Zhang said he felt excited, and blessed to be on a sacred mission, when he landed in the Liberian capital Monrovia in March 2012 at the start of his deployment. He soon discovered that a lack of medical support was a problem for peacekeepers.

“A slight bone fracture is not difficult to cure, but in Liberia the patient needs time to be transferred to a neighbouring country simply because there’s not enough machines that can be used and a shortage of doctors capable of performing such surgery,” said Zhang, now 29 and still serving in the PLA.

Zhang was fortunate enough to avoid armed conflict during his time as a peacekeeper. His main duties were to repair roads and provide roadside assistance in Zwedru, in the southeast of Liberia, and transport water and oil to UN peacekeeping bases in Monrovia.

But he said fellow peacekeepers had fractured legs while jumping from high trucks and there were also other potential dangers. One Chinese peacekeeper had his mobile phone stolen by a knife-wielding thief who was hiding in a base toilet in the middle of the night.

Endemic and potentially fatal diseases such as malaria were another hazard. Very likely curable in places with sufficient medical supplies, they posed serious problems for peacekeepers, whose lives were made more vulnerable by a lack of UN coordination with medical units.

Calls are mounting for Beijing to demand the UN step up the level of medical assistance provided to peacekeepers.

Senior Colonel Zhao Xiaozhuo, who spent a year as an observer with the UN peacekeeping mission in Congo in 2011, said treating an ill peacekeeper could take longer than expected, sometimes with fatal results.

“I saw several foreign and Chinese observers die from malaria in the Democratic Republic of Congo,” he said. “When one got a fever, an initial symptom of malarial infection, he could only take pills for several days and wait to see whether the fever would disappear.

“If uncured, the person would then be transferred to a place with better facilities by helicopter, because the landscape was too rough for road transport. But it could take days for a helicopter to arrive due to reasons such as extreme weather. The delay could see the malaria upgraded to fatal cerebral malaria.”

China’s UN peacekeeping effort started in 1990, when it deployed five military observers to the United Nations Truce Supervision Organisation in the Middle East. Two years later, China dispatched its first military engineering unit to Cambodia. And since then, Chinese peacekeepers have been seen in many regions and countries, including Congo, Liberia, Lebanon, Sudan, Mali and South Sudan.

The UN says that at the end of August there were 2,639 Chinese peacekeepers serving around the world, all but 420 of them in Africa. Most are military engineers and logistics staff, police and medical personnel.

Eighteen Chinese have died on peacekeeping missions – nine of them in Africa – from causes including disease, traffic accidents, extreme weather and armed attack.

President Xi Jinping promised in September that China would join the new UN Peacekeeping Capability Readiness System, build a peacekeeping standby force of 8,000 troops, and set up a permanent peacekeeping police squad. Over the next five years it will train 2,000 peacekeepers, carry out 10 mine clearance assistance programmes, and provide US$100 million in military aid to the African Union.

According to the Medical Support Manual for UN Field Missions, the UN aims to provide skilled first aid by trained non-medical staff, paramedics, medics or nursing assistants within 10 minutes of a trauma injury or the onset of symptoms, and advanced life support as soon as possible, but not exceeding one hour.

But that medical support mechanism obviously failed in four days of violent clashes between rival Sudan People’s Liberation Army factions in Juba, South Sudan, in July. Six Chinese peacekeepers were wounded by a rocket propelled grenade, with two of them dying. One bled to death over the course of 16 hours because there was no surgical team or blood bank on the base and he could not be evacuated to a hospital on another base just 15km away.

The report quoted one UN military official as saying that although UN had helicopters and ambulances, it could not conduct a medical evacuation without an escort of government forces because of the high risk that combatants would target a UN vehicle.

Liu Naiya, a West Asian and African studies expert at the Chinese Academy of Social Sciences, said peacekeepers themselves needed protection in extreme situations so they could better perform their duties.

“An inadequate early warning of sudden violence in war-torn regions always puts peacekeepers in a dangerous situation and a lack of medical support only worsens the problem when someone gets hurt,” Liu said.

Major General Qian Lihua, vice-president of the China committee at the Council for Security Cooperation in the Asia Pacific, said on the sidelines of the Xiangshan regional security forum in Beijing this month that the facilities and mechanism provided by the UN in South Sudan had failed to contain the conflict.

“China should suggest the UN increase the level of medical assistance, especially emergency rescue, to safeguard peacekeepers’ life and property,” he said.

Zhou Chenming, a Beijing-based military expert, said China had few alternatives to pushing the UN to provide more protection, unlike the United States, which had military bases around the world.

“It is very difficult for China to build a port itself in Africa to provide timely help when needed, because such a move would be criticised and objected to by Western countries as they view China as trying to project its military and diplomatic power,” Zhou said.

Additional reporting by Minnie Chan