In March 2018, a team of five UK Defence Medical Service (DMS) personnel deployed to Hawaii in order to take part in the US Navy-led PACIFIC PARTNERSHIP (PP18) mission. This was the third deployment of UK DMS personnel to this annual humanitarian and disaster relief preparedness mission and further supported a shift in focus into the Indo-Asia-Pacific Region.
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For the third time, the Royal Navy (RN) and broader Defence Medical Services (DMS) have deployed personnel to Pacific Partnership (PP), the largest Humanitarian Assistance and Disaster Relief (HADR) and Capacity Building mission in the Indo-Asia-Pacific region. The 2018 deployment (PP18) also represents a commitment to this region by the UK, especially as the RN is transitioning to an evermore global posture. The small team of five UK personnel may have formed only a tiny part of the 800 personnel involved, but the ability to use this mission as a means to influence and benefit UK interests should not be underestimated.
Much of the mission was planned, executed and delivered from USNS MERCY, an impressive 1000 bed-capacity Hospital Ship (Figure 1). Though predominantly designed to support US Navy (USN) and US Marine war-fighting operations, the MERCY, and her sister ship, USNS COMFORT, is on permanent 5 days’ notice to move to support humanitarian crises around the globe.
It was from the lessons identified from Operation UNIFIED ASSISTANCE, the US response to the 2004 Boxing Day tsunami, that PP was born. The need to have pre-existing relationships in place, an understanding and knowledge of national capability and, most importantly, the understanding of capability gaps and the areas at risk before disaster strikes and action is required, were thought to be key.
The Indo-Asia-Pacific region is described by the UN as the most disaster-prone region on the planet, and the requirement to be prepared for a planned response will remain for years to come.1 Now in its 13th year, the mission was largely based around the delivery of four key lines of effort: medical preparedness and knowledge exchange; engineering assistance; HADR training; and community relations. The achievements of the mission look impressive when considered at face value - over 550 separate events, involvement of over 8000 host nation personnel and the treatment of 12,000 patients. Engineers contributed by strengthening 13 schools and six healthcare centres, many of which double as regional emergency shelters. Alongside these two important activities, there was a specific focus on HADR training. Enhancing community relations with the local populations, through school visits, sports fixtures and band performances completed the package. Woven throughout were other key messaging strategies, such as Women, Peace and Security, Civil-Military Affairs and International Collaboration.
PP 18 was one of the more ambitious missions to date. Two ships were assigned to the task force, the hospital ship USNS MERCY and the Spearhead Class Transport-Expeditionary Platform Fast (T-EPF) USNS BRUNSWICK. Very much a Navy-led mission, the sites selected for 2018 were all chosen to maximise the projection of soft power which the MERCY can provide and, where necessary, deliver strategic intent.
The mission covered much of the Western Pacific, with visits to the Federated States of Micronesia, (Ulithi and Palau), South East Asia (Indonesia, Malaysia, Vietnam and Thailand), across the Bay of Bengal to Sri Lanka and up to Japan, before returning via Hawaii for Ex RIMPAC and the completion of the six-month deployment back to San Diego (Figures 2 and 3).
As well as the US and UK personnel, 11 other partner nations were involved including military personnel from Japan, Australia, Canada, France, Thailand, Chile, Singapore, Sri Lanka, South Korea, the Philippines and Peru.
The DMS team was comprised of three MS Officers (MSOs), one from each Service, and two medics, including one Petty Officer Medical Assistant RN and one Corporal RAMC. In addition to the DMS personnel, the UK was also offered the chance to fill the Deputy Commander’s appointment, with Captain Peter Olive OBE RN leading and being responsible for delivery of the mission from USNS BRUNSWICK, the first time a USN platform has been commanded by a non-US serving officer.
Deploying in March 2018 to meet USNS MERCY in Pearl Harbour, the team members were rapidly immersed into the mission programme. The MSOs were tasked to provide mission planning, MEDEVAC coordination and administration support, while the two medics worked within a very small team of first aid and healthcare trainers on board USNS BRUNSWICK. Some amazing locations were visited, but these were the busiest times for those on the mission, so there was little opportunity to enjoy each country.
The strategic intent of the mission is easy to understand, especially if one examines a globe with Guam in the centre; classical strategic choke points, international rules-based access and transits abound throughout this region. From an operational level, there is a significant drive to move away from earlier mission strategies of simply undertaking medical capability (MEDCAP) activity, with the aims of capacity building and knowledge enrichment. Every mission stop is planned to ensure that any medical or HADR project is delivered alongside, or assisted by, local military or healthcare providers. At a tactical level, the mission’s healthcare providers are provided with the opportunity to conduct surgical interventions on board a Hospital Ship, and instead of training serials, engage with local healthcare providers and develop (sometimes) lasting professional relationships.
For the medics attached to the BRUNSWICK, their main role was conducting basic first responder training as well as more focused education for remote providers. However, on one occasion real time emergency medicine support was provided to a local national who needed life-saving treatment. This is part of life on these remote islands and just one of many events where fate and the presence of US and Partner Nation medical support made a significant difference.
In addition to the medical and HADR operations, another important part of the mission was to enhance Community Relations, known colloquially as COMRELs. These events further support the PP18 mission and aim to help break down the stigma of (US) military forces, helping both locals and military staff to understand the respective cultures and customs, aiming to provide a lasting impression in the region.
For everyone deployed from the UK, the mission provided some unique and lasting memories. One of the most amazing experiences was being the first RN Officer to visit the Pacific atoll of Ulithi since it was used as a secret naval base by the USN and RN during World War 2.
What has PACIFIC PARTNERSHIP 18 achieved? During the 16,000 miles travelled by the MERCY and the BRUNSWICK, the mission conducted over 31 HADR training events and exercises in seven main mission stops, providing treatment to over 12,000 patients and interactions with over 8,000 providers. It has delivered multi-national preparedness in the response to disasters, increased local capacity and improved the relationships between governments, militaries and communities.
From the planning perspective, working in an HQ which had US leadership, a UK deputy, an Australian Chief of Staff and a Peruvian operations lead made for an interesting mix. The adage of ‘two nations divided by a common language’ was played out in almost every meeting.
In terms of the future, PP 19 is likely to be the last time the USNS MERCY is used in support of this mission, and there is a realisation that there needs to be more conscious linkage of operational and regional plans. USAID (the US equivalent of the Department for International Development, DFID) is not routinely involved in programme design or delivery, and the 20-year United Nations (UN) regional strategy (Leave No One Behind) was not widely understood.
Although ‘medical’ will still be a line of effort, it will be a lesser component. HADR and its links with other regional plans and strategies will become the dominating function of PP. The start of this transition occurred in Indonesia, when the MERCY hosted a UN Civil-Military Coordination Course on board the ship - a first for the UN and the USN. Long-term collaboration, tied in with local and regional plans, will become the norm. From a UK perspective, this will offer opportunities for engagement for medical staff, engineers, civil affairs and operational planners. These areas will ensure that the UK can contribute optimally to future PACIFIC PARTNERSHIPs.
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