The role of doctors during armed conflict. Episode 70

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme "First Patient". Beyond our borders, in Ukraine, a regular war is taking place. Soldiers are taking part in it, but they are also supported by medics. Are Polish medics ready to support the Polish military if the need arises? This is what I will be discussing today with my, but above all your guest, who is General Professor Grzegorz Gielerak. Good morning, and a warm welcome, General.

Grzegorz Gielera
Good morning, Madam Editor, good morning to you.

Monika Rachtan
Professor, I was wondering whether a civilian doctor, if he was walking down the street, for example, and a bomb suddenly fell on the buildings, would he know how to act, assuming, for example, that his mobile phone had stopped working?

Grzegorz Gielerak
Well, I think that if he has not previously received specialised training in this area - and this is optional training, that is, not compulsory at any stage of education, both pre- and post-graduate in Poland - he would probably have a serious problem to find himself in such a situation.

Monika Rachtan
Do the civilian doctors with whom you talk, because apart from military doctors you probably also meet civilians, think at all about the fact that there may be an armed conflict in Poland and that they will also be involved in providing help to the society? Well, because if there is a war, there are wounded people, and wounded people need help from a doctor.

Grzegorz Gielerak
Before I answer the question of whether they think, I will use a word on which I am absolutely convinced - they are interested. I am very happy and I take such opportunities when I have the chance to talk in a wider circle, in a wider forum, with colleagues at various conferences. I give them detailed information on what modern warfare is, what it looks like on the example of Ukraine, and what role the health system plays. I emphasise - the health system. And then, all of a sudden, it appears that many people do not have a well-established awareness that, in fact, the medical security, both of the state and, in the later stages of an armed conflict, of the armed forces, rests to a large extent, or even in the vast majority, precisely on the universal, commonly referred to as civilian, health care system. And here there is a reflection, an interest, and a very deep and positive one at that. We have a situation where people are not rejecting information and knowledge on this subject. They are very open to this information, only, above all, this information has to reach them in the right form and in the right way.

Monika Rachtan
We have information, but information is no substitute for training. Are civilian doctors already being trained in Poland for state security?

Grzegorz Gielerak
Well. We are a rather unusual country in this respect, because there is no training in battlefield medicine at any stage of training, either pre- or postgraduate, and this applies to rescuers, nurses and doctors alike (except for a very narrow group of specialists). The only scope of training is, as I mentioned, for a narrow group of specialist doctors, and we are talking about eight hours in the whole five- or six-year specialisation cycle. So this is really just an introduction, an encouragement for those interested to possibly deepen their knowledge and skills during other training courses that are offered on the market, for example by the Military Medical Institute. Also in answer to this question, unfortunately, we look very weak and pale in this respect compared to other countries, especially if we compare it with the potential risk of an armed conflict that may break out on Polish territory. The factor that determines this is, of course, geographical location. Countries like Norway or Switzerland certainly have a lower risk, and there, already at the stage of medical studies, in the third year, the local health service, including the military, provides training for students.

Grzegorz Gielerak
In contrast, we, occupying such a sensitive position as the Eastern European Plain, the only de facto link between Europe and Asia, which in itself carries the risk of clashing cultures and interests, have unfortunately not developed such a practice.

Monika Rachtan
Years of history have not taught us that we should be prepared for such an armed conflict. And do we currently have, is there any work going on in Poland in this direction? Because the fact that doctors are not trained during their studies has already been established. How many doctors do we have ready to go to the battlefield?

Grzegorz Gielerak
We certainly have military doctors, but there are about a thousand of them.

Monika Rachtan
That is, not many.

Grzegorz Gielerak
Yes, not many. I often use the expression, transferring it from economics, that the military health service consumes about 4-5% of the budget of the National Health Fund, and we can say that this is also its potential in the overall functioning of the health system. This shows to what extent this service, this segment of health care, is able to secure the needs. Not to mention the fact that the military health service will mainly be involved in the medical security of operational troops, fighting troops, and not the civilian population. Also, we are talking about the very serious challenge of preparing the entire health care system. And that is why, among other things, I am here in the studio today, because I believe that the task of the military health service is to prepare the entire health care system in peacetime to perform tasks in times of crisis, including a military crisis.

Monika Rachtan
Are such preparations already underway? Are discussions taking place between the Ministry of Health and other institutions? Is anything happening in this regard? Or, as before the COVID-19 pandemic, does everyone see the impending threat but completely fail to react and wait for the outbreak?

Grzegorz Gielerak
There are several situations that allow us to look at this problem with some optimism. Firstly, the Eastern Shield project is, in my opinion, an excellent example of how the issue of medical security should look. If we are preparing a certain defence belt extending tens of kilometres into the country, counting from our eastern border, then we must also prepare medical facilities. So this is a great opportunity to take such measures, and they are already happening to some extent. If I had to answer this question, it is yes. From a strategic point of view, that is, looking at it from the top, as a state, we have situational awareness, and that is already a lot. The state has an awareness, asks itself what needs to be done, and undertakes planning. However, from an operational and tactical point of view, i.e. what is happening realistically down below, with the involvement of the people, here we still have a lot to do.

Monika Rachtan
I hope that this work will soon get underway and that not only will we get a bird's eye view of our state's readiness, but we as a society will be assured that something is happening in this regard. Professor, and do we already have any guidelines, regulations? What should this security look like in general? I don't just mean securing the army or the battlefield, but also securing the civilian population. Have we already developed any procedures?

Grzegorz Gielerak
This is a very pertinent question. The answer should be unequivocal: yes, conceptually we are prepared to implement such a project. Earlier, on the occasion of the Eastern Shield project, in the armed forces, in the times of the previous Chief of Staff General Andrzejczak, a concept was worked out, which we call a plan for national medical security. I draw attention to the fact that the army, being aware of a potential military crisis, develops a plan that also includes the resources of the entire health care system. I come back to what I was saying - I am encountering a positive response from many politicians and decision-makers who are pleased that the military is thinking in terms of not just the military health service, but the whole system. To reiterate: the state defends itself with all its resources. The army does not produce anything, the army disposes of what the state and society give it - insofar as the state and society have the will and interest to do so. This is where Clausewitz's old principle of war being a continuation of politics, only with different methods, comes back into play. So the military implements the strategy of the state.

Monika Rachtan
I think it is good that the military is pursuing this strategy and thinking about civilian security. Civilians often have no idea how to create such security. This time it seems that the right person in the right place got the job done, a person who has not only theoretical but also practical knowledge.

Grzegorz Gielerak
We look at it through the prism of our previous experience. When we talk about previous conflicts, such as in Iraq or Afghanistan, we are talking about classic expeditionary warfare. This is a very different kind of securing and conducting medical operations. Given the threats from the East, we have to think about protecting our borders, state, society, critical infrastructure - those elements that are crucial to the functioning of the state. This is a very different challenge for both the armed forces and the state. We used to have an army of almost half a million, so you might think that the plans and knowledge are somewhere. Yes, some knowledge and remnants of those plans do exist, and we also had a developed civil defence, which unfortunately has been decapitalised.

Monika Rachtan
But 30 years ago we were preparing for a different armed conflict.

Grzegorz Gielerak
That is what I am getting at. At the time, we were tasked with following another country, but today we have tasks similar to those of Western countries at the time. This is an excellent opportunity for us to take what they have developed over the years of the Cold War and adapt it to our conditions. It is important for us to be aware that, as a member of the North Atlantic Treaty Organisation, our armed forces are preparing their defence plans, but they are also part of the tasks of the Alliance. In fact, the first troops to enter combat on our territory will be those of the Alliance.

Monika Rachtan
When I imagine war, I think of very difficult medical situations that doctors may never have had to deal with before. These may be operations that require cold blood, a quick response, very bloody. Doctors may see cases that they don't see every day, that they are not ready for. How do you Professor look at this situation? If it happens, can we cope? We see what is happening in Ukraine - there, it is not only the military but also civilians who are regularly killed and need highly specialised medical attention. Images of people who are practically all bandaged up, without limbs - these are things that Polish doctors are unlikely to see on a daily basis.

Grzegorz Gielerak
Exactly. Let's add another piece of information that makes you realise what a war is and what a tragedy for society and the state - between 100 and 200 amputations are performed in Ukraine every day. On Monday, Friday, Saturday and Sunday - every day. That is the statistic. This shows the catastrophic consequences for individual people, but also for the state. Because it is the people who build the state. The strength and wealth of a state is based on how strong and identified with their state its citizens are. If we talk about preparation, it is like a public performance - you know, everyone gets stressed, with time the stress becomes less, but you can lower it if you build the right visualisation. You can go to the venue, see the space, the distances and imagine yourself in that situation. This allows you to get your emotions under control to a certain extent - that's step one. Step two is, of course, preparation. You need to have the expertise, but you also need to get your head around it. A great example is the percentages of cases of PTSD, or battlefield stress, that we have recorded in both us and the Americans after missions in Iraq and Afghanistan. These figures are very similar to each other.

Monika Rachtan
What percentage was that?

Grzegorz Gielerak
Well. Those who are properly selected and prepared have zero to 2% cases of PTSD, while those who have simply been sent to a conflict area have a minimum of 25%. This shows the importance of preparation - you have to get your head around what you are doing and, of course, prepare properly.

Monika Rachtan
And in the beginning, you have to put it all together in your head. I also think that when we have these percentages of over 20%, in addition to preparing the medical cadre to secure the citizens, we need to prepare another cadre to then secure these doctors - to help them deal with their emotions and stress. Maybe someone should already start talking to them about this. There should be meetings with a psychologist, with someone who can pick out people who are suitable for defence.

Grzegorz Gielerak
And this is where we come to the topic of building a state medical security system. This fits into the concept of Shield East. Such preparation is, of course, people, but also adequate infrastructure, materials, resources, medicines. All these elements should be gathered in appropriate places and people trained to use them.

Monika Rachtan
General, I'm sorry, I'll get into a word. That is, if there were an attack on Poland now, for example tonight. We are not ready.

Grzegorz Gielerak
As a military officer, I cannot give an answer to this question. As a country, we are always ready.

Monika Rachtan
I understand, I understand. Because I think, for example, Poles. Well, exactly, and what should such a Pole have in his first aid kit? In case there is an armed conflict. I have an elastic bandage in my first aid kit, I have painkillers, and probably some leftover medication from an infection. And basically nothing else. Should I go to the pharmacy and do some shopping so that I am ready?

Grzegorz Gielerak
Is this a very good direction, certainly a large amount of gauze to supply a possible site that is a gunshot wound or a wound caused by multi-organ trauma. But the number one thing if we are talking about armed conflict is a tourniquet.

Monika Rachtan
So this one, however, is my bandage, it's good, it's flexible.

Grzegorz Gielerak
I would definitely suggest getting special tourniquets. There are those that allow you to actually squeeze, clamp the vessel and block it, and then let go every so often to prevent necrosis. Knowing how to use a tourniquet and also having one in the first place is one of the key skills in the field of battlefield medicine in the broadest sense. And someone will say well, difficult. Just put it on, tighten it. Yes, it is. Only our experience, we have done such research, shows that even people who are, you could say, professionals, because we are talking about our military medics during exercises, that is, there is stress and there is a proper dynamic. They used the tool effectively in about 70%, as many as 30% people were confident that they had put the brace on properly. After which we, by controlling it with ultrasound, by assessing the vascular flow, proved that. But the man continued to bleed.

Monika Rachtan
And we are talking about medics, that is, looking at.

Grzegorz Gielerak
Trained.

Monika Rachtan
On us, on the civilian population, we probably do not have such skills. But precisely, all these military projects that the general spoke about, which are about to take off in our country, do they also provide for the training of civilians?

Grzegorz Gielerak
They must. Among other things, this is the idea behind the creation of this system of national medical security, because I am of the opinion that, as in every case, rationality is particularly important here. Rationality is, of course, backed up by costs and resources, because deciding to create specific medical entities, which will be staffed by prepared, previously trained personnel, who will, in turn, be equipped with appropriate equipment, medical materials specific to those used in battlefield medicine, well, this is associated with an appropriate expense and cost for the state. But also the question is then do we want to do it everywhere. In the Lower Silesian, West Pomeranian Voivodeship as well? I answer yes, but not in the first place. So rationality is costs. But there is another more important factor - time. We do not have the time now to build such a nationwide, broad project. We don't. We should focus on what is the priority today, and the priority is the medical security of the eastern part of our country. On the question of what depth we are talking about to the Vistula line.

Monika Rachtan
And should we Poles, being rational people, perhaps just improve our knowledge? Would it perhaps be worth going to some training? Or does the Military Medical Institute organise such training for civilians somewhere where I could go and learn how to use this tourniquet, because I bet my primary care doctor doesn't have the time that if I come to see him, bring the tourniquet and say Doctor, I would like to learn here, would you help me, he won't have the time, so where can I add to my knowledge?

Grzegorz Gielerak
Exactly so. The Military Medical Institute, among others, provides such training for those interested. These are optional trainings, I emphasise, i.e. they are not required at any level of medical training. Nevertheless, I must admit that a large number of medics, in every professional group, are showing interest and taking part in such training, which makes us very happy, and I hope that there will be more and more of them, because it is essential to be prepared. Now, let's face it, I don't expect you, those interested, to be specialists in suturing wounds, because we also teach this. This is already the highest level of sophistication. We use tissue materials here in order to make this training as objective as possible. But we would like, above all I would like, the vast majority of people to have a broadly understood general idea of just how to put on a bandage, how to proceed in the event of an incident. Military medicine has a great deal in common with disaster medicine. These are mutually interpenetrating areas. In both fields, the basic principle of procedure applies. There, everyone knows what to do at any given time.

Grzegorz Gielerak
Everyone has their own task. If anyone may have seen in pictures, for example, how the ED at the Military Medical Institute Hospital functions, there you can sometimes find pictures where there is a stretcher over a patient who has been brought in by an emergency team after a serious traffic accident. Around him, around the stretcher, there are 5, 6 medics of different specialities. Of course, you can't see that. Well, that's what a lot of people look like as they converge. No, no. Each of them has a role. One assesses the functions, the vital signs and there is a person who writes it all down, reports and so on and so forth. These are procedures and if we don't have this in our blood, well, unfortunately we can't say we are well prepared. You have to be able to do it when you wake up in the middle of the night, automatically.

Monika Rachtan
Can only medical practitioners benefit from this training? Also for people who are not in the medical profession, does such training take place.

Grzegorz Gielerak
We do such training for everyone, both for people outside the medical profession, but also, of course, for people in the medical profession. And here, as I say, both for rescuers, nurses and doctors, we select the level of difficulty according to the needs and expectations of the other party. A very important, and here a good question, is the comment concerning precisely those outside the medical profession. Should they too? Definitely yes. Because the ability to behave in such situations can sometimes save lives. I remember a few years ago, we organised such training for one of the banks. Surprising, isn't it? But we got into a completely random situation during the talks. We were talking about anti-terrorism security and the bank was so convinced, sure Sure we have protection. That's all. But yes. All right, but the terrorists come in and what? They turn up, they turn up injured or. And then suddenly it turned out that we don't really. We don't have the knowledge at all. And the training of the staff just from the bank was conducted in terms of providing assistance to people, for example, injured during such an attack.

Monika Rachtan
I have this feeling that we in general rarely, until a few years ago, thought about the fact that we should just be able to give help, even first aid, When someone just fainted in the street, fell down. A lot of people were afraid to do it. I guess the Great Orchestra of Christmas Aid warmed up the task a bit and also showed Poles how to do it. Now there is also more training. There are such trainings appearing in schools, so I think that already this, this person who needs help. If we meet them on the street, we are a little less afraid, but I think that the kind of help that you are talking about today, that is, on the battlefield, is still something that is not well-constructed in the minds of most people in society, at least. I think that perceptions and reality are two different things, But some doctors in Poland go regularly to Ukraine and there they help doctors to treat people who have just lost their health as a result of the war. After these doctors come to Poland, what is your general's experience?

Monika Rachtan
Are they sharing their experiences, training Poles too, or are they keeping this knowledge to themselves?

Grzegorz Gielerak
The vast majority are people who bring this knowledge and then seek to apply here locally. This is due to two reasons. It is people like Damian Duda, for example, which is, let's say, this kind of tactical medicine. It stems from this person's conviction that I have acquired knowledge and I think we have a lot to say in this matter and I am willing to share this even with the military health service. There have been meetings that have taken place with Damian Duda, but there are also a fair number of visits organised by various types of institutions and these are often state institutions, that is, our personnel delegated to Ukraine, for example, to train medical personnel there. And, of course, these people then return to Poland and share what they saw there.

Monika Rachtan
So it seems that all we need to do is to put it together even better and really start these preparations. And it is possible for us to be at least a little bit prepared in the short term, but we would like to be sufficiently prepared. Well, and the subject of health education is due to appear in schools next year. Should elements of this battlefield medicine also appear there? This is also the place to talk to children about protection and assistance.

Grzegorz Gielerak
I think it certainly is, of course, on a limited level, but first and foremost to build some awareness of how this medicine, how medical protection for this type of injury differs from what we encounter in a civilian setting. I will use such an oft-used expression that in the standard of resuscitation rescue procedures in a civilian environment, in civilian life, we use this ABC Yes method. That is, first of all, point one make the airway clear. Restore breathing and then restore circulation. In the case of battlefield injuries, especially gunshot wounds, then we reverse it you could say well yes, but you need to know that.

Monika Rachtan
Yes, this is important to know.

Grzegorz Gielerak
This is important to know. In order to avoid situations such as we have also witnessed in Poland. When, under the watchful eye of the cameras, resuscitation was being performed on a person who had been severely stabbed with a sharp object, in a situation where, with every compression of the heart, we were actually pushing those remnants of blood that were in the vessels out of the vessels. That is to say, we aggravated the shock and all the associated complications of maintaining circulation, filling the vascular bed, because this is often also the method, i.e. supplying the wound, interrupting the haemorrhage and filling the vascular bed with first fluid, then blood, blood products is the basis of battlefield medicine. Hence, we also apply it. This is also another point to make, as I have used the term, that familiarisation with medical materials specific to military health care. We use precisely the kind of materials that we do not use in the civilian environment, because there is no need. We are a great country where situations like gunshots are rare.

Monika Rachtan
Fortunately.

Grzegorz Gielerak
I am smiling because what comes to mind is a visit by colleagues in the US Army from perhaps a year ago, and we were talking about the experience of supplying these wounds. We were building up this experience as an institute in the late 1990s and early 2000s. Those older viewers may remember that this was the time of the height of the mafia struggle in Poland and the deal. We had such an agreement with the Mazovian voivode that all cases of gunshots went to WIM. The provincial governor had the problem solved, and by the way we were also gathering experience and treating these people. And here it turned out that Americans were asking the question Well, what about you? Well, no, with us we don't have this problem.

Grzegorz Gielerak
They look. Well, yes, because we in Detroit or Chicago, for example, have 30 shots a day in the ED there. This shows the scale and, among other things, we also take advantage of this exchange in cooperation with the US Army and train in the conditions there. Well, because it is a great, great testing ground. Yes. And now back to just this security. We use medicines and materials, especially those medical materials which are only specific to the army. Among other things, their function is that if there is a gunshot wound, well, you have to cut that bleeding at all costs, which I don't see at the moment, because I have neither the conditions nor the possibility of securing them. This bleeding has to be cut and, among other things, there are dressings which, figuratively speaking, are pushed into such a wound. When they are exposed to heat, moisture and body fluids, they are activated, which results in, among other things, the generation of temperature, but also the release of chemical substances which close local vessels and thus stop the bleeding. But this is important to know. It is necessary to prepare the dressing properly and to apply it correctly.

Grzegorz Gielerak
Because the insertion does not consist of an application such as gauze, but unfortunately you have to, as I said here, push it into the wound.

Monika Rachtan
I am also thinking about the fact that in general, this eastern border may look completely different in Poland in a while, that special facilities may appear there. Well, when we think about medical security, well, just like during the COVID 19 pandemic, there must be special dedicated hospitals. Will these be converting current hospitals or will they be created? Probably the General is smiling and can't say but what will it look like? Will we just use the units that are there? Will this also cause chaos like there was in the COVID 19 pandemic? Because when the temporary hospitals were set up, their existing tasks were automatically transferred to another place. How will this be resolved?

Grzegorz Gielerak
This means that, as I said, we are very much informed by the Ukrainian experience, because, of course, this experience cannot be transposed from one country to another. Ukraine is a completely different, or in other words much larger, theatre of operations. It is a huge space. The length of the front line is currently like the distance between Warsaw and Barcelona. This is how it builds up the image, and it needs to be manned. Yes, it builds an idea of scale. We in Poland, in our area, taking into account geographical conditions, do not have such space, which on the one hand is a limitation, for example, of the maneuver that our troops are able to perform, but on the other hand it is an added value, because the enemy has the same limitation. Of course, the problem here and from the point of view of the health system is very important. There are means, different kinds of means of combat that are based on the principle of speed, precision, that is, and range. That is to say, there is no such thing as there was even 50, 70 years ago, that the range of artillery determined where we built field hospitals, especially providing advanced assistance. And it was those 30, 40 kilometres, because the shell didn't go any further.

Grzegorz Gielerak
Today we have hundreds, thousands of kilometres and they are hitting with precision, you could say almost spot on. Hence to the question And this is the Ukrainian experience. If anyone had doubts, and perhaps when planning defence policy in terms of medical security, they thought in terms of hospitals we have, we will prepare, we will prepare nothing, Everything that sticks out above the ground will be destroyed. The Russians use a tactic, which here again I quote the great Clausewitz, which is based on the principle that war is a clash of moral and physical forces via the latter. By breaking morale, they seek to tip the balance of victory in their favour. So attacks on hospitals, attacks on places where wounded soldiers are just being treated, are aimed at breaking the moral backbone of society and the army. And they will take place.

Monika Rachtan
In the first instance.

Grzegorz Gielerak
And we must be prepared for this, aware of it. Therefore, when thinking about building a system of medical security for the country, we should also think in terms of the fact that any hospital which is built on the line east of the Vistula in Poland, a new hospital, because we are going to build such facilities, should certainly be built a priori with the assumption that in the underground area we are building with reinforced concrete ceilings, spaces to which we can move all medical activities, especially the operational ones, in a short time. And if we do not have such possibilities, because the vast majority of hospitals in Poland do not have such possibilities, we should think about how to use all the infrastructure we have around us, the various underground car parks, to move medical activities there in a short space of time. Once again, anything that protrudes above ground can and will be destroyed.

Monika Rachtan
The Russians in Ukraine are now destroying a power station. Some 70% of power stations in Ukraine have been destroyed by the Russians. How do you prepare a hospital for a power shortage?

Grzegorz Gielerak
A priori, the hospital, it could be said, is already prepared today for a power shortage. And, as in the case of the Military Medical Institute, also for possible problems with the water supply. Every hospital has an obligation in Poland. This is due to a situation where a surgery is being carried out and there has been some kind of failure. Therefore, we have systems which automatically switch over in a fraction of a second, so that all these critical areas related to maintaining human life can continue to function. So that is one element. Are we prepared to some extent here.

Monika Rachtan
All right, General, but how long will this apparatus be operational?

Grzegorz Gielerak
Well, yes, that's a good question, because you know, it's UPS, yes, it's batteries and that's prepared for a period of a few hours to a day maximum. But also the other output is the generators and they are as well.

Monika Rachtan
What if the aggregates are destroyed?

Grzegorz Gielerak
It may be more likely to run out of fuel for them, because they are in underground areas, they are protected. Therefore, here, if they are destroyed, there is nothing left.

Monika Rachtan
And are we, for example, ready for such a situation? Well, because, as we said, these combat operations are completely different from those used 20, 30, 40 years ago. For example, if water is contaminated in a large city of 50,000 people, suddenly 50,000 people will have symptoms of food poisoning and all these people will need medical help. What should be done in such a situation? Do we even have a procedure for that?

Grzegorz Gielerak
Yes, these are tasks. Depending on the type of emergency we are dealing with. Here you used the argument of contamination. I understand, chemical contamination can be chemical biological can be radiation, the so-called dirty bomb. It is very popular because, one, it is difficult to identify the author, the person responsible for using it, because it is so primitive that almost anyone can do it, and two, it is very effective in order to, if only to arouse public alarm. And now all these situations in Poland are dealt with by the fire brigade. These are tasks. They have the means to identify the risks and counteract the effects. In the background, of course, is the health care system, because apart from the fact that we determine that someone has been contaminated, this someone needs to be taken care of. And here we have a huge challenge, because if we stick only to the hospital infrastructure in Warsaw, then at the moment we have literally a few places where we are able to isolate people who have been contaminated with, for example, radioactive material. But the Military Medical Institute, and this is a pandemic experience, has built a modular hospital.

Grzegorz Gielerak
This name is a bit misleading, because many people expect it to be a hospital made up of containers. No, it really is a normal hospital. Yes, it was built from modules, but you will not see that on the outside. It is a hospital that is perfectly capable of providing assistance to such people, because it has appropriate safety zones, it has separate water outlets. Therefore, it is fully prepared to take care of such people. We are talking here about a number of places already exceeding 100, and now the question is whether this type of solution should not be replicated on the scale of at least every voivodship in our country. In my opinion, yes, and this is the way to build a crisis-proof state. So that, on the one hand, we do not consume the resources of the existing health care system with all its consequences, with number one being the reduction of the accessibility of citizens to the health care system. Because let me remind you that in times of war also people have strokes, they have heart attacks, they get pneumonia, so you cannot cut them off from the system because we have a war.

Grzegorz Gielerak
This activity has to be preserved, but we are able to recreate and create some sort of area that will be this pre-supply site.
Monika Rachtan
Can some lessons from the COVID-19 pandemic be transferred to the threat of armed conflict? Could the pandemic have taught us something, looking at the challenges ahead?

Grzegorz Gielerak
It could and did teach. On the other hand, I feel a certain insufficiency in terms of how we codified and used this knowledge. I had imagined it differently. Among other things, together with the Jagiellonian Institute, we produced a document towards the end of the pandemic - '100 recommendations for the state in the event of an epidemic crisis'. It included not only recommendations on medicine, but also on the economy, drug supply, finance, logistics and global supply. However, we have not followed up with a process that would lead to every level - from the government to the region to the county - defining who is responsible for what, what resources they have and when they carry out specific tasks. This should be strictly codified. Most crises are similar. Someone might say: 'Well, okay, it was a pandemic crisis, maybe it will happen in a few years', but we know that crisis cycles, which used to be every 10-15 years, today can shorten to about eight years. So we still have some time.

Monika Rachtan
Not much anymore.

Grzegorz Gielerak
Yes, but it is not quite like that. Most crises, in 60-70% their complexity and maybe even more, have a similar way of countering the effects. They differ only in certain small elements in the final phase - what kind of damage you have at your disposal, what part of the population needs help, at what time you have to organise the transport of the wounded. It is different when a bomb has exploded and we have a lot of injured people, and it is different when the sick are gradually arriving. These are differences that we can recognise and take into account. In contrast, the foundation of counter-crisis measures, both in the health system and in the state, should be built on the pandemic experience.

Monika Rachtan
What is a worse crisis - pandemic or war?

Grzegorz Gielerak
War, definitely.
Monika Rachtan
Do Poles have awareness after the COVID-19 pandemic? Until now I hear: "What COVID was there? There was no COVID. We were vaccinated, we were microchipped. Why did they build these temporary hospitals? So much money was spent on ventilators, on masks, on everything. Why all this if COVID wasn't there?" This is what a section of our society says, especially in online comments, when reminded about vaccination, disinfection or isolation in case of illness. Will Poles react the same way to the expense of preparing for a possible armed conflict? How do you general look at our society? What is your opinion of it?

Grzegorz Gielerak
This is a perfect example of how we have not learnt the lessons of the pandemic. What you have described is unfortunately an area of failure in public communication. Many people understand war in the classic way - as a kinetic clash, i.e. direct combat between troops. Meanwhile, since 2012, when the Russians introduced the Gerasimov doctrine, armed conflict has been divided into six stages. The kinetic clash is just one of them, and one of the last. At the beginning we have an escalation of tensions, crises of various kinds: diplomatic, economic, social.

Monika Rachtan
We see what is happening on the internet, among other things, disinformation. I am referring to the false information that appears in the media. For example, we have seen a huge fire in Warsaw - this is already happening.

Grzegorz Gielerak
Exactly. These are already stages of armed conflict, but not in kinetic form. The enemy knows very well that it is easier to defeat the enemy if you first weaken its morale, disintegrate society and destroy the fighting spirit to defend the homeland. These actions may take weeks, but the decomposition of a society is a process that takes up to 20 years. We must be aware of this and, as a state, protect our society from such threats. Someone may say that it is a fine line between censorship and protection, but we must find the golden mean. The state cannot be defenceless and open to this kind of action, which is inherent in the non-military part of armed conflict.

Monika Rachtan
Finally, I will repeat after the General - we already know about the pandemic, we do not yet know about the war, but the war is worse than the pandemic, and we were not ready for the pandemic. It is worth preparing for war, because the threat is real. Personally, I do not feel ready and I think many Poles do too.

Grzegorz Gielerak
This is a very apt summary. I hope that this broadcast will provoke reflection in many people. War is not just a memory from the history books. We live in a time of the longest peace in Europe, but we must remember the old Roman principle: "You want peace - prepare for war". We live in a global world, which also involves a struggle of interests. These interests intersect, and the principle of economic and political Darwinism also applies in the modern world. We need to understand this as a state. Such broadcasts aim to raise this awareness, but must also lead to concrete action. The state and the army are first and foremost people, and their strength is determined by the character and values that society represents. Training, equipment, tactics and defence doctrine are important, but the real strength is in the society.

Grzegorz Gielerak
The strength of the army depends on who we are as a society, our awareness and willingness to defend our values. We don't have to be driven solely by patriotism - although I personally believe deeply in it - but also by self-interest. You are at home, defending your borders and identity. No one will treat you better than in your own country.

Monika Rachtan
You are defending, first and foremost, your loved ones, your family and your home - this is important to remember. General, thank you very much for the interview. I am glad that you agreed to accept the invitation. A subject perhaps unpleasant, but very important. Thank you.

Grzegorz Gielerak
Thank you very much.

Monika Rachtan
Thank you for your attention. We invite you to subscribe to our social media channels. We are on YouTube and available in all podcast listening venues. My guest and your guest was General Grzegorz Gielerak. Thank you for your attention.