Many in Britain may feel proud that the UK government is giving away £11.2 Bn per year in overseas aid, leading the world in ‘international development’. While growing poverty in the UK leaves increasing numbers dependent on food banks, the armed forces suffer cut after cut and national debt rises by £1Bn per week, for others, this generosity is hard to stomach. There is a case for overseas aid both on a pragmatic and moral level – we should do the right thing and besides, lifting people out of poverty should make us all richer. The adage that “charity begins at home” has lost much of its meaning in the context of the globalised interconnected 21st-century world where what happens in far off nations can have an immediate impact at home. The principle that governments of rich nations should be helping the poorest and the most vulnerable in the world is sound and should not just be left to charities or benevolent billionaires.
What is not in doubt is that UK overseas development has been mismanaged in some areas to the point of lunacy. Not only is much of the money wasted by corruption, absorbed by expensive ‘aid professionals’ or put into schemes with no accountability but we have been giving money to growing economic powerhouses such as India and even China. We are sending cash to relieve grinding poverty in India while their government has the resources to run a space programme and build aircraft carriers.
We don’t necessarily need to cut our overseas aid budget but we certainly should start spending it far more intelligently. Building and operating a hospital ship is a good example of how we could spend this money better.
With apparent climate change bringing more extreme weather, regular earthquakes and tsunamis, it is sad but safe to say that the services of hospital ships will be needed many times in the coming decades. With 95 of the 100 largest cities in the world port cities and the 90% of the world’s population living within 200 miles of the sea, aid and assistance from ships will often be the most appropriate way to deliver large-scale relief.
By diverting a small part of the Department for International Development’s (DFID) very generous budget into the building and running a hospital ship, the MoD would be spared further pressure on its already under-size budget. The taxpayer would be getting a highly visible ambassador for Britain and a force for good in the world. A hospital ship can deliver medical aid direct to those who need it most while avoiding potential corruption and the middle-men that plague so many aid projects.
Ideally, we would have two vessels. One ‘forward-deployed’ mainly around Africa or Asia making scheduled visits to provide a programme of free medical care but ready to respond to natural disasters. The second vessel would be at home either refitting or in reserve but at a few days notice to respond to emergencies. In their secondary roles, the ships would give the armed forces of the UK and its allies the assurance of a dedicated hospital ship able to cope with large numbers combat casualties. They would also provide a useful back up to the NHS in the event of a major incident or disaster in the UK. It is notable that with the closure of Royal Naval Hospital Haslar in 2009, the UK is now the only country in the Western world not to have a dedicated Military hospital.
RFA Argus is the nearest we currently have to a hospital ship. Designated a “Primary Casualty Receiving Ship” (PCRS), she is equipped with a 100-bed hospital. However, she is painted grey and does not conform to the requirements of the Geneva Convention on hospital ships because she carries weapons and embarks operational units. She is also the Navy’s helicopter training vessel, and in wartime, she would be a very useful extra helicopter carrier. Originally converted from a container ship for the Falklands War and then significantly rebuilt, few vessels have provided the taxpayer with better value for money. Argus is due for retirement in 2020 and like so many “gaps” in MoD equipment, there is no plan or funding to replace her. We would advocate her replacement as soon as possible this should be treated a separate issue to the hospital ships which would be white-painted non-combatants with a much larger capacity.
Design & build
To have sufficient capacity to cope with large numbers of casualties or medical cases the ship would need to be fully equipped to a standard similar to a large general NHS hospital with at least 500 medical beds. Procurement of these ships need not be particularly expensive. A new build vessel would provide welcome work for the UK shipyards. However, a merchant ship conversion would probably be more affordable and could be done faster. Ideally, the ship would be able to manage a sustained 25 knots as the speed of response could be important, although most merchant ships can manage a maximum of 18 Knots. A flight deck and large hangar would be required to support several helicopters. There would be ramps and a vehicle deck to allow casualties and stores to be driven on and off when in port. A couple of light landing craft (LCVPs) in davits would also be useful for embarking casualties when port facilities are damaged or unavailable, and the ship has to lie at anchor. If the ship had an RFA crew and was based in Portsmouth or Devonport it would utilise existing training and support infrastructure keeping costs down. The clinical staff would b drawn from across the armed forces and it would provide valuable and diverse experience for medical personnel.
The humanitarian aid mission is often forgotten in political discussions around the size and shape of the navy. We should perhaps consider allocating further DFID funds to support branches of the forces which can and do contribute significantly to humanitarian aid operations. If we purchased additional naval auxiliaries, helicopters and heavy lift transport aircraft we would be better equipped to respond to crises and have more badly needed assets without increasing the defence budget. Indeed there are already signs the government is thinking this way. With public opinion increasingly hardening against involvement in armed interventions, it is likely that humanitarian missions will occupy a growing proportion of our forces work. A British hospital ship is an ‘everyone wins scenario’ and would be a popular first step to reshaping the aid budget and would avoid the howls of criticism that aid money is being diverted to weapons spending.