Textbook of Maritime Medicine

Ship hospitals are not described in detail anywhere in international regulations, but different aspects of the topic are covered in a lot of different conventions, regulations and guidelines – rather complicated and somewhat confusing.

The following ILO Conventions deal with ship medical facilities:

• C 55 Ship owners' Liability (Sick and Injured Seamen) Convention, 19361
• C 56 Sickness Insurance (Sea) Convention 19362
• C 92 Accommodation of Crews Convention (Revised), 1949 Article 14, related to the hospital accommodation. 
• C 126 Accommodation of Crews (Fishermen) Convention, 1966 Article 13, related to the sick bay and medical chest
• C 133 Accommodation of crew
• C 134 Prevention of Accidents (Seafarers) Convention, 1970
• C 164 Health Protection and Medical Care (Seafarers) Convention, 1987
• Maritime Labour Convention 2006

In addition several ILO recommendations relate to the field:

• R105 Ships' Medicine Chests Recommendation, 1958
• R 106 Medical Advice at Sea Recommendation, 1958
• R142: Prevention of Accidents (Seafarers) Recommendation, 1970
• Convention C126 requires that the R105 shall be followed.

The IMO has given directions for the ship medical facilities through:

• International Convention for the Safety of Life at Sea (SOLAS), 1974, Section III
• International Life-Saving Appliance (LSA) Code – Resolution MSC.48(66)
• International Safety Management (ISM) Code 2002
• International Convention on Maritime Search and Rescue, 1979, SAR
• The Medical First Aid Guide for use in Accidents Involving Dangerous Goods (MFAG)

It is obvious that there is a need of merging and unifying the different recommendations. This has not yet been done on an international level.

The ship medical chest is mentioned in several ways. In a summary, we can say that ships must have adequate medical supplies that are periodically inspected, kept in good condition, are ready for use whenever required. Quantities will depend on duration and destination of the voyage, the number of crew members, and the nature of the cargo.

WHO has developed a recommended list of medicines, based on professional assessment and best practice, linked to the International Medical Guide for Ships (IMGS) and published as an appendix to the IMGS.

The list published in the 3^rd edition of IMGS, has given rise to discussions about the content of the list, and several professional has criticised the list for not being in accordance with the advices given in the IMGS, not being organized according to international accepted codification, not giving advice on quantities, even not being updated according to best practice at present.

There are several national lists as well, differing slightly from each others. The EU has regulated this rather strongly through a directive, the EU Directive 92/29.

The International Maritime Health Association has recently (2009) established a Workgroup on International Guidelines on Medical Chest on Board, to revise existing guidelines and try to establish consensus between the international bodies concerned, like WHO, ILO, IMO, and the social partners, International Transport Workers’ Federation and International Shipping Federation.