Belgium, Kingdom of
Geert Laire MD
Operational Command of the
Queen Elisabeth Barracks
Rue d’Evere 1
B-1140 Brussels (Evere)
Basic Task of the Medical Service
The main mission of the Belgian Medical Component is to ensure the provision of medical support to all defence activities assigned to the Land, Air and Navy Component, according to their level of ambition, both at home and abroad, and subsequently to secure adequate medical evacuation from the operational theatre.
Over and above that, the Medical Service is to maintain physical and mental integrity of all Defence personnel during (allied) military operations and training exercises and during daily business, in order to maximize medical readiness and to guarantee commanders permanently having healthy deployable forces to achieve their missions. To that effect, the Medical Service
- develops strategic health policy;
- provides territorial garrison health care in some specific domains and specialized hospital care to the Belgian Defence military and civilian personnel; and
- assists in their medical preparedness through medical selection and fit-for-duty evaluation.
The Belgian Medical Component is – similar to the Land, Air and Naval Components – part of the Intervention Force under custody of the Chief of Defence.
In agreement with the operational ambition, the Medical Component spans FOUR Elements for Medical Intervention geographically spread across the country and ONE military hospital in the capital city of Brussels.
The Elements for Medical Intervention (EMI 1/4, 2, 3 and 5) are static facilities containing all the personnel and material resources necessary for the deployment of a Role 1 or a Role 2 MTF in direct support of the combat units, except for the specialized medical care providers who are employed within the Military Hospital. 5 EMI has been assigned the responsibility of the production, storage and distribution of medical equipment and supplies. Each of the other EMI is mainly oriented towards particular needs and/or assets of medical support, such as aeromedical evacuation, CBRN decontamination, or in specific aid to maritime, light brigade, paratroopers or Special Forces Group operations etc. An EMI is also where the Medical Component envisions, designs, prepares and trains its own medical teams and modules up to combat readiness for the required spectrum of military activities.
The central Military Hospital Queen Astrid (Role 4) on the other hand, provides a limited lying-in facility as well as an outpatient clinic in selected medical disciplines, medical imaging and laboratory services. It also hosts an emergency and disaster medical services system, a burn care unit, a centre for hyperbaric oxygen therapy, a physiotherapy and rehabilitation unit, a centre for mental health care, the military centre for aviation medicine, the centre for medical fitness assessment etc. (see the section ‘Military Hospital’).
The Component has also a Medical Competence Centre (CC Med) for teaching both medical and combatant (non-medical) personnel, with the exception of the graduate and post graduate education of all medical professionals (physicians, physiotherapists, veterinarians, nurses etc.) which takes place in civilian universities and medical schools. The Centre is collocated with the Military Hospital that easily allows increased educational efficiency and economy of human resources.
Finally, the Staff of the Operational Command of the Medical Component (COMOPSMED), situated on the same campus as the Defence Staff in Evere, nearby Brussels, is responsible for the organization and implementation of the military garrison and operational health care portfolio to the beneficiary Defence personnel.
Regional Medical Centres
The FOUR EMI, as described above, operate Regional Medical Centres covering all kinds of common medical services to the military on a national territorial basis, including primary health care, dental care, pre- and post-travel medical advice, physiotherapy, pharmaceutical support and sanitation control (hygiene and water/food chain safety measures). Here also starts the MeNuFit (Medicine, Nutrition and Fitness) program of care, a dedicated initiative for all the Defence personnel aiming at optimizing their operational fitness through multidisciplinary help and guidance, simultaneously taking into account medical, nutritional, physical as well as psychological aspects of one’s condition.
The mission of the Military Hospital Queen Astrid is threefold: (1) to hold medical capabilities in stand-by and to preserve and train medical skills, necessary to support operations in theatre as well as on the national territory; (2) to contribute to the medical readiness of the deployable forces; (3) finally, with all non-deployed capacities, to participate in the Defence aid to the nation.
One of the main service objectives to achieve this mission is providing specialist medical care tailored to the military duty. The Military Hospital is not a distinct hospital in the traditional sense, but manages a number of specialized health care services in specific domains of military interest. That is why its activities are primarily focused on pre-hospital emergency care and disaster medicine (including CBRNe emergency ambulance), burn care, traumatology, orthopaedic surgery and rehabilitation, travel medicine, hyperbaric medicine, mental health care and crisis psychology. These hospital facilities are merely dedicated for the treatment of beneficiary active military and civilian Defence personnel. However, the burn care centre, being a national centre of excellence, the centre for hyperbaric oxygen therapy and the emergency medical services, both integrated in the Capitals emergency and disaster relief system, are open to the public through cost refund. Especially in these three fields of expertise, the Military Hospital contributes in the context of aid to the nation.
Since, as a consequence, the Military Hospital is not a genuine general hospital, multilateral collaboration with civilian partners have become of utmost importance. In this way, the Military Hospital holds several partnerships with university hospitals in the neighbourhood and even provides to one of these, part of its infrastructure. Besides, in the specialties not available in the Military Hospital, when necessary, Defence personnel will be referred to the civilian health care services and can get their costs reimbursed.
Secondly, the Military Hospital holds an important role as a medical training facility to maintain skills and competencies tailored to military operational medicine and serves as a reach back capability for the deployed medical forces. Moreover, the hospital is a key player when it comes to scientific research and development of innovative technology and treatment in certain niche activities that are of military concern such as infectious diseases, septic surgery, wound healing etc. The laboratory for molecular and cellular technology works closely together with several national and international (academic) partners and concentrates on the development of skin substitutes, on safety improvement of skin and keratinocyte grafts, on the molecular epidemiology of resistant microorganisms and on bacteriophage therapy. The laboratory for clinical biology, on the other hand, has been recognized as a national centre of reference for zoonotic diseases (Coxiella burnetii, Rickettsia and Anaplasma). The Military hospital runs also a complete blood bank guaranteeing the autonomy of blood and blood products for operations and territorial purpose.
Last but not least, and next to the ambition directly related to operations, the Military Hospital hosts a dedicated so called centre for medical fitness assessment, that is in charge of the medical readiness preparation of all deployable Defence personnel: from medical selection on enlistment to periodical fit-for-duty or operational fitness screening and disability evaluation during the entire professional career. This belongs to the expertise of several medical specialists working in the outpatient clinic of the hospital (ophthalmology, ENT, cardiology etc.), including the medical imaging department, the laboratory for sports medicine or the centre for aviation medicine. Physical rehabilitation through the MeNuFit-program (see above) also contributes to this service objective.
Number of the Medical Service Personnel
The Belgian Medical Component numbers approximately 1500 service members, of which 56 are medical officers (almost 65% qualified general physicians and emergency physicians), 24 qualified physiotherapists, 7 dental officers, 12 veterinary doctors and 27 pharmacists. An aggressive recruitment campaign will result during the coming years in a significant increase of this Medical Technical Corps with about 67 employees. Beside these medical technicians, another 64 officers constitute the Medical Support Corps of the Component. Moreover, 8 occupational medicine providers and 8 medical advisors serve within the Well-being staff department of the Belgian Armed Forces Command.
The Belgian medical evacuation chain concept starts with thorough self-aid and buddy-aid at the combatant level (combat life saver and aidman) all the way through EMT support, followed by emergency nursing and physician medical care, ending up, as needed, in initial surgical care (light forward surgical teams) and definitive surgery in variable compositions of MTF modules.
Flying the new light transport helicopter NH-90 results in new challenges for the flight surgeons when it comes to optimizing the forward and tactical aeromedical evacuation policy. State-of-the-art retrieval of the sick and wounded soldiers from the operational theatre completes this process of care. To that purpose, the Belgian Medical Component operates a dedicated strategic aeromedical evacuation program in close collaboration with the European Air Transport Command (EATC). Specialized assets include certified aeromedical crews and various types of patient transport units.
According to the political guidance, the mission of the Belgian Medical Component is to participate to joint medical support in the framework of EU, NATO or UN operations by filling either advisory or international staff positions, or either delivering Role 1, Role 2B and Role 2E capabilities conform and tailored to the activities, operations and level of ambition of the other Components or independently on its own.
Belgian military medical teams contribute to several EU-, NATO- and UN-led operations worldwide providing medical support to Belgian contingents and multinational forces. Medical Component personnel are currently deployed with units serving in Afghanistan (RSM), Iraq (OVP), Jordan (ODF), Mali (EUTM/MINUSMA), the Central African Republic (EUTM), the Baltic States (EAPM and EFP), Refugee Relief Operations in the Mediterranean Sea (EUNAVFORMED). Previous overseas missions have included i.a. Lebanon (UNIFIL), ISAF-theatres in Afghanistan and the Indian Ocean / Somalia Coast (ATALANTA). Since the terrorist attacks of 22 March 2016, Belgian military medical personnel participates in Homeland Ops. Moreover, the medical component contributes to stand-by operations such as EUBG and NRF/VJTF.