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"Our profession may also demand that we put our lives on the line. We seldom think about that"

Russia's war against Ukraine leaves great destruction in its wake; not just since the start of the large-scale attack in February 2022, but since the uprisings in the Donbas. The Bundeswehr hospitals have been treating severely wounded Ukrainians for several years now. For "Ethics and Armed Forces," Major General Dr. Stephan Schoeps, Deputy Surgeon General of the Bundeswehr, answered questions about the physical and psychological damage caused by war, about mental and material preparation, and about the Afghanistan mission as a "maturity test" for the Bundeswehr.

Dr. Schoeps, Russia has been at war in Ukraine for more than half a year now. Were you surprised by the attack? Should we have seen it coming, as people keep saying?

It is easy to be wise after the event. Looking back, there were clear signs that the Russian Federation would make a move. At the latest with the annexation of Crimea, it became apparent what Russia’s intentions were. We all wanted to believe that Putin was just making threats. None of us wanted to think that our comfortable, easy lives could be in danger, and we could not imagine that an illegal war of aggression would be waged in Europe again. The suddenness and intensity of the attack were very frightening, and certainly not only for me.

Did you think that the war would last so long and develop the way it has?

Ukraine is defending its territory. That is the greatest motivation for it to mobilize all its forces and fight with every means at its disposal. However, given the apparent military superiority and presumed superior military capabilities of the Russian army, I had not dared to hope that the Ukrainians would defend themselves so successfully. The Ukrainian army, with the support of the West, has done an incredible job. I take my hat off to them.

Since the beginning of the conflict in the Donbass region in 2014, the German armed forces have been assisting Ukraine in the treatment of war casualties. How is that going? How many patients have been treated?

Since 2014, we have treated more than 150 wounded Ukrainians across all Bundeswehr hospitals. Some will need more than twenty surgeries over a period of years and long-term rehabilitation before they can participate in life again. Caring for war wounded is enormously costly. Ukraine regularly asked the German government for support. We used to select the patients there and fly them to Germany. Now the procedure is different. Patients from Ukraine are spread throughout Europe. So far, Germany has taken the greatest number of patients. Patient allocation in Germany is handled by the Federal Office of Civil Protection and Disaster Assistance (BBK). The Bundeswehr hospitals are currently treating sixteen Ukrainian patients.
These hospitals are well equipped to treat war injuries.

How have working practices at the Bundeswehr hospitals changed as a result? What lessons can the medical service learn from treating these patients?

As I mentioned, our Bundeswehr hospitals are set up to treat war injuries and already have many years of experience with these types of wounds due to the various overseas missions. There are many parallels between civilian care for polytrauma, i.e. patients with multiple, simultaneously life-threatening injuries, and medical service care of the wounded in war zones.

What is the Bundeswehr leadership’s general view of the war in Ukraine? What scenarios are you preparing for, what conclusions can you already draw?

I think we all agree that this war of aggression, which is contrary to international law, must not be allowed to succeed. The Bundeswehr will prepare comprehensively for national and Alliance defence, and strengthen its presence on NATO’s eastern flank. In addition, the German Chief of Defence, General Eberhard Zorn, has ordered a division to be brought to combat-readiness by 2025. We are ready to defend NATO territory together with our partners. 

Do you think we could really enter into a military conflict with Russia?

We now know that Russia is willing to launch an attack against a country in violation of international law. In many of his speeches, the President of the Russian Federation has revealed imperialist goals. As the war has not been going his way, he has now ordered a partial mobilization. We must draw our conclusions from that. As a society, we must also be mentally prepared again to defend our country and our freedom. The declaration [by German Chancellor Olaf Scholz] of a “new era” (Zeitenwende) and the announcement of a special fund for the Bundeswehr are the right first steps in this direction. Coordinated and targeted arms deliveries and sustained cohesion among NATO and EU partner nations throughout the winter are essential. And there is a need for level-headed political and military leaders on both sides.

The Chief of the Army, Lieutenant General  Mais, famously said that the Bundeswehr is more or less “standing bare”. Do you agree with this statement? Will that change in the foreseeable future with the special fund and the commitment to meet the two percent target from now on?

I cannot speak for the army. But from an outside perspective I would say that the Inspector of the Army is certainly right. The Joint Medical Service (Zentraler Sanitätsdienst) is also pretty “bare” in several areas, including strategic transport of the wounded, in its leadership ability, and in digitalization. Steps must be taken here as quickly as possible. The special fund and the commitment to meet the two percent target are a first step in the right direction, but further investment will be necessary. This applies to the Bundeswehr in general, but also to the medical service in particular.

So will the medical service also benefit from the special budget and rising spending? And if so, how?

We need the capability to provide medical support for highly mobile combat. This requires appropriate flexibility in medical service facilities, the availability of small, forward surgical teams, tent-based and also protected treatment facilities, reliable and sufficient land and air transport capacity for the wounded, and modern command and control equipment. The defence plans take all of this into consideration, just often not as a top priority. Unless the medical service gets the up-to-date, high-quality equipment it needs, there will be no deployments. Our planners need to be reminded of this at times.

Apart from questions of materials and equipment, what about the service personnel in the German armed forces? Are they mentally and physically prepared for a national/Alliance defence scenario? Has the training changed since the war started?

Training is always evolving. For example, we have been successfully training troops to provide effective first aid for about ten years. Competent first aid from a colleague often makes the difference between life or death for a wounded soldier. The first priority is to stop bleeding.

Our medical personnel are excellently trained and are sent into action from ongoing patient care in Germany to give them a “warm start”, so to speak.

For me, however, the key is to change our soldiers’ mindset. We are an excellent employer with all the social benefits. For the most part, we have grown used to our roles in Germany and seldom think about the fact that our unique profession may also demand that we put our lives on the line. Physical and mental resilience, strength of character and a basic understanding of what service entails are essential requirements for soldiers in the field. We still have a lot to do to achieve this. However, I am convinced that we can communicate this better with the current threat situation than we could a year ago.

In this context, what is your opinion of debates like #leistungsschwach [underperforming] on Twitter? How much stress should military personnel be able to withstand? How tough does a soldier have to be, and how important are good leadership, help and support offerings, and pastoral care?

War is psychologically and morally stressful, which can make people ill. Everyone reacts differently to physical or mental stress, and to moral conflicts. We have learned a lot about this in recent years, and offer many possibilities for prevention and therapy. The psychosocial network – consisting of medicine, psychology, the military chaplaincy and social services – provides support for patients.

But it is also important to be well prepared for deployment. This means not only military and professional competence, but also coming to terms with the special circumstances of life during deployment, the associated dangers and one’s own fears. Here it is helpful to talk with experienced colleagues and superiors beforehand, and also with one’s own family, to guard against stress. Psychological stress reactions and moral injury are certainly no longer taboo in the Bundeswehr. 

More specifically, what does it mean to be confronted with the brutality of Russian warfare? Is that also something you discuss with soldiers, commanders and superiors?

Of course, we talk about it. War is always brutal, and in my opinion, there is no such thing as a clean war. It is always a matter of forcing one’s will on the other side. There is no squeamishness about the choice of means anywhere in the world. But the brutality with which the Russian Federation wages war is repulsive and clearly deviates from our own values. It also indicates poor leadership, low morale, and inadequate training. It is important to us that such atrocities, wherever they occur, do not go unpunished.

How would you respond to someone who argued that in a potential fight against such an enemy, you should not weaken yourself by observing principles of international law or ethical considerations? Does self-commitment imply a military or any other kind of disadvantage?

Good leadership, excellent training and the conviction of defending a just cause are necessary conditions for fighting successfully. I am convinced that it is not possible to achieve something “good” by doing wrong, such as violating international law. If the legal framework is abandoned, everything gets out of control. Our soldiers need to know very clearly what they stand for, what they are fighting for and, in the extreme case, what they are dying for. And they must know that atrocities will not be tolerated. They need to know that they have the support of society and of our politicians, and of course that their employer is looking after them.

We can currently observe the opposite approach in the Russian Federation. The brutality I mentioned can be found not only in the way war is conducted, but also in the way its own soldiers are treated. A war of aggression in violation of international law, inadequate medical services, poor support, avoidable losses, leaving the dead and wounded behind, and the use of mobile crematoria are just a few examples. 

The Afghanistan mission is hardly discussed in public anymore. Is it any different among the troops? Even though the mission was conducted under completely different conditions, to what extent has it contributed to a different understanding of the Bundeswehr among members of the armed forces and in the public’s perception?

Even among the troops, there has not been much talk about the Afghanistan mission lately. But the evacuation operation last year did rekindle the discussion, and brought the question of its purpose back into focus.

The Afghanistan mission was undoubtedly a kind of maturity test, for the German armed forces and for society. For the first time, Bundeswehr soldiers were involved in heavy combat in the Hindu Kush; they were wounded and also killed. We found out what war means. I experienced two missions myself as commander of the medical task force in Kabul and Mazar-i-Sharif. I consider it aunique privilege of the medical service that we always have a meaningful impact. We were able to do a lot for the Afghan security forces, the civilian population, and also the Afghan health care system. Many times we were able to make a difference to individual lives – I am thinking here of the numerous cleft lip and palate surgeries for children, for example. But it was clear to me even at the time that you cannot bring about lasting change in Afghanistan using the armed forces. They create conditions of security for certain periods of time, during which others are then able to work. These periods must be used to promote the economic, social and cultural development of the country. Despite all our efforts, we obviously did not succeed in doing this.

With regard to the war in Ukraine, which is virtually on our doorstep, my view is that the meaning and purpose of armed forces is once again becoming clear to large sections of the population.

So, in your view, have Germans recognized the seriousness of the situation? If we had to defend ourselves, would we be as resilient and resistant as the people of Ukraine?

Personally, I believe that the population has indeed recognized the seriousness of the current state of affairs and also keeps itself comprehensively informed about the geopolitical situation. Russia in particular, as a nuclear power, is perceived to be a real threat. There are some well-known politicians who had a change of heart after visiting the war zone, and who today support the urgently needed arms deliveries with no ifs or buts. Moreover, I hope that the German population would take up arms in defence of Germany with the same motivation and commitment as the Ukrainians.

What are your views on the reintroduction of compulsory military or civilian service?

Even if compulsory military service is idealized in retrospect, not everything about it was good or sensible. The suspension of compulsory military service was the end point of a distinct trend. The lack of fairness in the conscription system, the low numbers of conscripts, and the low level of social acceptance, as well as the difficulty in justifying a six-month period of military service ultimately led to its suspension. Today, the Bundeswehr lacks all the structures for reintroducing it.

Personally, I would very much welcome a compulsory year for men and women with service in the armed forces, the police, in old people’s homes and hospitals, social services, etc. But at the moment I do not see any majorities in favour of this.

Dr. Schoeps, thank you very much for the interview!

Questions by Rüdiger Frank and Heinrich Dierkes. The interview was conducted in late September 2022.

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Major General Dr. Stephan Schoeps was appointed Deputy Surgeon General of the Bundeswehr (based in Coblenz) in 2016. Previously, he served, among other assignments, as Commander of the Bundeswehr Medical Academy in Munich and the Operational Medical Support Command in Weißenfels. Foreign deployments in Afghanistan in 2003 and 2009.