Mobile Army Surgical Hospital

Phillip Lee Excerpts

Wednesday 9th October 2013 Commons Chamber

[Dr Phillip Lee (Bracknell) (Con)]

I never thought I would see the day when the words “Mobile Army Surgical Hospital” would be the title of a debate of mine. I grew up watching the television series “MASH”, which partly inspired me to become a doctor. I want to make a serious proposal about a capability that this country should be able to deploy abroad. I started thinking about the issue following the Syria vote in August. I voted against both motions before the House that day. After that, I thought that I should come forward with a constructive suggestion for our engagement with the crisis in Syria. This is my suggestion.

I will present a history of field hospitals in general—just a brief one; don’t worry—and discuss the humanitarian response capability that we need. I shall then mention the challenges of bringing that about and, perhaps more importantly, the details of the facility.

I became a doctor for a number of reasons, but a couple of things spring to mind. One is a book called “The Red and Green Life Machine” written by a commander in the Royal Navy, a chap called Rick Jolly. The title refers to a field hospital in the Falklands war, set up in a disused abattoir in San Carlos bay. I read the book when I was about 13. I watched every single episode of “MASH” and developed desire and ambition—initially, to become a trauma orthopaedic surgeon. I subsequently went to medical school and decided that I would be a GP. What inspired me was the desire to do something to help people in distress.

However, I stress that I am no pacifist. I did not vote in August against the intervention lightly; in fact, I am in favour of quite significant intervention if it is well thought through, coherent and backed up with a strategy for the region. However, I am against the wilful, somewhat reckless destruction of assets in a small way because that can breed more problems going forward.

We are experiencing the ongoing crisis in Syria through our TV screens. I first visited the country in 1998 and I went back as vice-chairman of the Conservative middle east council in February 2011, about three weeks before the civil war started. I have a sense of association with the country. I enjoyed both my visits—particularly the first one, when I was backpacking around as a medical student. I visited Homs, Hama and the beautiful parts of Aleppo that I fear are no longer intact. When I came back from my second visit, I was gripped with a sense of foreboding that trouble was about to start, although not as quickly as it did. I also felt the sense that Britain’s engagement with the country in its crisis should be constructive and trying desperately to bring about a peaceful end to the war.

The problem is that since then there have been more than 100,000 deaths and more than 2 million people have migrated away from the chaos. There has been one public use of chemical weapons, and it has been suggested that there have been others. We have all had to endure some pretty appalling footage of death and destruction, primarily affecting innocent civilians—women and children. It is pretty shocking to have to endure it.

Our response should be multi-pronged. We could foresee a situation in which hard power is wielded, but soft power should also be considered. This is where I come to the MASH or mobile surgical hospital facility that I envisage for Britain. The history of field hospitals goes back to the Napoleonic wars and the gentleman called the father of combat medicine, Baron Dominique Jean Larrey. From that concept of forward surgical hospitals bringing medical support to combatants at the front line, things developed slowly. I guess that the fastest development took place during the Korean war in the early 1950s; the “MASH” TV series is based on that war, although it was always associated with the Vietnam war because of when it was made. During the Korean war, major developments were made in pushing field hospitals closer to the front line. There was the famous image of a Bell helicopter with two casualties strapped into stretchers on either side, with the purpose of bringing people back to be treated very quickly. The dictum was, “Life takes precedence over limb, function over anatomical defects.”

Since then, there have been massive advances. I have not yet visited the hospital at Camp Bastion in Afghanistan, but I am told that it is a remarkable facility delivering the very best trauma care. Of particular note to Britain is our experience in Kosovo in 1999, where the British Army managed to create, in effect, a tented village for a load of refugees as well as medical facilities. It was a fantastic success, and proof of what our military are capable of.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this innovative idea to the House for consideration. I have a Territorial Army ambulance unit in my constituency and they are renowned for the good work that they have done and can do. Does he see the MASH unit being staffed by regular soldiers or TA soldiers, because I believe that both could do the job equally well?

[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.

[Jonathan Lord (Woking) (Con)]

I congratulate my hon. Friend on securing this debate and on the excellent idea that he is putting forward, which has my full support. There have been big increases in the budget for our international development funds but quite severe decreases in the defence budget. Perhaps this is a question for the Minister rather than my hon. Friend, but is there not a strong argument that when the Army is deployed on humanitarian grounds the money should come out of DFID’s budget rather than the Ministry of Defence’s budget?

[Dr Lee]

Yes, I was going to come to that. There should be a DFID-funded capability.

The capability needs to be constructive. A friend of mine has talked about having blue overalls, not blue helmets. In other words, we have a United Nations force with blue helmets, so why do we not have a force of people in blue overalls? Our intervention should not necessarily be military in appearance—we can also intervene in other ways. The capability should be resourceful. We are good at this stuff. We can draw on our experiences in the Balkans and the Falklands—I mentioned Rick Jolly’s field hospital—and prior to that. We are very good at this; we have the clinical expertise, in particular. The capability should be able to be expeditionary—that is, to go abroad. In the case of Syria, I foresee a situation where it could be located in a friendly country such as Jordan. It should also have a domestic application. God forbid that there is ever a chemical attack in this country, but the facility could also be deployed here.

The core goal should be to try to develop a stable world that we all appreciate, and that can be brought about by making friends and influencing people. The Arab street is not necessarily with the British or the Americans. We need to persuade civilians on the ground that we do not always have a malign, vested interest—a sense that we are just doing it for ourselves—in our approach to the middle east, but that we are there to do constructive and good things and to genuinely help people.

Turning to details and capacity, as a result of the conversations I have had I envisage a facility with at least 50 beds, perhaps more. If it is as successful as I think it will be I suspect we will extend it, but 50 beds is a good starting point. I think it should include a CT scanner, which is often not available in more rural areas and far-flung destinations. It is possible to put CT scanners in containers and companies such as Marshall Land Systems in Cambridge make container hospitals. There is no reason why we cannot do this. We need to consider whether the facility should also have paediatric and obstetric services, because it is not just soldiers such as those in the “MASH” television series who will be coming in, but children who have been affected by a neurological agent—such as those we saw in that dreadful footage—and pregnant women who have sustained injuries.

Cost is always relevant when it comes to Government spending and there are some figures available. Apparently the Finns purchased a hospital for deployment for about £5 million. I envisage that my proposal will probably cost between £5 million and £10 million. I think it should be a military asset, because the military is best placed to run it, but it should be staffed primarily with reservists, not regulars. Military logistics are important: the army are the best people to get this facility quickly into the field, and Kosovo is an example of that. The army’s command and control systems are relevant.

My hon. Friend the Member for Beckenham (Bob Stewart) has rightly referred to the facility’s security, which is of paramount importance. I think it would be a target. The facility would focus on hearts and minds and on delivering care on the ground, and if I were an Islamist jihadist I would think, “We need to knock that out, because it’s going to start changing minds and attitudes.” The facility’s security would need some thought. For example, RAF Akrotiri is stationed close to Syria and the deployment of troops may need to be considered in exceptional circumstances.

Clarity of funding is clearly important, as my hon. Friend the Member for Woking (Jonathan Lord) has said. The politics of international aid are tough on the doorsteps of Bracknell—trust me: I experience it quite often. This proposal would be one way of using DFID funds for something that is demonstrably humanitarian and of leveraging in some funds to a defence asset that would be used primarily for humanitarian purposes, but—this would always be at the back of my mind—that could also be deployed if we ever go to war.

[Jim Shannon]

We are discussing examples of armed conflict in places such as Syria and Kosovo. Does the hon. Gentleman also see this MASH unit playing a role in responding to humanitarian crises or disasters?

[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.