Healthcare on Alert: How European Civilian Hospitals Are Preparing for War Scenarios

In recent months, the conversation has shifted beyond just defending borders or strengthening armies: war, or rather, the real possibility of a conflict on European soil, has now entered hospitals as well. In France, Germany, and more slowly in Italy, a new reality is emerging: that of a civilian healthcare system being called upon to prepare for the management of war casualties, to ensure a medical response in the event of armed conflict.

This is a silent transformation, unfolding across hospital departments, administrative offices, training courses, and strategic plans. It’s a preparation that remains invisible and unheard, but speaks volumes about the times we are living in.

FRANCE: The Circular That Changes the Paradigm

The most concrete sign of this change came from France, where on July 18, 2025, the French Ministry of Health issued an official circular to all regional health agencies. The document instructs all hospitals, both civilian and military, to be ready, by March 2026, to receive up to 15,000 wounded soldiers in the event of war. The plan anticipates operational peaks of 100 patients per day for 60 consecutive days, and surges of up to 250 casualties per day for at least three days in a row.

It’s not just about adding more beds: the plan includes sorting centers at airports, ports, train stations, and other logistical hubs for initial reception, as well as procedures for stabilizing, sorting, or repatriating the wounded. Medical staff will need training to handle scenarios far different from their daily routines: explosion wounds, multiple traumas, blood management, and psychological support for those who have experienced the horrors of war.

But concerns are already emerging: how will regular care be maintained if resources and staff are redirected to emergency response? The shortage of healthcare personnel in France is already a major issue. The government insists that preparing now is less risky than facing an unexpected crisis unprepared: an idea made starkly clear by the COVID-19 pandemic.

GERMANY: Berlin as a Medical Hub in Wartime

Germany’s approach is no less concrete. In Berlin, a national framework plan for civil hospital defense has been presented, requiring facilities to be ready to receive up to 100 casualties per day while still maintaining essential services for the civilian population.

Fast-tracked emergency pathways are being created, specialized training is being developed to handle blast trauma, amputations, and polytrauma cases, and some hospital wards are being adapted for critical conditions. Berlin is being positioned as NATO’s medical hub: a strategic node not only for domestic response but also to assist allied countries, functioning as an international logistical center.

The German plan displays strong operational clarity, but questions remain: how will priorities be set when the number of wounded exceeds capacity? Who will be treated first? And how can the mental health of medical staff working in traumatic conditions be protected?

ITALY: Between Regulatory Strategy and Operational Ambiguity

Italy is also moving forward, albeit more slowly and cautiously compared to France and Germany. The Ministry of Health has launched a National Strategy for the Resilience of Critical Infrastructures, implementing EU Directive 2022/2557, which includes healthcare among the strategic sectors to be prepared for severe crisis scenarios.

An interministerial technical committee has been established, including Health, Defense, Infrastructure, and other agencies, with the goal of defining roles and guidelines for large-scale emergencies, including a possible war. Joint exercises between civilian hospitals and the Armed Forces are being initiated, the most “critical” wards are being identified for enhancement, and shared protocols for casualty management—from triage to evacuation—are being developed.

However, many aspects remain unclear: Italy has not released any official data on how many casualties it could manage, nor has it specified which hospitals would serve as referral centers in the event of conflict. And the crucial question remains: how will specialized training, costly equipment, and additional personnel be financed, especially within a healthcare system already under strain, with territorial disparities and persistent shortages?

Human Resilience as Well as Technical

Plans and numbers are necessary, but behind every government circular and national plan lie invisible stories, real fears, and personal tensions.

There’s a French surgeon wondering how he’ll manage 250 casualties in three days without enough anesthesiologists or operating rooms. There’s a nurse in Berlin preparing not only to treat explosion injuries but also to withstand the emotional weight of chaos. There’s an Italian citizen who, for the first time, looks at their local hospital and wonders if, in the event of war, there would still be room for them.

It is essential to remember that every wound is a story, and every plan is a responsibility that affects lives. Clinical choices will never be purely technical: they must consider ethics, equity, and invisible suffering.

Hospitals that withstand war are a form of peacekeeping. But it’s not enough to provide beds: we need trained professionals, modern infrastructure, emotional support networks, and fair mechanisms for accessing care. We need human resilience as much as technical resilience.

Preparing for war is not a belligerent act—it’s an act of protection. It means building healthcare systems capable of withstanding shock without losing their humanity.

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