By Olha Hembik | 2025-07-01

WARSAW -- Russia's invasion of Ukraine shattered assumptions about Europe's safety. Now, countries along NATO's eastern edge are rushing to prepare their hospitals for the unthinkable: mass casualties, underground surgeries and frontline medicine in their own cities.

NATO allies in the region are reevaluating crisis protocols, planning wartime drills for hospitals and health care systems and considering measures like stockpiling trauma kits and building underground operating rooms, POLITICO reported.

Poland and the Baltic states are exploring ways to protect medical staff during conflict.

"We have bad neighbors here: Russia and Belarus," Daniel Naumovas, the Lithuanian vice minister of health, said previously, citing regional military threats.

Ragnar Vaiknemets, deputy director general of the Estonian Health Board, noted, "It's not a question of if [Russia] will attack. It's a question about when."

Lithuania plans seven joint drills with the military and more than 10 civil defense exercises for medical staff this year, according to health ministry spokesman Julijanas Gališanskis.

Estonia is weighing backup systems, including satellite phones and an alternative internet network, to keep communication running during a crisis.

Some medics are traveling to Ukraine to gain firsthand experience in wartime care, learning how hospitals function under missile fire, drone attacks and blackouts.

Peacetime approach issues

Vilnius will host a seminar in October titled Battle Damage: Ukraine's Experience, featuring Andrey Volna, a Russian trauma orthopedist who fled Vladimir Putin's regime and received asylum in Estonia.

Volna has led about 15 military medical training courses in Ukraine and warned that while troops prepare for conflict, medical systems must do the same.

"It's probably very difficult to be fully prepared, but we must prepare," he told Kontur.

He said battlefield injuries have changed since 2022. Mortar wounds now make up 90% of cases, while gunshot injuries are rare. First-person-view drones, which explode like grenades, cause especially devastating trauma. Post-injury infections, particularly from the bacterium Acinetobacter baumannii, nicknamed Iraqibacter by US troops returning from Iraq, lead to soft tissue death and require multi-stage operations, since it is often unclear whether tissue is viable.

Peacetime protocols, especially for bone repair, often do not apply.

"You have to change a slew of things literally as you go along," Volna said, noting that Eastern Europe still lacks experience with such injuries.

To prepare, he urged countries to test evacuation systems, clearly assign hospital roles and organize logistics efficiently.

The war is close

Damian Duda, a Polish paramedic and director of the battlefield medic group W międzyczasie, has supported Ukrainian forces since 2014, providing first aid under fire and evacuating the wounded. He has repeatedly risked his life during Russian shelling and received a 3rd class Order of Merit in 2023.

Duda said both Poland and the West now recognize that war is no longer a distant possibility, but they still struggle to adapt. NATO's approach to field medicine still reflects lessons from Iraq and Afghanistan, not the scale of war now unfolding, he added.

"They're not thinking about a full-scale war ... the difference is significant," Duda noted.

In Ukraine, evacuation timelines have shifted. Instead of the "golden hour," wounded soldiers are often transported after a day or two, requiring different protocols and vehicles.

"[Evacuation] helicopters aren't even part of the conversation," Duda said, noting the risk of drone strikes.

Medics now rely on armored vehicles or small passenger cars for evacuations. Poland has few of these, Duda said -- "at most, enough for a week of combat." He argued that large ambulances should be replaced with vehicles better suited for the front.

"All infrastructure in Ukraine -- not just medical -- is moving underground," Duda said.

Poland still uses field hospitals in tents and cargo containers, which he called impractical in a conflict where aerial attacks are constant. He warned that European medical protocols must be overhauled to reflect the realities of modern, high-intensity warfare.

An important signal

"If Russia makes up its mind to strike, it will do so where it has land access," said Stanislav Zhelikhovsky, a Ukrainian scholar of international relations, in reference to the Suwałki Gap, widely considered the most strategically vulnerable point in the event of a NATO-Russia conflict.

He pointed to improvements in the medical infrastructure of the Bucharest Nine -- Poland, Estonia, Lithuania, Latvia, Bulgaria, Hungary, Romania, Slovakia and Czechia -- as evidence of growing readiness.

"Countries on NATO's eastern flank clearly understand how massive the losses in a war could be, and that they need to upgrade hospitals or even build new ones," Zhelikhovsky told Kontur.

He cited key developments: Poland is upgrading hospitals in its eastern provinces, Lubelskie and Podkarpackie; Lithuania is preparing mobile medical units and training staff for bombardment scenarios; and Estonia is developing announcement systems for mass casualty events.

"This sends an important signal to citizens that governments aren't ignoring the threats," he said.

Training military personnel in tactical medicine should be a top priority, said Duda. He noted that most medics in Poland's military units are trained in civilian, not battlefield, care.

"We are now finally going to replace these specialists, and the Combat Medic or Combat Lifesaver roles are just now being introduced into Polish military units," Duda said.

He stressed the urgent need for care between injury and hospital transport. Wounded soldiers often wait hours for evacuation and require treatment under fire.

"We must either give military medics expanded medical authority, such as administering medication, intubating or decompressing ribs, or create a special cohort of medics who will have this authority during wartime," he said.

Poland and the Baltic states will factor Ukraine's military experience into their preparations for potential wars, say analysts. Zhelikhovsky emphasized that the goal is for the countries to withstand an attack, push back against aggression and avoid the worst-case scenario.