Putting Medical Boots on the Ground: Lessons from the War in Ukraine and Applications for Future Conflict with Near-Peer Adversaries

Abstract

In the past 20 years of the Global War on Terror, the US has seen substantial improvements in its system of medical delivery in combat. However, throughout that conflict, enemy forces did not have parity with the weaponry, capability, or personnel of the US and allied forces. War against countries like China and Russia, who are considered near-peer adversaries in terms of capabilities, will challenge battlefield medical care in many different ways. This article reviews the experience of a medical team, Global Surgical and Medical Support Group, that has been providing assistance, training, medical support, and surgical support to Ukraine since the Russian invasion began in February 2022. The team has extensive experience in medicine, surgery, austere environments, conflict zones, and building partner nation capacities. This article compares and contrasts the healthcare systems of this war against the systems used during the Global War on Terror. The lessons learned here could help the US anticipate challenges and successfully plan for the provision of medical care in a future conflict against an adversary with capabilities close to its own.

Figure 1.

Linear effect of distance. This figure highlights the relationship of relative safety of MEDEVAC units as distance from the enemy position changes. The blue line shows the relationship in the GWOT, which highlights the rapid increase in safety with a small amount of distance from the enemy position. The red line shows the relationship in NPA conflict, which highlights that a large amount of distance from the enemy position is needed to achieve significant safety. GWOT, Global War on Terror; MEDEVAC, medical evacuation; NPA, near-peer adversary.

Figure 2.

Map of Ukraine. Russian forces have struck hospitals and medical facilities in Zhytomyr, about 400 km west of the Russian-Ukrainian border. Russian missile strikes have also occurred within 25 km of the Polish-Ukrainian border, which means nearly any location within Ukraine is within Russia’s reach. Image modified from Google Earth.