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in iq6 R°Val Navy’s experience in the Falklands Conflict l9g? the Iraqi attack upon the USS Stark (FFG-31) in fjjjj, ’ and the strike on the Iranian passenger jet by the tiire *‘ncennes (CG-49) this year exemplify the harsh na- 'nci(j0^ contemPorary missile-based naval warfare. Such safetCnts a*so demonstrate the urgent need to consider the effectiveness, and survivability of unarmed ships Ens'Cated exclusively to the care of the combat wounded. tect rI.'n§ that medical transports are respected and pro- idg^ beyond the visual range of their protective, identify- t^^klems recognized by the Geneva Convention entails ernizing identification procedures and the operational ^a§ement of hospital ships.
cr0s;b>P painted entirely in white and bearing large red-
symbols implies that the ship’s sponsor ascribes to
>n a, n international humanitarian conventions. Inherent Hie
j.r‘nciples of the Second Geneva Conven- l0n> protected operational zones, and neu- . al observers are some insurance against °spital ships, like the Comfort, falling cbni to errant fire in the fog of war.
‘her voices suggest close-in defenses, vj!ch may, in themselves, endanger the ships of mercy.
The modern naval warfare environment is growing increasingly unpredictable and dangerous. Unbri- Co hied offensive capabilities now threaten non- d batants that stray within range of satellite and sonar k lu'1'011 and long-range remote-controlled rocket-pro- |j h missiles and homing torpedoes. Even nonbel- rent hospital ships committed to caring for the sick and Dri ■, ec* during military contingencies no longer enjoy a ^*ieged immunity.
• *ne Rnvd \To„.,v 1982
Certain
surj Cse conventions are specified responsibilities for as-
part; *tae Protection of neutrality agreed to by the warring l,£s.
^t[^Utra^ty and Modern Naval Warfare: The Second Hen; V,a Convention stipulates the following parameters of % concerning the immunity of hospital ships in a tnark.§ °f armed conflict: notification, identification and i /y lngs, and operational and functional protections.
of Hospital Ships: According to Article 22 flicte, ^econd Geneva Convention, the parties to the con- tal J.a" be notified no later than ten days before a hospi- app^'P is employed, and the ship’s characteristics must theSLF jn the notification. Those characteristics include Herr) 'P s registered gross tonnage, its length from stem to In .ani? tfle number of its masts and funnels. lreat a<Jtlil'on to ships primarily constructed as medical tpedj e,nt Platforms, other craft may also be employed in tyed S suPP°rt of combat operations. Previously dedi- i"i(] c Passenger vessels, for example, may be chartered forj btlVerted for hospital duties. Others may be engaged ()r tin ra'lbeater or strategic sealift of stabilized casualties like|vn!|P0rt °f medical equipment and supplies. (It is un- at Navy’s two hospital ships, the Mercy
'19) and the Comfort [T-AH-20], alone would be
sufficient to satisfy all of the needs of our combined forces in a protracted engagement.)
Because of the diversity of craft that may be used in medical support operations, it may be a good precaution to adopt voluntarily notification criteria beyond those defined in Article 22, and to extend them to all medically related craft, including hospital ships. Such additional criteria may be found within Article 23 of the First Geneva Diplomatic Protocol of 1977, designed to ensure free passage of ships dedicated to portage of medically related materials. It is specified that each party to the conflict should notify the adverse party, in advance of the sailing, of the expected time of sailing, course and estimated speed of the ship, and any other information that would facilitate identification and recognition. The adversarial party is then required to acknowledge receipt of such information. Generally, although not specified within the Geneva Protocol, such information might include: a detailed description of the ship; photographs and silhouettes; a list of radiocommunications, such as the number of radio receivers and transmitters on board, the ship’s frequencies, call signs, permanently guarded frequencies, and frequencies used for radiocommunications with the hospital ship’s helicopters; a description of the ship’s radar systems, including the mode and code of identification; a description of the medical helicopter’s air surveillance radar, including the radar’s characteristics and the mode and code of identification; a description of any underwater acoustic devices (for example, an ultrasonic echo sounder); and descriptions of medical helicopters on board.
If the ship has been converted into a hospital ship, the information might also include: a description of the ship’s previous use; a description of any major modifications (for example, construction of a helipad); the hold capacity not converted for hospital use; and the nature and tonnage of stores destined for the ship’s time at sea and for flights of medical helicopters (including spare parts and other items). From a military perspective, at first glance, it would appear undesirable to transfer much of this data to an adversary. However, if such information is withheld, one can only conjecture whether the ship’s safety would be augmented or degraded if an adversary, armed with long-range, remote-controlled weapons, were unable to make proper identification of a “protected,” neutral hospital ship because of incomplete or inadequate data.
Other Navy platforms, such as carriers and amphibious ships, may also be equipped and manned to provide surgical care to the combat wounded. These functions, however, are subordinated to their primary mission, which is to further the success of combat activity. Such units do not bear the same identity of nonbelligerency ascribed to the traditional hospital ship. In terms of international law, they do not enjoy the status of neutrality defined by international agreement.
► Identification and Markings: The Geneva Diplomatic Conference of 1977 concluded that medical evacuation craft urgently need both visual and electronic means of identification to avoid their engagement by combatant forces. By international agreement, hospital ships are visually identifiable by their white paint and large, dark red
The hospital ship has a long, distinguished record in combat casualty care, supporting maritime, continental, and amphibious operations. Historians believe that the Athenian ship Therapia and the Roman ship Aesculapius may have served functions akin to those performed by today’s hospital ships centuries ago. By the early 1600s, however, it was customary for special ships to accompany naval squadrons and take the wounded on board after engagements. In the latter 1800s, the practice developed in earnest. During the Crimean War from 1853 to 1856, more than 100,000 sick and wounded were repatriated to England on board hospital transports. From then on, no major military expedition was ever undertaken without including the necessary ships to evacuate soldiers from the combat area and to render them necessary medical treatment.
During World War I, hospital ships were used more frequently, despite serious disputes and grave incidents between the belligerents. In most instances, passenger liners were converted for use as medical transports.
During World War II, specially designed hospital ships
Ships of Mercy
were built (for example, the Haven [AH-12] class), greatly improving the accommodations for patient care. In the Pacific theater, because bases and hospitals were few and far between, U. S. forces activated many ships to provide complete medical and surgical treatment afloat. Twelve hospital ships and three hospital transports supported U. S. combat operations. During the Okinawa invasion alone, six hospital ships evacuated the mounting shipboard casualties to hospitals on Guam. In following years, the United States used two to four ships during the Korean Conflict, and reactivated and deployed the USS Repose (AH-16) and the Sanctuary (AH-17) in support of U. S. military operations during the Vietnam War. Recently, the Navy added two new 1,000-bed hospital ships, the Mercy (T-AH-19) and the Comfort (T-AH-20), equipped to provide sophisticated state-of-the-art surgical support, to the fleet.
Respect and Protection: In the international sphere, laws of war, whether formulated in the Hague, Geneva, or elsewhere, are products of a realistic compromise between humanitarian
rockets) without adequate jnstl cation for doing so. More incriminating, the Ophelia had also thrown documents
pital ship Ophelia of carrying
signaling equipment (lamps an
' “til*
considerations on the one hand and the demands of military necessity on the other. Rules contained within the Law of the Hague (derived from the Hague Conventions of 1899, revised later in 1907) not only defined the rights and duties of belliger' ents in the conduct of military operations, but also outlined limitations on the means for in' flicting damage upon the enem)- The rules included an implied immunity for hospital ships, Pr° viding them with an identity aS neutral vessels within the theat of conflict. In return for this immunity, hospital ships were obligated to refrain from parhcl pating in the armed conflict- While most “neutrals” observed this obligation, there were exceptions. For example during the Russo-Japanese ^af of 1904-5, a Japanese prize court condemned the Russian hospital ship Orel for having transported able-bodied prisone of war and military equipment. Then in World War I, a British court convicted the German n
crosses (painted on each side of the hull, on the superstructure, both fore and aft, and on the horizontal surfaces), along with a white flag bearing a red cross flown high on the mainmast. During times of reduced visibility, and at night, their distinctive emblems can be illuminated. (These provisions similarly apply to their lifeboats.)
The Falklands Conflict tested the precepts regarding visual identification of the Second Geneva Convention of 1949 for the first time. The traditional marking methods of hospital ships, however, proved insufficient in the modern maritime warfare environment and in the particularly difficult climate characteristic of the South Atlantic in May and June. Even if the ships were completely illuminated, the red crosses were not very visible at night. By day, especially in poor weather, they were also difficult to identify.
Even under normal conditions, it is very difficult to
away. Only very large red crosses remain identifiable^
identify red crosses three meters high from two
distance, when the distinctive features of a ship afe longer clearly discernible. As the distance increases, ship becomes little more than a silhouette on whieb contrasting colors rapidly fade from view. As a result, protective red cross sign, even if it is very large, lS longer visible. ^
Additional dimensions of limited visibility further c
t • . mi XT .1 . ' I
pound appropriate identification. The Netherlands j
Force performed tests in 1936, which showed that a
cross three meters in each direction is not visible fr0111
altitude greater than 1,500 meters. It also determined j
a white square should be 50 meters long on each side
the cross upon it must likewise be 50 meters in
leng1
tli.
with arms almost 10 meters broad, to be visible fr01^ altitude of 4,000 meters. Since there is not enough L
pital ships were also attacked, and in some cases sunk. Most of these attacks apparently resulted from inadequate marking methods, making the hospital ships’ identifying symbols indistinguishable at great distances.
Subsequently, the Law of Geneva (defined by Conventions in 1929, and revised in 1949) evolved, incorporating the humanitarian principles first provided for in the Hague Conventions. These agreements brought international concerns to bear on issues, such as assured respect
W0r,Td/or torpedo attacks. In ^ar II, a number of hos
Doarfi
eod;u.and sent a message in Just before being boarded.
°the°me ^e*^8erents> on the fc0r ^ar|d, attacked and sank | T**al ships during World War h0sne offender alleged that the andta' ships transported troops nati Munitions. (The attacking C acknowledged that it was to [n6 to avah itself of the right sjncsPect these hospital ships, if, e lt mainly fought with sub- hos'nes ) The British lost 15 hits !Ul! ships, largely from mine
During the Vietnam War, the USS Repose (AH-16) sheltered and treated casualties in potentially dangerous waters, and survived. Many of her predecessors were not so blessed.
and protection of hospital ship neutrality. The Second Convention, “The Geneva Convention for the Amelioration of the Condition of the Wounded, Sick, and Shipwrecked Members of the Armed Forces at Sea,” among the four Geneva Conventions of 12 August 1949, addressed these issues directly.
A total of 161 nations are party to the Geneva treaties, making them, together with the United Nations Charter, the most widely ratified international agreements dealing with human rights. The four Conventions of 1949 entered into force in 1950 and have been ratified by the United States. (The Geneva Diplomatic Conference of 1977 added two Protocols to the 1949 Conventions, applicable to international armed conflicts. The United States is not a party to the Protocols.) These many agreements contain defined parameters for respecting and protecting the immunity of hospital ships in armed conflict settings.
—Captain Arthur M. Smith, U. S. Naval Reserve
"tent "as merit, because red paint mixed with black pig- can "
'-dark
Pau ,Can facilitate infrared detection, which requires a £da* contrast.
*0 i
aircre available to paint such large horizontal red crosses, hoSDa 1 flying at high altitudes will not be able to identify ln' a* sAips visually.
ni§ht§eneral’ l^e fl°sP'tai SA'P saAs w't*1 aA l*ghts on at
and ’ and A16 illumination of the red crosses on the hull ship ^structure tends to merge with the lights of the lied' lnce fl*e illuminated red crosses can only be identi- fiill sflort distance, the sight of a ship running under for s- ,s *n a combat zone may be the only visual means Co^H'.fying that it is a ship protected by the Geneva
shincC,nfl°ns. Painting “dark” red crosses on hospital
nar
ficatj ° ^Set ihe shortcomings associated with visual identi- Mentif. ’ d/st'nctlve radio, radar, and underwater acoustic 'cation mechanisms, as well as distinctive lighting,
may be effective means to protect medical transports. Radio signals on frequencies reserved exclusively for medical transports are critical requirements in any combat setting. These will permit the hospital ships and other craft protected by the Geneva Conventions to identify themselves by radio, and establish communications.
The Geneva Diplomatic Conference of 1977 recommended that the adversaries, through their intermediaries, arrange—whenever conveniently practicable—that hospital ships shall frequently and regularly broadcast particulars of their position, route, and speed when operating in a combat area. Such radio transmissions enable warships to identify, locate, and monitor a hospital ship’s movements. The signal can likewise be monitored by coastal radio stations, either military or civilian. The hospital ship can also communicate its position to aircraft overflying the area, and to submarines. This knowledge should prevent com-
harmful to the enemy, can deprive a hospital ship P tection. th
During the Falklands Conflict, six hospital ships oi
In the “Red Cross Box” during the Falklands Conflict, Great Britain and Argentina met peaceably to exchange their wounded. Here, an Argentine Puma helo rests on board the Royal Navy hospital ship Uganda. Below decks, British medical personnel treat those wounded in action.
batants from inadvertently attacking the protected ship. By international agreement, the frequencies prescribed for transmission of the radio signal are: 500 KHz, the international distress and calling frequency for radiotelegraphy; 2182 KHz, the international distress and calling frequency for radiotelephony; and 156.8 MHz, the international distress, safety, and calling frequency for the maritime mobile radiotelephone service (a link between ships and aircraft).
Article 34 of the Second Geneva Convention stipulates that “hospital ships may not possess or use a secret code for their wireless or other means of communication.” (Presumably, the belligerents must be able to ensure that no secret information regarding military operations will be divulged by the hospital ship’s crew, as the protected ship moves about freely because of its duties and under its immunity.) The use of secret codes, considered an act
warring parties exchanged radio communications °n ^ 2182 KHz frequency in the clear. It was not possible^, them to communicate directly with the warships, s'nceoSi- communication in clear could reveal the warship’s P tion to the adversary. m
To maintain long-distance contact with their bases, three British survey vessels functioning as “ambi11 ships,” and the hospital ship Uganda, a converted paS‘ \ ger ship, used radio telex via the InMarSat (Internat^,^ Maritime Satellite) system. Telex messages were like . s exchanged in the clear, which meant that the hospital s^ could not be informed in detail about the medical eV‘lgrjt' tions in which they were required to participate. The ^ ,(S ish Naval Command, from which the Uganda receive orders, could not use coded radio communications t° form the ship directly, and thus rapidly, about the m11 situation and dangers in the area where it was opera Neither could it safely broadcast information abou ^ numbers of casualties to be evacuated, the wounds tained, or emergency cases, etc. (This obviously Pre ^ a hospital ship from being prepared to receive them-C]] Perhaps modern radio communication technology j jts ultimately enable a fleet, in cases of emergency, to ca
jt'Vn hospital ships by radio without the risk of disclosing to P°sition. At present, it is apparently easier for warships communicate with their hospital ships by way of their to K ^ases on shore. Messages for the hospital ships have 1^ e deciphered on shore and retransmitted in the clear.
ls can result in considerable delay, since combat com- cnications have priority. If there is no satellite link, Hmunications with the hospital ships can also be inter- Pted by problems inherent in radio electric wave propa- '°n >n a combat environment.
0 be identifiable by radar, a ship must be fitted with a
radar
civili;
tran:
transponder similar to those installed on board all an and military aircraft today. Radar transponders are
rSceivers that pick up the signals from surveillance tj. ars and reply automatically, giving aircraft identifica- 4lsatl(l flight data prerecorded on the transponder. This is c0 known as secondary surveillance radar (SSR), bed Se interrogation by a primary surveillance radar pro- jles a reply from the transponder, cod a^ar identification requires using a specific mode and The SSR mode indicates the specific pulse spacing to , 'nterrogating signal. The code is a number assigned
Th,
rePly signal received from the transponder.
stalled high atop the masts.) Constructing standardized hospital ship transponders, however, would enable all ships and craft protected by the Geneva Conventions to also be identifiable by radar in hostile areas.
In the event of subsurface warfare, submerged submarines must be able to identify the sounds as consistent with those of a hospital ship. Protected ships, therefore, need transponder devices, such as those that transmit the ship’s call sign underwater in Morse code. Today, while submarines are fitted with increasingly sophisticated acoustic systems, underwater acoustic identification signaling remains, unfortunately for hospital ships, rudimentary.
Considering how difficult it is to see the red cross emblem at great distances, hospital ships must also have a distinctive light signal, such as the established flashing blue light. Tests made in the South Atlantic in 1982 with hospital ships bearing fixed blue lights, similar to those used on police cars, found that such lights were identifiable at night to the naked eye at a distance of three miles. With binoculars, they were identifiable at a distance of seven miles. (The ideal would be to have a flashing blue light identifiable by day and night at a distance of ten miles.) For maximum effectiveness, the blue flashing light (with a frequency ranging between 60 and 100 flashes per minute) should be placed at the top of the ship's mast or superstructure, so as not to interfere with navigation, but so it would still be visible from every side.
The Geneva Diplomatic Conference of 1977 also suggested that, in addition to the flashing blue light and the distinctive emblem, other means of visual identification, such as signal flags and combinations of flares (for example: white, red, white) should be used to identify medical transports.
► Operational Protections: A Neutral Zone on the High Seas—Article 30 of the Second Geneva Convention stipulates that hospital ships must in no way hamper the movements of the combatants or enter the line of fire during an engagement. Any deliberate breach constitutes an act harmful to the enemy, and the offending hospital ship would then lose its right to protection under the Convention. A hospital ship would also, obviously, lose its immunity under the Convention if it is being escorted by warships, except when the escort vessels are minesweepers, deployed in order to ensure its safe passage.
During the Falklands Conflict, at Britain’s suggestion and without any special agreement in writing, the parties to the conflict established a neutral zone at sea. This zone, bearing the name of the “Red Cross Box,” had a diameter of approximately 20 nautical miles and was located on the high seas to the north of the islands. Without hampering military operations, the zone enabled hospital ships to hold position, and exchange British and Argentine wounded. Inside the Red Cross Box, and between hospital ships in general, radio communications were an important factor in maintaining efficient operations. From this zone, the belligerents successfully conducted helicopter transfers, and the British hospital ship Uganda transferred patients to its three “ambulance ships” (converted survey ships) for evacuation to Great Britain by way of a 420- mile transit to a neutral MedEvac (medical evacuation)
e 1977 Geneva Diplomatic Conference indicated that
in
^diatdy be informed of the SSR modes and code Coa°*e t0 metbcal aircraft in the air traffic control area r;t|Cerned for the duration of the conflict. The selected d, r c°de would thus be withdrawn from general use in by Conflict area for a limited time, and used exclusively be belligerents. The conference further resolved that
the
event of armed conflict, the states involved would
tr°nicS t0 con^*ct may establish a similar SSR elec- craf( Astern for the identification of medical ships and
s are already equipped with such transponders, twCan Ihus identify each other at considerable distances 9 the visual horizon. (Transponder aerials are in-
Vdi
Hospital Ships: The Right of Limited Self Defense
By Lieutenant Commander Steven L. Oreck, Medical Corps, U. S. Naval Reserve
The Setting: After the death of the Ayatollah Ruhollah Khomeini, Iraqi forces shattered the cease-fire then in effect by launching a massive offensive that was stopped only when Iran’s religious leadership invited the Tudeh (communist) party into a coalition government and proclaimed the “People’s Islamic Republic of Iran.” Backed by Soviet equipment and advisors, the new coalition stopped the Iraqi offensive.
Faced with an Iran fully backed by the Soviet Union, Iraq quickly negotiated an end to the war, with return to near-prewar boundaries, with partial demilitarization of the Shatt-al-Arab waterway.
The mullahs and the communists maintained their coalition like two scorpions in a bottle, each warily watching the other. Both factions were united in their desire to spread the “revolution,” contempt for Western democracies, and hatred for the “great Satan,” the United States. It was in this new Persian Gulf environment that “revolutionary” activity in western Gulf states and sheikhdoms began to increase, supported by a rearmed Iran, aided and comforted by Libya.
Following a bomb explosion at a minister’s meeting that coincided with a major guerrilla assault, revolutionaries overthrew one regional government. Things then proceeded from bad to worse. Subversives from the new base, supported by Iranian and Libyan “volunteers,” ignited a crisis, and pro-Western governments responded quickly, inviting in the forces of the U. S. Central Command.
To provide medical support for these forces, the United States dispatched the USNS Mercy (T-AH-19) to the area via Diego Garcia in the Indian Ocean. With a 1,000-bed capacity, and almost 1,200 medical and medical support personnel on board, the Mercy could provide high-level care on the scene and badly needed relief to the overstrained air evacuation system.1 After loading some final supplies and medical personnel—including selected reservists—who had been airlifted to Diego Garcia, the Mercy left for the Persian Gulf.
Scenario I:
The Mercy left Diego Garcia in convoy with ships of the maritime prepositioning force and fleet replenishment ships, escorted by the USS Ticonderoga (GG-47) Aegis cruiser and two Oliver Hazard Perry (FFG-7)- class frigates. Once the convoy approached the war zone, aircraft from the USS Theodore Roosevelt (CVN-71) and the USS John F. Kennedy (C’V-67) would provide additional pr°teC tion. Maritime traffic along t^e convoy route was heavy, with shipping leaving the war zone and the usual numbers of sma‘ coasters and dhows.
At dawn, not far from the
southern coast of Iran, “unidef
tified” missile boats and heh-
The
copters attacked the convoy- 1 missile boats achieved some sur prise by mingling with local coastal traffic. The helicopters flew in low below radar coverage and popped up to acquire and locate targets on their radaf at relatively close range. .,
Missile alarms sounded on ' convoy ships, which immediately went to general quarters- The layered defense of the escort, with surface-to-air miss1 (SAMs) and Phalanx close-in weapon systems (CIWSs), t0°j out many missiles. Infrared an electronic countermeasures (ECMs), including chaff and flare decoys, distracted the m's siles’ homing devices. One m sile struck a fast stores ship- ^ which suffered moderate dam11-- and kept steaming, but no 'vaf ship was hit. Another ship- h° ever, had no defense—no
events that occurred during World War I, when the erents accused each other of making improper use o
staging point in Montevideo, Uruguay.
► Functional Protections: Article 31 of the Second Geneva Convention stipulates that the parties to the conflict have a right to control and search hospital medical ships and rescue craft. They can obligate such craft to pursue a certain course, control their telecommunications and other means of communications, and even detain them for a specified period, if the gravity of the circumstances so requires. The belligerents may put a representative on board temporarily, whose sole task is to see that the orders given in accordance with these provisions are carried out. The inspectors may make a thorough search of the hospital
ship, examine its equipment and supplies, verify patients, assess the situation of the wounded on board- check the identities of crew members. ( ,^e(
As an alternative, the parties to the conflict may ‘ el,,ir unilaterally or by particular agreements, put on board t ships neutral observers, who shall verify the strict o ^ vance of the provisions contained in the present Con tion.” This provision was inserted because of the sefj^,
' ,f h°s' pital ships, and in response, sank them.
At the request of the British and Argentinians.
dud11-
c°mbat, the battle below decks
the^6 **ves may be *ost early if
self-
Pwss sheep among the wolves.
- ’ maj uc IU31
hospital ship, lacking any ■defense measures, remains a
nQ . S, no ECM, no chaff, and tQ 'hfrared flare decoys—and [hree missile hits. This ship t the Mercy.
C(. ecause of her large, stout pr^!ructi°n, a legacy of her tlj i!?Us ro*e as a supertanker,
s,hii
ercy did not sink. De-
f,rCtl0n was widespread and
fC(l ln the medical spaces were paby ruptured oxygen lines. 0n|Su^ties Were relatively light,
So ^ *0-15% of embarked per- ttlone*> but that still amounted to Port2 ^an medical and sup- w Personnel killed or funded
TL
Dje6 Mercy limped back to 8° Garcia. Her fire-black-
eied
white hull made a dramatic
P|qc
re$re for Gulf press pool cor-
P^udents, whose TV coverage c Wounded had tremendous ‘°nal impact on the six (5bi°c^ news—fueling the inevi-
em.
e clamor of those who had latently opposed U. S. in-
*;,*k lands
volvement in the region.
From a military standpoint, the loss of the Mercy as a functional unit was a major setback. Her sister ship, the Comfort (T-AH-20), was weeks steaming away. Some of the doctors who were casualties were in shortage specialties, and replacing them would mean stripping some naval medical centers of all coverage in these specialties or calling up more reservists (if available) or both. In the meantime, morbidity and mortality among wounded U. S. forces increased, because of inadequate medical facilities, and morale suffered.
Scenario II:
The Mercy sailed from Diego Garcia along a predetermined track that had been publicly announced. She sailed alone and was brightly illuminated at night. Her protected status under the Geneva Convention was restated, and as a further measure, members of the Swedish Red Cross inspected her in Diego Garcia and gave her a clean “bill of health.” While under way, she received updates concerning potential threats from P-3 Orion aircraft based at Diego Garcia and from the carrier task force.
All went well until she neared the war zone, where her limited surface search radar picked up three suspicious contacts closing at high speed. The Mercy sounded general quarters, commenced evasive maneuvers, and
sent out a call for help. The carrier rapidly rearmed four F/A-18 Hornets for antisurface strikes, but before the aircraft could reach the area, the attackers launched 12 surface-to-surface missiles at maximum ranges on radar bearings, relying on terminal guidance. In spite of the limitations of this type of launch, the attackers scored six hits, as the Mercy had no active or passive defensive systems.
The F/A-18s passed over this flaming datum and sank two of three enemy boats, heavily damaging the third.
Revenge was not sweet, as the Mercy sank within four hours of the attack with more than two-thirds of her company injured or killed. The remaining one-third would be less than effective for some time, recovering emotionally and physically from the sinking. News coverage of the survivors’ return evoked memories of World War II newsreel footage of convoy survivors. Iranian radio denounced the Mercy as a “germ warfare ship in disguise,” which Iran had attacked in “selfdefense.”
Because of the high personnel losses, medical personnel shortages, especially in already undermanned specialties, became critical. Adequate medical assets to cover U. S. Central Command Forces and still provide minimum levels of care for other Navy and Marine Corps commitments (including dependent care) could only be obtained by Strip-
Conflict, the International Committee of the
*^ed - >--------------------- - - -
of b v'r°Ss dispatched an expert to visit the hospital ships
Ch Parties in order to verify that the installations con- ec* to the requirements of the Second Convention.
With0rile might argue that unresolved paradoxes exist ^ !n *he broad issue of hospital ship neutrality. For ex- Pou ^hen implementing the proposals previously pro
'll
tided
advanced adversary might merely use such raw signal information to guide a homing missile on target, without ever appreciating its origin from within a neutral vessel. The concept of “prior notification,” however, is specifically dedicated to augmenting advanced electronic identification. Its purpose is to reliably reveal the position and movements of a “protected” ship to all belligerents and allow its constant surveillance. Such electronic identification should also eliminate questions of abuse of the “protected” status by all parties, which led to many hospital ship attacks in previous wars.
It might be suggested that hospital ships should now be
critics might observe that it takes less technolog- tu
to identify the message carried on the signal. From
th4tl ^Pbistication to detect a radar or transponder signal ley might then suggest that a less technologically
*h,
ping naval medical centers and a large-scale immediate recall of reserve doctors, dentists, nurses, and corpsmen to active duty.
The domestic political repercussions of this were enormous.
Scenario III:
The Mercy sailed from Diego Garcia on a pre-announced track, as appropriate for a hospital ship protected by the Geneva Convention. Crew members passed the time on deck watching the dhows and coasters that traveled the Indian Ocean.
Nobody took much notice of an old coaster that was on a near-intercept course with the Mercy. It was flying the flag of an East African country, but the Arabic script on the bow read “A/ Jihad," or “holy war.” When the coaster was about 1,000 yards abeam of the Mercy, a bright flash exploded across the hospital ship’s bow. Simultaneously, the coaster sent a ship-to-ship radio message, demanding that the Mercy stop or be fired upon. Observers on watch identified two launchers for wire-guided antitank missiles on the deck, manned and loaded.
The Mercy stopped and sent an SOS. But by the time aircraft from the nearest carrier arrived, the coaster was alongside, and the terrorists from the coaster had boarded the Mercy and held a group of white-clad hostages at gunpoint on the helicopter deck.
Shortly after, the terrorists requested and received air and naval cover from Iran, which loudly proclaimed its solidarity with the “revolutionaries.” The terrorists then sailed the Mercy to the nearest Iranian port, where they disembarked and dispersed her crew to complicate any rescue attempt by the West. The Mercy, like the U. S. embassy in Teheran, was turned into an exhibit, in this case purporting to show U. S. “germ warfare” plans. In the meantime, the “revolutionaries” were demanding complete U. S. withdrawal from the Persian Gulf in return for the hostages, dropping dark hints about a trial and possible executions.
The political and military/ medical ramifications of the catastrophe were great. The loss of 100% of the medical and paramedical personnel on board was a crippling blow to the entire military medical system. Political commentators and journalists had a field day interviewing family members of hostages, discussing how once again the United States had become a “helpless giant.”
Responses: The Geneva Convention for the treatment of sick and wounded specifically allows for the limited right of self defense for medical facilities and personnel.2 It is standard practice for forward-area hospital units to be surrounded by barbed wire fences and to have guards armed with light weapons. De-
S. NAVY (R O' VCnGAfJ
The Geneva Convention grants medical facilities the right of I"11 ited self-defense. Phalanx is one measure that can keep hospital ships from becoming floating l'a bilities in the modern combat environment.
fensive systems, such as ECM- chaff, and Phalanx CIWSs, ar^ the seagoing equivalent of a " fence and military police guar. , Modern naval warfare doctf'^ emphasizes the ability to engaf the enemy at the longest practl cal range. With current weaP"vjS. ons, this means that positive ual identification of targets is sometime thing. The recent e* periences of the USS Stark (FFG-31) and the Vincennes (CG-49) in the Persian Gulf firm the problem of target iden tification in a war zone. Eve11 the most conscientious party would find it difficult if not impossible to ensure that a sile fired at a convoy does
under the Geneva treaties. «
As an alternative, the most effective protections obtainable through faithful adherence to the principl^^ spirit of the Second Geneva Convention. Such meaS ^ include the prior notification between belligerents an^.ca. simultaneous use of all available hospital ship *^entlftjeS tion and marking techniques. In addition, warring Pa j should consider the benefits of predetermined prote ^ operational “total exclusion zones” for such ships- aS the continuous presence of neutral observers, slj5 5s. those from the International Committee of the Red ,^\ Without the benefits of “protected” neutrality, h°sP
equipped, for defensive purposes, with electronic countermeasures, such as decoys and chaff, to deter errant missiles that might “home in” on them. The transport Atlantic Conveyor was sunk in the Falklands in part because she did not possess electronic countermeasures. The Exocet missile “homed in” onto an adjacent aircraft carrier that dispersed chaff, prompting the missile to “home in” on the next available target, the Atlantic Conveyor. Such electronic countermeasures, however, combined with the seemingly desirable capacity to encrypt or decipher coded messages, could well serve to threaten the neutrality status that “protected” hospital ships have heretofore enjoyed
r 19**
carrying Allied prisoners
s *ar was sunk by the USS
(SS-192), which “didn’t
-preannounced
s don’t guarantee immunity, eory, an internationally ap- foeVed identification-friend-or- sh' signal for hospital
Sj^s could be developed, but thjCe Potential for abuse of
SqS ttethod of identification is Unifat, its implementation is ^o‘ ely. For example, no pilot an(jU d trust this signal to close ^ §et visual identification „ en he suspected that the hospital- ' ' •
In
mj coming from a guided- a Sl e destroyer down.
*gn<
/ a hospital ship mingled like a ^ eeP among the wolves. Even a sPital ship sailing alone would ^. subject to attack from beyond . Ua. range. and as our experi- ^Ce in World War II proved— p,en Japanese escort carrier
ofUy° '
fl the word”
hack;
thei
realitysignal was in
,hQot ’ destr°yer wa‘ting to
sk(|n any case, experience has c0un. that communist-bloc /'tries and “revolutionaries” aid re the rules. The battalion $tr0S*ation in Beirut was dein |/ed in the truck bomb attack C(w °^« and in Vietnam, a ct> who wore the red Cois r required by the proto- ven..0^ the 1949 Geneva Con- be1(el0ni °nly made himself a T)^ r and more valuable target. h0 ^fortunate reality is that Co™31 ships can expect to c0nfl. Under attack in any future that t'h and it is highly likely ate r fSe attacks will be deliber- ather than accidental.
The solution, then, is to give these ships the limited selfdefense measures to which they are entitled. Equipping the hospital ships Mercy and Comfort with ECM, chaff, and infrared decoy dispensers and one or two Phalanx CIWSs would not present any particular engineering problem. The added weight would not be a factor, and the space is there, although some cube may need to be taken from medical spaces. In addition, given the highly automated nature of these systems, the numbers of personnel needed to man and maintain them would not be large and could easily be accommodated. At present, no defensive systems are scheduled to be installed on board the Mercy and the Comfort ,3
In the type of conflict where hospital ships would be used in the future, it is questionable whether any seas anywhere will be truly “safe,” but in order to be useful and fulfill their function, hospital ships will necessarily have to sail in waters that are not safe. If U. S. hospital ships can only function in a “no-threat” environment, or will need continuous close escort by warships (which may be needed elsewhere) in order to get to and maintain station, then they are not only useless, but they have become floating liabilities. A hospital ship is not, and should not be, a warship—but it is better to have an 800- or 900-bed hospital ship with defensive systems that can survive where she is needed, rather than a 1,000-bed ship that one dare not use, or if used becomes a flaming datum.
Prompt intensive medical care can save lives, prevent permanent disability, and enhance the rapid return to duty of injured service men and women. In peace and in war, this is the goal of the Navy Medical Department. The Mercy and the Comfort can become important tools in achieving these goals, but only if they, and the men and women who serve in them, remain protected. Exercising the right of limited self-defense will help ensure this.
'"Hospital Ships Are Back,” U. S. Na\y Medicine, January-February 1985, p 14. "Geneva Convention Protocols, 1949.
:U. S. Navy Medicine, op. cit; response to a question asked during the “Hospital Ship Program Update" seminar, presented at the 93rd Annual Meeting of Association of Military Surgeons of the United States in November 1986, at San Antonio, Texas.
Commander Oreck is currently the executive officer of Naval Reserve FH#20 PRIMUS DET P2402. Previously, he served with Fleet Hospital, in U. S. Marine Corps support, and in clinic units. As a civilian, Dr. Oreck is an or- thopedic/hand surgeon, with exclusive practice in hand and microsurgery. Upon graduation from the Massachusetts Institute of Technology (MIT) in 1970. he was commissioned and served as an antisubmarine warfare intelligence photo officer in VP-8. He attended graduate school at MIT and served in VP-92, Naval Air Station South Weymouth, Massachusetts. Commander Oreck then graduated from Louisiana State University School of Medicine and transferred to the Medical Corps.
States is not a signatory).
O^Smtth
ships _
\y jay be forced, for purposes of protection, to give This i° tde'r only other option—geographic dispersion. theiratter option may well prove counterproductive to Serj0J^lncipal mission. As such, Navy planners should Princ-s y consider recommendations for implementing the 'Ven ^.eS contamed within the Geneva Conventions, as bt)iteas/he diplomatic Protocols of 1977 (to which the professor of surgery (urology) at the Medical College of Augusta, Georgia, where he is also a medical school liaison officer for the Navy Recruiting Command. He received his medical degree from the University of Maryland School of Medicine, Baltimore, and was an intern and resident in surgery at the New York Hospital- Comell Medical Center. After a residency in urology at the Columbia- Presbyterian Medical Center in New York City, he was a fellow in urological cancer surgery at Memorial-Sloan Kettering Cancer Center in New York. Captain Smith entered the Navy in 1965 and served as a surgeon on board the USS Randolph (CVS-15), followed by a tour on the surgical service of the U. S. Naval Hospital, Memphis, Tennessee. He served as commanding officer of Naval Reserve Medical Contingency Response Unit 507 in Charleston, South Carolina, and as senior medical officer on the staff of Naval Reserve Readiness Command Region Seven also in Charleston. He currently is assigned to the Uniformed Services University of the Health Sciences in Bethesda, Maryland, in the departments of Surgery and Military Medicine.