Gen. Gielerak: Polish Healthcare System Can Support NATO

In an article published in The Moscow Times entitled ‘NATO is preparing for a potential war with Russia. Alliance strategy is revealed«, the head of NATO’s Logistics Command, General Alexander Zolfrank, outlined the alliance’s defence plans, noting the risks associated with the scale and breadth of a potential conflict with Russia and the resulting losses. He also mentioned the limitations on air evacuation, which has so far played a key role in the medical support for NATO troops. These limitations would be solved by ‘sanitary trains’, which would transport the wounded in the deep to hospitals in Germany and other Western European countries. Another measure advocated by the German general is the need to standardize the rules for medical operations. One proposed solution could be the creation of a ‘military-medical Schengen zone’, which would ensure a flawless distribution of medicines, including strong painkillers.

Are Polish hospitals too many?

In this context, it is worth considering what role Poland should play in these plans. Do we have resources at our disposal that could prove useful in NATO’s strategy, and if so, which ones? There seems to be ample scope for cooperation with NATO, which could not only benefit the Alliance and the Polish army, but also have a positive impact on the Polish health care system.

For years, the problem of an excessive number of hospitals and their over-concentration in the western part of Poland has been raised in the public space. Few people today remember that this situation is a direct consequence of our participation in the structures of the Warsaw Pact, which in its operational plans envisaged the use of Polish hospitals as medical facilities for soldiers carrying out offensive operations in Western Europe. The maintenance of most of these entities is today financed by local governments, which has a negative impact on the financial situation of the public sector.

Currently, as a NATO member, Poland bases its defence strategy on the assumption that the main operational activities will be concentrated on the eastern borders of the country, with the key importance of the Bug and Vistula rivers’ lines as natural defence frontiers. Accordingly, western Poland and the hospitals there can once again serve as highly specialised medical facilities for allied armies. The concept of transporting and treating the wounded in Germany or France loses its justification when adequate medical facilities exist in Poland. NATO could already plan and allocate funds for the maintenance and modernisation of hospitals in western Poland, bringing them up to its operational standards. In this way, the hospital infrastructure would be preserved, and part of the maintenance costs could be financed from funds allocated to the Alliance’s defence activities. We should consider such solutions within NATO and propose them to our partners.

As part of an effective and responsible reckoning with the past, it is also worth considering the Ministry of Defence’s participation in ownership transformations in the national medical services market carried out as part of the health system reform. Possible takeovers of medical entities in locations of particular importance for the Armed Forces, provide an opportunity to redefine elements that are remnants of the Warsaw Pact defence strategy in terms of the deployment of medical support units and the construction of a new organisational order, corresponding to real defence needs.

The optimal use of key resources, on the one hand dispersed, on the other over-concentrated in certain regions (western Poland), to achieve priority objectives supporting the state’s security potential, is of paramount value. It emphasises the importance of decisions regarding the location of medical structures, especially those with highly specialised treatment, taking into account the anticipated directions of warfare and initiatives such as civil-military cooperation, i.e. the allocation of civilian resources intended to support medical care during an armed conflict.

Poland’s active stance in this regard provides an opportunity to develop an economically rational and organisationally modern strategy for the Alliance countries, based on creating synergies between the universal health care system, the state’s potential and capacities, and the capabilities of the military health service. This means launching an entirely new way of thinking about the organisation of our own security. A return to the culture of strategic thinking abandoned in Europe after the Second World War, moving these activities from subcontracting to the US to the area of own initiative.

Si vis pacem, para bellum. Allied strength and unity in diversity - as long as supported by good planning....

Waging war is a reality, not a theory, therefore a state that wants to be strong in the face of threats and secure from the perspective of society’s needs must have directional, variant plans of action. A clash between states of equivalent military strength, based on political and economic polarisation, accompanied by extreme cultural and ethical differences regarding the rules of engagement (ROE), imposes an obligation to have a critical infrastructure that provides the highest level of security in terms of protecting the population. This means that strategic and operational planning within the Alliance should not be limited to issues related to medical evacuation or systemic improvements in drug policy.

A much more important challenge is to seek solutions to accurately determine the scale of the risks associated with a potential conflict with Russia. In this regard, the Ukrainian experience is invaluable and should be extensively studied in all aspects affecting the resilience of society and the state to a crisis caused by armed conflict.

The scale and structure of sanitary losses recorded during the war in Ukraine show that a modern full-scale military operation has its own specific needs and conditions in terms of medical support and security, and that these cannot be met in any other way than by combining all the resources, capabilities and organisational and technical solutions at its disposal, including those concerning new technologies supporting diagnostic and therapeutic processes.

Conducting a military operation on its own territory requires the definition of conditions, norms and rules for managing the processes of civilian and military health market resources. Taking into account the estimated needs, it is considered most expedient to establish a network of hospitals within the territory of the country, whose distribution, number, competence and capacity will correspond to the projected size of sanitary losses associated with a potential conflict. Accurate knowledge of the number and type (strength and complexity) of medical support units required for use during a military operation is the basis for planning calculations and, subsequently, for the effective use of available resources.

Poland’s initiative and involvement in this area opens new opportunities in the international arena, supporting the idea of creating a coherent and effective defence strategy for the Alliance countries, based on cooperation between the universal health care system, state resources and military health care capabilities. Our Allied strength comes first and foremost from coalition capabilities, which we should build together with countries committed to pursuing a viable defence policy - countries ready not only to defend their own territory, but also to effectively support their partners.

Author: LTG Prof. Grzegorz Gielerak (Military Institute of Medicine - National Research Institute)