History: the Bundeswehr Medical Service over the years

The development and therefore also the history of the Medical Service began to pick up speed not long after the Bundeswehr was founded. Starting in November 1955, just a few months after the Federal Ministry of Defence had emerged from its predecessor known as the “Blank Office”, the IV H: Health Care division of the ministry began to develop the first basic elements of the Medical Service’s structure. The Defence Committee of the German Bundestag’s approval of the planned structure on 11 April 1956 was preceded by lengthy debates over the status of the future military pharmacists and medical personnel. While representatives of the group called “comprehensive strategy/G4/medical services”, as well as civilian medical bodies and professional associations, advocated granting the personnel in question the status of “Medical Service officer”, the German government did not initially support this demand. After countless debates, however, the decision was finally taken to allow the status of Medical Service officer as we know it today for personnel with licences to practise in any of the four medical fields (medicine, dentistry, pharmacy and veterinary medicine).

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From the beginning and throughout its history, the Medical Service struggled with sometimes dramatic personnel problems. In the 1960s and 1970s, the Medical Service scarcely succeeded in meeting its requirements for Medical Service officers in all four medical fields (medicine, dentistry, veterinary medicine and pharmacy) who would serve longer tours of duty, despite various personnel management measures aimed at filling more of the posts. As of 1964, physicians, dentists and pharmacists completing their basic military service were an important means of supporting medical care, even though they often lacked military training and professional experience.

By the end of the 1980s, the personnel situation had improved due to financial incentives offered through grants for medical students, as well as the 1969 introduction of the career path for Medical Service officer candidates, including allocation of a place at university as of the 1973/1974 winter semester, and the recruitment of female Medical Service officers starting in 1975. Nevertheless, the Medical Service was initially completely unable to fill all of its posts with temporary-career volunteers and career service members. Only over time was the Medical Service able to sustainably meet its requirements for temporary-career volunteers and career service members by continually training Medical Service officer candidates. In 1989, this career path was also opened to women.

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The Medical Service consisted of six large subareas, one each for the Army, the Air Force and the Navy, as well as the Central Medical Agencies, the medical service of the central Bundeswehr agencies, and the recruiting organisation physician service. Aside from real-life support during peacetime, the Medical Service’s focus until the end of the Cold War was primarily on medical care in the event of a defensive war in the territory of the Federal Republic of Germany – a “state of defence”. To this end, it had various organisational structures that would go into effect in a state of defence. Over the decades, these structures were subject to constant change. In addition to the organic medical service, the medical regiments and medical battalions – the battalions being charged with setting up and operating the casualty collecting post – the “hospitals, 200-bed” and the Bundeswehr hospitals were particularly important elements.

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The Peaceful Revolution in East Germany, along with the subsequent reunification of Germany and dissolution of the Warsaw Treaty Organization – as the Warsaw Pact was officially known – presented the armed forces and therefore also the Medical Service with major challenges. As in the rest of the Bundeswehr, military personnel from the National People’s Army had to be integrated and prepared for their new duties in the armed forces of a democratic country.

Even before the political changes in Eastern Europe and the subsequent changes in the mission situation for the German armed forces, there had already been the first calls for structural changes in the Medical Service that would enable it to perform its duties across the various armed services in order to boost efficiency. The definitive end of the Cold War in the late 1980s and the resulting need to reorient the Bundeswehr ultimately led to the establishment of the Bundeswehr Joint Medical Service in which medical assets have been consolidated to the greatest extent possible under uniform functional, technical and administrative control since 2001. In retrospect, creating the new command and control structures in an independent major organisational element can be seen as one of the Medical Service’s most far-reaching reforms.

The reorientation decided upon in 2011 also radically changed the Medical Service’s structures. The Bundeswehr Medical Service Headquarters was established on 1 October 2012, followed by two other medical capability coordination commands: the Regional Medical Support Command in Diez and the Operational Medical Support Command in Weissenfels. While the command in Diez is responsible for outpatient medical care for all military personnel, as well as medical assistance for the armed services’ and major military organisational elements’ training and exercises, the command in Weissenfels takes the lead role for all operations in which the Bundeswehr Joint Medical Service participates, along with territorial tasks involved in civil-military cooperation, and national and international medical training assistance services.

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These structural changes were not an end in themselves or arbitrary political decisions, but rather always represented responses to developments in the security environment. Even by the early 1990s, the Bundeswehr’s task spectrum had changed dramatically, which could not fail to affect the history of the Medical Service. In 1992, the German government decided that the Bundeswehr would no longer only protect “Germany and its citizens from political extortion and external danger” but also serve “world peace and international security in accordance with the Charter of the United Nations”. For years, the constitutional basis for these “out-of-area missions” was a subject of discussion. It was not until 12 July 1994 – in other words, after the German armed forces’ first UNUnited Nations contingent operation in Cambodia in 1992/1993 – that the decision of the governing coalition at that time was ultimately approved in a judgment by the Federal Constitutional Court.

In the “technical guideline on medical care for Bundeswehr military personnel on operations”, which was issued the next year in 1995, the Surgeon General of the Bundeswehr defined the principle that medical care for all military personnel deployed outside Germany must ultimately be equivalent to the standard of medical care in Germany.

The attacks on the World Trade Center on 11 September 2001 and the resulting fight against international terrorism represented yet another caesura for the Medical Service. Whereas the focus up to that point had been primarily on caring for members of humanitarian and stabilisation missions, the operations in Afghanistan starting in 2002 were the German armed forces’ first combat mission after World War II, which not only resulted in changes in the injury patterns and the types of treatment they required, but also came with ethical challenges.

Hardly any other area of the armed forces has had more discussions about its position and identity as a professional category than the Medical Service. History has shown that this situation can be accurately described as a balancing act between being a physician and being an officer. The Medical Service leadership has made its position on the professional identity of Medical Service officers clear.

On 8 July 2015, Dr Ingo Patschke, Lieutenant General, Medical Corps and Surgeon General of the Bundeswehr at that time, issued the directive on the “Identity of the Bundeswehr Medical Service” while putting the “Mission Statement of the Bundeswehr Medical Service” – with the subtitle “Committed to Humanity” – into effect as some of his last official acts.

The words “We protect and maintain the health of the patients entrusted to us” establish a clear link to the code of medical ethics. The unconditional acceptance of the national and international provisions applicable to armed conflicts are clearly reflected in these guiding principles: “We live and act in accordance with the ethical and moral values of our democratic state governed by the rule of law and with those of international humanitarian law” and “In keeping with international humanitarian law, we use our weapons exclusively to defend our patients and for our own protection”.

In this way, both the mission statement and the associated basic directive clearly express the Medical Service’s humanitarian standards as an essential basic requirement for the actions of all its members.