Mobile Army Surgical Hospital

Alan Duncan Excerpts

Wednesday 9th October 2013 Commons Chamber

[The Minister of State, Department for International Development (Mr Alan Duncan)]

I thank my hon. Friend the Member for Bracknell (Dr Lee) for introducing this debate on such an interesting topic. Put simply, I entirely agree that military field hospitals could play a vital role in any international humanitarian response. Indeed, the Department for International Development has collaborated with UK forces in humanitarian responses over many years, for instance in Bosnia, which is well known to my hon. Friend the Member for Beckenham (Bob Stewart), East Timor, Kosovo, Iraq, Afghanistan, Pakistan and Haiti, to name some of the more notable examples.

DFID, the MOD and the armed forces continue to co-operate closely. Since 2007, that co-operation has been codified in a memorandum of understanding that sets out how DFID and UK forces will work together. Its main principles are that DFID will lead the UK response to overseas disasters, that it can ask the MOD for military support if necessary, and that the MOD will charge DFID only the additional operating costs for, for example, ships or aeroplanes, and not the full capital costs. In requesting military support for overseas disasters, it is clearly understood that UK defence requirements will always take precedence.

Alongside that established framework of co-operation, the two Departments have made explicit provision to use military field hospitals if required. DFID has agreed with senior military medical colleagues that, subject to defence priorities, military field hospitals may be deployed as part of a humanitarian response by DFID. To that end, DFID has visited the Army’s 34 Field Hospital at Catterick garrison, which is the MOD’s designated rapid response field hospital. DFID has held detailed practical discussions with it and has contributed to its humanitarian training and preparedness.

Importantly, it must be understood that the deployment of a military field hospital requires substantial logistical support. It might also require a considerable force protection package, which would have a bearing on the location and appropriateness of the facility. Our experience is that the use of any military asset is expensive. Issues around permission to operate and the command and control of such a facility would need to be agreed with the receiving nation, which would inevitably prove more complicated with a military facility than a civilian one.

[Stephen Barclay (North East Cambridgeshire) (Con)]

The Marshall facility in Cambridge specialises in building modular medical equipment. Is it not a key point that the initial funding for the equipment could come from the DFID budget under the existing definitions, which might ease the concerns of other countries about the military aspects of the facility?

[Mr Duncan]

Spending on humanitarian matters is official development assistance, so in that respect my hon. Friend is right. However, we must also show that there is value for money and we must know that the assets can be appropriately deployed. I will discuss that issue further.

DFID has worked on the ground alongside UK forces in Bosnia, Kosovo, Sierra Leone, Iraq and Afghanistan. DFID has also used Royal Air Force aircraft and helicopters in earthquake and flood relief in Pakistan, and in sending search and rescue teams to Indonesia. The Royal Navy was able to make its Royal Fleet Auxiliary Largs Bay ships available to help with relief after the Haiti earthquake.

So far, UK military field hospitals have not been deployed under the auspices of DFID. However, the way it would work is that DFID would request the support of the MOD in response to a natural disaster, in accordance with United Nations guidelines known as the Oslo guidelines. Those guidelines stipulate that support should be provided in line with the humanitarian principles of impartiality, neutrality, humanity and independence. They also state that military assets should be requested only where there is no comparable civilian alternative. That implies that the military asset must be the only way of meeting the particular need and that its use should be a last resort.

DFID has to design its humanitarian responses carefully according to the specific humanitarian needs that they face and based on what responses are best provided by the UK and by other donors. Very often, what works best is help to restore and rebuild an afflicted country’s own health system. If a field hospital is needed, there are already well established civilian organisations that are used to providing such hospitals in humanitarian crises, notably the International Red Cross, which has been mentioned.

A civilian response will usually be what is needed in a delicate and complex situation, rather than a foreign military presence which, however well intentioned, is still military and may not be welcomed. For example, in Pakistan, which has also been mentioned, it was a difficult, finely balanced, decision to include RAF aircraft in the NATO relief airlift, when extremists had explicitly threatened the foreign relief effort and relief workers if NATO were to operate in that country. Like other international donors, therefore, while we are glad to have military field hospitals available, we will use them as a last resort, when it is too difficult or dangerous to use civilian measures and if the circumstances permit a military medical unit to be deployed.

DFID has also been building a UK civilian medical response capability. UK surgeons and other medical staff performed heroically in Haiti after the earthquake in 2010, saving lives and limbs which might otherwise have been lost. Building on that experience, DFID is supporting a programme of training and regional workshops for NHS doctors and other medical staff to equip them to deal with the additional challenges of surgery in a conflict zone. That is underpinned by an arrangement with the Department of Health and the national health service to deploy surgical trauma teams drawn from the British health service. Many of those personnel will also be military reservists, thus further exemplifying good civilian/military co-operation across Government.

My hon. Friend specifically mentioned the Syria crisis. As the House is aware, the UK Government’s relief response is considerable. The UK has so far pledged £500 million, making us the second largest donor. Much of that relief is to provide health and medical care. Through our funding we are supporting vital medical help on civilian channels and with civilian medical personnel, not all details of which can be openly revealed. I can say, however, that the range of services provided by DFID is wide and big. It includes ensuring the running, supply and necessary specialist training for a large number of emergency surgical facilities, including in remote areas. For example, we are supporting primary health care centres to help look after vulnerable groups such as women and children, as well as the elderly, who often have chronic unmet health needs. In Syria’s neighbouring countries, which now host more than 2 million refugees between them, DFID-supported health programmes provide medical evacuations and ambulance services, widespread primary health care facilities, mental health and psycho-social services, and highly specialised facilities for victims of sexual and gender-based violence.

We provide specialist training courses for health professionals, many of whom are specialist staff seconded into emergency departments to reinforce their capacity and specialist care. We provide health services for refugees, as well as for vulnerable resident populations that are hosting huge numbers of refugees in their communities. DFID and MOD officials are in frequent touch in London and the region, and the need for and suitability of mobile field hospitals is often discussed. While options remain open, it is agreed that deploying a mobile field hospital at the moment would not be the most effective way to reach the diverse needs faced by so many people in so many different locations.

DFID’s new civilian surgical trauma facility also remains an option, but so far it has not been necessary to deploy a surgical team in any of the refugee-hosting countries. Inside Syria, the level of conflict makes access to health care difficult in many areas, and unfortunately the security challenges also prevent the deployment of a field hospital or a civilian UK surgical team. DFID will therefore continue to support existing health facilities on the ground, and constantly review the situation.

[Bob Stewart]

Does DFID have the capacity to deploy not just a surgical team, but the equipment and some primary buildings in support of that team? Is that what my right hon. Friend is referring to?

--- Later in debate ---

[Mr Duncan]

I like to think that DFID is well prepared always to procure and lay its hands on any such equipment, to which end many framework contracts permit us to draw at short notice on many companies’ equipment so as to do whatever is appropriate in whatever humanitarian situation we face, be that an earthquake, a tsunami or a conflict.

In conclusion, the Government value their ability to deploy military surgical teams as an important option, additional to other means of response. DFID’s response is based on the needs of the affected population, and so far the need for a UK military field hospital has not arisen. If it does, we remain ready to respond as required in the best and most appropriate way.

Question put and agreed to.