Eleven Years in Kandahar: The Life and Legacy of the NATO Role III Multinational Medical Unit, 2009-2020

By André B. Sobocinski, Historian, BUMED Communications

For nearly 15 years, the NATO Role III Multinational Medical Unit (MMU) has served as the premier trauma and casualty receiving center in Afghanistan. And for 11 of those years, the U.S. Navy has stood at its helm.

In September 2020, the U.S. Navy relinquished command of the Role III, ending a storied chapter in the hospital’s illustrious history.

“Completing this mission in the name of Navy Medicine is a great accomplishment and I make an effort to remind my team of Active Duty and Reserve Component medical professionals of this as often as possible,” said Captain Melanie Merrick.

Merrick holds the distinction as the last Navy commanding officer of the Role III.  Her team was comprised of 83 physicians, nurses, dentists, corpsmen, and administrators, each part of personnel rotation dubbed “Whisky.”  Since October 2009—when then Captain (later Rear Adm.) Darin Via took command, 22 Navy personnel rotations have come through the Role III hospital. 

For Capt. Jeffrey Klinger, Executive Officer of the Navy’s Whisky rotation, serving at the Role III was a coveted opportunity.  “I’ve known a lot of people who have served here; I’ve heard their stories and I wanted to be a part of that history, be part of the conversation,” said Klinger.  

Over the years this state-of-art hospital located at the Kandahar Airfield (KAF), 10 miles southeast of Kandahar City, has served as a beacon of hope for thousands of U.S., Coalition and Afghan casualties who have passed through its halls and wards. 

Prior to the War in Afghanistan, few could have predicted that ancient, landlocked Kandahar would one day serve as an outpost for Navy Medicine.  All that changed in May 2009, when a contingent of Navy medical providers reported to the Role III as Individual Augmentees (IAs) to support, what was then, a Canadian Forces Health Services (CFHS)-led facility.  

File photo from April 7, 2009 – Navy Lt. Janet West teaches Navy Petty Officer 3rd Class Christopher Paulson how to apply a splint to a broken arm April 7, on Kandahar Air Field, Afghanistan. West conducts medical training with her corpsmen on a regular basis, ensuring her staff is prepared for any medical issue they may encounter. West is the aviation combat element flight surgeon for Special Purpose Marine Air Ground Task Force – Afghanistan. Paulson is a hospital corpsman with the aviation combat element.

The MMU was first conceived by the North Atlantic Treaty Organization (NATO) in 2005 to provide Role III medical support for the International Security Assistance Force (ISAF), then engaged in the very heart of the Taliban insurgency in southern Afghanistan.  On February 7, 2006, the NATO Role III Multinational Medical Unit opened for business from a group of wooden and canvas structures.  Colloquially known as the “Wooden Palace,” these structures had formerly belonged to the U.S. Army’s 48th Casualty Support Hospital (Pfc. Jerod Dennis Combat Hospital). 

In those first years, the Role III operated as a “Canadian M*A*S*H,” and the experiences even inspired a popular 2011 network television show, Combat Hospital, which dramatized many of the trials and tribulations at the Kandahar facility. 

Initially supported by NATO partner nations Denmark, Great Britain, the Netherlands, New Zealand, the United States and later Australia, Belgium and Germany, the Role III was an integral cog in the continuum of care—receiving, treating and then evacuating critically wounded out of theater.

In October 2009, CFHS turned over the command to the U.S. Navy marking the first (and only) international turnover of the MMU.    This transfer coincided with the so-called “surge”—the deployment of 30,000 additional military personnel to Afghanistan to protect the civilian population and counteract insurgency operations in Helmand and Kandahar Provinces.  The intensification of fighting guaranteed many sleepless nights for MMU personnel over the next several years. 

Along with the influx of combat and civilian casualties came the logistical challenges of relocating from the makeshift hospital to a new, 70,000 square foot brick and mortar facility. 

Opening on May 23, 2010, the new Role III was 30 percent larger than the previous facility, had 18-inch rocket-resistant walls, its own water purifying capabilities and “power autonomy” ensuring a seamless transition from central to generator power in case of an outage.

File Photo from November 2014 – Lt. Cmdr. Matthew Bradley, the Chief of Trauma at the Kandahar Airfield Role III Medical facility, highlights the original Role III hospital sign to the Deputy Secretary of Defense, Bob Work during a tour of the medical facility Nov. 28. The Deputy Secretary of Defense visited KAF to thank service members for their continuing contributions.

The expanded facility included four operating rooms, 12 trauma bays, 12 intensive care beds, 35 immediately available beds and, for a time, offered the only neurosurgery, ophthalmology, oral and maxillofacial surgery and interventional radiological services available in southern Afghanistan. 

“When I was told that I was going back to the Role III, I pictured my old trauma shack that was so familiar, with plywood walls and tents that served as operating rooms,” remembered Commander Lindsay McQuade, USN, a pediatric intensivist who served at both the old and new facility. “The hospital that welcomed me back was definitely not the shack I had left behind.”

Some 10 years later when Captain Klinger arrived at Kandahar he was struck by the uniqueness of the facility. “The Role III building is a non-descript brick structure and its entrance isn’t anything spectacular,” said Klinger.  “But then you walk in the doors you are struck by the cleanliness and air-conditioning.  The decks just shine.  The ER, OR, ICU, Radiology, Lab, Pharmacy all are equal to what you’d find in the USA.”

Whether conducting resuscitative care, wound surgery, damage control surgery or providing postoperative treatment, the Role III continually distinguished itself for its excellence in trauma care.   In 2012, the Navy awarded the NATO Role III a unit commendation for “outstanding achievement in medical care” and for maintaining a survival rate of over 98 percent.

With the completion of the ISAF’s mission on December 28, 2014, the Role III shifted into a new phase—supporting Operation Resolute Support, a NATO-led non-combat, training, advisory and assistance mission. This new mission led to the gradual scaling down of the hospital’s footprint and the end of a chapter.

File Photo – KANDAHAR PROVINCE, Afghanistan (August 5, 2018) — U.S. Navy Lt. Cdr. Justin S. Clark, radiology technician for Kandahar Airfield NATO Role III Multinational Medical Unit, watches as his Afghan radiology counterpart checks the results of an x-ray, August 5, 2018, during a medical advisory visit at Kandahar Regional Military Hospital, Camp Hero in Kandahar, Afghanistan. Staff members from the Role III conduct routine visits to KRMH to train and advice Afghan medical staff. (U.S. Army photo by Staff Sgt. Neysa Canfield/TAAC-South Public Affairs)

For Klinger, the Navy’s legacy in Kandahar is embodied by the thousands of U.S., Coalition and Afghan troops that are home today with their families because of the efforts of personnel who have staffed the Role III.   “They are alive to celebrate holidays and family events due to the extraordinary efforts of all the physicians, nurses, corpsmen, and administrators here at the Role III.”

After 11 years in theater, the Role III can be recognized as the longest operating U.S. Navy-led combat hospital in history.  More than anything, its greatest legacy is the indispensable role its staff has played in meeting the advanced healthcare and surgical needs for thousands, and fulfilling the mission to save life and limb.