Category Archives: Humanitarian

U.S. Southern Command Needs a Permanently-Assigned Hospital Ship

The Southern Tide

Written by Wilder Alejandro Sanchez, The Southern Tide addresses maritime security issues throughout Latin America and the Caribbean. It discusses the challenges regional navies face including limited defense budgets, inter-state tensions, and transnational crimes. It also examines how these challenges influence current and future defense strategies, platform acquisitions, and relations with global powers.

“We focus on partnerships…Our partners want to work with us. They want the advantage of the United States education, training, exercises and military equipment. It’s the best in the world. And so it’s up to us to deliver that in a way that’s relevant and also provides a return on investment for American taxpayer. So that is our focus.” –Navy Adm. Craig S. Faller, commander of U.S. Southern Command, before the Senate Armed Services Committee July 9, 2019.

By Wilder Alejandro Sánchez

The variety of extreme natural disasters that annually hit U.S. Southern Command’s (SOUTHCOM) area of responsibilities, exacerbated by climate change, demonstrates the Command’s need for a permanently-assigned hospital vessel. While the Command can obtain assets if needed in case of a crisis, like the current deployment of the San Antonio-class amphibious transport dock ship USS Arlington (LPD-24), among other naval units, to Haiti after the deadly earthquake on August 14, there are benefits to having a permanently-assigned hospital vessel.

Comfort: SOUTHCOM’s key asset

In an interview that will soon be published by Janes, U.S. Navy Admiral Craig Faller, the current commander of SOUTHCOM, explained to the author that it would be great to have the Mercy-class hospital ship USNS Comfort (T-AH-20) sail annual four-to-six month missions in the region. Comfort last sailed in Latin American and Caribbean waters in 2019. 

As part of Operation Enduring Promise 2019, the vessel made 12 port calls across Latin America and the Caribbean, providing free medical services to local populations, an important humanitarian operation that helps win the hearts and minds of civilians and authorities alike.

SOUTHCOM’s activities in Latin American and Caribbean waters also include a constant participation in humanitarian assistance/disaster relief (HA/DR) operations. HA/DR will become more critical due to the increasing frequency, violence, and impact of weather-related events, particularly hurricanes. 

The role of vessels in HA/DR operations

The Greater Caribbean – meaning Caribbean and Central America – is a region that knows very well how catastrophic these disasters can be. Just in the past decade these areas experienced the devastating 2010 and August 2021 earthquakes in Haiti and the April 2021 La Soufrière volcano eruption in Saint Vincent and the Grenadines. 

Moreover, the region is hit annually during its summer months with frequent hurricanes, which are existential threats to many countries. Hurricane Irma in 2017, for example, hit Antigua and Barbuda particularly hard, as ReliefWeb explains,

“The impact on Barbuda was particularly severe as the eye of the hurricane passed directly over the island; 81% of Barbuda’s buildings were reported to have been destroyed or severely damaged, and the island was deemed uninhabitable, as all resident households (HHs) on Barbuda were seriously affected by the hurricane.”

In November 2020, past the usual hurricane months, Hurricanes Eta and Iota, category 4 and 5 respectively, hit the Colombian Caribbean islands of San Andres and Providencia, and then made landfalls that affected El Salvador, Honduras, Guatemala, and Nicaragua with devastating results. Climate change will increase the strength of the hurricanes that hit the region for the foreseeable future, making regional cooperation and partnerships all the more important.

In response to the devastation caused by the two hurricanes the Arleigh Burke-class guided missile destroyer USS William P. Lawrence (DDG-110) “arrived off the coast of Honduras… to support Joint Task Force Bravo’s (JTF Bravo) mission by conducting familiarization flights, delivering medical supplies, and coordinating with other JTF Bravo assets to identify future HA/DR needs.” U.S. Navy helicopters and U.S. Army watercraft also participated in the relief effort. SOUTHCOM’s 2021 Posture Statement explains that by working together with partners and components like JTF-Bravo, the Command “[conducted] search and rescue operations and [delivered] lifesaving aid to areas isolated by the storms, delivering over 1.2 million pounds of life-saving humanitarian aid and rescuing 852 people.”

As for the response effort to the recent earthquake in Haiti, apart from Arlington, other ships deployed include the Freedom-class littoral combat ship USS Billings (LCS-15), and USNS Burlington (T-EPF-10), a Spearhead-class expeditionary fast transport ship. A total of six U.S. ships have been deployed as of the end of August. RFA Wave Knight, which serves in the Royal Navy, and the Mexican ships ARM Papaloapan and ARM Libertador have also been deployed.

One vessel that was not in Central America after the 2020 hurricanes or the recent incidents in the Caribbean islands was Comfort. The hospital ship last deployed in Latin American waters in 2019 (my commentaries for CIMSEC on Comfort include “USNS Comfort’s Latest Humanitarian Mission Throughout Latin America,” and “The Significance of U.S. and Chinese Hospital Ship Deployments to Latin America”), even though it has proven to be a critical component of SOUTHCOM’s strategy to strengthen relations with regional partners by providing civilians free and efficient medical services. While the ship has other duties and maintenance requirements, its value to SOUTHCOM’s HA/DR operations is undeniable.

What are the Options?

The US Navy is currently considering the expansion of its fleet of medical vessels to replace Comfort and its sister ship USNS Mercy (T-AH-19). For example, the Australian shipyard Austal displayed a model of its expeditionary medical ship (EMS) during the Sea Air Space 2021 defense expo, held outside Washington DC, in August.

Another proposal to revamp the Navy’s medical ship fleet was made in a July 2 CIMSEC commentary by Lieutenant (Junior Grade) Misty Wilkins, a US Strategic Sealift Officer. Lt (j.g.) Wilkins proposed that unused offshore supply vessels (OSVs) “are ready to be used and ripe for re-purposing to meet Navy, Marine Corps, Army, and Air Force needs.” The officer proposed that “these vessels could be converted at relatively little cost and would likely be available much sooner than the time needed to construct and test the [Expeditionary Fast Transport] ambulance ship concept.”

I certainly agree with Lt (j.g.) Wilkins’ argument, and I would take it one step further, highlighting that the U.S. fleet requires more hospital ships not solely for wartime missions but also to help with HA/DR operations, which are a critically important activity for a command like SOUTHCOM.

Therefore, in the very near future, an OSV-turned-ambulance ship must be permanently assigned to SOUTHCOM given the constant activities the Command carries out in its area of operations. While units like LCSs or destroyers are certainly helpful to HA/DR operations, it would be even more beneficial to have a specially-designed hospital vessel deployed annually in the region and ready to help with disaster relief when, not if, it is needed. Admiral Faller explained to me during our interview for Janes that it would be great if SOUTHCOM had Comfort deployed annually. This type of assistance and cooperation would strengthen US relations with partners and allies throughout the Western Hemisphere, and win the hearts and minds of regional populations. 

The Case for a Permanent Ship

SOUTHCOM and its naval component, U.S. Fourth Fleet, do not have ships permanently assigned. Rather, SOUTHCOM deploys a variety of units that are assigned on rotation, including Arleigh Burke-class destroyers and LCSs. Admiral Faller has requested additional ships to combat drug trafficking and monitor the activities of U.S. adversaries like Venezuela in the region.

SOUTHCOM’s leadership is very aware of the challenges and threats (not just drug trafficking-related) that regional partners face. Thus, the Command trains with Caribbean forces via exercise Tradewinds, tabletop exercises, and also works with agencies like the Regional Security System and the Caribbean Disaster Emergency Management Agency (CDEMA). The goal is for regional forces to cooperate more effectively when the next hurricane or other type of disaster occurs.

Given that natural disasters afflict Latin America and the Caribbean, combined with the success of medical assistance operations like what Comfort has carried out in the recent past, SOUTHCOM has demonstrated the need for a permanently-assigned hospital vessel in order to be ready for the next HA/DR operation or medical deployment to its area of responsibilities. While the likelihood of SOUTHCOM obtaining additional warships is low, the Command should still lobby for a permanent hospital vessel.

Final Thoughts

SOUTHCOM’s Posture Statements routinely highlight the success and relevance of HA/DR operations that the Command carries out in its area of responsibilities. Case in point, the 2021 Posture summarizes what the Command did to help Central America after the 2020 hurricanes, stressing that “there is no better way to demonstrate U.S. commitment to the region than to respond to our neighbors’ needs in times of crisis.” Working together to face natural disasters is not just a cliché, it is how SOUTHCOM gets the job done. 

Looking to the future, by acknowledging that climate change-enhanced weather events will get worse; by taking into account the positive impact of SOUTHCOM’s role in HA/DR operations in Latin America and the Caribbean, and by highlighting the fact that that the U.S. fleet in general needs more hospital ships, it is clear that SOUTHCOM not only deserves, but also requires, a permanently-assigned hospital ship in order to effectively carry out its missions.

Wilder Alejandro Sánchez is an analyst who focuses on international security and geopolitics. The views expressed in this article belong to the author alone and do not necessarily reflect those of any institutions with which the author is associated.

Featured image: The Military Sealift Command hospital ship USNS Comfort (T-AH 20) sits anchored off the coast of Colombia during Continuing Promise 2015. (U.S. Navy photo)

The Significance of U.S. and Chinese Hospital Ship Deployments to Latin America

The Southern Tide

Written by W. Alejandro Sanchez, The Southern Tide addresses maritime security issues throughout Latin America and the Caribbean. It discusses the challenges regional navies face including limited defense budgets, inter-state tensions, and transnational crimes. It also examines how these challenges influence current and future defense strategies, platform acquisitions, and relations with global powers.

“The security environment in Latin America and the Caribbean is characterized by complex, diverse, and non-traditional challenges to U.S. interests.” Admiral Kurt W. Tidd, Commander, U.S. Southern Command, before the 114th Congress Senate Armed Services Committee, 10 March 2016.

By W. Alejandro Sanchez

USNS Comfort (T-AH-20) has become a regular visitor of Latin American and Caribbean waters as it often carries out humanitarian operations in those regions. Mostly recently, it was deployed to Puerto Rico to assist those affected by Hurricane Maria. Furthermore, there is now an extra-regional hospital ship which is also traveling to these areas, namely China’s Peace Ark (866 Daishan Dao), a Type 920 hospital ship that is operated by the People’s Liberation Army Navy. Given that the governments these two platforms belong to are experiencing growing national security tensions it is necessary to discuss their activities and put this medical diplomacy in its proper geopolitical context.

This commentary is a continuation of an essay that the author drafted for CIMSEC titled “The uses of the U.S. Navy’s Fourth Fleet;” and draws from an analysis by CAPT John C. Devlin (ret.) and CDR John J. Devlin titled “Aligning HA/DR Mission Parameters with U.S. Navy Maritime Strategy.”

USNS Comfort

We will not supply an exhaustive list of Comfort’s operations throughout Latin America and the Caribbean, but will rather provide some highlights. Most recently, as previously mentioned, Comfort was deployed to Puerto Rico to assist those in need after Hurricane Maria hit the island. The vessel also traveled to Haiti after the 2010 earthquake to assist with the relief and support efforts as part of Operation Unified Response.

Additionally, Comfort has been deployed to the region as part of initiatives like the Partnership for the Americas and Operation Continuing Promise. Countries that were visited during these voyages include Colombia, Dominica, Ecuador, El Salvador, Honduras, Jamaica, Peru, among others.

USNS Comfort (T-AH 20) (U.S. Navy photo)

It is worth noting that Comfort is a large vessel, with a length of 894 feet and a beam of 105 feet, the same as its sister ship, USNS Mercy (T-AH-19) – the two are converted San Clemente-class super tankers. According to the U.S. Navy,  each platform “contain[s] 12 fully-equipped operating rooms, a 1,000 bed hospital facility, digital radiological services, a medical laboratory, a pharmacy, an optometry lab, a CAT-scan and two oxygen producing plants,” along with helicopter decks. Hence, the vessel is able to provide for vast numbers of patients simultaneously with different services. For example, according to the magazine Dialogo, some 19,000 patients were treated by Comfort personnel when the vessel docked in Belize and Guatemala as part of Continuing Promise 2015.

Peace Ark

As for Peace Ark, the Chinese vessel is newer than Comfort, as the former was commissioned in 2008 while the latter was commissioned in 1987 – a two decade difference. The newer vessel reportedly measures 583 feet in length and displaces 10,000 tons fully loaded, and fields a Z-9 helicopter. It also has 300 beds for patients, eight operating rooms and 20 intensive care units. When deployed, its crew is made up of up to 328 plus 100 medical personnel.

In a 2014 article by USNI News, Peace Ark’s Senior Captain Sun Tao declared, “other than internal organ transplant …or any kind of heart disease treatment, [Peace Ark] can pretty much do any kind of treatment.” The article goes on to note that “This includes, perhaps not surprisingly, traditional Chinese medicine. A room onboard Peace Ark is specifically reserved for the ancient therapies of cupping, massage, and acupuncture.” 

Medical workers treat mock wounded people during an exercise aboard the Chinese navy hospital ship Peace Ark Sept. 15, 2010. The ship on Wednesday arrived in the Gulf of Aden to provide medical service for the Chinese escort fleet, as its first overseas medical mission. (Xinhua/Zha Chunming)

Because the Chinese vessel has also been deployed throughout Asia and Africa in the last decade, Peace Ark has traveled significantly fewer times than Comfort to Latin America and the Caribbean. Its first tour was “Harmonious Mission 2011, a 105 day trip in which the platform visited Costa Rica, Cuba, Jamaica, and Trinidad and Tobago. The platform returned to the region in 2015, visiting countries like Barbados, Mexico, and Peru.


At a local level, the arrivals of these vessels are a welcomed development as they provide medical services that local populations may not be able to obtain otherwise from their local governments. Thus, it probably matters very little to the inhabitants of these areas whether a hospital ship flies either a U.S. or Chinese flag, as long as they provide health services that are needed. Indeed, articles published by Latin American and Caribbean media outlets that reported visits by either Comfort or Peace Ark included generally positive statements by local authorities and patients.

At a geopolitical level, these hospital ships carry out humanitarian assistance and disaster relief operations (HA/DR) that are in line with their respective navy’s overall strategies of aiding populations in need. Moreover, and unsurprisingly, these visits help to boost up the image of the nation deploying the platform in the eyes of the hosting government and population. For example, a 2011 article by Mercopress that discussed Peace Ark’s arrival to Jamaica had the following statement “the mission is part of a global campaign by Beijing to portray its rapidly growing military as a responsible power.” Similarly, the aforementioned CIMSEC article states that HA/DR operations “are a vital part of U.S. Navy maritime strategy by ensuring regional stability through building partner nation capacity and expanding our sphere of influence.”

While an exhaustive analysis of each nation that Comfort visits is beyond the objectives of this commentary, it is worth noting that the countries it regularly visits are those that the U.S. has good relations with, though there has been one notable exception. In 2011 Comfort docked in Manta, Ecuador: this is was a significant visit as then-President Rafael Correa was known for his anti-Washington rhetoric and for having ordered the shutdown of the U.S. military facilities in Ecuador in 2009. Thus, it is somewhat bizarre that President Correa would authorize a (unarmed) U.S. ship to enter his country’s territorial waters. It would be interesting if the government of Venezuela would similarly allow Comfort to dock in Venezuela’s coast, given the problematic situation of the country’s health system. Nevertheless, the tense bilateral relations make it highly unlikely that Caracas would authorize such a visit, or that Washington would offer it in the first place.

Moreover, as far as the author can determine, Peace Ark has only visited countries whose governments recognize the People’s Republic of China and not the Republic of China (ROC/Taiwan). It will important to monitor if future Peace Ark deployments include countries that still maintain relations with Taipei, as Beijing may be looking to obtain the recognition of Taiwan’s last remaining allies in the region – the latest nation to switch sides was Panama in mid-2017.

Ultimately, setting aside the geopolitical motivations for the deployment of these vessels, the humanitarian activities that they carry out ensures that both Comfort and Peace Ark will continue to be welcomed across the Latin America and the Caribbean as future harsh climate events will require greater humanitarian assistance and disaster relief operations.

In 2017 alone, regional navies had to carry out major relief operations. Case in point, the Peruvian Navy (Marina de Guerra del Peru) deployed several platforms to the country’s northern regions to provide assistance after torrential rains hit many areas. Similarly, the Colombian Navy (Armada de Colombia) has deployed offshore patrol vessels to transport humanitarian aid to areas hit by floods. Even more, the Honduran Navy (Fuerza Naval) has acquired a multipurpose vessel, Gracias a Dios, to combat maritime drug trafficking and to provide assistance to coastal communities. In other words, humanitarian assistance has been a key component of naval strategies, and its importance will only increase in the near future, meaning that support from allies will remain a necessity for many Latin American and Caribbean states.

Final Thoughts

USNS Comfort and China’s Peace Ark have carried out commendable humanitarian work throughout many coastal communities in Latin America and the Caribbean as their tours in these regions have helped individuals who would otherwise have trouble accessing medical services. These humanitarian assistance deployments will continue to be necessary in both the short- and long-term. As for the geopolitical value of such deployments, they are a non-dangerous and effective example of “soft power” via which both Beijing and Washington utilize to maintain and improve their image in these regions.

Alejandro Sanchez is a researcher who focuses on geopolitical, military, and cyber security issues in the Western Hemisphere. Follow him on Twitter: @W_Alex_Sanchez

The views presented in this essay are the sole responsibility of the author and do not necessarily reflect those of any institutions with which the author is associated.

Featured Image: This a Chinese hospital ship. Called the Peace Ark, this ship is under the command of the Chinese Navy. (Photo by Jake Burghart)

The Advent of Feral Maritime Zones

By J. Overton

Massive amounts of seaborne debris were created from the 2011 Great East Japan Earthquake. The debris fields caused alarm as they floated about the Pacific Ocean, reaching all the way to the western United States. Components of the debris field included marine waste, invasive species, toxic discharge, derelict vessels, and even some radioactivity. Individually, these components were nothing new in the maritime environment. However, as these components combined and spread over an area larger than any oil spill, they impacted many different countries. The debris fields were poorly understood and comparisons and analogies to previous situations fell short. Expert opinions ranged from “mostly dissipating before landfall” to “environmental catastrophe.” 

While the outcome has been less damaging than some warned, the situation was not totally innocuous, nor unrepeatable. More than six years after the event, nearly 300 different species have crossed the world’s largest ocean and landed in North America, helped along on “rafts” of unsinkable, long lasting, man-made products. Although none of the species have appeared to establish themselves on American shores, the same phenomenon could play host to the next wave of invasive species.2 

The giant, seaborne, evolving environmental and navigational hazard that escaped nation-state boundaries was perhaps the first emergence of a phenomenon best described as a feral maritime zone (FMZ).

The feral, that which is a product of civilization but is now in some manner wild, has always held a fascination and challenge for still-domesticated humanity. Entities that can become feral and ways in which that condition may be brought about have historically been limited and managed locally. The possibilities for greater impact, however, are expanding. In a 2003 edition of the Naval War College Review, Richard Norton posited the idea of a “feral city.” He described it as “…a metropolis with a population of more than a million people in a state the government of which has lost the ability to maintain the rule of law within the city’s boundaries yet remains a functioning actor in the greater international system,” and “…where state and international authorities would be massively ignorant of the true nature of the power structures, population, and activities…”3

The FMZ’s composition, size, complexity, and international impact make it, like the feral city, an occurrence only possible in the last half-century. Cities have always had areas of danger, disease, and crime. But these problems, like urban decay and violence, have remained local issues and could be mostly confined. In recent decades, with uneven and accelerating surges in technology and population, cities have gained the potential to become feral. Likewise, the same surges in technology and population has allowed for the possibility of a rudderless flotilla of debris, animals, and plants surviving for years and crossing thousands of miles of ocean. “Shoreline species usually don’t find a way to get across the Pacific,” said an Oregon State University biologist who specializes in invasive species. “But the combination of the tsunami and man-made objects such as docks and floats meant that Japanese species got a rare chance at a ride to the West Coast.” 4

Because this debris exists in an already volatile and mysterious medium, there is massive “ignorance of its true nature” and a lack of consensus on how to deal with it. The FMZ, like the feral city, is now a part of the greater international system which no state controls, nor fully understands. While it may be hard to imagine circumstances aligning to produce another FMZ with all the elements of that caused by the Japanese tsunami, the fundamentals remain present. There are more people living in large unstable areas, using technology and creating more waste as a consequence. In addition, human activity has long exacerbated natural disasters and natural disasters have in turn created more unstable societies. For example, thousands of non-native farm-raised salmon were released into Washington State’s Puget Sound when their net pen broke open. Through the confluence of these factors, a new major feral maritime zone seems inevitable.

Feral situations may not seem like a problem with military solutions. For example, the remediation plan for the accidental salmon release has been to encourage unrestricted fishing on the species. However, in the case of the Japanese tsunami disaster, political leaders described the tsunami debris field’s landfall as a national emergency. The U.S. military is often tasked with solving these “national emergencies” because of their range of capabilities and assets. The U.S. Coast Guard, perhaps the most logical service to respond to an FMZ, was used post-tsunami to sink a derelict Japanese fishing boat found adrift near Alaska. In addition, National Guard troops and the U.S. Navy have been used in the past for beach clean-up after oil spills and oil-spill response, recently used in the 2010 British Petroleum disaster in the Gulf of Mexico.

GULF OF ALASKA – The Japanese fishing vessel, Ryou-Un Maru, is sunk in the Gulf of Alaska after receiving significant damage from the Coast Guard Cutter Anancapa crew firing explosive ammunition into it 180 miles west of the Southeast Alaskan coast April 5, 2012. (U.S. Coast Guard video by Petty Officer 2nd Class Brandon Thomas)

An effective and holistic response and recovery effort for
a more severe FMZ’s impact on land and sea would be a tremendous and taxing effort. Although the first occurrence of an FMZ was thankfully not as destructive as some predicted, as Norton wrote of feral cities, so too with feral maritime zones: “It is questionable whether the tools, resources, and strategies that would be required to deal with these threats exist at present.”7 Although the sea services face many challenges and competing priorities, now may be the time to at least consider how dealing with a future FMZ might fit into that mix.

J. Overton is a civilian writer/editor for Navy. He was previously an adjunct instructor in the Naval War College Fleet Seminar Program and the Marine Corps Command and Staff College Distance Education Program. J. served in the U.S. Coast Guard, and has worked in other public affairs and historian positions for the Navy and Army. The views and opinions expressed are those of the author and do not necessarily state or reflect those of the United States Government.


[1]   “ Japanese tsunami debris: It’s not the problem California feared”  From March, 2016,

[2] “Tsunami Debris Continues To Bring New Marine Species To The Pacific Northwest” at

[3]  Richard Norton’s article “Feral Cities” in the autumn 2003 Naval War College Review.

[4]  Read or listen to the NPR story on tsunami debris washing up on the west coast of the U.S. at

[5] “Washington State’s Great Salmon Spill and the Environmental Perils of Fish Farming” and the now-debunked “Eclipse blamed for accidental release of thousands of Atlantic salmon into Puget Sound” –

[6] “BP Oil Spill: Navy Sends MZ-3A Blimp to Help Survey Gulf of Mexico” at

[7] See ‘Feral Cities’

Featured Image: Response crews battle the blazing remnants of the Deepwater Horizon oil rig off the Louisiana coast on April 21, 2010. (U.S. Coast Guard/Reuters)