WW2 Hospital Ships

USAHS Comfort (patient capacity 702, entered service June 1944), US Army-controlled, US Navy-built and operated Hospital Ship, off Los Angeles Harbour, California. Army medical personnel, and Navy crew are on deck, prior to their trip to the Pacific Theatres, via Australia (departure June 21, 1944).

Background Information | Eve of WW2 | World War 2 | Procurement and Operation |

Background Information:

The US Navy operated its first Hospital Ship during the years of the Tripolitan War (1801-1805). In June 1804, a small vessel, in fact a 6-foot ketch named ‘Intrepid’ was fitted as a floating Hospital to receive sick and wounded for medical treatment. The very first official Hospital Ship was a converted six-wheeler vessel, called ‘Red Rover’ which was commissioned on December 26, 1862. During the American Civil War (1861-1865), it continuously sailed the Mississippi River treating almost 3,000 patients from both sides. The US Army converted a passenger line into a kind of floating Ambulance, named ‘Relief’, and used it for a short period during the Spanish-American War (20 April-12 August 1898).
During the Great War, Hospital Ships were mainly engaged in transport of sick and wounded military personnel from the Theaters of Operations to Hospital facilities at home. Between November 1918 and March 1919, three US Navy-operated and staffed Hospital Ships, ‘Solace’ – ‘Mercy’ – ‘Comfort’ evacuated patients from Europe to the United States.

Picture illustrating USAHS Maetsuyker (converted Dutch-built liner), which operated in the Southwest Pacific area. Hospital Ships were painted overall white, with large red crosses, and their hull received a broad green stripe.

Eve of World War 2:

During WW2, Hospital Ships were again to play a major role in the evacuation of patients from overseas Theaters of Operations. They offered maximum safety, comfort, and medical care, and moreover they were protected by the Geneva Convention! Hospital Ships were manned by civilian crews, employed by the Army Transportation Service, and received a contingent of medical staff provided by the Army’s Medical Department. Most ships were converted passenger liners and cargo or troop ships. 
The deployment of Army Hospital Ships was determined chiefly by combat operations. The ships were mainly employed in evacuating patients to the United States from North Africa, the Mediterranean Theatre, the United Kingdom, continental Europe, the Southwest Pacific and the Western Pacific. They also served for evacuation of patients from forward to rear bases in the MTO and PTO Theatres.
Voyage assignments were made by the Chief of Transportation in accordance with reports and lists of patients awaiting evacuation, and estimates of casualties likely to result from impending military operations.

Interior view of the surgical ward of the USAHS Shamrock. This particular Hospital Ship operated in North Africa (1943) and Southern France (1944).

 
The 23 US Army-operated Hospital Ships made their first journey to the transatlantic Theatres in 1943, later, some were transferred to the Pacific, while others were decommissioned, after no longer being needed for evacuation of patients from the European Theatre. It must be noted that the first 3 US Navy-operated Hospital Ships ONLY served in the Pacific, none was ever engaged in Europe!

Regardless of the number of Hospital Ships in service, it is important to note that the greater part of patients evacuated by water to the ZI was moved by Troop Transports, i.e. 97% in 1943 – 75% in 1944 – 74% in 1945.

Covered ramp to waiting Hospital Ship. View of berth 64 at Leghorn, Italy. PBS (Peninsular Base Section) 883d Medical Collecting Company Ambulances bring in their patients for evacuation by Hospital Ship, from Leghorn to Naples. Picture taken in fall of 1944.

World War 2:

Since the Army had not made adequate plans for wartime evacuation of sick and wounded, early measures to provide Hospital facilities afloat were taken with hesitation; of course it was difficult to forecast requirements, but opinions regarding the extent of their use, their operation, and their number, varied enormously. Regulations were changed in many respects, but finally basic responsibilities were set up: Army Hospitalization and Evacuation were under the general direction of the Commanding General, Army Service Forces (ASF), while The Surgeon General was directly responsible for coordination and completion of evacuation plans and control of bed capacity in ZI General Hospitals, and for making available medical personnel, equipment and supplies for the care of patients, and the Chief of Transportation was responsible for providing adequate shipping (and rail) facilities, scheduling and operating the ships, debarking of patients at US ports, and transfer of patients to either Hospital Trains or Ambulances. Local Commanders of the different Service Commands, staffed and operated the Hospital Cars and Ambulances, used for removal of patients from ports of entry and transportation to the ZI Hospitals.  
At the beginning of WW2 and during the gradual build-up of United States Forces in the British Isles, transatlantic evacuation from the United Kingdom back to the ZI was still an unresolved issue. In January of 1942, the Army requested US$ 36 Million for the construction of 6 Hospital Ships. The request was refused by the Bureau of the Budget, on grounds that the Maritime Commission should procure the vessels from its own funds, and stating that such ships came under the cognizance of the Navy! Studies and numerous discussions with Army and Navy representatives took place, doctrines and policies differed a lot. In May 1942, it was decided to use cargo ship hulls and convert them into Hospital Ships. The JCS then decided to provide 3 vessels through the Maritime Commission to the Army, for conversion to Hospital Ships. Inter-service misunderstandings and rivalry, as well as incomplete specifications, and endless discussions, not only delayed the project, moreover it was even given a low priority! From mid-1942 onwards, the Medical Department advocated a 180-day evacuation policy (the Theatre would send home only those patients who were unlikely to return to duty within that time period). This policy was formally authorized in August 1943 for the ETO.

Litters ready to receive patients. A US Hospital Ship arrives at Charleston, South Carolina, with a load of patients evacuated from overseas Theatres.

In 1942, mental and litter patients only travelled on British or Canadian Hospital Ships, as the United States had no such vessels at their disposal. Ambulatory patients to be returned to the ZI, and who could care for themselves, crossed the Atlantic on returning American Troopships OR British fast liners such as the ‘Queen Mary’ or the ‘Queen Elizabeth’! Between August 1942 and December 1943, the European Theatre sent 7,800 patients to the United States by sea. In March 1944, as the number of transatlantic evacuees increased due to the expansion of American Forces and the drive to clear Hospital beds before the D-Day operation, the Army obtained temporary WD permission to embark non-ambulatory patients on Troop Transports. There was however a serious risk, as contrary to Hospital Ships, which were protected by the Geneva Convention, Troop Ships did not bear specific Geneva Convention symbols, and thus represented legitimate targets for the enemy! Hence the Theatre policy would consider sending non-ambulatory cases on plainly marked and regularly operated Hospital Ships only. Hospital Ships could also carry medical supplies and personnel outbound from the United States, without violating international conventions.

View of British Hospital Carrier "Prague", during one of its cross-Channel evacuation runs. Shuttles ran between Cherbourg and Southampton.

Procurement and Operation of Hospital Ships:

As stated before, the problem was that in mid-1942, Hospital Ships simply did not exist! There was an Army-Navy dispute over how many Hospital Ships should be obtained, and which service should build and operate them. As a result of these problems, the Joint Chiefs of Staff decided to procure only 3 Army Hospital Ships (General Dwight D. Eisenhower initially had requested 5 ships by April 43). After discussions, meetings, and lobbying from both services (Army and Navy) and based on an analysis of the various military operations, the Chiefs of Staff reviewed their initial decision and now authorized the Army to develop its own fleet of 23 Hospital Ships, USAHS, (most of them converted from other passenger and cargo types). Precious time had however been lost, and as refitting and commissioning went slow, the first US Army Hospital Ship only reached British waters a short time before the Normandy Invasion.

The initial 3 Hospital Ships ordered by the Army, and allowed by the Joint Chiefs of Staff only became available mid-1944 – they were named ‘USAHS Comfort’ (entered service Jun 44), ‘USAHS Mercy’ (entered service Aug 44), and ‘USAHS Hope’ (entered service Sep 44). They were Army-controlled, but Navy-built, commanded, and operated and were all earmarked for service in the Pacific (only the medical staff was Army personnel)! 
Continued deliberations, additional requirements, lack of decisions, took their toll, and not much happened. In spring of 1943, The Surgeon General again requested Hospital Ships for evacuation purposes (not to be used as floating hospitals, like the Navy did), and after thorough deliberation, this resulted in a decision to convert two smaller Troop Ships, the ‘USS Acadia’ and the ‘USS Seminole’ to Hospital Ships, and to register them under the Geneva Convention …
(additional planning contemplated 13 additional ships by 31 Dec 43, and 6 more by Dec 44). Unfortunately the program was never met!

Personnel chart showing the organization of a Medical Hospital Ship Company, as per T/O 8-537 dated April 1, 1942

According to T/O 8-537 dated April 1, 1942 the total Hospital Ship complement consisted of 12 Officers, 1 W/O, 35 Nurses, and 99 EM  (Medical Hospital Ship Company) i.e. 12 Officers – 1 Warrant Officer – 35 Nurses – 1 Master Sergeant – 1 First Sergeant – 3 Technical Sergeants – 3 Staff Sergeants – 3 Sergeants – 1 Corporal – and 87 Technicians. The Hospital Ship complement was subdivided into a Headquarters, a group of Administrative Sections (Registrar-Supply-Chaplain-Chief Nurse-Laundry-Mess), and another group of Professional Sections (Surgical-Medical-Laboratory-Pharmacy-X-Ray-Dental-Receiving & Disposition). Equipment varied according to the size of the complement, and generally included basic unit equipment and 0 to 4 expansion units (based on a 100-bed capacity). All instruments for major surgery, such as operating tables, lamps, autoclaves, inhalation, intravenous, and anesthesia facilities, skeletal tractions, gowns, and masks were stocked on board. Prescriptions, balance, mortar and pestle, graduates, pharmacy, centrifuge, microscope, incubator, refrigerator, dental equipment, laboratory equipment, typewriters, safes, tables, chairs, washing machines, laundry equipment, medical library, drugs, dressings, linen, pajamas, food trays, hot plates, ward cases, bed cradles, medicine cabinets, were all available, except motor vehicles. The ship was a genuine ‘floating’ Hospital.      
A new T/O & E 8-534 was drafted in 1944, allowing for separate Medical Hospital Ship Platoons consisting of 25, 50, 75, 100, 250, and 500-bed units, with manpower strength varying from approximately 1 Officer & 4 EM (25-bed unit) to 6 Officers & 45 EM (500-bed unit). These units provided medical care for patients being evacuated on regular cargo or transport ships on their return trip to their Port of Embarkation, and were in fact supplementary to the permanently assigned medical personnel on board of the transport.    
The Hospital Ship could only be used for medical purposes and was therefore painted overall white and marked with the Geneva Cross. It was to be unarmed and registered with both friendly and enemy powers, in accordance with the provisions of the Hague Convention of 1907.     

The very FIRST Hospital Ship to sail on its maiden trip, was bound for North Africa, it was  the ‘USAHS Acadia’ which departed on June 5, 1943, to be followed by the ‘USAHS Shamrock’ (departed 4 Sep 43) and the ‘USAHS Seminole’ (departed 20 Sep 43), all with the same destination. During  the early stages of the Tunisian Campaign (17 Nov 42 > 13 May 43) and as previously indicated, litter patients destined for the ZI were evacuated from Algiers and Oran to the United Kingdom on British Hospital Ships, while neuro-psychiatric and ambulatory patients were sent directly to the United States by unescorted Troopships. A total of 20,358 US Army patients were evacuated from N. Africa to the United States during 1943 (481 by British Hospital Ships, 3,593 by US Hospital Ships, 16,284 by US Transport Ships).

In North Africa, only British Hospital Ships were involved at first, as no American Hospital Ships were yet available, and transfer from shore to ship, was handled with help of LSTs. During the Invasion of Sicily, both the ‘USAHS Acadia’ and ‘Seminole’ were on call, with additional support from British Hospital Ships and Carriers, while evacuation from the beaches was again handled by LST. Evacuation from the Anzio Beachhead took place by LST to offshore British and American Hospital Ships and Carriers too. While the ‘USAHS Shamrock’ evacuated the majority of its patients to Oran (Algeria), the ‘USAHS Acadia’ and ‘Seminole’ were on site to return the most serious cases to the Zone of Interior.   

For D-Day, June 1944, Navy shore parties loaded casualties onto LSTs and other vessels for evacuation to England. Fifty-four out of 103 LSTs were converted to accommodate casualties (capacity 144 + 150 litter patients + 100/150 walking wounded).  LSTs received ample allowances of battle dressings, morphine, sulfa, whole blood, plasma, and penicillin, and on its outbound voyage each LST carried exchange units of blankets, litters, splints, plasma, and surgical dressings for the French beaches. There was still some apprehension however; indeed the LSTs had no Geneva Convention protection! Between D-Day and D+11, LSTs transported almost 80% of the wounded evacuated from Normandy. The casualties that were not, or could not be evacuated by LST, crossed the Channel on 4 British Hospital Carriers, i.e. converted ferries and coastal steamers, painted white and bearing Red Crosses (for Geneva Convention protection) which shuttled between Southampton and Utah or Omaha Beaches – they were the ‘Dinard’ (patient capacity 208), the ‘Naushon’ (patient capacity 300), the ‘Lady Connaught’ (patient capacity 341), and the ‘Prague’ (patient capacity 422). Since there were not enough ships to carry all the wounded, American and British authorities negotiated and secured a total of 7 Hospital Carriers and 2 Hospital Ships for the cross-Channel run.

Picture of British Hospital Carrier "Naushon" (converted American ferryboat with a capacity for 300 patients). Four British Hospital Carriers helped evacuate casualties from the American D-Day beaches.

After the landing in Southern France, initial evacuation was by LST to Ajaccio (Corsica), while the most serious cases were flown to Naples by air. On D+1, the first three US Hospital Ships arrived on call of the Seventh United States Army Surgeon, soon to be followed by more vessels, such as the ‘USAHS John L. Clem’, ‘Acadia’, ‘Shamrock’, ‘Thistle’, ‘Algonquin’, ‘Château Thierry’, and ‘Emily H. M. Weder’. In total 12 such vessels would at first operate out of Corsica, afterwards all ships embarked casualties at Ste-Maxime (S. France) and discharged American patients at Naples (Italy) and French patients at Oran (Algeria). As more fixed hospital beds became available with the fall of Marseille and Toulon, evacuation out of France became less necessary. Another change was the beginning of air evacuation on D+7 which greatly reduced the need for Hospital Ships!

After the Battle of the Bulge, and the new and final offensive against Germany, extra patients began overcrowding many Hospitals placing a strain on personnel and bed capacity. Cross-Channel evacuation looked impossible to improve, and sea evacuation to the United States was reaching its maximum capacity. More efforts were now aimed at obtaining additional transatlantic hospital-type accommodations, including enlarging troop capacity of ‘Queen Mary’ and ‘Queen Elizabeth’ liners, and converting 6 additional Troopships to Ambulance vessels. Air evacuation by C-54 transport aircraft achieved a long-promised rate of 2,000 patients per month. Evacuation numbers were now rapidly increasing; 24,666 patients crossed the Atlantic by plane and ship in January 1945, another 29,743 went in February 1945, and 30,410 returned in March 1945 … the ETO Hospitalization and Evacuation crisis was now over; lighter battle casualties and the opening of extra continental General Hospitals produced a steadily growing of bed capacity … but though the crisis had been overcome, the last offensive against Germany would entail more problems, as medical groups became unable to assume their responsibilities – by the end April 1945, the First United States Army controlled 216 German Military Hospitals, 4 German PW Camps, 22 DP centres, and 3 RAMP Hospitals; it not only had to deal with combat forces, but also to care for prisoners of war and non-combatants, and arrange for their evacuation. Meanwhile the front moved too rapidly for medical supply to keep pace, and air evacuation brought a partial solution …     
  
After May 1945 (V-E Day), patients tagged for quick return home were transported to the 1st General Hospital at Paris, airlifted to the Embarkation Hospitals at Cherbourg and Marseille for return to the United States by sea.
 
After V-J Day, Hospitals Ships which could be released from patient evacuation were to be employed as passenger vessels for repatriation of American servicemen and women.  

For further information regarding E.T.O. Hospital Ships, please view the artice found here.