Mobile Army Surgical Hospital

Bob Stewart Excerpts

Wednesday 9th October 2013 Commons Chamber

[Dr Lee]

I was going to come to that. I see it as being a reserve force, not part of the regular Army, although I suspect that there will be some logistics staff maintaining the kit and the facility.

[Bob Stewart (Beckenham) (Con)]

I had a field surgical team under my command in Bosnia in 1992-93. It was absolutely vital, and it was operated by a mixture of regulars and territorials. We must not think that this is necessarily soft power, because it needs security and it needs to be guarded.

[Dr Lee]

I thank my hon. Friend, who of course has a wealth of experience in the field in this matter. I was also going to come to the need for security. In the discussions I have had since I first mentioned this at Defence questions, there has been some disagreement about the level of security required.

The broader point is that this is about the re-tasking of our armed forces. Clearly a lot of change is going on at the Ministry of Defence and there are some cuts to regiments and to forces, but there is also a need to reconfigure forces so that they are interested in delivering not just hard power but softer power. Ultimately, in any response to a crisis—it could be a natural catastrophe such as an earthquake as well as the civil war in Syria—there needs to be joined-up thinking across all the parts of Government that would be involved.

--- Later in debate ---

[Dr Lee]

Yes, I do. In fact, the last American MASH unit was deployed in response to the 2006 earthquake in Pakistan and it was then given to the Pakistanis. I would hope that the facility would be used less for military purposes. There are likely to be future crises and I think it should be used in response to them.

[Bob Stewart]

I am sorry to intervene a second time, but it strikes me that, if this facility is going to work, the way to demilitarise it would be for it to be connected to the British Red Cross or the International Committee of the Red Cross. That way it would certainly get some kind of international protection in terms of security.

[Dr Lee]

I have detected in conversations that there are difficulties with non-governmental organisations being associated with military assets, so that needs some thought.

[Bob Stewart]

We did it.

[Dr Lee]

I am personally not against it, but I gather that there are difficulties.

Why do we not have such a facility? I wonder about that. DFID has global respect and does good work. There are issues with DFID funding—I am thinking of audit trails in sub-Saharan Africa and the like—and concerns have been expressed on where the money eventually ends up. In this situation, we can spend the money here at home for humanitarian aid. As I understand the definition of international development funding, that is acceptable. Indeed, we could use Marshall of Cambridge—my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) has joined us in the Chamber. We could buy the facility new at home, and DFID money could, as I understand it, be used for such a humanitarian purpose.

Why is that not happening? Is it silo thinking? Is it to do with DFID not talking to the Ministry of Defence or the Foreign Office? If that is the case, we have a responsibility to try to overcome such bureaucratic hurdles. I recognise that the MOD has concerns about the long-term liability of cost and staffing. I am sure the NHS will have questions, such as, “You’re taking my orthopaedic consultant. Who’s going to do his list?” There are problems, and I have not come to the Chamber with a perfect project outlined and ready to go, but I see no reason whatever why the project cannot be brought about. If we could establish a British MASH unit with a Union Jack on the side of it, it would be fantastic for this country. Our reputation would be enhanced, and such a facility is clearly desperately needed in Syria and the surrounding countries. We are dealing with a significant humanitarian crisis. I know the Minister and his Department are responding in a good way, but that added capability would be much valued. We can do it and do it well.

I shall conclude with a quote which, of course, has to be from “MASH”—I was expecting to turn up in the Chamber to hear hon. Members humming the tune. The quote is from Hawkeye Pierce, the primary character in the series.

“I’m very impressed now with the terrible fragility of the human body and the unbelievable resiliency of the human spirit.”

By creating such a capability, we would display the best facets of that human spirit—we are all human beings. The quote comes from an episode titled, “Our Finest Hour”. If we were to bring that capability about, it would play a part in creating a further finest hour in the history of this country.

--- Later in debate ---

[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?