KANANASKIS, Alberta – For paramedic Martyna Veronika Noreikaitė, a recent training exercise in Jonava, Lithuania, simulating a mass casualty event, was a stark awakening. As she sped towards a smoke-obscured school, sirens blaring, the chaos of “people running around, lying on the ground, screaming” was a world away from her usual calls for high blood pressure. This intense drill is part of a larger, urgent effort by Europe’s eastern flank countries to ready their healthcare systems for the unthinkable: a potential military attack.
Since Russia’s full-scale invasion of Ukraine shattered the illusion of perpetual peace in Europe, countries like Lithuania, Estonia, and Poland – all formerly under Soviet occupation and now NATO members – are scrambling to bolster their defenses. The threat of conflict, particularly given the vulnerability of the Suwałki Gap linking NATO to the Baltics, has transformed “if” Russia will attack into a chilling “when.”
Healthcare Under Fire: A New Reality
Modern warfare, as demonstrated in Ukraine, no longer spares civilian infrastructure, including hospitals. This harsh reality is driving sweeping changes across Eastern European healthcare.
In Vilnius, Lithuania, the Santaros Clinics hospital, just 50 kilometers from the Belarusian border, is developing underground operating theaters, shelters, helicopter landing sites, and autonomous systems to ensure functionality even if power or water supplies are cut. Estonia is equipping ambulance crews with ballistic helmets and vests, distributing satellite phones, and even planning for an independent internet network. Across the region, hospitals are reinforcing their own electrical generators, learning from Ukraine’s experience with targeted civilian infrastructure.
“We know for certain that Russia targets the civilian infrastructure and energy structures,” stated Ragnar Vaiknemets, deputy director general of the Estonian Health Board. “You cannot have these kinds of situations where the hospital doesn’t work because there are some power plant problems.”
Many existing hospitals, relics of the Soviet era, are vulnerable due to their large, consolidated structures. The focus is now on repurposing basements for critical functions, as Vaiknemets added, “I can’t imagine working on a top level … of the hospital just waiting to get hit.” Estonia is also investing in mobile medical units to rapidly increase critical care capacity, addressing a continent-wide shortage.
Stockpiling and Supply Chain Resilience
Even the most robust hospitals are useless without supplies. Baltic nations are aggressively stockpiling medicines, equipment, and trauma kits for mass casualties. Estonia has allocated €25 million for such supplies, including orthopedic gear and tourniquets. Latvia has mandated a three-month supply of medicines for healthcare institutions, a policy bolstered by lessons learned from the COVID-19 pandemic.
However, experts like Jos Joosten of the European External Action Service warn that proximity to the front lines makes it difficult for smaller nations to secure their own emergency supplies. He advocates for greater EU-wide solidarity and centralized decision-making to identify scarce resources and ensure equitable distribution when needed, with supplies from the Red Cross, national reserves, and the EU’s rescEU emergency service all prepared for rapid deployment.
Staffing the Frontlines: A Human Challenge
Beyond equipment and supplies, the human element remains a critical challenge. The Baltics face existing healthcare workforce shortages, and a significant concern is whether staff will remain during a conflict. A Lithuanian survey revealed that over a quarter of health workers would likely flee, with fewer than 40 percent committed to staying.
Paramedic Martyna Veronika Noreikaitė, who has signed a declaration to stay and work if war breaks out in Lithuania, reflects this uncertainty. “But how it would really be — who would come and who wouldn’t — I don’t know,” she admitted. Estonian authorities are working to ease concerns, particularly about family safety, recognizing that personnel won’t stay if their loved ones are at risk.
Many medical professionals, like Latvian pulmonologist Rūdolfs Vilde, express a commitment to stay but emphasize the need for clear directives and training. “Should I be prepared … to provide some kind of military medicine, or should I be just prepared to come into my regular work and just have a bigger flow of patients?” Vilde questioned, highlighting the distinct needs of wartime healthcare.
Intensive Training for Unimaginable Injuries
To address these challenges, training efforts are intensifying. Hospitals, ambulance crews, and health workers are being drilled on switching to “crisis mode,” handling massive patient influxes, and treating severe wartime injuries rarely seen in civilian settings – blast wounds, gunshot trauma, burns, amputations, and spinal or head injuries.
Lithuania alone plans seven military-medical exercises and over 10 civil-security drills for medical professionals this year. Some medics are even volunteering in Ukraine to gain firsthand experience with missile strikes, mass casualties, and power outages. Vaiva Jankienė, a nurse who has volunteered over 20 times near Ukraine’s front lines, underscores the brutal reality: “Injuries like these,” she sighed, “every single medical professional who saw them said the same thing: We couldn’t have imagined it would look like this.”
The Broader Impact: Refugee Surges and EU Solidarity
The impact of war extends beyond national borders. The use of long-range weaponry means attacks can reach far from traditional front lines, necessitating evacuation plans for hospitals and civilians. This also means that countries further from the immediate conflict must prepare to receive both patients and a massive influx of refugees.
Joosten warns that the scale of casualties and displaced populations could dwarf anything seen in Ukraine, testing the very foundation of EU solidarity. “If Lithuania is overrun, who’s responsible for Lithuanians, because there’s no Lithuania anymore? But the European Union is (still there),” he said, urging the EU to create dedicated funds for civilian and military casualties and displaced populations.
“Crisis never shouts when it’s coming,” Vaiknemets concluded. While no one knows if or when war will come, the message from Europe’s eastern frontier is clear: prepare for the worst, and hope it never arrives.
