We translated this important interview on the militarisation of the health sector by a friend in Germany. In the coming weeks we will publish our own article about how the UK state is attempting to increase military intervention into and control over the NHS. We will also feature an interview on the history of the Association of Democratic Doctors (vdää*), the organisation in Germany to which the interviewee belongs.
The Telegraph recently published an article on the cooperation between UK and Ukraine military medical corps. The article quoted Dr Hettiaratchy, the lead trauma surgeon at Imperial College Healthcare, who trains Ukrainian military surgeons. He suggested the NHS would have to be all but shut down in order to deal with war casualties if Britain was to be dragged into a full-scale conflict. Since the war started in Ukraine, 400,000 soldiers have been wounded, out of which 50,000 lost limbs. The military strategists complain about a low ‘return rate’ – that only around 50% of wounded soldiers could be patched up well and quick enough to be sent back to the frontline.
The current global capitalist system is in crisis and drives us towards war – we have written about it in Vital Signs before. As health workers who struggle for a new human society we repeat:
Not one man, woman, penny, or paramedic for the bosses’ wars!
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‘The Bundeswehr wants control over employees in the civilian health sector’
The quiet militarisation of medicine. Interview with doctor Bernhard Winter about the military turning point in healthcare.
17 January 2025, Interview by Matthias Becker
“We have to be ready for war by 2029,” said German Defence Minister Boris Pistorius, in disturbingly specific terms, in the Bundestag last year. Karl Lauterbach, the Minister of Health, followed suit less than a week later. “We also have to be better prepared for major disasters and possible military conflicts,” said Lauterbach, calling for “clear responsibilities, for example for the distribution of a large number of injured people among hospitals in Germany”. In Bundeswehr (German army) and NATO war games, the German health system has always played an important role. Now the preparations for war are becoming more concrete.
The interviewee, Bernhard Winter, has been a board member of the Association of Democratic Doctors (vdää*) for many years and has been dealing with the militarisation of the health system for a long time.
The prevailing scenario – What would a war mean for the health system?
Bernhard Winter: The prevailing scenario assumes that NATO’s eastern flank is attacked by Russia. Germany would then serve as a hub for moving around 750,000 soldiers to the front. On the other hand, about a thousand wounded soldiers would have to be brought back and medically treated per day, 300 of them in need of artificial respiration. These figures were allegedly derived from experiences in the war in Ukraine. It is difficult to say whether they are realistic.
Ten thousand acute care beds needed
At the last surgery congress in Leipzig, it was stated that in this scenario many bullet and blast injuries are to be expected. These wounded would have to be treated primarily in civilian hospitals because the military hospitals have only 1,850 beds available. Dietmar Pennig, Secretary General of the German Society for Orthopedics and Trauma Surgery (DGOU), believes that this capacity would be exhausted within 48 hours.
Bernhard Winter: That is quite possible. In the scenario mentioned, ten thousand acute care beds would be needed. Two thousand are available in the hospitals of the professional associations, which have been working closely with the military for a long time. They have comprehensive cooperation agreements which also include practical war-related training. The Bundeswehr expects that a further two thousand beds can be provided by the university hospitals. That still leaves four thousand wounded who would have to be accommodated in normal hospitals. Because the crisis in inpatient care is unmistakable, representatives of the Bundeswehr are also turning against the commercialisation and profit orientation of hospitals. They should serve the public good, they argue. However, the Bundeswehr also wants to have a say in hospital requirement planning. Hospital beds should be located near train stations that can be reached quickly, so that they can be reached quickly from the front.
A changed mindset
What do healthcare workers think about this?
Bernhard Winter: Military publications often talk about the sceptical or even hostile attitude of large sections of the population towards the military. Civil and military actors are therefore calling for a change in the mindset of healthcare workers in particular. After 75 years of peace, people would have to get used to the idea that military action was necessary and normal. Cynically, war is presented as the norm and the desire for peace is denounced as a luxury attitude. That is, so to speak, the ideological front line. In the 1980s, there were fierce disputes about a law that, among other things, provided for compulsory further training in war medicine. For example, medical professionals were to practice triage, meaning, the prioritisation according to the severity of injuries and prospects of successful treatment. The peace movement and many health care workers protested against it. At the time, our slogan ‘We won’t be able to help you!’ was very effective in making it clear to the population that effective protection in the event of a nuclear war is impossible. At the time, there was a risk that the government would have access to health care workers in order to deploy them from a military point of view. However, this health security law failed.
Shaping opinions in the medical profession
At the beginning of January, Michael Giss, the commander of the Baden-Württemberg federal state military command, said in a newspaper interview that the population had to be prepared for the fact that in hospitals ‘the seriously wounded soldier will be treated first, the appendectomy patient later’.
Bernhard Winter: The Bundeswehr is currently making increased efforts to influence how opinions are formed in the medical profession and among medical personnel in general, including public events and symposia and cooperation with state medical associations, professional associations or emergency services. Behind the scenes, the aim is once again to gain access to employees in the civilian health sector. The last NATO manoeuvres have shown that logistical experts are necessary for the operating base that deploys military towards the east. The military cannot carry out the transports alone. Therefore, the military wants it to become possible for employees in the transport sector to be conscripted into the army service. The operating base that organises the return must transport injured soldiers, but also fleeing civilians. Health Minister Lauterbach had actually announced a new Health Security Act in preparation for disasters and military conflicts, which would have included corresponding rules for war. The collapse of the coalition government of SPD, Green Party and Liberals has put an end to that for the time being.
Blurred boundaries
Will the next federal government try this again?
Bernhard Winter: Definitely, regardless of which parties form the government! But the line between the civil health system and the military is also being blurred beyond this federal law. As early as 2008, the Red Cross was placed under the command of the Bundeswehr medical corps in the event of war. I doubt whether many nurses at the DRK are aware that they are subordinate to military structures in the event of war. The leadership of the Maltese and the Johanniter health service are pushing to be integrated in the same way because they expect material benefits from it. Since 2023, there has been a national security strategy with an ‘integrated security approach’. The following events are listed in it: ‘environmental and natural disasters, chemical and nuclear accidents, epidemics and pandemics, terrorism and military conflicts’.
Is the Association of Democratic Doctors against preparing for such events? After all, it is not unrealistic to assume that they will occur.
Bernhard Winter: Of course, after the experiences with Covid-19, the healthcare system must prepare for future pandemics, there’s no question about that, as well as for environmental disasters and attacks. We have nothing against institutions practising how to react in such situations. However, medicine in war is something completely different. In medicine, the guiding question is: What will do the patient the most good right now? War medicine has a different focus. Its purpose is to get wounded soldiers back in fighting form as quickly as possible and send them back to the front. This applies especially to the armies of rich countries with large medical capacities and highly qualified military personnel.
Criticism of the cooperation between civilian and military institutions
Your association criticises the increased cooperation between civilian and military institutions – why?
Bernhard Winter: Under international law, attacking a hospital is always considered a war crime. The reality is different: medical facilities are increasingly becoming military targets. If we mix civilian and military, it is hardly possible for a military opponent to distinguish between the two either.
In the 1980s, the peace movement succeeded in pushing back the military’s influence on medicine. The political situation has changed a lot since then. Will there be resistance if the next government passes a new Health Security Act that puts medical personnel under the command of the Bundeswehr in the event of war?
Bernhard Winter: There will certainly be clashes and protests, although perhaps not as strong as they were back then. Our association is receiving an increasing number of enquiries on this topic. After all, the situation is not the same after Russia’s attack on Ukraine. Young people were overwhelmed by the threat of war. Now they are gradually beginning to have to deal with it, to overcome their passivity and also to talk about their fears.
The question that is suppressed
The 2023 ‘Framework Directive on Overall Defence’ also mentions ‘temporary treatment facilities’ in the event of the use of chemical, biological, radiological or nuclear weapons.
Bernhard Winter: That seems to be an important point. In the 1980s, the threat of nuclear war played an important, mobilising role. This threat still exists, but it no longer plays any role in the debate. But who says that the war on the so-called eastern flank will only be waged with tanks against tanks? At the moment, the government and the military are managing to suppress this question…
