Strategic Mercy: The Case for Japanese Hospital Ships

The 2013 deployment of Japan’s gleaming 10,000-ton hospital ship auxiliary of the Maritime Self-Defense Force, the JS Tomodachi, to the Philippines in the wake of the disastrous Super Typhoon Yolanda was a turning point in the use of Japan’s soft power. Arriving early, well before China’s hospital ship Peace Ark, it demonstrated in non-military terms Tokyo’s growing commitment to Southeast Asia. While smaller than China’s 14,000-ton vessel, Japan’s hospital ship provided urgent, on-site medical services to the Philippine population.

Japan’s support furthermore provided a necessary counterpoint to China, which is new to the use of constructive soft power, but likely to learn its lessons soon. Beijing was at the time heavily criticized for the paucity of aid it initially provided and the tardiness of its response. Commentators nearly-uniformly noted that Beijing is locked in a bitter territorial dispute with Manila over the nine dash line, Second Thomas Shoal, and other maritime features in the South China Sea, and insinuated Beijing was punishing the Philippines for the dispute. China is, after all, rarely accused of understanding or effectively executing soft power. Even if it is not true that Beijing was tardy because it let political squabbles override humanitarian support, that the accusation made sense to so many reputable publications is damning.

Japan’s presence is only growing in Southeast Asia, home to a globally important sea line of communication but far removed from Japan’s immediate neighborhood. In the last two years alone the Self-Defense Force has increased both its presence and activities with port calls, exercises, and presence operations concurrently with new government outreach. This is almost assuredly designed to show the region that the Washington-Tokyo partnership is a credible counterweight to unsubtle Chinese allusions to its inevitable regional hegemony. The presence and activities of the Tomodachi not only strengthen this allied argument, but allow the United States Navy’s two hospital ships Mercy and Comfort to function in different theaters and respond to more disasters. It also underscores Japan’s political desire to do more for the U.S.-Japan Alliance and show the relationship has more than just military dimensions.

The only problem with Japan’s use of the hospital ship Tomodachi is that it doesn’t exist.

Tokyo’s lack of a hospital ship is nearly inexplicable. Any otherwise informed observer, if asked to name the countries that possess hospital ships, would probably list Japan with the United States. It is a platform and a service seemingly tailor-made for Japan’s situation: Quasi-military in nature but unarmed, humanitarian focused but crewed by Self-Defense Force personnel, providing operational experience to its crew but unobjectionable in execution, and a public expenditure that Japan’s population could support. Yet, Japan does not have one – but it needs one for both domestic and international reasons.

A hospital ship capability would further increase Self-Defense Force prestige in broader civil society. The Japanese population as a whole is no longer as sensitive to defense expenditures as it has been, but it still casts dubious glances at new military capabilities.  Much the same way that the Self-Defense Force’s well-publicized and brave response to the March 11, 2011 “triple disasters” dramatically increased its public standing from an almost perfunctory aspect of modern society into what is now the most trusted institution in the country, it would be difficult for even the most pacifist holdouts or cautious National Diet constituency in Japan to argue against a hospital ship for the country. There is no doubt its operation would be a boon to the SDF’s image and credibility every time a daily newspaper published a story on its work.

As Kenneth Spurlock, a naval officer attending Japan’s National Institute of Defense Studies, pointed out almost a decade ago, Japan needs a hospital ship for its own purposes anyway. The country is situated precariously on the Ring of Fire and suffers regular natural disasters that would enervate a less developed nation of similar mountainous, sometimes inaccessible terrain. If Japan had possessed a hospital ship during 3/11, the response would have relied less on the United States and aid probably would have arrived sooner to the stricken. More recent natural disasters, such as the recent Kumamoto earthquake, demonstrate the utility of a hospital ship for Japan so clearly that further argumentation along this line seems a distraction.

The Maritime Self-Defense Force naval standard, still a rising sun, on a hospital ship providing emergency relief after a tsunami in Bangladesh would send a strong signal and assist in rehabilitating the flag’s image. The inevitable Chinese criticism will be that Japan is just perfecting its overseas operating and logistics capabilities under non-military cover. Japan’s four helicopter-carrying destroyers in the 180 series are obviously aircraft carriers, Beijing’s various state-controlled news outlets report, and the region should worry about the blatant political-semantical fraud Japan is playing with its hull classifications as it remilitarizes.

Undeniably, this characterization is partially true. But it is should be immaterial next to potentially broader and impactful policy aims. U.S. policy supports a growing Japanese defense capability that supports the alliance and reassures the region. This is evidenced by Washington’s statements of support for Japan’s recent package of security legislation, such as collective self-defense, and praise for its outreach in Southeast Asia. That the Self-Defense Force will gain much-needed operational skill and will need to develop its logistics infrastructure to support overseas deployments on such a massive scale should be a deciding factor in its favor for U.S., Australian, and other policymakers to lobby Japan to create a hospital ship.

Moreover, it would demonstrate to the Japanese the non-military aspects of a growing Japanese military role in Southeast Asia and remind them that military normalization must not entail a return to the specter of Japanese aggression that is farcically raised by some. Normal militaries of sufficient power, size, standing, and respect have hospital ships. That Japan does not have one, the argument may go, is the oddity.

A hospital ship would also provide joint, intra-service training to a Self-Defense Force that certainly needs it, but in a relatively benign operational environment. As the United States learned from its own experience in the joint realm, these capabilities and competencies grow from the routinization of joint operations, an understanding of their necessity, and command requirements.  Much like amphibious capabilities are inherently joint in planning and execution, so too are hospital ship operations. The commanding officer will always be a Maritime Self-Defense Force captain, but no service in Japan has more experience in humanitarian assistance-disaster relief operations than the Ground Self-Defense Force (the author has a Self-Defense Force recruiting pamphlet offered him in 2006 that emphasizes the ground component’s disaster relief mission – and this was pre-March 11). The GSDF will run relief operations on the ground and their doctors, corpsmen, and medics would work side by side with Maritime Self-Defense Force and civilian personnel. Conducted properly, it could even serve as a cornerstone for a reservist corps.

If this goal is realized, it is likely a bureaucratic turf war will ensue in which Japan’s more prestigious, established agencies and ministries such as the Japan International Cooperation Agency or the Ministry of Foreign Affairs will attempt to hijack or encumber operation of the hospital ship program for their own ends. This must not be allowed to occur. The hospital ship should be an established auxiliary of the Japan Maritime Self-Defense Force, staffed with reserve doctors from all three services as well as civilians. It should be answerable to the cabinet and act in concert with national objectives as a strategic political asset. No other agency in Japan has the resources of the Self-Defense Force to build, operate, and maintain a hospital ship. For operational advancement, political objectives, and regional security, it is time this idea be given the policy consideration it deserves.