The Navy hospital ship USNS Mercy is in Honolulu making a pit stop to stock supplies and pick up crew as it makes its way across Oceania for the annual Pacific Partnership humanitarian mission.

This will be the first full Pacific Partnership deployment since 2019. Pandemic restrictions limited the size and scope of the mission to much smaller medical engagements, but widespread vaccination and less deadly variants have made countries around the region more willing to welcome the ship.

“We’ll build schools, hospital wings — the host nations asked for whatever it is they feel like they need, and then we do our best to oblige,” said Navy spokeswoman Lt. j.g. Molly Sanders.

The Mercy has 1,000 beds, making it larger than many hospitals on land. The ship operates with a skeleton crew to keep it operational, as well as medical personnel who intimately know the systems on board.

In the event of a deployment, the military calls up specialists to operate the ship for whatever mission it’s been called up to. For the Pacific Partnership it has a mixture of medical personnel, veterinarians, engineers and other specialists for the mission.

It left San Diego with about 600 crew and will pick up more crew and supplies in Hawaii before it continues its voyage. It’s an international crew: Joining the U.S. service members on board are military personnel from the U.K. It will also pick up members of the Japan Self-Defense Forces.

“We’re really excited to have our partner nations on board with us as well. This isn’t just a U.S. mission. From the get-go in San Diego, we’ve got Australia and the United Kingdom on board,” said Sanders. “So we’re just really excited for this joint mission and to share all that knowledge and learn more about how to be better.”

But the mission isn’t purely altruistic. Its focus on Oceania comes as Pacific island nations have become a major strategic priority for all four countries. China is making moves to expand both its influence and physical presence in Pacific island nations.

In 2020 Kiribati joined Beijing’s Belt and Road Initiative, a series of Chinese-­backed infrastructure plans around the world to extend its global influence. Among projects China is exploring in Kiribati are a proposed modernization of a former U.S. military landing strip from WWII.

This year the Solomon Islands signed a security pact with China that would allow the country’s central government to call in Chinese troops and police to “assist in maintaining social order” and invite the Chinese navy to send warships to its ports.

Since the end of the Cold War, the United States has shuttered several embassies and consulates in the Pacific, as well as cut back Peace Corps and USAID presence. Both lawmakers and analysts have warned that the U.S. has neglected relationships in the islands and risks losing influence.

On Friday, U.S. Sens. Mazie Hirono, D-Hawaii, and Tom Cotton, R-Ark., introduced a bill calling on the government to craft a report on how the U.S. government could rebuild and expand its diplomatic presence in the region.

“The United States has long had important partnerships with many nations in the Pacific region,” Hirono said in a news release. “But for various reasons, the U.S. still does not have a permanent diplomatic presence in many of these nations.”

The Mercy began life as an oil tanker in 1976, but in 1984 it underwent renovations to convert it into a military hospital ship. It was commissioned into the Navy in 1986 and called up during Operation Desert Storm, during which the ship admitted 690 patients and medical personnel aboard performed almost 300 surgeries.

In 2004 the Mercy was called up after an Indian Ocean earthquake and tsunami ravaged Indonesia and several other countries, causing thousands of deaths and serious damage to homes and infrastructure. The annual Pacific Partnership deployments began after the tragedy. Mercy has participated in seven iterations of the initiative.

The Mercy’s last Pacific Partnership deployment was in 2018, when it visited Indonesia, Vietnam, Malaysia and Sri Lanka.

But the Mercy was called elsewhere as COVID-19 spread in 2020, when it assisted domestic COVID-19 response operations off the coast of Los Angeles, hosting patients as hospitals on land struggled with overcrowding.

Afterward it was sent to Portland, Ore., for a planned maintenance and overhaul. During its overhaul its flight deck was modified to accommodate landing by V-22 Osprey tilt-rotor aircraft that the military is increasingly looking to as key to supporting operations in the Pacific.