Historically neutrals were sometimes subject to enforced blackouts depending on where they sailing around. This mostly applied to the America's were the most neutral ships were sunk (in the shortest period of time) due to an enforced blackout rule for any shis sailing in or between certain area's at night. Several Brazillian ships were mistakenly sunk and Mexican ships (afterwards the Mexico which was neutral flipped sides to the allies after feeling betrayed for being neutral, Brazil wasn't exactly happy either) as well. Inside a port though or alone at sea I've yet to see a neutral not properly lit up.
Sinking a hospital ship is nothing but pure bad karma. There's a good chance many of your own country's casualties may be on board. Even in poor weather those things are lit up like Christmas Tree's, something so large so well lit up is probably not doing so for the sake of trying to be stealthy; its doing everything short of keying down the radio and screaming out Hospital Ship!
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