The Memorandum below was approved for implementation by the Commander, Third Fleet, on 22 July 1999. Minor modifications have been inserted as the mission details have unfolded.

MEMORANDUM

From: Fleet Surgeon (J00S), Third Fleet

To: Commander, Third Fleet

Via: Chief of Staff, Third Fleet

Subj: MISSION CONCEPT: USNS MERCY (T-AH 19) Humanitarian “Mission to the Americas”

1. SUMMARY: This document contains plans for deploying the USNS MERCY (T-AH 19) on a humanitarian mission to the west coast of Central America. The mission requirement is established as an adjunct to the Third Fleet engagement strategy, and has been developed by the Fleet Surgeon, THIRD Fleet, in concert with the principal officers aboard MERCY, with Naval Medical Center San Diego (NMCSD), and with several other likely participants.

2. BACKGROUND: The hospital ship USNS MERCY participated in Kernel Blitz ’99 as an Echelon Three Medical Treatment Facility (MTF) afloat, and was used both for large numbers of exercise casualties (in excess of 200 aboard at one point) and as a real-world casualty management facility. In both efforts MERCY was strikingly successful, and her participation contributed materially and significantly to the success of that amphibious exercise.

The Third Fleet Commander, VADM McGinn, was aboard for a portion of the casualty management phase of Kernel Blitz ‘99 and received both a comprehensive tour of MERCY and a review of her capabilities. In recognition of the asset the United States has in MERCY, he requested that a plan be developed to deploy MERCY to the west coast of Central and South America. The mission basis would be four-fold:

a. to deliver appropriate medical care to those in need, in close cooperation with existing Host Nation and non-governmental organization (NGO) medical providers, and with the guidance and assistance of the US Department of Defense and the US Department of State.

b. to train Joint US military medical providers in a humanitarian scenario that reflects missions seen by the US military through the past decade.

c. to train a Joint Task Force Battle Staff in the support of a purely humanitarian mission, exercising the decision processes required to manage the uncertainties found at the Operational level of Civil-Military Operations.

d. to enhance regional and international positive regard for the leadership by the United States. Our recognized position obligates us to do well by our allies in ways that strengthen our mutual political, economic, social, and cultural goals. Assessments by the World Bank and the International Monetary Fund have shown that the delivery of medical care to an under-served population can do much to enhance the capability of a developing country to achieve self-sustainment. This will be a significant and direct contribution to that effort.

3. HISTORICAL REVIEW: USNS MERCY, one of two hospital ships in the Navy, is a converted San Clemente-class oil supertanker. She was designed to function as a 1000-bed trauma center for managing casualties in a Major Regional Conflict. In the years since her conversion in 1986, her original mission has been largely supplanted by changes in the political structure of the world, and her broader foundation as a general medical treatment facility has risen to the fore.

As it happens, and in agreement with VADM McGinn’s current impression, MERCY’s exceptional capabilities as a humanitarian relief ship and a national political asset were recognized with her maiden voyage to the Philippines in 1987. During that deployment, tens of thousands of patients were treated by MERCY in three Philippine ports over four months with a very long trans-Pacific transit. That mission was openly published as a political statement in support of the government of Corazon Aquino.

4. PRESENT MISSION: This Year 2000 Mission to the Americas will be far simpler. It will be relatively short, relatively local, and relatively low-cost. It can also be highly effective due to several fortunate circumstances, giving a very good return on investment:

a. There is a recently formed “Joint US Military Working Group on Humanitarian Assistance to the Americas”. A conference on the subject was held in Santiago, Chile in 1998, and the project infrastructure for the MERCY mission is, therefore, already present. We are in contact with several of the conference participants and each has volunteered support.

b. MERCY recently achieved and sustained Full Operating Status under simulated wartime conditions (in Kernel Blitz ‘99) with all systems, manning requirements, and operating doctrines tested and found ready to answer all bells. That significantly reduces the workup time required to prepare for this deployment.

c. A number of organizations have recently accrued significant experience in Latin America as a result of Hurricane Mitch relief efforts. We are working with several of them to tap their knowledge early in the planning process.

d. Third Fleet has an International Liaison Officer Program, with Latin American Host Nation expertise already present on staff. That simplifies international logistics considerably and ensures that we will be informed of developing pitfalls early and often.

e. Fuel is a major expense in any naval mission of this magnitude. Fortunately, on 11 May 1999, Third Fleet was able to budget for the provisioning of all fuel required for the duration of the mission as a contribution to the humanitarian effort. In one stroke, that significantly reduced the overall cost of the MERCY humanitarian mission and thereby erased some of the initial funding hurdle.

f. This mission can have several useful facets because the request for the mission has been generated by a Numbered Fleet Commander in support of the Theater Engagement policy. The location of the mission crosses from Third Fleet’s ocean into SOUTHCOM’s land, so there is an opportunity for complex emergency coordination across boundaries rarely transgressed. We anticipate a significant degree of collaboration with SOUTHCOM so, in addition to the pure medical effort, the mission will also serve as a Humanitarian Mission Task Response exercise, a Joint Task Force exercise for combined Fleets and combined CINC’s, a training opportunity for host nation militaries, a test of the Civil-Military Operations Center concept aboard both a hospital ship and a Fleet Command Ship (and so the difficulties of meeting Geneva Convention standards), an integration exercise with Joint US militaries, host-nation militaries, and International Organizations (including IFRC, UNICEF, WHO, CDC, and CARE), and a Joint Reserve integration exercise.

g. The Center of Excellence for Disaster Management and Humanitarian Assistance co-chaired the Asia-Pacific Disaster Conference in September of 1999. At that Conference, several UN organizations expressed interest in participation as observers and mentors. Those agencies wish to help us understand information management and coordination guidelines for complex emergency response. Subject to the approval of the appropriate command structure, we’ve agreed to their participation.

With recognition that a humanitarian mission in the summer of 2000 is well placed to take advantage of each of these circumstances, we envision a mission as described below.

5. MISSION CONCEPT:

a. MERCY will depart San Diego on 01 October 2000.

b. The mission duration will be 49 days. Seven weeks.

c. MERCY will call at three ports in three countries, spending a bit more than 10 days in each port. The ports that meet criteria very well are Puerto Quetzal in Guatamala, Acajutla in El Salvador, and Corinto in Nicaragua. Each will be evaluated with the US Department of State, the Department of Defense, SOUTHCOM, the host nations involved, and the international organizations now providing care in those countries.

d. MERCY is strongest in her surgical capabilities for definitive care and that will be our most effective focus. She will serve as an aid and an augmentation resource to existing healthcare facilities within the host nation. She will not work alone, but rather in concert with those already providing care. Our intent would be to expand their capabilities to deliver care to their patients and to ensure those local providers can take an active part in such assistance as MERCY can provide.

e. The medical staff will take every opportunity to train local providers in subjects where we can offer expertise. We can, for example, train trauma life support techniques, methods of advanced life support for cardiac emergencies, pediatric and neo-natal resuscitation techniques, lab, radiology, and blood-banking techniques, medical equipment repair, respiratory therapy, and sanitation, just a representative examples. We thus hope to enhance the future delivery of care locally after MERCY’s departure.

f. MERCY will carry donated medical supplies to each site in an effort to improve the longer-term capabilities of the local providers. Those supplies will be jointly identified and supplied though host nation, NGO, DoS, DoD, academic, and philanthropic collaboration.

g. MERCY will be staffed to support six Operating Rooms, a six-bed ICU/PACU, 50 ward beds (with some overflow flexibility up to 100), and with staff to manage a large additional outpatient population. We estimate a total shipboard staff of about 425.

h. MERCY will bring a Joint military medical staff, using MERCY-assigned medical staff to the extent possible without compromising source MTF care. We anticipate close and frequent coordination with Naval Medical Center San Diego, the staffing source MTF, during all phases of development and implementation. Navy Medical Reservists and medical providers from other Services will be used where appropriate to fulfill the mission. Civilian NGOs will provide advice and assistance in the development of the mission but will probably not be afloat. We anticipate supporting the NGO teams already in-country through close planning and detailed mission collaboration.

i. The medical care delivered will be coordinated through State, Defense, Host Nation, and NGO collaboration, with the recognition that little can be achieved without the help of those who know the needs of the area best.

j. The areas of care that can be delivered by the organic medical assets aboard MERCY when she is loaded for surgically-focused humanitarian assistance include the following:

1. General Surgery

2. Burn Surgery (severe burn scars are a common problem in a cooking-fuel economy)

3. Orthopedic Surgery

4. Pediatrics and Pediatric Surgery

5. Dermatology

6. Tropical Infectious Disease

7. Plastic and Reconstructive Surgery

8. Gynecology and Gynecologic Surgery

9. ENT Surgery

10. Eye Surgery

11. Optometry

12. Physical Therapy

13. Dental Surgery

14. Immunizations

15. Eyeglass Construction

16. General Internal Medicine

17. Anesthesia and Pain Management

18. Preventive Medicine and Public Health

k. The mission will be coordinated through Third Fleet and SOUTHCOM, and will allow the testing of reachback capability to the Operational level (CJTF) Joint Medical Center, Joint Logistics Center, and Civil-Military Operations Center (CMOC) at Third Fleet, and similar organizational structures at SOUTHCOM. That CMOC effort will be augmented with the training of host-nation militaries and international organizations in our coordinated response to humanitarian relief.

6. FUTURE PLANS OPTION: The planning for the mission will incorporate the outline of resources necessary for the inclusion of other Services and other “Rim of the Pacific” locations. Of particular interest would be future planning for the expansion of the return trip to include a broader geographic area, yet to remain within the AOR for Third Fleet. While not anticipated for this mission, the understanding of the means by which MERCY could render effective assistance to Easter Island, the Cook Islands, and French Polynesia, incorporating both associated nations and US military resources, might prove invaluable

7. FUNDING: The cost of the mission is built on a seven-week deployment for a ship nearly as large as an aircraft carrier, with four days each of preparation and stand-down, a rotating staff of 425 to run a 100-bed hospital afloat, the supplies necessary for treating thousands of patients in three countries, a security detachment, small-boat transfer capability, normal ship services (non-medical), and travel costs to rotate staff though the mission. That cost has now been significantly reduced by the provisioning of all necessary fuel by Third Fleet, and the costs are being adjusted accordingly. The ongoing cost refinement will continue throughout the pre-deployment planning, but the current estimate is very close to $3.4 million for the entire mission, start-to-finish.

8. MISSION RESPONSIBILITY: The Fleet Surgeon for Third Fleet has responsibility for all initial mission planning:

LCDR Eric Rasmussen, MC, USN (Code J00S)

(619) 524-9541 voice shipboard

(619) 925-7701 cellular

(520) 752-0592 e-fax

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