In the event of an armed conflict, Polish hospitals would sink into chaos. There is a lack of comprehensive plans, established standards, stockpiles, and guarantees of energy supply for hospitals in case of emergencies. Polish institutions are still at the stage of defining needs. The road to building a serious resilience system is still long. Meanwhile, there are countries that introduced specific solutions a long time ago.
Recently, Defense Minister Władysław Kosiniak-Kamysz boasted about creating Military Medical Services. Earlier, Health Minister Izabela Leszczyna spoke about drafting a plan for healthcare in case of armed conflict. Although more than three years have passed since Russia launched its full-scale invasion of Ukraine, and the current ruling coalition has been in power for nearly two years, the development of a healthcare security system in case of war is still only in the planning stage.
Other countries plan ahead
The situation is different in some European countries. In the UK, hospitals submit an annual self-assessment of their readiness for crisis situations, which allows for regular stock replenishment and adjustments. Similarly, Germany’s Federal Office of Civil Protection and Disaster Assistance (BBK) requires hospitals to draw up plans that include management schemes, evacuation procedures, communications, logistics, and cooperation with emergency services. Hospitals are obliged to prepare such plans and update them regularly. In Sweden, the Totalförsvaret (“Total Defense”) concept applies. It provides guidelines for regions, prioritizes services, divides responsibilities, sets rules for information circulation, and provides professional support for staff. Training is also organized for healthcare organizations to operate under conditions of drug or power shortages. Finland’s National Emergency Supply Agency (NESA) coordinates hospitals’ crisis plans to enable the rapid deployment of fuel reserves and power supplies in critical areas.
Power, training, and ownership chaos
Access to electricity is particularly crucial for hospitals in crisis situations. In Scotland, there are strict guidelines for securing power supply, including a stringent requirement—stricter than in many other countries—for hospitals to have fuel storage sufficient to power appropriately matched generators for 200 hours at full load. Germany’s BBK recommends 72 hours of backup power, while in the U.S. some hospital plans assume 96 hours of generator operation.
In Poland, however, current regulations only state that hospitals must have an automatic-start generator capable of providing 30% of peak power, with a proper level of backup supply. But no specific operating time is indicated. A short operating time would mean the need for frequent fuel deliveries, which could become a huge problem under wartime conditions.
Hospital staff speaking anonymously to Gazeta Polska admit that crisis drills and training are rarely conducted in practice. Meanwhile, Maria Ochman, chair of the National Healthcare Secretariat of the “Solidarity” trade union, stresses that in Poland hospitals are run by many different entities.
“We have county, provincial, municipal, and ministerial hospitals. Coordinating their operations is not simple—it requires good central organization. Ownership differences also affect hospitals’ functioning in terms of safety and resilience to crises. Different hospitals have different practices, influenced by funding or medical community interests. We cannot leave everything to the so-called invisible hand of the market. Hospitals cannot operate solely based on profitability,” Ochman said.
An alarming report
A new report, Safe in Crisis, prepared by the Military Institute of Medicine, Rynek Zdrowia (Healthcare Market), and WNP Economic Trends, was recently published. The authors state that Poland’s healthcare system faces the challenge of building a resilient, flexible, and integrated management model that can function effectively both in peacetime and in crisis. One of the biggest problems is the lack of qualified medical personnel, felt by both patients and facility managers.
According to the report, the military has 829 filled doctor posts out of 1,419 planned—just 58%. Poland has 2.4 doctors per 1,000 residents and 5.2 nurses, below the EU average (3.9 doctors and 8.3 nurses). The armed forces have about 1,800 medical service soldiers, including fewer than 500 doctors prepared for operations in military or sanitary crisis conditions.
Staff shortages are especially severe in emergency medicine and infectious diseases—over 30% of infectious disease ward positions remain unfilled. Poland has 1,193 hospitals (nearly 300 public entities of strategic importance), but only 8% have full facilities to operate under CBRN (chemical, biological, radiological, nuclear) threats. Only five provinces have hospitals with functioning decontamination and epidemiological isolation systems.
The report also highlights drug shortages. Over 70% of active pharmaceutical ingredients (APIs) used in European drug production come from China and India; for some therapeutic groups, dependence reaches 90%. Over 80% of APIs used in Polish drug production are imported, mainly from Asia. Domestic production covers only 30–40% of national demand, and for medicines on the so-called “critical list” (essential in public health emergencies), self-sufficiency is below 20%. During the COVID-19 crisis, only 37% of hospitals had supplies of medicines and personal protective equipment sufficient for more than 14 days of operation (the NATO standard is 30 days).
Poland still at the starting point
Gen. Grzegorz Gielerak, director of the Military Institute of Medicine, commented on the report in an interview for niezalezna.pl.
“In peacetime, the role of military healthcare is to transfer knowledge about the requirements civilian facilities—especially those critical for medical security—must meet. In other words: what infrastructure and equipment are necessary for a hospital to be ready to treat severe war injuries. Hospitals must have communication and IT systems at a level that ensures integration and creates shared platforms for medical data exchange, which will be key to organizing medical logistics, especially casualty evacuation. Logistics, staffing, material supplies, and the ability to maintain and use hospital infrastructure in wartime are equally important,” Gielerak said.
He stressed the most important issue in preparing healthcare for emergencies:
“Civil-military integration is key. COVID-19 showed this, and war will make it even clearer. There is no ‘civilian system’ and ‘military system’—healthcare is one. That is why already in peacetime we should establish unified procedures, conduct joint casualty evacuation exercises, learn resource-sharing, and build the system along with the competencies of the people who operate within it.”
He also pointed out the need to secure facilities in critical healthcare infrastructure:
“We cannot allow a repeat of the pandemic, when patient numbers spiked, the system had no reserves, and other patients lost access to services. Today, based on forecasts of expected sanitary losses, we must establish reserves—properly prepared and equipped treatment sites, maintained in constant readiness for crisis situations.”
When asked about Poland’s current standing, he said:
“We are at the stage of defining needs and ways to meet them. The report helps organize this knowledge. Following its recommendations, we should move to concrete implementation and build elements of a national medical security strategy. Some areas have different timelines: for example, a nationwide training system for medical staff, based on existing resources, could be developed within 18–24 months, which I consider realistic. On the other hand, building and modernizing hospital infrastructure resistant to wartime threats must be carried out intensively over the next two years. Hospitals must be adapted to operate under wartime conditions, including hardened and shielded medical work areas, shelters or deep basements, and helicopter landing sites. A similar timeline applies to crisis communication infrastructure and alternative communications in case of civilian network failures. IT systems must also be integrated through the creation of a shared medical data exchange platform.”