The US and China both operate a fleet of Hospital Ships as part of their soft power approach. It is a sensible strategy and whilst the benefits might be difficult to quantify and analyse there is a general feeling that for many reasons, medical diplomacy is the right thing to do.
Both nations also deploy their military capabilities in support of humanitarian disasters, Haiti being a particularly recent example of US commitment. I think that the US does not get enough credit for its disaster responses but perhaps this ambivalence is exactly the reason it does so.
For the UK, I am not suggesting a capability on the scale of USNS Comfort and Mercy, but recognition that military capability can be used for soft power, far removed from the normal combat missions. Of course we contribute as well, RAF flights to Pakistan or an RFA Largs Bay LSD(A) to Haiti are modest yet still solid examples.
The Department for International Development or UK Aid is the UK Government Department charged with administering the considerable UK public sector contribution to overseas development and relief. Purists will no doubt draw the distinction between aid and development and try and place clear blue water between the military and aid but we must be clear that even 1 penny that the UK government spends on other nations is in our gift and at our discretion.
The government made it quite clear that the left leaning DFiD organisation would be changed but inexplicably ring fenced its budget. I have blogged a few times about this, especially in relation to the UK armed forces losing capabilities whilst facilitating other nations to acquire similar capabilities by displacing their spend on their own welfare but that is not the main argument here.
Hopefully, the National Security Council and Foreign Office primacy will reign in some of DFiD’s excesses and align their projects more closely with UK national interest. It might be noble to support poorer nations and the UK is in the top 5 of nations for both public and voluntary giving but we have to set sensible limits and impose achievable goals that deliver tangible security benefits. One of the great justifications for spending nearly £8 billion per year on overseas development is that it prevents conflict, DFiD cannot object therefore to funding a dual use capability.
The maritime afloat component will be resourced by a large and adaptable ship, one of the about to be decommissioned Bay Class LSD(A)
A recent Parliamentary Answer indicated that the running costs of a Bay Class LSD(A) were in the order of £20m per annum and yet despite this very modest sum, the SDSR indicated one will be decommissioned. The HSG represents an opportunity to retain the 4th Bay Class for military contingencies yet create a permanent Humanitarian Support capability to be used by DFiD, FCO and potentially, charities and other NGO’s
The vessels would have utility across many areas governmental business but the cost burden, for a change, would fall outside the MoD. Much as the MoD is expected to bear the costs save for a limited chargeback mechanism for civil resilience and response activities the HSG will similarly be available to the MoD with appropriate cross charging.
We need cross governmental joined up thinking and should not be afraid to sully our pure overseas aid/development credentials, I suspect those in receipt of the HSG’s services would neither know nor care about the principle.
Some might say this is a transparent means of transferring some of the DFiD’s substantial budget into a dual use capability that means we don’t have to sell off one of the most useful ships the UK has.
Perish the thought!
Given that this is a maritime capability the operating scope or nations/people we can assist is self evidently limited by access to the sea but as we know from the many carrier strike discussions we have had, the majority of the world’s population lies relatively close to a shoreline so this is a limitation we must accept. Other capabilities might be deployed for those inland locations.
There would be a published visit schedule but the ship might converge on a location in response to a large scale natural disaster. The scheduled activities would include medical, engineering and training activities and the reactive activities would largely be the same but with a slightly different focus.
There is some overlap and duplication with the Forward Presence Squadrons, this is intentional.
The HSG will supplement and enhance the presence squadrons on both a scheduled and reactive basis, it is important that there exists a link, not only for operational and organisational reasons but also because one will reinforce the other, the sum being greater than the parts. In the description of the Forward Presence Squadrons I suggested they should be multi-agency and multi-national in composition, this could extend to voluntary groups like the Voluntary Service Organisation and NGO’s.
Capabilities may be deployed independently of the main vessel or split between it and the Forward Prsence Squadrons, hence, its a group!
Making sure the interaction between the Royal Navy, RFA, DFiD, FCO and other contributory organisations must be addressed in the command and control structure, all organisations have to pull in the same direction.
Capabilities – Medical
One of the greatest gifts we can give to people in developing nations or those afflicted by natural disasters is medical assistance. Whether it is for emergency life saving intervention or elective but life changing operations for conditions such as cataracts, cleft palates or obstetric fistula, the effect is far reaching.
One of the operating experiences of the US hospital ships is that their deep draught prevents them from operating at many locations which results in a need for expensive helicopter or slow surface transport of patients.
In general, the Bay class has a relatively shallow draught but it is still unable to berth at shallow and/or austere locations so the simple answer is to separate the medical facilities from the ship. I think most readers of Think Defence know where I am going with this!
Either working aboard or detached and transported to shore/inland the medical facilities should be fully containerised. There is some loss of space efficiency but the flexibility afforded by a transportable facility provides many more deployment options and ultimately a greater reach.
A modular medical capability may be split between multiple locations or combined and different treatment facilities also increase flexibility. A simple first line medical container for example could be transferred to shore and driven to site or carried on a landing craft to enable access to isolated coastal or riverine communities.
Crewing of the medical facilities should be independent of the ships crew and might include volunteers, secondees from the NHS, NGO’s or the Defence Medical Service. There is also a valuable training opportunity to realised in continual operations of the medical facility.
The medical capacity has to be modest and/or complimentary because a visit may have a destabilising impact on local healthcare provision or burden it with extensive post operative obligations. Again, the Forward Presence Squadron multi agency ashore component can coordinate visits with local providers and the system as a whole could be used not only to provide but also to teach and develop local capacity.
Capabilities – Disaster Response and Regional Development
The ships will routinely carry a range of disaster response supplies and suitably trained personnel. Even though they will be forward located they might not be on scene until some days after the disaster so capabilities must reflect this.
In the days following the acute phase of any disaster response the most likely use need will be medical (covered above), shelter, transport, communications and potable water.
The Bay class has a great deal of vehicle and cargo space so substantial stocks of roofing sheet, shelter materials, water containers and similar supplies would be routinely carried.
A particularly brilliant concept has been pioneered by the UK charity, Shelterbox. The pre packed box has a range of tools, shelter and cooking materials. Have a look at some images of the Shelterbox being used worldwide here. Again, the HRG could link up with organisations such as Shelterbox and simply carry 3 or 4 containers worth on board at all times.
In addition to supplies and materials the next greatest need is for construction and all wheel drive vehicles. Instead of disposing of ex MoD vehicles and construction plant to the open market they might simply be transferred to the HSG and used on operations, gifted to the target nation after the response.
I looked at containerised water purification a few months ago, here, again, carrying three or four systems would not be overly expensive but make a significant contribution.
Other disaster response capabilities might include portable power generation equipment and perhaps even radio broadcast or other communication systems.
When the ship is not being used for disaster response the focus would be on development and training, reinforcing and building local capabilities.
Capabilities – Aviation
The utility of helicopters in a disaster response is obvious so at least a single government owned and operated medium helicopter should always be carried. Military helicopters are scarce and this should not take away from existing capabilities but the ship should still be able to operate military helicopters in a surge capacity.
Obtaining decent aerial imagery of a disaster area should be seen as a critical need so the helicopter should be equipped with a suitable electro optical sensor and the ship, a image analysis and dissemination system. An off the shelf UAV might even be carried.
Capabilities – Ship to Shore
The well deck provides multiple options; first it allows a sheltered and safer transfer of patients, personnel, vehicles and stores to and from the vessel. Secondly, it provides the ability to carry a number of smaller craft for transfer of materials, personnel and vehicles between ship and shore.
It would fill the well deck but a large LCU Mk10 would provide a tremendous and flexible capability. The LCU Mk10 would allow a decent amount of stores to be transported and because of its extended endurance it could also operate semi independently with a containerised medical facility for riverine or coastal community access.
A well deck does add complexity and cost but for the flexibility on offer and for the dual military use, it is a worthwhile system to retain. A mexeflote would also provide additional capacity but inclusion would depend on cost.
Capabilities – Security
Security is always an issue and for this, a small RMP or RM detachment might be appropriate in some circumstances. The ship is largely non military but security is still a valid concern and again, a valuable training and command opportunity.
Another option worth considering is simply to offer Largs Bay to Mercy Ships on a semi permanent basis.
######## OTHER POSTS IN THIS SERIES ##########