Proactive utilisation of civilian medical talent in a cost-effective manner under the Territorial Army umbrella ensures that the ‘sword arms’ of all branches of the military, i.e., troops, plus dependants and veterans, are supported by a robust, deep and unbreakable medical shield while also freeing finite financial resources that can be allocated for combat-related needs.

War is fundamentally an onslaught on an entire nation and not just the armed forces. It is incumbent upon all State resources to collectively plan and prepare for any eventualities. Accordingly, this brief examines certain aspects of healthcare and their intersection with national security. It outlines a framework to re-engineer the Territorial Army Medical and Dental Corps (TA AMC and ADC) through a structural Civil–Military Fusion (CMF) model.

Contemporary high-intensity warfare paradigms can compromise traditional medevac lines, and injury profiles can be higher and more rapid in proportion than before. This shift would require extensive capabilities to be deployed directly within the life-saving ‘Golden Hour’ at the tactical edges. Concurrently, during peacetime and in static formations, many military medical facilities face challenges due to escalating epidemiological shifts. The rapid rise of non-communicable diseases, malignancies and complex metabolic and lifestyle disorders among the population requires highly skilled tertiary super-speciality care across the board in smaller military hospitals as well, which is not possible, leading to extensive referrals causing fiscal loss and compromise in patient care.

Integrating civilian healthcare providers via the TA model solves these challenges. Commissioning civilian specialists under relaxed benchmarks in a fiscally beneficial model will bring premier clinical, academic, and technological edge and assets to the ecosystem and within its own jurisdiction. This model delivers cost-neutral operational surge capacity, guarantees absolute information sovereignty, eliminates commercial billing exploitation, caters to modern-day felt needs of tertiary care in all hospitals, and builds a resilient approach.

Hence, there is a strategic need to revive the Territorial Army AMC and ADC while enabling resource and staffing buffering in static establishments. The essence of CMF, anyway, lies in the convergence of civil and military resources and systems to maximise a nation’s ability to express its comprehensive national power in both war and peacetime. Accordingly, this ‘civil-military fusion’ model provides a cost-neutral and fiscally beneficial surge capacity of specialists and super-specialists, leverages localised terrain expertise, and remediates certain clinical gaps, especially in smaller-than-command hospitals, which form the bulk of military hospitals.

Strategic Context: The Changing Face of Conflict

Recent conflicts (Russia–Ukraine, Israel–Gaza, US–Iran), with their protracted nature and domestic standoffs (Galwan, Op Sindoor), underscore a ‘new normal’ in all aspects of modern warfare, including military medicine and the necessity of civil–military fusion, including in healthcare. Some of these scenarios are military in nature, as detailed further, and some are biological as well.

Unconventional Injury Profiles

Open-source published data, such as from Gaza, shows a surge in complex polytrauma and femoral injuries at multiple locations and closer to conflict zones in both military and civilian populations, leading to higher loss of limb/life. Newer high-intensity formations (e.g., Rudra/Bhairav) and the unethical nature of adversaries will invariably lead to more situations requiring immediate proximity to multiple teams of Vascular, Trauma, Orthopaedic, Maxillo-facial, and Anaesthesia specialists across multiple locations simultaneously to reduce mortality.

DRAM (Drone, Rocket, Artillery, and Mortar) Scenarios

Overwhelming drone swarms and loitering munitions can paralyse traditional road and air medevac corridors, apart from also being highly cost- and equipment-intensive, such as in air medevac. When aerial and road evacuations are contested, life-and-limb-saving care must be pushed forward.

Future Weapons and Targeting of Civilian Hospitals

AFMS in future will be dealing with potential fallouts of newer weapons such as high-energy weapons systems, which are not individual-specific, such as bullets, which could potentially inflict a high number of non-CBRN casualties; in which case, both civilian and military infrastructure in large areas could get quickly destabilised. There have also been many instances of hospitals being targeted in conflicts despite the Geneva Conventions, as their locations are well known. In such scenarios, AFMS will be called upon by the GOI and will thus need many hands rapidly.

Hybrid and Non-Kinetic Resilience

COVID-19 and recent cybersecurity breaches (e.g., AIIMS Delhi) demonstrate that medical infrastructure is a primary target. A ‘whole-of-nation’ approach is needed to ensure resilience against multi-dimensional assaults. The National Health Policy 2017 also advocates for two beds per 1,000 population, distributed to enable access within the Golden Hour, a goal TA can support.

In the event of exigencies arising from kinetic actions by adversaries that may cause large-scale civilian casualties in border and nearby areas, AFMS may be tasked with addressing them; augmentation by TA AMC & ADC is a good way forward.

Establishing new infrastructure is cost-prohibitive. Currently, mid-zonal military hospitals and below cannot operate at peak capacity due to a lack of year-round specialists and super-specialists (e.g., a smaller hospital with an ultrasound but no radiologist) or a hospital with a single specialist who is on leave. TA AMC/ADC will enable permanent specialist cover across all streams. This optimises existing assets by redirecting capital expenditure to equipment.

Operational Benefits of TA AMC/ADC Revival

The revival of TA AMC and ADC offers some of the following advantages.

Enhanced Combat Support and Proximity Care

The golden hour is widely recognised as the most crucial window of the first........

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