At the end of May, a relatively rare event was scheduled to take
place: The USNS Comfort (T-AH 20)—one of the nation’s
two military hospital ships—would pull away from its layberth
at Baltimore’s Canton Pier, steam down the Chesapeake Bay
and head out to sea.
This happens no more than once a year. It is noteworthy, because
when the Comfort sets sail, it can mean that large numbers of U.S.
military personnel are about to become casualties.
“These are valuable ships for making a profound statement
to the world that we mean business,” Capt. John Zarkowsky,
the Navy’s hospital ship projects officer, told National Defense.
“When these ships sail out on a real mission, it means that
we are willing to fight, and we are prepared to take care of a lot
It’s reassuring for U.S. combat troops to know that medical
care is close at hand, Zarkowsky said.
“That’s one of the reasons that these ships are so
well-funded,” Zarkowsky said. The Navy spends about $14 million
per year—or $7 million each—to keep the two ships ready
Keeping them ready is no easy task. The Comfort is as long as three
football fields and as tall as a 10-story building, almost as big
as an aircraft carrier. Within this space, she has 12 operating
rooms, 1,000 hospital beds, physical-therapy facilities, a burn
intensive-care unit, a frozen blood bank, an infectious-disease
ward, even a morgue.
“It’s as big as the fifth-largest trauma center in
the United States,” according to Lt. Cmdr. Shawn M. Cali,
a spokesman for the Navy’s Military Sealift Command (MSC),
which operates the two ships.
The Comfort is painted a brilliant white, with nine huge red crosses
placed all over her hull, rather than the battleship gray of most
Navy ships, in order to make it easier for enemy ships to recognize
its noncombatant status. Under the Geneva Convention, hospital ships
are protected against hostile fire, Zarkowsky said. In return, he
noted, such ships are required to accept “all comers,”
even enemy casualties.
No casualties, however, were expected on this brief mission. The
Comfort would sail a short distance into the Atlantic Ocean, off
Norfolk, Va., and conduct a ship material-assessment and readiness-testing
All of the ship’s equipment—engines, boilers, rudders—would
be checked. Drills would be conducted on the helicopter flight deck.
A small cadre of medical personnel would inspect its surgical, radiological,
pharmaceutical and recovery facilities. “We want to make sure
that everything is working,” Zarkowsky explained.
The Comfort is one of two hospital ships now serving in the Navy
fleet. The other one is the USNS Mercy (T-AH 19), based in San Diego.
Both were originally built as supertankers in the 1970s, but were
converted for medical use by the National Steel and Shipbuilding
Co., of San Diego, and delivered in 1987 to the MSC.
The concept of a hospital ship is not new. The Spanish Armada,
in the 16th century, had one. The United States had 12 during World
War II. The Navy retired the last two of these at the end of the
Vietnam War. But subsequent events—such as the bombing of
the U.S. embassy in Beirut and the U.S. invasion of Grenada, both
in 1983— suggested the need for a new generation of hospital
The Comfort and Mercy are maintained in reduced-operating status
(ROS), at their homeports, on standby to sail within five days of
notification. While on ROS, the ships have only small crews. The
Comfort, for example, has 58 Navy personnel and 18 civilian mariners
on board, explained her civilian captain, Master Mariner Dean Bradford,
in a tour of his vessel.
Like all MSC ships, the Comfort is operated by civilian mariners.
“We handle everything for the ship,” Bradford said.
“The Navy provides the medical people to take care of the
If the Comfort is ordered to sea to deal with a real crisis, “1,800
pallets of perishable medical supplies and other material would
have to be loaded within 24 hours,” said Zarkowsky.
Preparing to Sail
While the ship prepares to sail, its full complement of medical
personnel has to move quickly to report on board. Just how many
are needed depends upon how many casualties the Navy expects. The
Comfort’s military treatment facility (MTF) may be activated
at a 1,000, 500 or 250-bed level, Zarkowsky said.
The 1,000-bed level typically requires 1,214 Navy doctors, dentists,
nurses and support personnel, including chaplains and at least one
officer from the Navy’s Judge Advocate General’s (JAG)
Corps. The 250-bed level usually has about 730 such personnel, explained
Cmdr. Bess Harrahill, the Navy’s officer in charge of the
Comfort during ROS.
The Comfort gets two thirds of its medical staff from the National
Naval Medical Center in Bethesda, Md., just a few miles from Baltimore.
The rest come from naval medical facilities all along the East Coast,
including Annapolis and Patuxent River, both in Maryland; Portsmouth,
Va., and Newport, R.I.
A minimum of 250 Navy personnel must be on board the Comfort within
24 hours. Others may board at Norfolk, where the ship will take
Five days after notification, the Comfort is supposed to go to
sea. Even then, however, it probably won’t have a full medical
“Reality says that it’s not practical for us to put
all of those people on board the ship early on,” Zarkowsky
said. That is especially true of highly trained doctors, who may
have busy schedules at home. Their places at their regular practices
are taken temporarily by reservists and contractors, but that’s
not as satisfactory—for patients or physicians—as business
For the medical people, the transatlantic cruise—at a speed
of 16.5 knots, with little to do—is especially boring and
frustrating, Zarkowsky said. “It’s 14 days to the U.S.
naval base at Rota, Spain, and if our destination is the Arabian
Gulf, through the Mediterranean Sea and the Suez Canal, that’s
another 10 days.”
Rather than have the medical people stuck on board for all that
time, the Navy flies most of them across the Atlantic, Zarkowsky
said. Typically, they join the ship in Rota.
The Comfort and the Mercy first saw action during the 1990-91 Gulf
War. The two ships, normally berthed on opposite sides of the United
States, made naval medical history by steaming together in the Gulf.
The Gulf War was the first deployment for both ships, and the Navy
learned a lot from the experience, Zarkowsky said. The crews of
the two ships now train regularly.
Every quarter, for example, the Comfort has five-day dock trials
without leaving the pier. “We check every piece of equipment
on board,” said Bradford. “We do fire-fighting drills,
practice damage control, man overboard and abandon ship.”
During the war, many crewmembers were concerned about the Comfort’s
ability to survive an Iraqi attack. Despite its noncombatant status,
they feared that Iraqi President Sadam Hussein would not hesitate
to strike at such an inviting big, white target with its red crosses,
if he had a chance.
Navy officials tried to calm those fears. They pointed out that
hospital ships deploy to combat areas only under the considerable
protection of aircraft carrier battle groups, which include not
only the carriers and their aircraft, but also destroyers and submarines.
If the Comfort were seriously damaged, it has enough lifeboats
and rafts “to get everybody off our ship,” Bradford
said. The ship also is equipped with decontamination showers to
use after a chemical or biological attack, he noted.
The ship itself has few arms, Bradford admitted. “We have
a few small arms—M-14 rifles, pistols, shotguns, light machineguns—to
provide internal security and repel boarders.
“If the threat is any larger than that, we have to seek outside
help,” he said. “Ultimately, if the threat is too great,
the best protection is to get out of Dodge.”
In addition to dock trials, the hospital ships go to sea every
year. The USNS Mercy just completed participation in the two-week
Exercise Kernel Blitz 2001, off the coast of California, involving
25 ships, 75 aircraft and 15,000 military personnel from the United
States, Canada, Britain and Australia.
Next year, the Comfort is planning to take part in Baltic Challenge
2002, a multinational exercise in the sensitive Baltic Sea, which
is surrounded by Scandinavia, Germany, Russia and several countries
once dominated by the former Soviet Union, including Lithuania,
Latvia, Estonia and Poland.
Such exercises permit the Comfort’s medical teams to practice
their skills under conditions similar to wartime. During Baltic
Challenge ‘98, the Comfort conducted a 230-person casualty
drill and trained more than 100 medical personnel from Baltic nations
in casualty care. It was the first time since World War II that
a U.S. ship of that size entered the Baltic.
The Comfort’s doctors did more than just drill during the
exercise. Following a humanitarian request from the U.S. embassy
in Lithuania, a team of the ship’s surgeons—consulting
with colleagues in Bethesda by satellite—successfully removed
a brain tumor from a 13-year-old Lithuanian boy.
Sometimes, the Comfort participates in purely humanitarian missions.
In 1994, she provided medical support for the Haitian migrant rescue
effort. More than 2,300 Haitian migrants were plucked from the sea.
Later that same year, the Comfort was tasked to provide a 250-bed
facility for the 35,000 Cuban and Haitian migrants at the U.S. Navy
base at Guantanamo Bay, Cuba.
The problem was, Harrahill said, “a lot of Haitians had tuberculosis,”
which is contagious. “We couldn’t bring them inside
the skin of the ship.” Instead, Bradford said, they were placed
in tents on deck.
Navy doctors recognized that, to conduct humanitarian missions
in the Third World, the Comfort has to be able to cope with infectious
diseases, including AIDS and the Ebola virus. Last year, the ship
received an isolation ward in its intensive-care unit to protect
against airborne communicable diseases. Advanced digital radiography-processing
equipment also was installed to reduce hazardous materials on board
and to provide spontaneous imaging capability.
The Comfort, in addition, has six freezers to store blood for use
in operations. “We use a lot of blood,” said Harrahill.
“Fresh blood would go out of date very quickly, but frozen
blood lasts forever.”
The ship has two oxygen-producing plants, which take regular air,
compress it and freeze it, separating it into liquid oxygen at minus
297.3 degrees Fahrenheit and liquid hydrogen at minus 320.5 degrees.
The liquid oxygen can be heated to produce pure oxygen for use in
medical procedures. The procedure, however, is risky, said Machinist’s
Mate First Class (SW) Joseph DeMun.
The plant “is probably the most dangerous place on the ship
after the engine room,” he said. “Pure oxygen is highly
explosive. It produces extremely hot fires that burn for a very
long time. We never, ever—not ever—light the smoking