casualties. Rather, they served as giant ambulances and transported casualties from forward area hospitals to safer, rear hospitals, or to the United States mainland.

Despite their purpose clearly being non-combatant and of goodwill, another question did come to my mind while researching this topic: what keeps hospital ships safe from hostile forces? Well, during the Hague Convention X of 1907, international leaders decided on the restrictions placed on hospital ships:

  • The ship must be clearly marked and lighted as a hospital ship
  • The ship should give medical assistance to wounded personnel of all nationalities
  • The ship must not be used for any military purpose
  • The ship must not interfere with or hamper enemy combatant vessels
  • Belligerents, as designated by the Hague Convention, can search any hospital ship to investigate violations of the above restrictions
  • Belligerents will establish the location of a hospital ship

If a hospital ship does not comply with these restrictions, the ship must be warned and given a reasonable time to comply. If it does not, the belligerent is legally entitled to capture or take other means to enforce compliance. A hospital ship may only be fired upon under the following conditions:

  • Diversion or capture is not feasible
  • No other method to exercise control is available
  • The violations are grave enough to allow the ship to be classified as a military objective
  • The damage and casualties will not be disproportionate to the military advantage.

In all other circumstances, attacking a hospital ship is a war crime. Desire to show they are protected is why modern hospital ships display large red crosses or red crescents.

USNS Mercy at anchor off the Philippine Islands. U.S. Navy Photograph

Today, the United States has two hospital ships, the USNS Mercy and USNS Comfort. Their primary mission is to provide emergency on-site care for combatant forces, with a secondary mission of support for disaster relief and humanitarian operations. Each ship contains 12 operating rooms, a 1,000-bed hospital facility, digital radiological services, a medical laboratory, a pharmacy, an optometry lab, an intensive care ward, dental services, a CT scanner, a morgue, and two oxygen-producing plants. They are equipped with helicopter decks to assist with patient transport, and side ports designed to facilitate the patient transfer directly from other vessels.