At the request of the Ministry of Health, an instruction dated July 18, 2025 was issued. It orders the regional health agencies (ARS) to prepare to accommodate a large number of military casualties. This must be organized in France before March 2026. Confirmed by Catherine Vautrin, the initiative comes as Europe tightens its stance against Russia: deadly strikes in Kiev on August 28, NATO reinforcement on the Eastern flank, and new sanctions in preparation.
What the July 18 letter specifically says
Revealed by Le Canard enchaîné, the document sent to the ARS describes a rapid build-up. Moreover, it aims to prepare the hospital system to face a "major engagement". It sets a very concrete framework:
- inventory of capacities (critical beds, operating rooms, imaging, transfusion);
- creation of temporary medical centers near ports, stations, and airports for the sorting, stabilization, and rerouting of French and allied casualties "to their nation of origin";
- preparation for an influx estimated, according to planning hypotheses, between 10,000 and 50,000 patients over 10 to 180 days, with possible peaks;
- training in war traumatology and psychological care.
When questioned, the Minister of Health, Catherine Vautrin, did not deny the existence of the letter: "It is normal for the country to anticipate crises," she said, recalling that hospitals already activate, depending on the situation, the hospital white plan and the ORSAN system, as part of the crisis management plan.
A logic of resilience, not a general mobilization
The instruction is part of the French doctrine of the crisis management plan. It is supported by the General Secretariat for Defense and National Security (SGDSN). It does not create a new mechanism: it updates existing tools and synchronizes the civil chain with the Armed Forces Health Service (SSA) in case of a massive influx.
Concretely, the goal is to endure over time. Dedicated pathways must be opened and non-urgent activities rescheduled. Additionally, it involves pooling resources between public and private establishments. Then, securing the flows in emergencies is essential to ensure the continuity of resuscitation and rehabilitation. This preparation also concerns logistics: oxygen, blood products, critical medications, medical devices, maintenance, and emergency water supply for hospitals.
A Europe fortifying itself against Moscow
The French movement is part of a European trend. The Baltic countries and Poland are improving their medical infrastructures. Moreover, they are restoring or tightening conscription. Finally, they are investing massively in rearmament. In Germany, the debate on a return to mandatory service reflects a change in mindset.
On the Eastern flank of NATO, multinational battalions are deployed from Poland to Romania and in the Baltic States, supported by a reinforced air policing in the Baltic. France is the framework nation in Romania (mission AIGLE), with ground-air, logistics, and support capabilities. In this scheme, France could play the role of a medical rear base for the Alliance if the conflict escalated.
Kiev under fire, the EU tightens sanctions
On August 28, 2025, Russian strikes hit Kiev, causing numerous casualties and damaging notably European Union and British Council offices. The UN, several European capitals, and NATO have condemned these attacks. Ursula von der Leyen announced working on a 19th package of sanctions, after an 18th adopted mid-July 2025. This tightening is part of a strategy to support Ukraine and deter Moscow. Furthermore, it aims to strengthen the civil resilience of member states.
France–Russia: minimal dialogue, a lasting power struggle
Since 2022, the Paris–Moscow relationship has hardened. Emmanuel Macron has called Russia a "predator". However, he advocates for a Europe capable of defending itself. Moreover, he wishes for it to be less dependent. The Kremlin, on its part, denounces NATO and Western aid to Ukraine and multiplies hybrid means: disinformation, cyberattacks, intimidations.
On the French side, the challenge is twofold: deter any extension of the conflict and protect national cohesion. Authorities warn of influence campaigns aimed at weakening support for Ukraine. European officials mention the need to be ready by 2028 for a resilience test. The line remains the same: talk peace, but plan for the worst.
What the letter changes for hospitals: examples of hospital white plan
The main expected consequences:
- Capacities: detailed counting of intensive care and major surgery beds, levels of stocks (medications, oxygen, blood) and supply chains;
- Flows: protocols for mass entries at arrival points (ports, airports, rail hubs) and interregional transfers with SAMU-SMUR; activation of the hospital’s internal disaster plan.
- Skills: training in war traumatology (ballistics, burns, polytrauma), rehabilitation, and mental health (prevention of post-traumatic stress disorder);
- Human resources: bridges to the SSA (reserve, detachments), mobilization of networks of emergency physicians and intensivists; additional mobilizations in line with the white plan framework;
- Exercises: simulations involving ARS, prefectures, SSA, and public/private establishments, with MCI exercises (mass casualty incidents), feedback and dashboards.
Clear communication with the public is essential. This includes signage in hospitals and information on urgent pathways. Additionally, regulation via 15/112 plays a crucial role. Finally, coordination with primary care helps avoid unnecessary emergency visits.
Probabilities and scenarios
At this stage, the central scenario remains that of a high-intensity war confined to Ukraine, accompanied by hybrid reprisals on European territory: cyber, information, air incidents, energy or migratory pressures. For France, it is about maintaining its rank in the East, unwavering in allied solidarity, while protecting its rear. Hence the emphasis on emergency services, resuscitation, and rehabilitation: capacities as strategic as tanks or missiles.
Areas of uncertainty calling for transparency
The letter of July 18 has not been published in full. Questions remain:
- what activation thresholds and what distribution of casualty flows by region?
- what funding for the build-up (personnel, equipment, stocks)?
- what coordination between civil hospitals and SSA establishments in a surge situation?
The legal framework exists, however: white plans, ORSAN, and, as a last resort, requisitions governed by the Defense Code. The checks and balances – Parliament, health authorities, Court of Auditors – will be able to monitor the execution and transparency of choices.
Reference points: white plan (definition), ORSAN, SSA
- White plan: an emergency device specific to each establishment to immediately mobilize resources and personnel in the face of a victim influx (international equivalent: Emergency Operations Plan, EOP).
- ORSAN: regional framework for the preparation and coordinated response of the health system to exceptional situations.
- Armed Forces Health Service (SSA): service of the Ministry of the Armed Forces responsible for the medical-surgical support of the forces, in external operations as well as on the national territory.
- Mission AIGLE: French contribution to the NATO multinational battalion in Romania, with ground-air, logistics, and support capabilities.
To follow
- Presentation of the 19th package of sanctions by the European Union and effects on the Russian war economy.
- Evolution of NATO rotations on the Eastern flank (Baltic, Poland, Romania) and France’s role.
- ARS-SSA-prefecture exercises and publicly shared lessons.
- Resuscitation and rehabilitation capacities, crucial for complex injuries.
- Political signals in the Paris–Moscow relationship: diplomatic exchanges, hybrid incidents, consular disputes.