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 of
international speculation regarding the Chinese Navy’s future roles and
missions. The use of hospital ships in non-military operations by the
U.S. Navy has long been associated with the concept of soft power.
While soft power consists of such areas as diplomacy and economic
assistance, 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 the
use of military doctors, can be extremely powerful [1]. In spite of the
prominent role that Chinese hospital ships increasingly play in the
Chinese Navy’s effort to shape international perception of the Peoples’
Liberation Army Navy (PLAN), a detailed examination of the evolution of
the Chinese hospital ship program and its strategic implications has
been lacking in discussion of the PLAN’s growing naval capabilities.

Given
China’s growing maritime HA/DR capabilities, there are now more
opportunities for cooperation between the United States and China in
HA/DR. During the PLAN’s Qingdao Fleet Review in April 2009, Chief of
Naval Operations Admiral Roughead was invited to tour the Daishan Dao.
Subsequently, Admiral Roughead extended an invitation for Chinese
participation in a U.S. HA/DR mission. In June 2009, four Chinese
visited the USNS Comfort in Colombia during Continuing Promise 2009.
Chinese visitors composed a mix of civilian and military, and their
attendance during the HA mission demonstrated the first step toward
afloat medical cooperation between the United States and China. This
was rather significant for the overall maritime and strategic
relationship as it demonstrated cooperation despite the USNS Impeccable
incident in March 2009. The United States will again embark on an HA
mission, this time to Asia during Pacific Partnership 2010, providing
another potential opportunity for U.S.-China cooperation in maritime
HA/DR.

Conceptual Origins in South China Sea Skirmishes

Some
observers have claimed that the development of this new ship was a
response to China’s inability to respond with maritime HA/DR during the
2005 Tsunami relief efforts. That explanation, however, ignores the
fact that the 10,000-ton 866 Daishan Dao was under construction as
early as May 2004 [2]. Moreover, China has been deploying hospital
ships 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 entered
the fleet in the early 1980s. Chinese analysts assert that the
skirmishes in the Paracels and the Spratlys, 1974 and 1976
respectively, were the main motivating factor driving the development
of first-generation Chinese hospital ships. The Nankang-class hospital
ships are deployed in the South Sea Fleet and their placement reflects
the purpose for which they were designed. According to Qu Zhaowei:
“Given the scale of an amphibious campaign to land on the islands in
the South China Sea would not be too large, the two Nankang ships would
prove sufficient to meet the need” [4].

The distance of these
naval skirmishes from mainland China was enough to warrant the need for
a hospital ship. Lacking a hospital ship at the time (1970s) of these
maritime conflicts, Chinese soldiers and sailors who were wounded were
not able to receive treatment offshore in the immediate zone of
conflict. The primary historical reason for building hospital ships has
been to create the ability to treat wounded military personnel during
combat at some distance from one’s home shores. Up until that time, all
hospital ships built by other countries had been conversions from other
ships. The Chinese response to the disputes in the Spratlys and
Paracels of converting other hulls into hospital ships followed the
trend of international hospital ship conversions at the time.

Interim Experimentation with Defense Mobilization

Commissioned
in January 1997, the Shichang was built as a multi-role aviation
training ship. The second-generation Chinese hospital ship is actually
referred to as a “national defense mobilization ship” (guofang dongyuan
jian). Mobilization refers to the ability to mobilize civilian assets
for military use. When medical modules, painted white with red crosses,
are placed on the Shichang, rather than cargo containers, the ship
effectively becomes a hospital ship. It is likely that dual-use
platforms such as U.S. Navy LPDs that have used modular hospitals on
deck influenced the design of the Shichang. Canada (ships forthcoming)
and Germany also have similar hospital ships.

The Shichang was
actually built in response to the Chinese observation of the Falklands
War according to Chinese sources [5]. During that conflict, the SS
Uganda was converted by the British from an educational cruise liner
and was used as a hospital ship. One Chinese author reflects: “The
experience of the [Falklands War] illustrates that the fighting of a
war is closely linked to the issue of the mobilization of transport
assets” [6]. As recently as 2008, China mentioned its desire to have a
clearly defined national defense mobilization system that is compatible
and commensurate with its national security needs [7].

A Purpose-Built, Dedicated Hospital Ship

According
to the People’s Daily, the 866 Daishan Dao is the world’s first
purpose-built hospital ship (People’s Daily Online, November 3, 2008).
Jane’s Fighting Ships lists the Russian hospital ship, Yensei, as the
first purpose-built hospital ship. The Daishan Dao belongs to the East
Sea Fleet and was commissioned on 22 December 2008. The exterior of the
ship is painted white along the guidelines of the Geneva Convention and
has six red crosses. It has a helicopter hangar with the capacity to
hold 1-2 helicopters along with a helicopter pad. The indigenously
built Z-8 large shipborne helicopter has been photographed operating
with 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 sail
the ship. In addition, it is said to have over 500 beds with 8 surgical
operating rooms and the capacity to “accommodate 40 major surgeries a
day – about as many as a large hospital in Beijing” (People’s Daily
Online, March 24, 2009). Xinhua News Agency indicates: “This ship makes
China one of the few countries in the world to possess long range
medical rescue capabilities. A large hospital ship is considered an
important division of a modern navy” [8].

Yu Dapeng is the
captain of the 866 that held its first exercise in mid-March 2009
(People’s Daily Online, March 24, 2009) followed by exercises in June
and September. On October 20, 2009 the Daishan Dao departed Shanghai on
a 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 the
islands and reefs in the South China Sea to include visiting many
military outposts. China’s HATM shows the first indication of the
ship’s potential soft power.

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

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

Rethinking Dedicated Hospital Ship Platforms

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

According to
Jane’s Fighting Ships, vessel 865 is the largest modularized hospital
ship in the world (4xs larger) with over 100 modules and weighing in at
30,000 tons. A recent photograph in Renmin Haijun actually shows two
modularized hospital ships being assembled side-by-side, suggesting
that the use of medical modules for container ships could be
significant in scale [12].

The Impact of Hospital Ship Missions on Maritime Strategy

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