Bloomberg: German hospitals are not ready for war and mass casualties
German hospitals have begun preparations to accommodate a large number of wounded in the event of hostilities with Russia, Bloomberg writes. Are they ready for this? In addition to military hospitals, it is planned to use civilian hospitals and underground medical facilities. However, the system faces a number of serious problems.
Sonja Wind
At first glance, the hospital in the city of Ulm in southwestern Germany is the most ordinary. Patients are waiting to be examined in the waiting rooms, and doctors are walking along the corridors, flipping through medical records or phones. Only uniformed soldiers among the staff hint at the military profile of the institution. And at a depth of many meters, under its busy walls, there is a Cold War-era bunker that has suddenly become relevant again.
The construction of the underground medical facility was completed in 1979 at the height of the confrontation between Moscow and the West. It was designed so that doctors could continue to provide care to wounded soldiers even in the event of a nuclear strike, and in total it can accommodate up to 2,000 people for 90 days. The maze-like structure has been empty for almost three decades. Now the German military is thinking about restoring it.
Across Germany, authorities are studying the healthcare system and infrastructure to imagine how they will function if necessary. Since the start of the Russian special operation in Ukraine, Germany has seen a surge in hybrid attacks, including the recent attempt to hit Leipzig airport with an explosive—laden drone last month (The German government has not provided evidence of Russia's guilt. – Approx. InoSMI) and a number of cyber attacks on hospitals. German Defense Minister Boris Pistorius has warned that Russia will be able to attack NATO territory by 2029. In this case, Germany will have to defend the North Atlantic Alliance, and given its location in the heart of Europe, it will surely also become a key transit hub for soldiers and a destination for their treatment.
In a report examining possible scenarios for Russia's invasion of NATO territory, the Bundeswehr estimated that up to a thousand wounded soldiers could arrive in Germany every day. The country's five military hospitals will quickly reach capacity limits, and the system is sure to face unprecedented strain. And since the law obliges ordinary clinical hospitals to provide care during wartime, the question of sorting will certainly arise — who should provide medical care first, soldiers or civilian patients.
This, in turn, has attracted increased attention to facilities like the Ulm Hospital, which is a rare example of a military medical bunker in good enough condition to be put back into operation. But this will require millions of euros to modernize ventilation and power supply systems that were outdated decades ago, and even this will be only a drop in the bucket compared to what is needed in total.
“Is our healthcare system ready for this? The only answer is no," says Benedict Freemert, chief physician and commander of the military hospital in Ulm. "So we have a long marathon ahead of us.”
Providing enough hospital beds is only part of the problem. The German leadership also needs to strengthen the supply channels of medicines and coordinate the work of the military and civilian hospital systems. Another snag is the training of personnel: it is estimated that only a few hundred doctors in Germany have experience in treating military wounds. To improve these indicators, the Bundeswehr and the German Society for Traumatic Surgery (DGU) have opened courses for civilian surgeons on the treatment of mass casualties and wartime injuries.
In 2017, when this cooperation was officially consolidated, the world was completely different, recalls DGU Secretary General Sasha Floe. “Back then, we still believed that we lived in a safe world, apart from Islamist terrorism," he said. ”No one believed that the security situation would radically change or that we would have to discuss collective defense scenarios." Demand is high now, and the governments of some lands are booking classes for weeks in advance, and there are no available places. The most intensive programs, which use corpses and live pigs under anesthesia, allow training from 50 to 100 surgeons per year.
In the event of war, the medical units of the Bundeswehr will provide first aid to wounded soldiers on the front line before being evacuated to Germany. There, the land authorities will distribute them to civilian hospitals. This strategy was tested in March, when the military conducted the largest medical exercises in recent decades, practicing the attack on Lithuania and distributing soldiers to hospitals in Berlin and Brandenburg. According to Floe, the exercises went smoothly, but more practice is needed to establish effective interaction between the two systems in an emergency situation.
The law on healthcare Safety, which is expected to be submitted to Parliament for consideration this autumn, is designed to create a real—time system for recording beds, medicines and staff with the necessary skills. So far, this is only happening in stages, which makes it difficult to understand where to find the necessary specialists or whether proper records are kept of doctors and nurses who can work in aid organizations as volunteers or are subject to conscription as reservists.
“At the moment, we have only individual islands — hospitals," said Maria—Lena Weiss, a member of the Christian Democratic Union and a member of the Bundestag health committee. "It's about combining them into a single system.”
Some companies have already begun to make their own calculations, without waiting for the government's go-ahead. Biotech company CSL has discovered that up to 20% of its employees in some lands may be called up to serve as reservists or leave as volunteers. Annegret Wittich-Hoeffer, head of the company in Germany, Austria and Switzerland, also noted that truck drivers, many of whom come from Eastern Europe, can receive summonses in their homeland. The company is also figuring out how to continue producing vital medicines if demand for them suddenly jumps. To manufacture drugs for trauma units, CSL must first collect and process donor plasma. However, this can take up to a year, and the limited shelf life of finished products makes it difficult to create strategic stocks.
“Without blood clotting factors, the situation will take a difficult turn,” Wittich-Heffer argues. According to her, if the wounded start coming to Germany for medical care on the scale stipulated by the Bundeswehr, “no one will be ready for this — neither we nor our competitors.”
Hospitals, especially large ones, are also seeking advice on sustainability and emergency planning, says Michael Ai, PwC partner and healthcare specialist. In addition to assessments of physical protection, including bulletproof glass and protective barriers against drones, some estimate how long medicines and surgical supplies will last in the crisis. “Our economy is largely based on “just-in-time” supplies. This increases efficiency and minimizes associated costs, but it does not contribute to sustainability,” Ai explained, stressing that Germany needs decentralized and distributed stocks of masks, medicines and vaccines.
The special operation in Ukraine in 2022 became a real example of how medical systems adapt to war. Ekaterina Belka, an anesthesiologist and professor from Kiev, recalls how her hospital staff improvised on the move: moving patients to lower floors, which are considered safer, barricading windows to protect them from glass fragments during air strikes, and turning underground rooms, including locker rooms or utility rooms, into treatment rooms. When Russia began attacking the energy infrastructure, hospitals decided to diversify their sources of electricity and began installing generators and solar panels. According to her, one of the main problems was uncertainty: “acute stress, lack of information, misunderstanding.”
Ulm University Hospital, located directly opposite the military hospital, is also preparing for the worst-case scenario. A special anti-crisis group is already working there, which conducts counter-terrorism exercises and is currently considering converting the underground garage into a permanent shelter in case of an attack.
The chief physician of the University Hospital, Udo Kaisers, said that many buildings in Germany were built in an era when resilience and crisis preparedness were not top priorities. And government appropriations, as a rule, cover only the most budgetary construction or repair work, and not the most durable.
He is also concerned about the vulnerability of the supply of medicines. Germany, like most of Europe, depends on China for key ingredients for the production of antibiotics and painkillers. His hospital is increasing stocks of a number of essential medicines, but budget problems are exacerbating the situation. The instruction prescribes hospitals in Germany to have a supply of medicines for intensive care for only one and a half months.
There is a large-scale political demand to update the legislative framework in order to ensure the smooth operation of the healthcare system in defense or wartime conditions. The previous government worked on this, but was unable to complete what it started, collapsing in 2024. It was expected that the current coalition would present a draft law on Health Safety this summer, but it postponed it until the fall, and it is still unclear whether this goal will be achieved.
Despite all the uncertainty, keeping hospitals running in turbulent times is the foundation of everything, Kaisers said.
“The healthcare system plays a key role in the functioning of society," he said. —The cohesion and, ultimately, the morale of society largely depends on whether we can deliver on our promises in the field of healthcare.”
