National Hospital Ship and India’s Maritime Security Strategy

In May 2022, a Request for Information (RFI) was issued by the Ministry of Defence (MoD) for the construction of a National Hospital Ship (NHS) for the Indian Navy.1 The RFI has indicated that the navy seeks the construction of a task-specific ship that is capable of providing mobile and comprehensive medical care to patients on the high seas. The acquisition of such a ship for the Indian Navy’s fleet is timely, taking into consideration two important factors. First, the Indian Ocean Region (IOR) is increasingly becoming susceptible to recurrent natural disasters owing to the effects of climate change. Second, India is currently engaged in making efforts for the reorientation of its image from being perceived regionally as a ‘Net Security Provider’ to that of a ‘Preferred Security Partner’.2 Hospital ships play a critical role in supplementing a navy’s combat potential, enhancing its soft power capability and augmenting its ability to be the first responder to humanitarian crises.

Strategic and Tactical Naval Asset 

Major naval powers across the world possess hospital ships in their fleets. The 1949 Geneva Conventions prohibits belligerent parties from attacking vessels that are designated as hospital ships. Article 22 in the Third Chapter of the Second Geneva Conventions 1949 defines military hospital ships as vessels built or equipped by navies solely for the purpose of treating the wounded and transporting them.3

Even though hospital ships are generally unarmed, they have enormous tactical and strategic significance for navies, both during combat and peacetime. The global maritime security environment is imperiled by both traditional and non-traditional threats. Hospital ships act as multi-faceted naval assets that can augment maritime capability. 

Supplement Combat Capability

Supporting combat operations has always been the traditional role of hospital ships of navies the world over. Hospital ships have played a pivotal role in supporting the US Navy’s combat operations since the American Civil War in the 19th century.4 These ships are forward-deployed by navies to provide rapid and flexible medical support to injured combatants and civilians. During the 2003 US Invasion of Iraq, the US Navy forward-deployed its 1,000-bed hospital ship, USNS Comfort, to the Persian Gulf. As the invasion progressed, hundreds of US military personnel received immediate medical treatment on board the USNS Comfort for combat-related injuries. After the combat operations, the ship provided trauma care to some Iraqi civilians injured during the invasion.5

Hospital ships have become an important requirement for navies for conducting combat operations in the distant seas. When the Falklands War broke out in April 1982, the Royal Navy was in dire need of hospital ships for supporting its combat operations over 12,000 kilometres away from the British Coast. For this purpose, three civilian liners, namely Uganda, Canberra and Queen Elizabeth,were requisitioned and retrofitted.6 These examples illustrate the fact that hospital ships are an indispensable requirement for blue water navies.

Humanitarian Assistance and Disaster Relief

Over 40 per cent of the world’s population resides within 100 kilometres of the coast. The heavy population density and economic activity in the littoral regions puts tremendous pressure on the coastal ecosystem.7  The effects of climate change have resulted in the growing recurrences of cyclones, droughts, earthquakes, tsunamis, floods and tidal surges. This creates a domino effect on poverty, famine and societal imbalances in the world’s coastal zones. As a result, Humanitarian Assistance and Disaster Relief (HADR) and Non-combatant Evacuation Operations (NEO) have become key maritime security challenges for modern navies.8

Hospital Ships are best suited to undertake large-scale and complex HADR operations in the aftermath of disasters. The US Navy’s hospital ship, USNS Mercy, played an important role in the aftermath of the 2004 Indian Ocean Tsunami. Thousands of Indonesian victims received advanced medical treatment on board the USNS Mercy deployed off the coast of Sumatra. The 2004 Tsunami underscored the importance of naval assets like hospital ships for mounting large-scale HADR operations.

Projecting Soft Power

Joseph S. Nye defined soft power as the ability to obtain preferred outcomes through appeal and attractions.9 To this end, the People’s Liberation Army Navy (PLAN) has extensively utilised its first hospital ship, Dhaishan Dao (also known as Peace Ark), for projecting Chinese soft power across the IOR and beyond. Since 2010, the ship has regularly embarked on voyages to South Asia, Africa, the Caribbean and Latin America. During its port visits to several developing nations, the Peace Ark engages in conducting altruistic and philanthropic activities among the local populace. A notable example of this was during the Peace Ark’s first port visit to Chittagong in 2010, where the crew of the ship saved a local Bangladeshi woman with complications arising from pregnancy. This is an illustration of how these vessels can play an important role in building favourable public opinion at the grassroots level overseas, even during non-crisis times.10  

Similarly, in the post 2004 Tsunami relief operations, the US’s public opinion among the Indonesians increased. In today’s complex geopolitical environment, a state’s foreign policy objective overseas can be better achieved through winning over local populations than delivering ordnance on targets.11 Hospital ships are the most conspicuous naval assets for projecting a state’s soft power overseas.

Importance of a Hospital Ship for the Indian Navy

India has always been a de facto first responder to crises in the IOR owing to its geographical position and military prowess. However, the IOR and its littorals have become far more vulnerable to natural disasters and other calamities than any other maritime region. The 2004 Tsunami underscored the necessity for naval assets like hospital ships to spearhead large-scale HADR operations. Robert Kaplan opines that in the face of receding American naval presence in the region, the US can no longer be the prime deliverer of disaster assistance in the IOR.12 In such a scenario, naval capabilities of India, China, Australia, Japan and South Korea must be augmented to respond to future emergencies.13

India’s October 2015 maritime security document has acknowledged the fact that HADR and NEO have become a mainstay in the security dynamics of the IOR.14 As a result, the most important advantage of possessing a hospital ship is its potential to critically enhance the Indian Navy’s HADR capabilities.

Secondly, naval assets like hospital ships are essential for the Indian Navy considering its efforts to become a multi-dimensional blue water force. India’s maritime security strategy earmarks the IOR in its entirety as the Indian Navy’s primary area of interest.15 In such a scenario, hospital ships are bound to play a pivotal role in supporting the Indian Navy’s combat operations across the IOR.

Finally, given India’s endeavours to strengthen its engagement with its maritime neighbours, the acquisition of the hospital ship becomes all the more significant. The potential of a hospital ship to project India’s soft power across the IOR is in consonance with Prime Minister Narendra Modi’s vision of ‘SAGAR- Security and Growth for All in the Region’. 

Apart from these factors, considering India’s 7,516 kilometre coastline, hospital ships can play a pivotal role in responding to national emergencies. In the past, there have been several instances when hospital ships were deployed to meet domestic contingencies. After the terrorist attack on 11 September 2001, the US Navy deployed USNS Comfort in the New York City harbour and hundreds of victims received treatment onboard. More recently in 2020, USNS Comfort was once again deployed in New York to relieve pressure on the city’s hospitals owing to the Covid-19 pandemic.16

These instances have also underscored the importance of reconfiguring the designs of modern hospital ships. For instance, the massive 1000-bed hospital ships of the US Navy including Mercy and Comfort, were originally oil tankers. The open-bay design and single ventilation system hindered infection control that was necessary for treating Covid-19 patients. As a result of this, the US Navy’s hospital ships were not successful in supporting America’s fight against the pandemic.

Similarly, during the 2004 Tsunami relief, USNS Mercy took five weeks to transit to the crisis location and could not participate in the immediate relief operations. Owing to these factors, US Naval officers have suggested smaller and faster hospital ships similar to China’s Peace Ark for replacing the ageing Mercy and Comfort in the US Naval fleet.17 The schematics and technical parameters that have been specified in the May 2022 RFI have indicated that India seeks to build a purpose-specific hull like that of China’s Peace Ark and induct it within four years after the finalisation of the contract with an Indian Shipyard.

Conclusion

The significance of hospital ships in navies has acquired greater strategic significance owing to changing maritime security dimensions. The threat to the coastal population from natural disasters, pandemics and other man-made calamities has increased substantially. Recent developments in Europe and the Indo-Pacific have also underscored the resurgence of great-power competition and the risk of state-on-state confrontation. In this context, the relevance of hospital ships to modern navies has risen considering their potential as combat enablers, first responders and symbols of the state’s soft power. As an emerging blue water navy, the national hospital ship provides great value addition to India’s maritime capability by serving as the flagship for projecting Indian soft power and as an auxiliary ship for augmenting Indian hard power across the IOR.

Views expressed are of the author and do not necessarily reflect the views of the Manohar Parrrikar IDSA or of the Government of India.

• 1. Krishn Kaushik, “Navy Issues RFI to Get 250-Bed Hospital Ship in the High Seas”, The Indian Express, 24 May 2022.
• 2. “Address by the President of India, Shri Ram Nath Kovind on the Occasion of the Presidential Fleet Review – 2022”, The President of India, 21 February 2022.
• 3. “Geneva Convention for the Amelioration of the Condition of Wounded, Sick and Shipwrecked Members of Armed Forces at Sea of 12 August 1949”, United Nations, p. 68.
• 4. “Records relating to Hospital Ships and USNS Comfort during Operations Desert Shield and Desert Storm”, Naval History and Heritage Command, 18 October 2021.
• 5. “USNS Comfort”, CNN International, 2003.
• 6. Michael S. Baker, Jacob B. Baker and Frederick Burkle, “The Hospital Ship as a Strategic Asset in 21st Century Foreign Policy and Global Health Crisis”, Military Medicine, March 2022, p.4.
• 7. “Percentage of Total Population Living in Coastal Areas”, United Nations, 15 June 2007.
• 8. “Disaster Risk Management”, Indian Ocean Rim Association, 21 June 2022.
• 9. Joseph S. Nye Jr, “Get Smart: Combining Hard and Soft Power”, Foreign Affairs, Vol. 88, No. 4, July–August 2009, pp. 160–63. 
• 10. Christain Le Mière, Maritime Diplomacy in the 21st Century: Drivers and Challenges, Routledge, New York,  2014, p. 6.
• 11. Michael S. Baker, Jacob B. Baker and Frederick Burkle, no. 6.
• 12. Robet D. Kaplan, Monsoon: The Indian Ocean and the Future of American Power, Random House, New York, 2011, p. 278.
• 13. Ibid.
• 14. “Ensuring Secure Seas: Indian Maritime Security Strategy”, Indian Navy, October 2015, p. 43.
• 15. Ibid., p. 33.
• 16. Bill Chappell, “Hospital Ship USNS Comfort Arrives in New York to Ease Coronavirus Pressure”, NPR, 30 March 2020.
• 17. Michael S. Baker, Jacob B. Baker and Frederick Burkle, no. 6.