Prehospital and Disaster Medicine

Original Research

Hospital Ships Adrift? Part 1: A Systematic Literature Review Characterizing US Navy Hospital Ship Humanitarian and Disaster Response, 2004-2012

Derek Licina 

Department of Global Health, The George Washington University, Washington, DC USA


Background United States foreign policy is tied extensively to health initiatives, many related to the use of military assets. Despite substantial resource investment by the US Department of Defense (DoD) in hospital ship humanitarian assistance and disaster response missions, the impact of this investment is unclear.

Methods A systematic literature review of both peer-reviewed and grey literature using eight databases representing the international community and multiple sectors was conducted. Data on the characteristics of missions directly related to US Navy hospital ship humanitarian assistance and disaster response from 2004-2012 were extracted and documented.

Results Of the 1445 sources reviewed, a total of 43 publications met criteria for review. Six (13.9%) met empirical documentation criteria and 37 (86.0%) were considered nonempirical expert opinions and anecdotal accounts that were primarily descriptive in nature. Overall, disaster response accounted for 67.4% (29/43) and humanitarian assistance 25.6% (11/43). Public and private sector participants produced 79.0% (34/43) and 20.9% (9/43) of the publications respectively. Of private sector publications, 88.9% (8/9) focused on disaster response compared to 61.8% (21/34) from the public sector. Of all publications meeting inclusion criteria, 81.4% (35/43) focused on medical care, 9.3% (4/43) discussed partnerships, 4.7% (2/43) training, and 4.7% (2/43) medical ethics and strategic utilization. No primary author publications from the diplomatic, development, or participating host nations were identified. One (2.3%) of the 43 publications was from a partner nation participant.

Discussion Without rigorous research methods yielding valid and reliable data-based information pertaining to Navy hospital ship mission impact, policy makers are left with anecdotal reports to influence their decision-making processes. This is inadequate considering the frequency of hospital ship deployments used as a foreign policy tool and the considerable funding that is involved in each mission. Future research efforts should study empirically the short- and long-term impacts of hospital ship missions in building regional and civil-military partnerships while meeting the humanitarian and disaster response needs of host nation populations.

D Licina. Hospital ships adrift? Part 1: a systematic literature review characterizing US Navy hospital ship humanitarian and disaster response, 2004-2012. Prehosp Disaster Med. 2013;28(3):1–10..

(Received August 08 2012)

(Accepted December 02 2012)

(Revised October 11 2012)

(Online publication February 15 2013)


  • disaster response;
  • hospital ships;
  • humanitarian assistance;
  • systematic literature review


  • CRD:Centre for Reviews and Dissemination;
  • DoD:US Department of Defense;
  • HIA:health impact assessment;
  • IOM:Institute of Medicine;
  • NGO:non-governmental organization;
  • SR:systematic review


Correspondence: Derek Licina, MPH, DrPH(c) The George Washington University Department of Global Health 2175 K Street, NW, Suite 200 Washington, DC 20037 USA E-mail