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The United States Navy is traditionally known for its military might.

It is, by far, the largest and potentially most capable Navy in the world thanks to its

innumerable aircraft carriers, destroyers, and submarines.

But, beyond those, and beyond all the cruisers and patrol boats and other combat ships, there

are two more that lurk in the shadows of the 490 ship fleet—the USNS Mercy and Comfort.

These are America's hospital ships.

Hospital ships are more or less a forgotten relic of a time when wars were far deadlier

and the world was far larger.

During those times, when fighting a war abroad, just like today, one had to consider where

casualties would go, but unlike today, there were no capabilities to quickly fly injured

personnel away from a battlefield.

One had to treat close to the conflict and for that, the most viable option was often

to bring a hospital-ship to the fight.

These ships were once so significant that, when nations came together to write the Geneva

Conventions, defining the rules of war, hospital ships were a significant focus.

They specifically denote these as any that specifically and solely work to assist the

wounded or sick, with the important distinction that they cannot carry any arms or ammunition.

These ships also must be painted white with red crosses to identify themselves, but assuming

these requirements are met, they are officially classed as a hospital ship.

Those with this classification cannot, under the Geneva Conventions, be attacked or fired

upon.

This was all plenty useful at the time the Geneva Conventions were signed, but today,

land-based warfare is increasingly obsolete, and it just doesn't make sense to float

a hospital to a conflict zone when field hospitals are more capable, and medical evacuation is

easy.

That's why only eight nations' navies still include hospital ships.

Most of these are rather small and primarily deployed for humanitarian purposes, but the

US' two hospital ships, meanwhile, are massive.

They're the size of cruise ships and comparable in capability to the largest land-based hospitals.

Each holds 1,000 hospital beds including 80 intensive care beds.

In comparison, the entire state of Maine has 1,061 total and 64 ICU beds.

To have an entire state's worth of medical facilities available anywhere in the world

is an immensely useful strategic power, but not entirely for the purpose of actually treating

US soldiers.

Within the military, the Comfort and Mercy are officially classified as, “flexible

deterrent options.”

That's to say, they're an option for, “show of force.”

In wartime, sending a ship with capacity for a thousand patients sends a message that the

US is willing to accept an immense amount of casualties.

That may or may not be true, but the message is there.

In peacetime, parading a hospital ship around the world for humanitarian missions both fosters

good will for the US military, and also shows countries the capabilities of the US' military

health system.

The effectiveness of these ships as “flexible deterrent options” could be debatable, but

in the military's mind, this is the purpose behind these ships.

They're an option for deterrence or escalation.

That's part of the reason why they've seen so little deployment to combat zones.

That's just not the primary purpose.

Each ship has only seen one deployment primarily treating casualties of war—the Mercy to

Operation Desert Shield and Storm in 1990, and the Comfort to the Iraq War in 2002.

For the rest of their 30 year histories, they have spent their time deployed on humanitarian

missions to disasters or impoverished nations, or in reduced operating status at their home

ports in San Diego and Norfolk.

While during active service the Mercy houses well over 1,000 crew, most of its time is

spent in port, in that reduced operating status.

At such times, the massive ships will house just 70 crew members who will keep it ready

to go at a moment's notice.

By the nature of their service, expediency of deployment is key.

Therefore, they're designed so that they can go from reduced operating status to leaving

San Diego or Norfolk in just five days.

But while they can leave quickly, that doesn't mean they can necessarily get to their destination

quickly.

The Mercy and Comfort are both converted oil tankers that originally launched in 1975 and

1976, respectively.

Oil tankers are not designed for speed, as it's just not necessary, so the ships can

only travel at about 20 miles or 31 kilometers per hour.

Compare that to a Nimitz-class aircraft carrier which, at almost twice the size, can travel

at 35 miles or 56 kilometers per hour.

If there was, say, a disaster in Sri Lanka, it would take five days to get the ship into

full operating status, and then 20 to sail all the way to the Indian Ocean.

By that time, nearly a month after the disaster, the trauma phase of medical response would

be largely done.

This is likely a reason why a majority of the ships' deployments have been near the

US—in the Americas.

Of those, many have been long-planned humanitarian missions to provide advanced healthcare to

areas without it.

These are, of course, incredibly impactful for those they serve, but overall, the ships

just aren't designed for super-fast response to critical crises.

The very size that slows it does, however, have a purpose.

Beyond just allowing for a massive capacity, the ships are stable enough that, even when

floating, it is possible to conduct most types of surgery in their 12 operating rooms.

There are exceptions—the floating platform doesn't allow for open-heart surgery—but

still, the possibility of conducting advanced medical interventions at sea is impressive.

There are, however, more issues related to the origins of the ships.

You see, hospitals are quite tricky facilities to design.

Small and subtle differences can mean the difference between life and death, and so

the accumulated experience of hundreds of years has resulted in explicit knowledge on

how hospitals should be built.

One of the myriad principles is that movement bottlenecks should be minimized.

That leads to features like wide hallways and doors, but it also means that, as much

as possible, the use of elevators should be avoided.

The technique to achieve that is, of course, to make hospitals wider.

You want as much as possible on the same floor so that there is as little need as possible

to put patients in elevators when transferring them from one area to the other.

If, for example, a patient takes a turn for the worse and needs to be rushed to an operating

room, the 90 seconds waiting for and riding the elevator can mean the difference between

life and death.

This also has an implication on overall hospital efficiency.

For example, you ideally want radiology rather close to and on the same floor as the emergency

room since many patients often need x-ray imaging right when they present to the ER.

The further away it is, the longer it takes to get a patient to and from there, and then

the longer they spend in the ER department overall, and the more beds are needed to serve

the same number of patients in the ER.

These principles are all why hospitals tend to be wide.

Even in places with incredible density and high real-estate costs like New York, most

hospitals are wider than they are tall.

In all, hospital design is a puzzle where all the elements that patients most commonly

are transferred between need to be as close, in travel time, to each other.

Looking at the outside of the USNS Mercy and Comfort, you would think that they would properly

follow this principle of width before height, but unfortunately, during their conversion,

legacies of their past lives were left behind.

You see, tanker ships, on the inside, are not just one big empty hull filled with oil.

They were when they first emerged, many years ago, but the issue there was that, with a

slight tilt forwards, backwards, or to a side, oil would start sloshing to that side, which

leads to more weight on that side, which leads to more tilt, which leads to more oil sloshing,

and so on and so forth until a ship capsized.

That was clearly an issue, but one easily solved by creating bulkheads both laterally

and longitudinally so that oil couldn't slosh around.

The problem, though, is the these were left in the Comfort and Mercy.

There are no doors between bulkheads on the lower floors.

Therefore, if one needs to get a patient from here to here, they have to be brought up an

elevator, across the top deck, and back down again.

This leads to huge movement issues, making the ship's effectiveness as a hospital more

limited.

That's just one large example, but there are plenty of other smaller issues with the

ship designs that make them less effective than they could be.

They are, after all, nearly 50 years old, and the Navy was already starting to plan

their retirement decades ago.

Their original cost, including both the ship purchase and conversion, was $275 million

each, which may seem like a lot, but this is the same Navy that spends billions on single

destroyers.

A couple hundred million is a bargain for a ship of this size and, yearly, its operating

costs are rather insignificant in the context of the Navy.

It's the kind of asset that makes sense to keep around just in case it becomes useful,

as it does every once in a while when disaster strikes in the US or abroad, but also one

that the US is likely to be unwilling to invest in upgrading.

A dedicated, purpose-built hospital ship of this size could be an enormous step up from

these, but when given the choice between a new destroyer or a new hospital ship, the

Navy's going to pick the destroyer.

It's for that reason why the Comfort and Mercy have stayed in service for so long,

and why they're likely to stay in service until the very last day possible.

They may not be of enormous use in the Navy's eyes, but to the thousands that they treat,

they're a symbol of hope in tough times and, until they're incapable of helping

anyone, they serve a crucial purpose.

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