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At the request of the Ministry of Health, an instruction dated July 18, 2025 was issued. Thus, it orders the regional health agencies (ARS) to prepare to receive a large number of military casualties. This must be organized in France before March 2026. Confirmed by Catherine Vautrin, the move comes as Europe is tightening its posture toward Russia: deadly strikes in Kyiv on August 28, reinforcement of NATO 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 scaling-up. In addition, it aims to prepare the hospital system to deal with a “major engagement.” It sets out a very concrete framework:
- inventory of capacity (critical care beds, operating rooms, imaging, transfusion);
- creation of temporary medical centers near ports, train stations, and airports for the triage, stabilization, and rerouting of French and allied casualties “to their nation of affiliation”;
- preparation for an influx estimated, according to planning assumptions, at between 10,000 and 50,000 patients over 10 to 180 days, with possible peaks;
- training in war trauma care and psychological support.
Asked about it, the Health Minister, Catherine Vautrin, did not deny the existence of the letter: “It is normal for the country to anticipate crises,” she said, noting that hospitals already activate, depending on the situation, the hospital white plan and the ORSAN system, as part of the crisis management plan.
A Resilience Logic, Not General Mobilization
The instruction fits into the French doctrine of the crisis management plan. It is backed by the General Secretariat for Defense and National Security (SGDSN). It does not create a new mechanism: it updates existing tools and synchronizes the civilian chain with the Armed Forces Health Service (SSA) in the event of a massive influx.
In practical terms, the goal is to hold out over time. Dedicated care pathways must be opened and non-urgent activities rescheduled. In addition, resources must be pooled between public and private facilities. Then, securing flows in emergency departments is essential to ensure the continuity of intensive care and rehabilitation. This preparation also concerns logistics: oxygen, blood products, critical medications, medical devices, maintenance, and emergency water supply for hospitals.
A Europe Arming Itself Against Moscow
The French move is part of a European trend. The Baltic states and Poland are improving their medical infrastructure. In addition, they are restoring or tightening conscription. Finally, they are investing heavily in rearmament. In Germany, the debate over a return of compulsory service reflects a shift in mindset.
On NATO’s Eastern flank, multinational battalions are deployed from Poland to Romania and the Baltic states, backed by a reinforced air policing mission in the Baltic region. France is the framework nation in Romania (the AIGLE mission), with ground-to-air, logistical, and support capabilities. In this setup, mainland France could serve as the Alliance’s medical rear base if the conflict escalates.
Kyiv Under Fire, The EU Tightens Sanctions
On August 28, 2025, Russian strikes hit Kyiv, causing numerous casualties and notably damaging offices of the European Union and the British Council. The UN, several European capitals, and NATO condemned the attacks. Ursula von der Leyen said work was underway on a 19th package of sanctions, after a 18th was adopted in mid-July 2025. This tougher stance is part of a strategy to support Ukraine and deter Moscow. It also aims to strengthen the civilian resilience of member states.
France-Russia: Minimal Dialogue, A Lasting Power Struggle
Since 2022, the Paris–Moscow relationship has hardened. Emmanuel Macron has described Russia as a “predator.” However, he argues for a Europe capable of defending itself. In addition, he wants it to be less dependent. The Kremlin, for its part, denounces NATO and Western aid to Ukraine and is multiplying hybrid tools: disinformation, cyberattacks, intimidation.
On the French side, the challenge is twofold: deter any widening of the conflict and protect national cohesion. Authorities are warning about influence campaigns aimed at weakening support for Ukraine. Some European officials are speaking of the need to be ready by 2028 for a test of resilience. 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:
- Capacity: detailed counting of intensive care and major surgery beds, stock levels (medications, oxygen, blood) and supply chains;
- Flows: protocols for mass arrivals at points of entry (ports, airports, rail hubs) and interregional transfers with SAMU-SMUR; activation of the hospital’s internal emergency plan (internal disaster).
- Skills: training in war trauma care (ballistics, burns, polytrauma), rehabilitation, and mental health (prevention of post-traumatic stress disorder);
- Human resources: links to the SSA (reserve, detachments), mobilization of emergency physicians and intensive care specialists networks; additional mobilizations in line with the white plan framework;
- Exercises: drills involving ARS, prefectures, SSA, and public/private facilities, with MCI drills (mass casualty incidents), after-action reviews, and dashboards.
Clear communication with the public is essential. This includes signage in hospitals and information on urgent pathways. In addition, regulation through 15/112 plays a crucial role. Finally, coordination with primary care helps avoid unnecessary visits to the emergency room.
Likelihoods And Scenarios
At this stage, the central scenario remains a high-intensity war confined to Ukraine, combined with hybrid retaliatory measures on European territory: cyber, information, air incidents, energy or migration pressures. For France, the goal is to hold its rank in the East, unwavering in allied solidarity, while protecting its rear. Hence the emphasis on emergency services, intensive care, and rehabilitation: capabilities as strategic as tanks or missiles.
Blind Spots That Call For Transparency
The July 18 letter has not been published in full. Questions remain:
- what activation thresholds and what distribution of casualty flows by region?
- what funding for the scaling-up (staff, equipment, stock)?
- what coordination between civilian hospitals and SSA facilities in an influx regime?
The legal framework does exist, however: white plans, ORSAN, and, as a last resort, requisitions governed by the Defense Code. Checks and balances — Parliament, health bodies, Court of Auditors — will be able to monitor implementation and the transparency of decisions.
Benchmarks: White Plan (Definition), ORSAN, SSA
- White plan: each facility’s own emergency system to immediately mobilize resources and staff in the face of a mass influx of victims (international equivalent: Emergency Operations Plan, EOP).
- ORSAN: regional framework for preparedness and coordinated response of the health system to exceptional situations.
- Armed Forces Health Service (SSA): the Ministry of the Armed Forces service responsible for the medical-surgical support of the forces, in overseas operations as well as on the national territory.
- AIGLE mission: France’s contribution to NATO’s multinational battalion in Romania, with ground-to-air, logistical, and support capabilities.
What’s Next
- Presentation of the European Union’s 19th sanctions package and its effects on the Russian war economy.
- Evolution of NATO rotations on the Eastern flank (Baltics, Poland, Romania) and France’s role.
- ARS-SSA-prefecture drills and publicly released lessons learned.
- Intensive care and rehabilitation capacities, decisive for complex injuries.
- Political signals in the Paris–Moscow relationship: diplomatic exchanges, hybrid incidents, consular disputes.