Assessments of the Components of the Military Medical System and Proposals for Addressing Its Challenges
"The Human Being and Military Medicine – A Comprehensive Perspective" is a qualitative study conducted in 2023, following interviews with 29 respondents from various sectors and levels of the medical system — from combat medics and volunteers to heads of military hospitals and representatives of the Ministry of Health.
The study aims to identify challenges and offer recommendations to improve the system. The researchers’ key question: “What needs to change in the existing military medical support system to transform it into a more human-centered and resilient one in the medium and long term, considering the value and scarcity of the human (mobilization) resource in Ukraine?”
Contributors to the study include Oleg Petrenko, Oleksandr Danyliuk, Arsen Zhumadilov, as well as researchers from the School of Political Analytics at the National University of Kyiv-Mohyla Academy, led by Maksym Yakovlev and Anna Osypchuk.
An important note: the qualitative methodology does not allow for verifiable representative claims or the use of percentages. Instead, its strength lies in uncovering the diversity of experiences, perceptions, opinions/visions, assessments of respondents, and typical patterns of interaction with the system that may indicate systemic issues.
Key findings:
- The system did not collapse; it reorganized and synchronized with the civilian system, forming a so-called unified medical space. This added flexibility in using resources, particularly from civilian medicine, to support military needs and allowed for quicker responses to challenges. However, interoperability between civilian and military medical systems still needs improvement, especially regarding the responsibilities of civilian healthcare. It is crucial for civilian doctors to gain experience in treating gunshot and explosive injuries.
- New solutions, although not perfect, have been and are being implemented in response to needs. Changes are occurring but not always at a pace that meets urgent demands.
- There is a relatively high level of organization and operational efficiency in the system from the stabilization point to the hospital stage. If a person with a survivable injury is successfully evacuated from the battlefield and delivered to a stabilization point, their chances are promising, and the level of medical care provided is appropriate. This is the result of practices developed during the ATO/JFO period since 2014, which have been continuously improved.
- At the tactical level, personal responsibility is most evident — in learning tactical medicine by service members or assembling first aid kits, both at the individual and commander levels. Respondents noted the lack of material and technical resources for practical training, as well as reduced training time. They emphasized the need to standardize stabilization points in terms of equipment and level of care. Regarding the training of combat medics, one respondent stated: “The level [of training] is not bad — it’s unknown.” The situation with evacuation transport, especially armored (casevacs and medevacs), was described as critical by the vast majority of military respondents.
- The functioning of the military medical system at the hospital stage was considered by most respondents to be the most well-organized and least problematic. However, all respondents confirmed problems with rehabilitation or characterized it as practically absent, primarily due to a lack of trained specialists.
- Regarding psychological support, most respondents noted that military psychologists are insufficiently prepared to meet modern challenges and needs. There are no clear criteria for selecting these professionals, and there is a lack of a culture of seeking psychological support among service members.
- Medical personnel reported a lack of rotation, and therefore, no opportunity for rest and recovery. The most critical issue is staffing at the "lower" or combat levels, particularly with combat medics, who are often targeted by the enemy. Respondents highlighted issues with staffing medical companies and units with qualified personnel. Surgeons, anesthesiologists, and trauma specialists are among the most needed. Another issue is that many qualified doctors lack officer ranks, leading to their reassignment to non-medical roles during mobilization.
- Almost all respondents stressed the need for digitalization and improvements in medical documentation processes.
- There is a lack of institutional and personal leadership in military medicine from the Ministry of Defense of Ukraine. There are multiple decision-making centers without proper expertise, leading to blurred responsibilities and powers.
Proposals and Solutions:
- The state should adopt a new Military Medical Doctrine of Ukraine (the previous one dates back to 2018), incorporating the experience of the full-scale war. It should implement unified standards used jointly in the civilian and military healthcare systems. A human-centered approach to premedical and medical care must be introduced.
- The state should develop a system that encourages all components of healthcare to maintain a standardized level of care that military personnel (patients) can rely on. Clear standards for the structure, training, and staffing of the medical support system should be implemented both in peacetime and during special periods. Monitoring and compliance with standards must be systematized.
- The state should build within the Ministry of Defense the capacity for analysis and policy development in the military healthcare system. The formation of expert organizations to enhance policy quality should be encouraged, including through partner support and international technical assistance.
- To restore the Ministry of Defense’s capacity to develop policies in the military healthcare field, it is proposed to create a new structural unit — the Directorate of Military Medicine of the Ministry of Defense. The appendix to the study outlines the proposed functions, structure, and staffing of this unit in detail.
