In the event of collective defence , the state’s overall ability to act is decided not only at the front but also in hospitals, control centres, laboratories, pharmacies and supply networks. The healthcare system acts at the same time as critical infrastructure, as the backbone of civil protection and as an indispensable part of total defence. Hybrid threats, cyberattacks, sabotage and armed conflict turn security of supply into a security issue. At the same time, fragmented responsibilities, sector boundaries and defensive structures hamper rapid coordination and the integration of new processes.
What changes in a crisis or conflict
A collective defence case brings parallel pressures that reinforce each other:
- More wounded and more complex situations: simultaneous care for the civilian population, German military patients and potentially also patients from allied nations in the country.
- Attacks below the threshold of war: Sabotage, disinformation, drone sightings, GPS jamming and cyberattacks target critical infrastructure and processes, not just military targets.
- Competing demands for capacity: staff, transport, energy, communications, medicines and medical devices become scarcer and, at the same time, strategically more important.
Where the greatest vulnerabilities lie
1) Preparedness gap in hospitals
Data from hospital alarm and emergency plans show that only a small proportion of hospitals are prepared for the national defence scenario. At the same time, a great many hospitals regard infrastructure failures, major incidents and cyberattacks as realistic stressors.
2) Technical resilience
Backup power is covered in many places, but additional redundancy is much rarer – for example drinking water reserves and treatment systems, mobile backup power modules or decontamination capability.
3) Digital attack surface
Systems that can be reached from outside may remain vulnerable if patch management, version transparency and vulnerability management are not carried out consistently. In the event of collective defence, this is not an IT issue but a risk to care.
4) Staff as a bottleneck and source of conflicting goals
Medical staff become a critical resource. Dual roles can create conflicting objectives in an emergency, for example when reservist duties, disaster control duties and clinical care all apply at once. A reliable staff situation picture and plannable capacity recording thus become resilience measures in their own right.
What total defence needs in concrete terms
For resilient healthcare in the event of collective defence, binding structures and clear responsibilities, a nationwide health situation picture and joint exercises across ministry boundaries are indispensable. Resilience emerges where coordinated care structures, joint training, digitalisation, crisis and self-protection awareness among the public and a workable legal basis for preparedness and emergency supply come together.
A recurring key point is: coordination is decisive. This requires reliable data on the current situation, clear communication chains, defined responsibilities and simulations before an emergency occurs.
What does this mean for operators, local authorities and citizens?
- Operators and facilities need priority lists for “must run” functions, redundancy for energy, water, IT and logistics, and coordinated communication channels with authorities, control centres and suppliers.
- Local authorities need reliable interfaces with hospitals, clear expectations regarding civil protection, evacuation, care and supply, and exercises with realistic outage scenarios.
- Citizens strengthen the system through personal preparedness and self-protection, because every supply situation that does not escalate keeps clinical capacity free. The BBK’s emergency preparedness recommendations aim precisely at ensuring self-sufficiency in the initial period and relieving the emergency services.
Preparedness and emergency supply laws
Energy: Energy Security Act (EnSiG)
Hospitals and emergency services depend on energy, from medical technology to IT and building infrastructure. The EnSiG supports the state’s ability to set priorities in a supply crisis so that healthcare and critical services keep running.
Water: Water Supply Security Act (WasSiG)
Hospitals, care services and emergency services need water for hygiene, treatment and operations. The WasSiG is relevant because healthcare is quickly restricted in water crises without prioritisation and emergency operation, making legally sound management essential.
Food: Food Security and Preparedness Act (ESVG)
Food security is a health issue: outages hit vulnerable groups, care services, hospitals and rescue structures particularly hard. The ESVG is relevant because it provides the basis for organising supply measures in a way that considers health protection and basic supplies together.
Postal Act (PostG) and Telecommunications Act (TKG)
- PostG: Healthcare also needs physical delivery (documents, materials and, in everyday life, often medicines/mail-order logistics). The PostG sets the framework for these postal and parcel services.
- TKG: Hospitals, emergency services, control centres and digital health processes rely on stable telecommunications. The TKG therefore directly concerns the communication infrastructure that supports medical coordination and crisis operations.
Transport and logistics: Transport Security Act (VerkSiG)
Healthcare depends on transport: emergency services, patient transport, medicines, blood products and material supplies need functioning routes. The VerkSiG is relevant because prioritising transport services in crisis mode helps determine whether medical care can be maintained across the country.
Resilience regulation for critical infrastructure (physical & cyber)
- The KRITIS Umbrella Act strengthens resilience requirements for critical health structures, especially with regard to emergency operation and restart.
- NIS2 is relevant because healthcare is digitalised; minimum standards for cyber risk management and reporting channels support operational capability in crisis mode.
