Initially, in the late 1950s and 1960s, the structures and facilities necessary for a functioning medical service as a self-sufficient health system for the soldiers of the new armed forces – such as the Bundeswehr Medical School, the Bundeswehr Medical Office, various institutes, the Bundeswehr military hospitals, the reserve hospital organization, and others – were established and expanded.

Over the next two decades until the end of the Cold War, the medical services of the armed forces, and in particular the army, underwent repeated restructuring and adaptation to changing military and security policy requirements and military concepts. In addition to providing medical care for the troops in basic operations, the focus was on the readiness of the medical service for a “V-case,” i.e., a potential defensive war on the territory of the Federal Republic of Germany.

The central problem – the personnel situation

One of the main problems facing the medical service, particularly in the early decades, was the precarious personnel situation, especially in the area of medical officers. This problem was all the more serious because the medical service was not only reserved for emergencies, but also had to ensure the medical care and health prevention of soldiers in peacetime.

Initially, the demand for personnel, especially doctors and dentists, could not be met by a long shot, and medical care was often provided by civilian contract doctors and, from 1964 onwards, mainly by pharmacists, dentists, and doctors performing basic military service, who shaped everyday military medical practice until the 1980s.

Despite all the commitment and recognition of the achievements of these conscripted medical officers, it cannot be overlooked that, on the one hand, most of these young colleagues came straight from university and had little experience and, on the other hand, the short periods of service led to frequent changes of doctors in the troops. It was only after the introduction of the medical officer cadet career path in 1969 (with university places allocated since the 1973/74 winter semester) that a consistent and sustainable regeneration of young medical officers was achieved.

After women had been serving as medical officers in the German Armed Forces since the fall of 1975, women were also able to be recruited as medical officer cadets from 1989 onwards, and finally, from January 1991, the careers of non-commissioned officers and enlisted personnel in the medical service were opened up to women. This not only addressed personnel problems, but also made the medical service an important pioneer in terms of integrating women into the Bundeswehr.

New challenges for the “army of unity”

An important turning point for Germany and thus also for the Bundeswehr was German reunification, which took effect on October 3, 1990, on the basis of the “Treaty between the Federal Republic of Germany and the German Democratic Republic on the Establishment of German Unity (Unification Treaty)” through the accession of the German Democratic Republic to the Federal Republic of Germany.

The erosion and eventual collapse of the Eastern Bloc with the disintegration of the Warsaw Pact as its military alliance had a significant impact on the global foreign and security policy landscape.

The consequence for the Bundeswehr on its way to becoming an “army of unity” was a significant reduction in the size of the armed forces imposed by the so-called “Two Plus Four Treaty” (“Treaty on the Final Settlement with Respect to Germany”) of September 12, 1990. This downsizing and restructuring, combined with a simultaneous shift in the range of tasks towards a combat army, necessitated a restructuring of the Bundeswehr, which was accompanied by a mission-oriented reorganization of the medical service.

In addition to providing medical and medical services to Bundeswehr soldiers in basic operations, medical service tasks were now also performed in the context of international “out-of-area” NATO operations and international UN military missions. During the Cold War, the medical service was involved in humanitarian aid operations like hardly any other branch of the German armed forces, such as earthquake relief in Agadir, Morocco, in 1960, in Turkey in 1976, in southern Italy in 1980/81, and in Iran in 1990.

And in 1992/93, the establishment and operation of a field hospital in the Cambodian capital Phnom Penh as part of the UNTAC (United Nations Transitional Authority in Cambodia) peacekeeping mission marked the first contingent deployment of the Bundeswehr beyond humanitarian aid – at that time still with an uncertain legal status.

In its ruling of July 12, 1994, the Federal Constitutional Court finally confirmed – subject to the prior approval of the German Bundestag – the constitutionality of armed Bundeswehr missions under a UN or NATO mandate.

During subsequent deployments of the German armed forces as part of their alliance obligations and international peacekeeping missions, particularly in the Balkans in the 1990s, the medical service undoubtedly played a pioneering role and, thanks to its achievements, which were recognized both at home and abroad, became an “asset” in the Bundeswehr’s participation in international missions. The nature of the missions took on a whole new dimension after the attack on the World Trade Center on September 11, 2001.

The mission in Afghanistan lasted twenty years, until 2021, and presented the Bundeswehr, and thus also the Medical Service to a considerable extent, with new technical, medical-tactical, and ethical challenges due to its length, intensity, and personnel requirements. This affected not only the scenarios in the country of deployment and the changing spectrum of injuries, but also the treatment of a large number of soldiers who suffered both physical and psychological injuries and developed post-traumatic stress disorder.

The consistency of change

For the Bundeswehr Medical Service, all these restructuring measures and further developments represented a particular feat of strength, as the actual provision of care at the locations had to continue alongside increasing tasks and capability requirements in the context of the missions and could neither be suspended nor scaled back.

Further structural reforms and reductions were to follow in several stages. The most significant milestone for the structure and leadership of the Bundeswehr Medical Service was undoubtedly the consolidation of the medical forces and resources of all branches of the armed forces and organizational areas into the “Central Medical Service of the Bundeswehr” in 2001.

With the exception of a few branch-specific capabilities and elements, the medical service was now under unified professional, troop, and specialist command. This so-called “single-source command of the medical service” enabled a high degree of efficiency and flexibility in view of the diverse challenges and new developments in medicine.

New structures for the future

This model did not last either, but was redirected in April 2024 after more than two decades by the so-called “Osnabrück Decree.” Over the past decade, the global and security policy situation had changed once again. Since the Crimea crisis in 2014 at the latest, and especially since the outbreak of the war in Ukraine on February 24, 2022, the focus of German security policy and the Bundeswehr has once again been on national and alliance defense.

The Bundeswehr Medical Service, as well as the German healthcare system – which is undoubtedly a task for society as a whole – must be prepared for significantly higher numbers of casualties and mass care for German and allied soldiers in the event of an emergency.

Structurally and organizationally, the Bundeswehr Medical Service lost its independence in 2024 with the “Osnabrück Decree” and was integrated into the new support area in order to achieve synergy effects and increased effectiveness and efficiency.

Under the umbrella of the Support Command, the Bundeswehr Medical Service remains consistent in itself and is led by the Commander of the Central Medical Service in the Bundeswehr Support Command (who also acts as deputy to the Commander of the Support Command). The commander is also the military medical advisor to the leadership of the Federal Ministry of Defense, i.e., the Minister of Defense, and thus represents the Medical Service at the ministerial level. The subordinate areas are currently being reorganized.

Standards and (self-)commitment of the Medical Service

The Bundeswehr Medical Service sets high standards for the care of the soldiers entrusted to its care, which remain indispensable – and, in view of the real threat to national and alliance defense, more so than ever. The 1995 “Technical Guideline for the Medical Care of Bundeswehr Soldiers on Foreign Missions,” which is still valid today, postulated that “in the event of illness, accident, or injury, soldiers should receive medical care that in effect corresponds to the professional standard in Germany.”

This requirement is by no means excessive (as is sometimes claimed), but is justified above all by the fact that soldiers belong to the so-called vulnerable patient groups in terms of medical ethics: They have to put up with the peculiar conditions of military service, such as living together in confined spaces or limited hygienic conditions in the field, as well as being exposed to particular dangers or psychological stress from weapons in the event of deployment or war. In addition, they are required to tolerate certain examinations or vaccinations and, especially in deployment and combat scenarios, restrictions on their free choice of doctor.

It is precisely this vulnerability that requires employers and society to take particular care of the health of soldiers, both in terms of care standards and the provision of the necessary resources.

Consistency in change

In the 70 years of its existence, the Bundeswehr Medical Service has been confronted with a whole series of changes: these have affected its command structures, its integration into the framework and its status within the armed forces as a whole, and the organization of its care structures against the backdrop of changing security policy challenges.

However, they also affected the tremendous advances and technical changes in medicine over almost three quarters of a century, which found their way into the Bundeswehr’s medical facilities and were, in some cases, significantly influenced by the scientific institutions of the Medical Service and the Bundeswehr hospitals.

This “consistency in change” is undoubtedly a major and not always easy challenge for all members of the Medical Service – but on the other hand, it also offers opportunities and chances to shape the future for the benefit of the soldiers entrusted to their care.