The State Audit Office of Latvia has assessed the existence of prerequisites for the readiness of the civilian medical sector to provide medical support to the National Armed Forces of Latvia in the event of war. Although several significant steps have already been taken in Latvia to strengthen civil and military cooperation in the field of medical support, the audit has indicated areas where further development is required. Therefore, the State Audit Office of Latvia has provided recommendations, the implementation of which will help to coordinate cooperation between the civilian and military sectors more effectively, strengthen the resilience of hospitals and ensure that medical personnel are better prepared in military medical matters.
“Medical support capacity is crucial, as it is aimed directly at preserving the health and life of the most valuable and limited resource of the armed forces, namely, soldiers. In Latvia, the possibilities for restoring human resources are limited significantly, therefore, reducing battle casualties and returning soldiers to the ranks in a timely manner are a strategic priority. It requires an effective military and civilian medical system that is able to operate together both in peacetime and in crisis. In the audit, we call on each involved sector to take purposeful leadership in matters within its competence both in planning, improving regulatory frameworks, and developing resources and human resources in order to achieve significant and sustainable results in strengthening medical support capacity through close and coordinated mutual cooperation,” outlined Mr Gatis Litvins, Council Member of the State Audit Office of Latvia.
The interim audit report was prepared as part of the performance audit “Development of the Medical Support Capability of the National Armed Forces” conducted by the State Audit Office of Latvia, and it has been assigned the status of restricted access. To provide the public with an idea of the focus of this audit and the importance of medical support in national defence, publicly available information has been prepared, which explains the importance of medical support capability, presents the issues assessed in the interim report, and provides insight into the practice of other countries in this area.
In the audit, the State Audit Office of Latvia analysed the cooperation model between the civilian sector and the National Armed Forces of Latvia (NAF) in providing medical support, the readiness of the civilian medical sector to provide assistance in wartime, the preparedness of medical personnel in military medical matters and their involvement in the reserve soldier system and also examined the experience of other countries in this area. This report complements the State Audit Office’s audit of inpatient healthcare. Based on the findings from both audits, one is able to build a sustainable, resilient, and effective healthcare system in both peacetime and wartime conditions.
Mr Andris Sprūds, Minister of Defence of Latvia, states, “Effective, side-by-side cooperation between military and civilian medical services in the field of medical support in the event of a crisis is an essential element of comprehensive national defence. In close cooperation with the healthcare sector, we have developed not only a regulatory framework but also implemented specific initiatives from educating and strengthening medical personnel to ensuring the availability of medical supplies over the past few years. For example, with the support of the Ministry of Defence, a new study course “Basics of Military Medicine” has been established at the Riga Stradiņš University. The NAF, together with medical institutions, is testing readiness for crisis situations within the framework of the civil and military medical exercises “Panaceja” and “Ausma”. The defence budget has also supported funding for the health sector for the availability of critical medicines and the creation of supplies. We will continue intensive interdepartmental cooperation, as well as use the experience of Ukraine even more actively in the implementation of an effective model in the NAF. Support for soldiers in critical conditions is my priority.”
For the healthcare sector to be able to provide medical support to the NAF in the event of war, two closely related prerequisites are essential, that is, sufficient and trained medical personnel and the ability of hospitals to ensure continuity of operations in emergency. It means that doctors, physician assistants and nurses must be trained in military medicine and a targeted reserve of medical personnel must be established for the needs of the NAF. At the same time, medical institutions must also be able to operate in threat situations by ensuring physical security, infrastructure resilience, evacuation and logistics solutions, availability of supplies of medicines and medical equipment, energy supply and functioning communications, etc. Only the fulfilment of these prerequisites allows the civilian sector to fulfil its role in the national defence system fully.
In Latvia, medical care is provided by a network of medical institutions, which includes 41 hospitals and more than 3,900 outpatient medical institutions, including doctor practices, paramedical health centres, medical rooms in educational institutions, etc. Medical personnel are trained by 11 higher education institutions and colleges in Latvia, where an average of 1,146 students, including doctors, physician assistants and nurses, obtain medical qualifications annually. 24% of students are foreign students, however, it is still important for Latvia to ensure sufficient training of local specialists and their involvement in the system in the long term.
Mr Hossam Abu Meri, Minister of Health of Latvia, indicates, “The report by the State Audit Office of Latvia emphasises clearly that medical support capacity is the shared responsibility of the entire country. In emergency, the civilian healthcare network ensures the saving of soldiers’ lives and their return to the ranks, therefore it is essential to strengthen both the resilience of hospitals and the preparedness of medical personnel in military medical matters. In recent years, both the State Emergency Medical Service and hospitals have been preparing purposefully, and several institutions have demonstrated a very high level of readiness, which has also been assessed positively by GLOBSEC experts. A military medicine curriculum is taught at the Riga Stradiņš University, simulation training areas are being created, and medical personnel improve their first-aid skills regularly. Valuable experience has also been gained by providing assistance in Ukraine and treating wounded soldiers in Latvia, this is both our contribution and professional knowledge in the care of unprecedented physical and psycho-emotional injuries. With the current tight budget, there is always a challenge to balance funds carefully between daily healthcare and strengthening readiness. However, the health sector is working purposefully to provide that every medical institution and every medical personnel are ready to act professionally and in a coordinated manner in both peace and emergency.”
The audit also assessed whether the experience of the war in Ukraine was used in the planning and development of the medical support system, namely, whether information on the operation of the Ukrainian civilian medical sector in war conditions was collected and analysed and this experience was integrated into training and preparedness plans.
“The experience of Ukraine confirms how important creating a sustainable system is where the civilian and military sectors operate in coordination, medical personnel are prepared adequately, and hospitals are able to adapt quickly, operate mobile and maintain functional self-sufficiency even in extreme conditions. The transfer of this experience must take place systematically so that the transfer of knowledge and experience is targeted and effective. The experience of Ukraine teaches how to save lives in modern war conditions, for example, in situations where assistance to the wounded can be delayed for days due to the threat posed by drones,” added Mr Gatis Litvins.
The State Audit Office of Latvia is continuing to work on the next report in this performance audit, which will be dedicated to the organizational model and performance of the medical support capability within the National Armed Forces itself. Its preparation is planned for early 2026.
Additional reading: 🔗 Informative material on the prepared interim audit report “Civil and military cooperation in the field of medical support”.
About the State Audit Office of Latvia
The State Audit Office of the Republic of Latvia is an independent, collegial supreme audit institution. The purpose of its activity is to find out whether the actions with the financial means and property of a public entity are legal, correct, useful and in line with public interests, as well as to provide recommendations for the elimination of discovered irregularities. The State Audit Office conducts audits in accordance with International Standards of Supreme Audit Institutions of the International Organization of Supreme Audit Institutions INTOSAI (ISSAI), whose recognition in Latvia is determined by the Auditor General. Upon discovering deficiencies, the State Audit Office of Latvia provides recommendations for their elimination, but it informs law enforcement authorities about potential infringements of the law.