China’s Growing Maritime HA/DR Capabilities

China launched what it claims is the first purpose-built hospital ship(Type 920) in the world in 2007, stirring a considerable amount ofinternational speculation regarding the Chinese Navy's future roles andmissions. The use of hospital ships in non-military operations by theU.S. Navy has long been associated with the concept of soft power.While soft power consists of such areas as diplomacy and economicassistance, it is also inclusive of elements of communication.Particularly in the case of humanitarian assistance and disaster relief(HA/DR) missions, the ability to convey a message to "relieve …conditions such as human pain, disease, hunger…” especially with theuse of military doctors, can be extremely powerful [1]. In spite of theprominent role that Chinese hospital ships increasingly play in theChinese Navy's effort to shape international perception of the Peoples'Liberation Army Navy (PLAN), a detailed examination of the evolution ofthe Chinese hospital ship program and its strategic implications hasbeen lacking in discussion of the PLAN's growing naval capabilities.

GivenChina's growing maritime HA/DR capabilities, there are now moreopportunities for cooperation between the United States and China inHA/DR. During the PLAN's Qingdao Fleet Review in April 2009, Chief ofNaval Operations Admiral Roughead was invited to tour the Daishan Dao.Subsequently, Admiral Roughead extended an invitation for Chineseparticipation in a U.S. HA/DR mission. In June 2009, four Chinesevisited the USNS Comfort in Colombia during Continuing Promise 2009.Chinese visitors composed a mix of civilian and military, and theirattendance during the HA mission demonstrated the first step towardafloat medical cooperation between the United States and China. Thiswas rather significant for the overall maritime and strategicrelationship as it demonstrated cooperation despite the USNS Impeccableincident in March 2009. The United States will again embark on an HAmission, this time to Asia during Pacific Partnership 2010, providinganother potential opportunity for U.S.-China cooperation in maritimeHA/DR.

Conceptual Origins in South China Sea Skirmishes

Someobservers have claimed that the development of this new ship was aresponse to China's inability to respond with maritime HA/DR during the2005 Tsunami relief efforts. That explanation, however, ignores thefact that the 10,000-ton 866 Daishan Dao was under construction asearly as May 2004 [2]. Moreover, China has been deploying hospitalships since the early 1980s in preparation for combat-related missions[3].

China’s first-generation hospital ships, the Nankang-class,were converted from Qiongsha-class attack transport ships and enteredthe fleet in the early 1980s. Chinese analysts assert that theskirmishes in the Paracels and the Spratlys, 1974 and 1976respectively, were the main motivating factor driving the developmentof first-generation Chinese hospital ships. The Nankang-class hospitalships are deployed in the South Sea Fleet and their placement reflectsthe purpose for which they were designed. According to Qu Zhaowei:“Given the scale of an amphibious campaign to land on the islands inthe South China Sea would not be too large, the two Nankang ships wouldprove sufficient to meet the need” [4].

The distance of thesenaval skirmishes from mainland China was enough to warrant the need fora hospital ship. Lacking a hospital ship at the time (1970s) of thesemaritime conflicts, Chinese soldiers and sailors who were wounded werenot able to receive treatment offshore in the immediate zone ofconflict. The primary historical reason for building hospital ships hasbeen to create the ability to treat wounded military personnel duringcombat at some distance from one’s home shores. Up until that time, allhospital ships built by other countries had been conversions from otherships. The Chinese response to the disputes in the Spratlys andParacels of converting other hulls into hospital ships followed thetrend of international hospital ship conversions at the time.

Interim Experimentation with Defense Mobilization

Commissionedin January 1997, the Shichang was built as a multi-role aviationtraining ship. The second-generation Chinese hospital ship is actuallyreferred to as a “national defense mobilization ship” (guofang dongyuanjian). Mobilization refers to the ability to mobilize civilian assetsfor military use. When medical modules, painted white with red crosses,are placed on the Shichang, rather than cargo containers, the shipeffectively becomes a hospital ship. It is likely that dual-useplatforms such as U.S. Navy LPDs that have used modular hospitals ondeck influenced the design of the Shichang. Canada (ships forthcoming)and Germany also have similar hospital ships.

The Shichang wasactually built in response to the Chinese observation of the FalklandsWar according to Chinese sources [5]. During that conflict, the SSUganda was converted by the British from an educational cruise linerand was used as a hospital ship. One Chinese author reflects: “Theexperience of the [Falklands War] illustrates that the fighting of awar is closely linked to the issue of the mobilization of transportassets” [6]. As recently as 2008, China mentioned its desire to have aclearly defined national defense mobilization system that is compatibleand commensurate with its national security needs [7].

A Purpose-Built, Dedicated Hospital Ship

Accordingto the People’s Daily, the 866 Daishan Dao is the world’s firstpurpose-built hospital ship (People’s Daily Online, November 3, 2008).Jane’s Fighting Ships lists the Russian hospital ship, Yensei, as thefirst purpose-built hospital ship. The Daishan Dao belongs to the EastSea Fleet and was commissioned on 22 December 2008. The exterior of theship is painted white along the guidelines of the Geneva Convention andhas six red crosses. It has a helicopter hangar with the capacity tohold 1-2 helicopters along with a helicopter pad. The indigenouslybuilt Z-8 large shipborne helicopter has been photographed operatingwith the Daishan Dao. Pictures also show that there are six lifeboats.The vessel has a medical staff of 600 along with a crew of 200 to sailthe ship. In addition, it is said to have over 500 beds with 8 surgicaloperating rooms and the capacity to “accommodate 40 major surgeries aday – about as many as a large hospital in Beijing” (People’s DailyOnline, March 24, 2009). Xinhua News Agency indicates: “This ship makesChina one of the few countries in the world to possess long rangemedical rescue capabilities. A large hospital ship is considered animportant division of a modern navy” [8].

Yu Dapeng is thecaptain of the 866 that held its first exercise in mid-March 2009(People’s Daily Online, March 24, 2009) followed by exercises in Juneand September. On October 20, 2009 the Daishan Dao departed Shanghai ona 39-day, 5,400 nm humanitarian assistance training mission (HATM)carrying nearly 100 civilian and military medical experts (PLA Daily,November 30, 2009). China’s HATM took it to many stops among theislands and reefs in the South China Sea to include visiting manymilitary outposts. China’s HATM shows the first indication of theship’s potential soft power.

Nevertheless, Chinese analystsassert unequivocally that support to large-scale amphibious warfare wasthe primary reason for building the Daishan Dao. They state that theChinese hospital ship can “integrate and participate in amphibiousattack squadrons.” They go on to say that: “Once war erupts, theDaishan Dao and Shichang or other modular hospital ships, anchored at acertain distance, can prepare to admit the injured” [9].

Interestingly,Qu Zhaowei also notes the hospital ship’s potential as a “new means toinfluence developing countries.” China has growing relationships withmany resource-rich countries, especially in Africa. The Daishan Dao’spotential to positively influence these areas through hospital shipvisits might increase economic gains.

Rethinking Dedicated Hospital Ship Platforms

Verylittle is known about the fourth-generation hospital ship, vessel 865,except for a few photographs that have surfaced recently [10]. The shipappears to be a container ship that has been refitted with medicalmodular units much the same as the Shichang. The 865 is a dual-useship; it can be used as a container ship or a hospital ship. It ispossible that this type of ship was designed in response to the factthat the maintenance and repair of a purpose-built hospital ship,especially in peacetime, is expensive [11].

According toJane’s Fighting Ships, vessel 865 is the largest modularized hospitalship in the world (4xs larger) with over 100 modules and weighing in at30,000 tons. A recent photograph in Renmin Haijun actually shows twomodularized hospital ships being assembled side-by-side, suggestingthat the use of medical modules for container ships could besignificant in scale [12].

The Impact of Hospital Ship Missions on Maritime Strategy

Whileassisting in wartime is its first responsibility, the use of a hospitalship in non-war environments such as HA/DR has increased dramaticallyover the past few years. The exercise of soft power with hospital shipshas gained increased importance after HA/DR was designated as one ofthe U.S. Navy’s core interests in A Cooperative Strategy for 21stCentury Sea Power. Thus, while the Chinese hospital ship program andthe impressive Daishan Dao in particular was not the result of the 2005Tsunami relief effort, it is likely that higher profiles for thesevessels in the aftermath of that event and other major USN maritimeHA/DR efforts are having an impact on Chinese strategy in this domain.Indeed, the need to improve China's HA/DR support capacity wasidentified in the country's 2006 Defence White Paper. Moreover, a PLANavy captain recently announced at an international conference inVancouver that China would soon begin HA/DR missions deploying the newhospital ship beyond East Asian waters [13]. Hospital ships havedemonstrated an enormous capacity to produce a range of positive andhighly significant effects and this is clearly recognized in Beijing.

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