A UK Hospital Ship
A UK Hospital Ship has been a recurring theme in the media and over the years, accompanied by much online discussion, but it has never really gained much traction in Government. Comments from the Secretary of State for International Development (Penny Mordaunt MP) reported in the Daily Mail would seem to have improved its prospects.
Without seeing the letter the article reports on or understanding the full background it is difficult to determine the staff work that underpins the suggestion or indeed, the basics of ENDS >> WAYS >> MEANS that results in a hospital ship being the logical end-point.
That said, it is not unreasonable to see how the motivation for the suggestion has roots in making better use of the UK’s significant and politically difficult Overseas Development Assistance (ODA) budget, reinforce the post BREXIT ‘Global Britain’ vision and provide some relief to a defence budget that is in permanent crisis.
At a high level, a ‘hospital ship’ ticks all the boxes so would appear on face value to be a no brainer, but like many subjects, scratch the surface and you find significant challenges that might be cause for pause and reflection.
This article takes a look at those issues, and of course, has a broad stab at a few alternatives!
Although hospital ship is often used as a generic term and is arguably much easier to understand than Primary Casualty Receiving Facility (or Ship), there is a very big difference so it is important that this is understood, we need to get this out of the way early in the article.
Ships dedicated to providing medical support have a long history but the term Hospital Ship was first defined in the Geneva Convention and Maritime Law (3rd Hague Convention) of 1899 and additionally in the Tenth Treaty of the Hague Convention of 1907.
It was very specific about restrictions, marking and rules of use, read it here but as an example, they must not be used for any other purposes, all belligerents have right of search and must be painted white with a green band.
After WWII, the Geneva Conventions of 1949 further enhanced and updated provisions for Hospital Ships, specifically Convention (II) for the Amelioration of the Condition of Wounded, Sick and Shipwrecked Members of Armed Forces at Sea. Geneva, 12 August 1949, Chapter III.
The comprehensive 1949 Convention has also been subject to two sets of ‘commentary’, one in 1960 and the latest, in 2017, again, links above. Needless to say, the legal definition of a hospital ship is a serious matter for anyone thinking they might want one.
Now if you read that and thought, bloody hell, that is a complex business, can I introduce you to the 280 pages of AJP-4.10 Allied Joint Doctrine for Medical Support?
It is not possible to summarise such a comprehensive document easily but of most relevance is the concept of different types of facility role, we often hear terms like Role 2 or Role 3 in relation to medical facilities.
A Role 3 Medical Treatment Facility is defined as;
RFA Argus is often called a hospital ship but she isn’t, instead, she is a primary Casualty Receiving Facility as defined by AJP 4.10 and UK specific doctrine. Painted grey, armed and able to conduct other non-medical tasks, she is most definitely not a hospital ship, even though her primary role is medical in nature.
More on this later, but we need to be very clear about the differences.
We might want a hospital ship, we might not, which leads on to a question…
What do We Actually Want?
Accepting that a Hospital Ship is not a Primary Casualty Receiving Facility we need to try and define what it is we might actually want, what doctrinal or strategic context any such facility would exist in and examine a range of options for delivering against the requirement.
- A medical capability for disaster response i.e. in the aftermath of a Caribbean hurricane or African Ebola outbreak
- A medical capability that supports deployed forces in a military operation i.e. a deployed Bastion hospital
- A multi-purpose capability that can be used for both the above, and potentially other roles in support of both civilian and defence operations
You might note I described these as capabilities, not ships.
Payloads not platforms is perhaps a hackneyed phrase but it does provide the opportunity to look at other means of providing the effect. For example, could a combination of air deployment and ship deployment be optimal, or even developing and supporting local responders as a valid alternative.
We should really look at them all.
There must be some reference to span of capability, capacities, threats and potential locations. When the need/requirement has been established, the thorny problems of manning and finance will also need to be addressed. The answers to these questions might make one path or the other preferable, there may be some answers that also close off options and force compromise in one area or the other.
A civilian manned hospital ship paid for by the DFiD budget might be just what DFiD wants, but it would have very little utility for the MoD and still leaves the replacement of RFA Argus to be discussed.
The final part of this article in three parts;
- Establishing the Need
- Existing Capabilities and Previous Examples of use to Guide Discussion
- A Proposal
Establishing the Need
We can place the requirement for a hospital or HADR ship/capability in the wider context of the MoD’s approach to stability.
Conflict prevention, is a simple concept that at its core seeks to make the UK safer by providing help to unstable nations such that they can help themselves to stabilise. The theory is that an Ounce of prevention saves a Pound of cure. Getting in early, de-escalating early stage conflict and supporting overseas development efforts are all seen, quite rightly, as effective means of preventing wider and much more expensive conflict.
The Army’s Adaptable Force as part of Army 2020 continues to evolve, the August 2015 Joint Doctrine Note 1/15 describes the MoD’s defence engagement approach and (although it is a few years old) the International Defence Engagement Strategy provides additional information.
JDP 05 Shaping a Stable World: the Military Contribution pulls these together and provides a good diagram that illustrates how they all fit together. Defence engagement is therefore designed to build understanding and develop capacity with the objective of preventing conflict. The Building Stability Overseas Strategy (BSOS) is a joint Foreign and Commonwealth Office (FCO), Department for International Development (DFID) and MOD strategy for conflict prevention. BSOS also outlines three main mutually-supporting pillars of the Government’s stability strategy; Early warning, Rapid crisis prevention and response and Upstream conflict prevention.
The 2015 SDSR included provision for the £1.5 Billion Joint Security Fund and other changes to overseas development assistance parameters.
From the Commons Library a description of the funding landscape for conflict prevention, Changing parameters of Overseas Development Assistance
In a significant move, ODA was now to be used to serve the national interest.
The Conflict, Security and Stability Fund starts…
It is clear that the UK sees ‘stability’ as a significant part of the remit of Overseas Development Assistance (ODA) and that funding will follow. It also demonstrates that it is well established; organisationally, doctrinally and financially.
With the Modernising Defence Programme, new National Security Objectives and the emergent Fusion Doctrine, there is a concious effort to provide even greater alignment and direction across departments, or joined up government in the old fashioned vernacular.
A less well known aspect of the recent changes to the UK’s strategic outlook has been work completed on Cross Government Funds, if there is cash for a hospital ship, it may well find its roots in this work.
Click here to read more.
We can, therefore, place the requirement for a hospital or HADR ship/capability in the wider context of the Governments strategic approach to stability but dropping down to the operational level we should have another look at the medical support and disaster response doctrine publications published by the MoD.
Disaster relief operations (JDP 3-52) provides guidance for planning and conducting military support to humanitarian relief efforts overseas.
This text is particularly important;
It also describes the generic phases of disaster management and establishes the military response element to the lower right quartile of the cycle, perhaps reasonably.
There is no doubt that military medicine has progressed significantly during recent operations, as have expectations.
Upon the closure of the Role 3 Hospital at Camp Bastion, Lieutenant Colonel Jaish Mahan, Commanding Officer UK Medical Group, said;
The three diagrams below show the complexity of patient pathways and general approaches, you will note they include the UK as a key element, in a HADR context, this may not be viable.
Medical care is organised on a role or echelon basis, read more at the Allied Joint Doctrine for Medical Support.
The medical doctrine describes the UK’s modular approach to medical care.
- Emergency Area
- Initial Surgery Response Capability
- Specified Diagnostic Capabilities
- Patient Holding Area
- Post OP (high/medium dependency)
- C4I (including telemedicine support)
- Medical Supply
- Ward (general)
- Primary Healthcare
- Intensive Care Unit (long-term ventilation)
- Mental Health
- Internal Medicine
- Isolation Ward
- Hospital Management
- Additional Clinical Specialists
- Specialist Surgery
- Oxygen Production
- Preventive Medicine
- Hyperbaric Medicine
- Transient / Response Ambulances
- Magnetic Resonance Imaging
- Frozen Blood Product
- Animal Care
- CBRN (Decontamination & Treatment)
These are represented (or not) at the care echelons. There are two Role 2 variants, Basic and Enhanced, and the Role 3, a hospital response capability that provides secondary health care at theatre level. A Role 3 MTF must provide all the capabilities of the Role 2E MTF and be able to conduct specialized surgery, care and additional services as dictated by mission and theatre requirements. It can be seen from this that there is some degree of flexibility and scalability within the UK’s approach.
The diagram below shows the span.
The MoD has also recently taken delivery of a modular deployable Role 3 Hospital from Marshall. The Queen Elizabeth aircraft carriers will have Role 2 facilities and Role 3 is currently provided by RFA Argus when designated in the role.
Role 3 facilities required include resuscitation, operating theatre, intensive care wards, advanced diagnostics (X-ray, MRI etc), recovery wards, sterilisation, pharmacy, hyperbaric facilities, blood/blood component storage, medical waste disposal, command and control, laboratory, dental, isolation, medical gas handling, power generation, uninterruptible power supplies, storage space, catering, mortuary, laundry, extensive communications for telemedicine and a computing environment that supports the secure generation, storage and processing of large volumes of data.
As can be seen from the image above, the Role 3 field hospital occupies a single layer but is approximately 120m by 60m. The Camp bastion diagram clearly shows a substantial layout and RFA Argus has an equally voluminous installation.
The doctrine also includes specific references to disaster relief operations.
This is a fairly long winded (sorry about that) way of saying a handful of very simple things;
- The UK benefits from global stability
- The UK in invested across multiple departments with significant budgets in contributing to this stability
- Disaster prevention and response is a fundamental part of the UK’s approach to contributing to global stability
- The UK has done a great deal of thinking about this, and its thinking continues to evolve
- The UK is doing a great deal
- Defence has an enduring and evolving need for medical treatment facilities of various types including a Role 3 deployable facility
- The Role 3 deployable facility can be land or sea based, or even air deployed, but of we have a deployed force and that if that force is on or near the sea, it pretty much makes sense to have an afloat capability
Existing Capabilities and Previous Examples of Use to Guide Discussion
Perhaps the most well-known hospital ship was the SS Uganda and her service during the Falklands conflict. She was converted from an educational cruise liner into a three ward hospital ships in a very short period of time and served with distinction throughout.
During the 1982 Falkland Islands conflict, the Contender Bezant was utilised as an aircraft transport, ferrying helicopters and Harriers south to the Falkland Islands.
Following purchase by the MoD in 1985 for £13million, she was converted to an aviation training ship at Harland & Wolff, Belfast, with the addition of extended accommodation, a large flight deck, aircraft lifts, naval radar and communication equipment. A Primary Casualty Receiving Facility was added before Argus deployed in 1991 to the Gulf War. Another role of RFA Argus was that of RORO vehicle transport with vehicles carried in the hangar and on the flight deck, a role she performed in support of United Nations operations in the former Yugoslavia. During the 2003 invasion of Iraq, Argus was again present in the Persian Gulf as an offshore hospital for coalition troops, earning the nickname ‘BUPA of Baghdad’.
More recently, RFA Argus participated in OP GRITROCK, the UK’s response to the Ebola outbreak in Sierra Leone, and of course, a star turn in the Brad Pitt film, World War Z.
The 1998 Strategic Defence Review stated that the MoD would ‘acquire an additional 200 bed primary casualty receiving ship’ with a second available on contract at longer notice (up to a year) when required. The assumption was that the second vessel could be a conversion project, completed on demand.
An IPT formed in 1998 to start the project and scoping contracts let for initial concept and requirement work with BMT and Atkins, this initial work also envisioned JCTS would be delivered through a PFI rather than outright purchase but after it was shown there would be little scope for alternative revenue generation the requirement was changed.
After some progress on JCTS, the project was shelved in 2005. There was also some discussion and a proposal to convert one of the Bay class vessels to a JCTS at a reported cost of £360m in 2005 but this didn’t proceed either.
At 28,000 tonnes, RFA Argus is a very large vessel and it is the space that allows it to have such flexibility and capability. RFA Argus has a range of extremely impressive medical and support capabilities, improved over a number of years and refit periods.
In 2009, a £37m programme, for example;
The Role 3 medical facilities can flex but in the largest configuration is designated as 4/4/10/20/70 which means 4 resuscitation bays, 4 operating tables, 10 intensive care beds, 20 high-dependency beds and 70 general beds (in two wards). Other facilities include a dental surgery, imaging (Ultrasound, 64 slice CT and X-Ray), pathology, pharmacy and physiotherapy. She has an oxygen concentrator and various laboratories.
The Maritime Aviation Support Force often deploy support teams to RFA Argus on a demand basis and the 180 medical personnel are drawn from the joint defence medical service and wider NHS. Regular training and exercises not only ensure the professional medical standards are maintained but also that they can be exercised on board the ship, with the various unique factors that this involves, something often overlooked by many when discussing this.
She will eventually need replacing.
Other nations have their own variation on hospital ships, from very large to very small.
The largest of the modern hospital ships is the US Mercy Class, USNS Mercy and USNS Comfort. Both are converted San Clemente class tankers, displacing approximately 70,000 tonnes. With a 1,000 bed capacity and 12 operating theatres they are also equipped for the widest range of medical treatment options. Mercy is home based on the Pacific coast and Comfort, the Atlantic. Both are activated in response to need rather than being permanently in operation and they have a number of design flaws that are often the subject of much discussion; lack of aviation facilities, poor patient movement routes, relatively low speed and their sheer size makes them unsuitable or overkill for many situations.
Russia and China also have hospital ships, the former with the 11,000 tonnes 100 bed Ob class (Yenisey) and China with 30,000 tonnes 400-bed Daishan Dao, alternatively known as the Peace Ark.
China also has an interesting ‘medical evacuation ship’ called the Zhuanghe which is a converted 30,000-tonne container ship. She can be equipped with a various combination of containerised shelters although it does seem the range of facilities is relatively limited.
There are also a few other interesting designs to consider, the Spanish Esperanza del Mar is a civilian vessel used to provide medical cover for Spanish fishermen off the coast of Africa, the Brazilian Navy Soares de Meirelles which is riverine vessel used to provide healthcare to remote communities and the Indonesian KRI Dr Soeharso, a converted LPD.
The 21 million Euro (part funded by the EU) 5,000 tonne Esperanza del Mar is a custom built vessel and quite modest compared to those above. The Soares de Meirelles has a very shallow draught to enable it to navigate Brazils numerous rivers and the KRI Dr Soeharso is a multi purpose vessel that has a great deal of flexibility for getting patients on and off with small craft and helicopters.
What is interesting about these last three examples is how they are very specifically designed for their requirement and environment.
There are any number of options available; do nothing and gap the capability when RAF Argus is withdrawn, convert one of the BAY Class LSD(A) vessels, wrap it up into potential future replacements for Albion/Bulwark, contract a civilian provider for a HADR only hospital ship, or most simply, replace RFA Argus with something like for like, a civilian merchant vessel conversion.
What makes this so difficult is a Deployable Role 3 PCRF is so rarely needed so it becomes subject to conversations on likelihood v impact and cost savings. For many years those conversations have confirmed the post 98 SDR status quo of keeping RFA Argus in service, but she cannot last forever.
Converting one of the Bay’s would be simplest, but it would result in a tangible capability loss and doesn’t solve the RFA’s and DMS manning issues, and we would be converting a ship that is likely over 15 years into its lifecycle.
I can’t see gapping the capability has much merit either, that would send all the wrong messages to service personnel and their families.
This means the most likely would be design and build a bespoke vessel (less likely) or simply convert a second hand new(ish) merchant vessel. The former would be good from a UK prosperity perspective, probably look something like HMS Ocean, and produce the most optimal solution, but it doesn’t solve any of the issues about use rates v cost.
The proposal is in the form of three activities, each in ascending order of likely cost but all within an overall framework that improves the ability of the UK and its overseas territories to both prepare for and respond to natural disasters. Proposal two and three also have a dual role aspect, being applicable to medical support to military operations and HADR.
ONE – Build Local and Civilian Medical and Disaster Response Capabilities
Fundamentally, the ultimate goal of any overseas development organisation must be to make themselves redundant. The more we can enable, support and develop local responders and civilian organisations the more they can look after their own and the more we can spend money elsewhere.
Mercy Ships is a UK based faith charity that operates the M/V Africa Mercy, a hospital ship with 82 beds and a full range of modern diagnostics and support facilities. They also operate a screening and minor surgery facility on land whilst ensuring that multiple training and infrastructure development activities are delivered during their stays at various locations.
Although not nautical, Orbis is a similar UK charity that specialises in eye care. They operate in a capacity of both doing, training and capability development, including some very advanced telemedicine, but with the obvious difference of operating from an ex Fed-Ex DC-10, rather than a Danish railway ferry.
These are not responding organisations, they work on a planned basis to both deliver services and develop local organisations.
Although there is benefit to overseas basing and defence obligations will remain, an alternative might be to share and expand existing facilities where appropriate. A good example of this is in the Caribbean where there has also been some speculation about basing for defence, counter narcotics and disaster response.
The recent operation to render assistance to the hurricane hit islands in the Caribbean was a textbook example of response at range and demonstrated the very finest qualities of the UK armed forces, civil servants and voluntary sector, but the irony of UK taxpayers paying for infrastructure restoration on an island that is a significant part of the offshore finance industry cannot be ignored. The issue of being unable to qualify assistance as part of the UK’s official ODA funding has also been controversial. For the future. Instead of a response, the UK should focus the Caribbean British Overseas Territories on infrastructure resilience and local/regional response, a key lesson from Op RUMAN now being implemented.
Counter narcotics smuggling is also a role carried out by RN/RFA vessels on a regular basis, again, we should question whether this can be delivered in alternative and lower cost ways to reduce RN/RFA workloads.
For the Caribbean BoT’s, some have suggested a permanent presence like that of the Dutch support ship HNLMS Pelikaan but there is an alternative. The Royal Bahamas Defence Force have recently completed their $200m ‘Sandy Bottom’ project which has delivered a number of patrol vessels, a large RORO craft, containerised disaster relief equipment and significant port facility.
The 600 tonne, 52 meters, multi-purpose cargo vessel (in the last video above) has a landing ramp and 25-tonne crane. It can carry 42 containers on deck with water and oil in fitted tanks. These will be used for logistic support and disaster relief and included in the deal are a number of containers specifically for the disaster relief mission.
As an alternative to responding and regular deployments, the UK could fund an expansion of Sandy Bottom or do the same somewhere else to include hurricane hardened relief supplies storage, improved command and communications facilities and another RORO vessel to create a sustainable regional capability. This is just one example, other locations with better proximity to suitable airports may well be more suited but the concept would remain, work with local civil resilience organisations (like the Caribbean Disaster Emergency Management Agency) and build up local capability.
The first proposal is, therefore, to fund from DFiD (and perhaps a small bit from the MoD) UK based charitable organisations and local responders. This is arguably the most cost-effective path and certainly, the best from a long term perspective. And it is absolutely possible within the DFiD budget, with little or no impact to the MoD
TWO – Air Deployable Rapid Response
Within 5 days of the 2010 Haiti Earthquake, Israel had a joint team on the ground conducting a blend of rescue and medical activities. It was a hugely impressive display of rapid response in a disaster context.
They flew there, 3 days after the earthquake.
As impressive as it was, it would not have been possible without the efforts of a handful of people from the US 1st Special Operations Wing’s Joint Special Operations Air Component. 26 hours after the earthquake, two MC-130H’s from the 15th arrived at the airport, flying from Hurlburt Field in Florida. Within 30 minutes of arriving the combat air controllers assumed command of air movements, setting up shop in the open air using a couple of folding tables. Aircraft were guided to their parking spots using motorcycles.
These combat air controllers were absolutely instrumental in enabling the inflow of aircraft.
The UK actually has a very good similar capability, we have very high readiness force protection airfield engineering, medical and logistics forces across 16 Air Assault Brigade and the Royal Air Force, backed with various teams of specialists including those that can parachute in if necessary.
Where airfields are available, the first priority should be ‘enabling’ them for follow on military and civilian capabilities. The very same capabilities have broad utility across the spectrum of operations, there is no need to dedicate them to HADR or combat operations, it’s all there, it’s all good.
Where time is available, and infrastructure not damaged, as per the Ebola response in Sierra Leone, medical facility design and build are also sensible options to exploit,
Where the response is HADR and not solely in support of military operations there are a number of charity rapid-response organisations that could be integrated with the MoD and DFiD’s capability framework.
This proposal is less about any new capability but one of integration, exercise and selected equipment improvements.
THREE – A Multi-Function Vessel
Proposals Two and Three have nothing whatsoever to do with a ‘hospital ship’, the subject of this article, but they do place a ship in a wider context that I think is important to note.
When we look at a multi-function vessel we can easily envisage RFA Argus, or one of the Bay’s, both being excellent examples of course. Going to the second-hand market reveals several bargains can be had, whether using Container ships, CONRO’s, Vehicle Carriers or those like the current Point class strategic RORO vessels. A similar vessel to the Strategic RORO’s has been converted by the US for SF support, look up the M/V Cragside for further information.
ROPAX; RORO and passenger, perhaps most used in the short sea crossing routes with accommodation for cars/trucks, foot and car passengers. The image below shows a ROPAX design from Flensburger for Caledonian MacBrayne, built at a cost of £43 million. They are usually equipped with stern and aft ramps and extensive passenger facilities.
PCC/PCTC; Pure Car Carrier and Pure Car Truck Carrier are specialised vessels that are designed to carry new vehicles. They have close spaced decks to maximise carrying capacity.
CONRO; a CONRO combines container and RORO cargo, the Atlantic Conveyor was a CONRO and the Atlantic Conveyor Line continue to specialise in this type of vessel. The upper deck is fitted with container guides and the lower decks, used for RORO cargo. Open deck conventional RORO vessels can also usually accommodate containers and reefer containers on their upper deck.
RORO/LOLO; In addition to RORO vehicle decks, the LOLO part of the combination adds high capacity cranes for outsize or hazardous cargo, in addition to containers. Technically, the Point Class Strategic RORO vessels are RORO/LOLO vessels as they can self-load using a deck crane.
RORO; the classic RORO, used mainly for vehicles and trailers, the trailers can also be substituted for cassettes or devices used specifically for certain cargo types, bananas and paper for example. They can have their superstructure forward, aft or at a mid point. The superstructure usually contains accommodation for drivers and other passengers but in most designs, this is relatively limited, as drivers do not travel usually internationally.
Some might even be tempted by the ‘fastcat’ type short route ferries but just to show a couple of alternatives, a new RO-CON design by Knud E Hansen for the former National Shipping Company of Saudi Arabia (now Bahri) and a concept for a banana carrier, from the same company.
Bahri has taken delivery of six vessels of this design, all built between 2013 and 2014, for the princely sum of £49 million each, no, that is not a spelling mistake. They are designed with RORO, container and heavy lift on cargo in mind, flexibility built in.
They would have to be inspected, transported, faults rectified, modifications made, re-inspected and accepted into service, but when your starting point is between one and twenty million Pounds, it is easy to see the attraction of dabbling in the second-hand market.
The main problem with a merchant conversion is just that, you have to convert, permanently. This means you are always carrying around the medical facility because just putting ISO container modules is highly unlikely to meet the demanding needs of a Role 3 MTF.
You don’t solve the utilisation problem so, in reality, the ship isn’t multi-function at all.
When the ship isn’t doing the medical thing, it needs to earn its keep doing something else.
Traditionally, we would look at this and think aha, the ISO container module is the answer, in this case, it isn’t.
Modularity is the answer, but in this case, we need to think big about modules.
Now bear with me, because I will grant you this might sound a bit insane, but this is a post to promote discussion, not provide definitive answers so being a bit radical is not a bad way to start!
What facilitates this approach is the simple fact it isn’t new, innovative or especially uncommon.
Some examples are shown below.
It is also how we move large vessel blocks as well, recent examples notably include the QE carriers.
When not on a deployment, the Role 3 MTF Module(s) would simply be stored onshore, they would also provide an excellent training environment or emergency capability. They can be designed from scratch, optimised for patient flow and with all the facilities required. Medical personnel accommodation (which always seems to be a problem) could be built in or configured as another large module, each self-contained from the other.
Aviation or boat handling, again, built according to specific requirements, possibly including facilities for handling landing craft or hovercraft to enable quicker ship to shore transfers.
Where could we store modules?
A lot would depend on availability and proximity of medical and maritime personnel but potential locations could include Marchwood, Glasgow or Liverpool.
If we were to take the approach of separating payload from the platform and making those payloads supersized modules, there is still an obvious need for a suitable vessel to transport them when needed.
What is needed is a robust, relatively cheap and adaptable vessel which can be used for shifting stuff, or with the addition of ‘modules’ a more integrated capability for more complex roles.
Several years ago BMT looked at the options for replacing RFA Diligence under the Operational Maintenance and Repair (OMAR) study. It concluded that the optimum solution was an unpowered barge carried to the area of operations on Float On Float Off (FLOFLO) heavy lift vessel. The barge was 120m x 30m and displaced approximately 3,500 tonnes.
The study suggested using a FLOFLO vessel of opportunity or one on a long term charter. With the withdrawal of RFA Diligence and pending withdrawal of RFA Argus, it is perhaps worth another look at the general concept.
Putting aside heavy lift barge/tug combinations, there are three basic configurations for a heavy lift ship;
- Lift On Lift Off; the ship has a large open deck area onto which outsize and extremely heavy cargos are lifted on and off using dockside or integral cranes.
- Roll On Roll Off; the payload is moved on-board using multi-wheeled heavy lift platforms called Self Propelled Modular Transporters (SPMT). Ballasting allows a straight path to be established between the ship deck and quayside
- Float On Float Off; the deck area flooded after ballasting down to an appropriate depth and the cargo manoeuvred in, usually with tugs, although when transporting smaller vessels, they can self-load. The ship is ‘re-floated’ and secured for the journey.
Different ships can use one or more of these methods, the most flexible being able to use all of them.
Operators of such vessels include Jumbo Maritime, Bigroll, Dockwise, RollDock and Combilift. For transporting leisure craft, Yacht Transport provide a specialised service, the FLO-FLO vessels generally have higher capacity accommodation for the yacht crew. The Combi Dock is longer than the Roll Dock ST class, 170m and 151m respectively, but in other regards, they are very similar. Moveable deck panels are used to create a deck at one of six levels and a temporary bulkhead can also be installed to allow the vessel to be submerged without flooding the cargo hold. The cranes can be used together for a tandem lift of approximately 700 tonnes.The hold has enough space for 1,383 TEU .
With a little shaved off the width, the BMT OMAR barge would fit perfectly on the cargo deck.
The M/V Combi Dock cost €100m to build, these are not hugely expensive.
Interestingly, the later vessels in the Combi Dock series have been purchased and converted for use in the offshore industry
The OIG Giant II, formerly Blue Giant, formerly Combi Dock IV, is just such a conversion. The work included modifications to the cranes (anti heave and lift extension) and adding a helideck, moon pool, accommodation module, additional generators and a Dynamic Positioning system using azipods and thrusters. The 500 tonnes 13mx18m accommodation module is built across seven decks and includes facilities for 86 personnel, including leisure, sleeping, work spaces and water/waste treatment. Something for a Role 3 MTF would need at least triple that in terms of crew space.
A new build contract at the same ‘offshore’ specification for two was reportedly €200m for the pair.
If the UK is going to make use of such a design the mantra must be ‘minimum modification’ but would the heavy lift cranes really be needed, probably not. If there were no FLOFLO or RORO capacity, there might be an argument for retention, but otherwise, there is no real need for them. The only thing they would be used for is lifting the hatch covers in and out of the cargo hold. Using a fixed crane, 3 in the case of the Combi Dock, allows the entire length of the cargo deck to be covered, but it does mean they have to be hefty enough for the weight at a specific outreach.
Having one or two of these massively flexible vessels would provide the ability to embark for training or deployment, a Role 3 MTF module(s) but when not doing this, and this is the key attraction of this approach, they could do something else.
What that ‘something else’ actually is could include all manner of operational and logistic support activities.
At a very basic level, over 1,300 TEU’s could be carried by a vessel like the Combilift. Using 20ft tank container, for example, would mean the ship could transport 24,000 Litres of water, fuel or other liquids (regulation permitting)
At 4m width, there is 528 Lane Metres, with vehicles using a shore-based loading ramp or lifted in and out. This would be across two decks using the standard hatch covers only, each deck being just over 4m high. There would also be space on the hatch covers if it were permissible to carry vehicles exposed to the elements.
The USMC used the MV Combi Dock III for just such a deployment
As with containers, the vehicles could be easily lifted onto lighters whilst at sea, in reasonable sea states.
Because the vessels are semi-submersible, they can be used to transport small craft and patrol boats, and even submarines. Smaller craft such as patrol boats or MCM unmanned boats could simply be lifted from the deck into the sea. Using the two deck approach, the vessel could comfortably transport 110 Pacific 24 RHIB’s, more than we have in service. Larger vessels could also be transported, right up to an MCM or even Type 31 Frigate.
More complex large modules could perhaps be developed. An MCM command module, for example, could include UUV/USV storage, aviation, command and workshop spaces all within a single structure. For repair, maintenance and salvage, a module could be arranged to include heavy, electrical and composite workshops, electronic workshops, stores, personnel accommodation, helicopter landing facilities, stores lifts, power generations, compressors, extensive diver support.
Would it need a higher speed, thrusters or positioning equipment to negate the need for tug support, potable water or oxygen generation, how would medical gasses be managed and would vibration damping be sufficient for complex diagnostic equipment, how would it operate alongside or offshore, what about inshore access, patent transfer, medical resupply and a million other questions would need to be answered.
But the biggest question is that of manning, (and cost, obvs)
One option might be to make this a multinational capability, operate it through the JEF or other NATO/Multilateral structure, take personnel from Norway or Poland or Italy for example. We should certainly not discount any options or discount the difficulty of manning what actually is a very complex and demanding capability that must meet a variety of standards, safety and certification demands.
This is not necessarily about a specific design, but a design approach that decouples the infrequently used medical treatment facility from a vessel that could be used for many other tasks when the medical element is not required.
By taking the large module approach, it can be maintained on land, conduct much training on land (although of course, not all)
It is certainly radical, there are many engineering pitfalls to consider, but the basics or large module and heavy lift vessel are well established, they are in use today.
Could it be adapted to the Role 3 MTF and HADR requirement, who knows, certainly not I
I honestly think there is an enduring demand for an afloat Role 3 Medical Treatment Facility for defence operations and I also think the UK has obligations and desired outcomes in terms of responding to disasters.
Can we combine these in such a way that is not so flawed by compromise that makes the chosen solution useless for either?
There is money, as one look at the ODA and MoD budgets would confirm, is this enough of a priority though, again, a tough question>
My proposal is in three parts, help others to help themselves, maintain a rapid response air deployable capability (together with general medical design, build and operate), and finally, do something floaty.
That floaty element is the main subject of this article and no doubt many options exist, my slightly bonkers suggestion of a multi-thousand-tonne large module attached to a heavy lift vessel tries to address the perennial problem of infrequent use v specialised nature of the requirement.
Does it make any sense, dunno, see you in the comments.
And I managed to get through all that without mentioning soft power