By Rear Adm. James A. Johnson, Jr., Medical Corps, U.S. Navy, Retired
Editor’s Note. In the years following Josip Tito’s[i] death the tenuous confederation of states known as the Socialist Federal Republic of Yugoslavia disintegrated under the strain of ethnic nationalism. Serbs, Croats, and Slovenians—Catholics, Orthodox Christians and Muslims— each fought to establish their own geographic borders based on their deep-seated cultural and religious differences. Within this forge of conflict new nations like Bosnia and Herzegovina, Croatia, Serbia, and Slovenia took shape.
In 1992, under the banner “Operation Provide Promise,” the United Nations (U.N.) deployed peacekeeping forces to the Balkans. Lead by the United Nations Protection Force (UNPROFOR) and over 37,000 troops representing some 20 different nations, the mission sought to ensure a peaceful resolution to the conflict while leading various humanitarian relief operations throughout the region. The United States supported the mission through the deployment of a succession of military field hospitals[ii] to the U.N. base at Camp Pleso, Zagreb, Croatia beginning in November 1992.
In March 1994, the Navy’s Fleet Hospital 6 took over the medical mission. Led by (then) Capt. James A. Johnson, Medical Corps, USN,[iii] Fleet Hospital 6 was comprised of personnel from naval hospitals and clinics on the West Coast from Bremerton to Twentynine Palms. Fleet Hospital 6 not only held the distinction as the first U.S.-based medical unit deployed to the Balkans, but it was also the first Navy unit to take part in the U.N. Peacekeeping Operations.
During its six months in theater (March-August 1994), Fleet Hospital 6 treated over 91,000 UNPROFOR soldiers and civilians and help pioneer innovations like tele-radiology and oversee groundbreaking treatment of land mine injuries.
In the following lightly edited excerpt of a 2018 oral history,[iv] Rear Adm. James Johnson looks back on this history-making mission. ABS
When the United Nations peacekeeping mission started the U.S. agreed to provide medical support to Zagreb city where the U.N. set up its logistics headquarters. The administrative site of the U.N. mission in Croatia was in downtown Zagreb, but the execution piece was at Camp Pleso located at the Zagreb Airport. Part of that site was a U.N. mission, part of it was a Croatian military base, and part of it was a civilian airport. They were separated areas, but it was all the same piece of real estate, not unlike like Joint Base Pearl Harbor-Hickam, where Hickam Airfield is right next to Honolulu Airport and they both share the same runways. Similarly, when planes took off at Zagreb they would use the same runways. Sometimes it would be a U.N. plane, sometimes it would be Croatian airline and sometimes it would be the Croatian military.
The medical mission to Zagreb was well-publicized. In the United States the [coverage] on that was significant because although this was not a new mission it was a new mission as far as most of CONUS [continental United States] and the Navy was concerned. It was a high-profile mission for the Navy Line because it wasn’t a geographic area that people associated with the Navy. When we left to go it was a big deal, and not only because the Fleet Hospital was CONUS, it was West Coast CONUS. And because we were a composite from all the various naval hospitals and clinics on the West Coast it was a major news item from every local newspaper from Bremerton to the Bay Area to San Diego.
From a functional standpoint the medical side was incredibly challenging because within the Croatian theater we were the most comprehensive military medical facility that existed for U.N. forces. In peacetime, Yugoslavians were good medical people. They were well-trained, and very competent people. That competence gets degraded by war. By the time we arrived, Zagreb had essentially returned to a peaceful, peacetime existence and their major medical centers within the city were pretty much back to normal and comprehensive; but they weren’t part of the U.N. peacekeeping mission for the most part. So casualties that occurred in Croatia and in Bosnia were initially treated by medical battalions from a variety of countries taking part in the mission.
The quality of the care you got on the frontline depended on the quality of what was available for your particular country of origin. Once you got to us we were able to not only stabilize, but we were able to do definitive care. We were augmented with equipment capabilities beyond the standard fleet hospital at the time. The only thing we didn’t have was the CT machine and we arranged for one because the local Zagreb doctors were able to send people downtown for procedures; they would get the CTs and then we would transmit them via satellite back to San Diego where our doctors would interpret it. That was new and innovative.
Taking care of U.N. forces depended on what contingent they were in. First of all, they had to survive the “will to live” test. So wherever they were injured, they had to survive some sort of basic stabilization and then survive the trip over land or by helicopter-occasionally fixed-wing, but not usually-that would get you to Zagreb.
We were providing medical care at a level two and a half; we did much more than usual battlefield medicine. We actually did a lot of definitive care, particularly for severely injured casualties from [countries with fewer capabilities], which was new.
We didn’t take care of casualties from more medically capable countries longer than 10 days, and usually they were out of our facility in a week or less. We took care of casualties from less medically capable countries for as long as we needed to take care of them. We took people with severe extremity injuries all the way through prosthetic fits and rehabilitation. The funding for this definitive care had been worked out between the U.S. and the U.N.
Another issue we faced were landmine injuries. The whole country was mined. Something we don’t appreciate in the United States is how extensively some countries are covered with anti-personnel mines. And particularly, if you’re losing a war and retreating you leave mines because that’s the ultimate retribution. You may have to give up that ground, but you can still inflict hate and discontent by leaving mines everywhere. Even in the city of Zagreb there were places that were roped off because they were still active minefields. Camp Pleso was located next to an active minefield and there were signs that read “Dangerous Area” and “Be aware of mines.”[v] Every now and then there’d be an explosion that would go off in the middle of the night when some animal stepped on the mine. The entire time I was in Croatia, I can tell you, literally, I never stepped on the grass.
At Fleet Hospital 6 we had the largest mine injury experience of any medical unit since Vietnam. We cut our teeth on that; we had a lot of things going on with people with mine injuries downrange and we developed an incredible expertise dealing with mine injuries. My orthopedic surgeon, Dr. Dana Covey,[vi] did all kinds of innovative work treating mine injuries that he wrote about extensively. He became, and still is, an orthopedic expert on mine injuries.
Since the main contribution of the United States was the medical mission it became important for the State Department to publicize what we were doing in theater. We had all kinds of VIPs come through the Fleet Hospital during that six months. One of the people we took care of was a close friend of the Crown Prince of Jordan,[vii] who was very grateful that we saved his friend’s life. So, at one point, he flew into Zagreb on his own private airplane, not like something you and I would fly on, but more like Air Force One.
Zagreb was an extraordinarily interesting and deep mission for the United States.
For us, it was unique in the attention and the media coverage that was paid to the mission at the time we were there. We put that mission on the map with respect to awareness back in the United States.
From March to August 1994, Fleet Hospital 6 surpassed the previous medical facilities in the number of operations performed and patients seen. On August 30, 1994, Fleet Hospital 6 transferred medical command to Fleet Hospital 5 out of Naval Medical Center Portsmouth, Virginia.
In December 1994, Fleet Hospital 6 was awarded the Meritorious Unit Commendation for meeting the myriad of challenges associated with providing “superior quality combat-zone medical and dental care” in an austere environment.
After his tour as CO of Fleet Hospital 6, Rear Adm. James Johnson served as the Commanding Officer, Naval Hospital Bremerton, Washington, The Medical Officer of the Marine Corps and then Commander of the Naval Medical Center San Diego, California. He retired in 2004.
[i] Tito, Josip (1892-1980). Communist leader and president of Yugoslavia from 1953 until his death in 1980.
[ii] The medical mission commenced in November 1992 with the deployment of 212th Mobile Army Surgical Hospital
(MASH) followed by the 502nd MASH, 48th Air Transportable Hospital (ATH) and ultimately the Navy’s Fleet Hospital 6.
[iii] CAPT (later RADM) James A. Johnson was serving as the Deputy Commander of the Naval Medical Center, San Diego, Calif. At the time of his selection as CO, Fleet Hospital 6.
[iv] Johnson, James A., RADM, MC, USN. Oral History, Session IV, December 12, 2018. (Session conducted by A.B. Sobocinski). BUMED Oral History Project, BUMED Archives.
[v] Pazi Mines (“Be aware of Mines”)
[vi] Covey, Dana, CAPT, MC, USN
[vii] Abdulluh II, King of Jordan since 1999. In 1994, as the Crown Prince, Abdulluh was serving as a Brigadier General with the Jordanian Special Forces.