[Hospital care in times of crisis : Are German hospitals prepared for military conflicts?]

Abstract

Background: Considering the evolving security policy framework conditions in Europe, it is imperative to assess if the German hospital system is prepared to face military conflict scenarios, such as disasters, crises and wars.

Methods: This study was conducted as a narrative literature review and covered the period from January 2020 to June 2026 in the PubMed and Google Scholar databases. The study used combinations of the search terms "hospital preparedness", "hospital resilience", "war", "military conflict", "mass casualty incident", "disaster planning", "Germany" and their German language equivalents. The search terms were used both individually and in various combinations. The study included original articles, reviews, guidelines, government reports and health policy publications in both German and English that addressed hospital preparedness for armed conflicts or comparable large-scale disasters. Publications without a direct connection to hospital care in crisis situations as well as those for which the full text was not available, were excluded.

Results: There are no controlled, randomized and blinded studies (RCT) examining the question whether German hospitals are prepared for military conflicts. The available evidence on this topic consists primarily of expert recommendations, government reports and experiences from current military conflicts.

Discussion and conclusion: Germany has a highly developed civilian healthcare system but recent studies and official risk analyses reveal shortcomings in its preparedness for large-scale military conflicts. There are particular concerns about its ability to handle long-lasting mass casualty incidents (MCI), and the systemic resilience of the healthcare system in general. Experience from the Russia-Ukraine war shows that modern wars generate enormous numbers of seriously injured patients and quickly push the healthcare system to its limits. While smaller influxes of wounded would be manageable, a large-scale military conflict would require additional military, logistical and international support. Challenges lie not only in infrastructure, but also in the availability of qualified personnel and intensive care capacity as well as in logistical resilience. Greater integration of civilian hospitals into national security planning, along with regular exercises and investments in resilience, could be the key to ensuring medical care during a military crisis.