Abstract. This paper analyzes the effect of hybrid warfare factors on the operations of the RF AF medical service, identifies the extent of their influence on providing medical support, and formulates activity lines, considering the threats of new-type warfare.

The present-day geopolitical conditions of the globalization era manifest themselves in weakened national borders, advances in communication means, increased demand for energy sources and natural resources, and several other factors. Simultaneously, there is an obvious desire of some countries to ensure their global hegemony. The struggle for resources and the achievement of economic and political objectives has grown over the last few decades, being implemented not only and not so much by various nonmilitary means of impact as by forceful methods of settling interstate disagreements.1,2

With regard to the Russian Federation, international relations are characterized by a drastic increase in political, economic, and social grievances, and in some cases there are territorial disputes. Clearly, the existing contradictions are a basis for placing a number of demands on Russia, which, if we fail to meet them, will entail various sanctions and pressure methods within the limits of the established legal means and short of violating the interstate relations standards. At the same time, if the measures applied fail to produce the intended effect, it is not ruled out that methods of force will be resorted to. Moreover, the forms, methods, and scale of the force will depend on the established goals and also on the ability of the Russian Federation to repel threats to its national and military security.3,4,5,6

On February 24, 2021, at a session of the Federal Security Service board, Russian President Vladimir Putin listed global challenges and threats to the country’s national security at the current stage. It was mentioned that global threats such as terrorism, transborder crime, and cybercrime are not diminishing, and special attention was given to the role that special services play in them.7 Thus, for instance, NATO and Pentagon documents make liberal use of the hybrid threats concept, one of whose originators is Frank G. Hoffman, a researcher at the US Department of Defense. The latter wrote in one of his works that the link between criminal and terrorist organizations proved fairly fruitful, while the growing numbers of drug-terrorist and transnational organizations resorting to smuggling, drugs, human trafficking, extortion, etc. to undermine the legitimacy of the local or national government is obvious enough. The text later defines a hybrid threat as simultaneous and adaptive use by any adversary of a combination of conventional weapons, irregular tactics, terrorism, and criminal behavior in the combat area to achieve their political objectives.8

In the part concerning the so-called containment policy, the adversary resorts to economic measures, attempts to interfere in political and public affairs, destructive propaganda methods, and other means. The purpose of this kind of comprehensive impact is to create internal instability in the country and to diminish its ability to protect its national interests and counter domestic and foreign threats.9,10

The threats to national security listed above are essentially elements of so-called hybrid warfare or new-type wars, which are the subject of several theoretical works.11,12,13,14,15,16 Even though a generally accepted interpretation of the notion has yet to appear, we in this paper share the definition of hybrid warfare given by A.A. Bartosh, who describes it as a covert conflict with a complex internal structure unfolding in the form of an integrated military-political, financial-economic, informational, cultural-ideological confrontation lacking a definite status and aimed at putting the country subjected to hybrid aggression under outside control with minimal military violence thanks to concentrated financial-economic and information-psychological pressure, as well as to the use of cyberweapons.17

A.V. Serzhantov et al. in the paper Transformation of the Concept of War: From Past to Present – Hybrid Warfare Technologies give a fundamentally different structure and order of problem solution in the new-type warfare, which includes eight phases of its conduct with not only the content, but also the very ideology of waging war changing considerably. Without delving too deeply into an analysis of the hybrid warfare concept, it appears expedient within the framework of this paper to specify the factors that affect the work of the medical support system in the Armed Forces of the Russian Federation (RFAF).18,19

With regard to the specifics of providing medical support to troops/forces, based on the sequence of missions carried out by the warring parties, we have grouped the phases of hybrid warfare into two conventional periods – covert confrontation and overt military struggle involving regular and/or irregular armed formations. During the first stage, measures are taken to prepare conditions to change the regime in the hybrid warfare target and achieve a coup d’etat (using color revolutions technologies), i.e. this is the stage of soft power. During the second stage, which is in fact open struggle involving military force, they create conditions for dismantling the political system and seizing control of the target of aggression.20

The period of covert confrontation is characterized by the aggressor’s compound impact on the target of aggression involving political, socioeconomic and information-psychological measures. Also, there is a high probability of disorganizing the functioning of control and life-support systems, committing subversive and terrorist acts against critically important facilities, fostering outbreaks of infectious and mass noninfectious diseases, etc. Since the period under examination is a sum of threats that do not involve armed clashes that damage the more vulnerable points of the target in political, economic, philosophical, educational, moral-psychological, medical-social, and other areas, it should be viewed as a crisis situation.

Obviously, during a crisis situation, the work of the RF AF medical service will be tangibly affected by a number of general factors that are to be characterized individually.

Disruption of the work of state power and military control bodies, including those of the medical service. This is accomplished not only by means of influencing key officials, but also thanks to measures to disrupt communication channels, among other things, by packing them with false information. The said circumstance may entail taking unjustified decisions that do not match the situation, and as a result, the irrational use of medical support forces and equipment.

Disrupted functioning of transport communications in conditions dictating the need for a prompt response to emerging threats can substantially hamper the maneuvering of forces and asset, and also result in irregular supplies of material reserves.

With regard to the specifics of providing medical support to troops/forces, based on the sequence of missions carried out by the warring parties, we have grouped the phases of hybrid warfare into two conventional periods – covert confrontation and overt military struggle involving regular and/or irregular armed formations.

Information impact, i.e. misinforming political leaders and the public, provoking acute cultural and social conflicts in society, coupled with a socioeconomic impact that by and large aims to worsen the social and material position of the general public and increase separatist and opposition sentiments, can influence the work of military medical organizations, owing to the following psychological and emotional factors:

• diminished motivation of staff for fulfilling their professional functions

• growing numbers of conflict situations in collectives

• risk of sabotage in assignment execution on the part of some staffers.

In addition, economic measures per se can radically aggravate the provision of medical support thanks to shortages of material resources.

Even though the covert period of hybrid warfare does not presuppose direct use of military force, the methods of armed struggle with regard to the target of aggression will be implemented by means of subversive-terrorist activity undertaken by criminal communities and irregular armed formations. There one should expect attempts at affecting primarily critically important facilities, whose destruction or failure could cause emergency situations or man-made disasters. On one hand, this may result in instant mass casualties, but on the other, should the adversary target a life-supporting facility, in a considerably worsened sanitary and epidemiological situation.

The general factors examined here, along with use of hybrid warfare target measures with the immediate goal of undermining public health and/or provoking mass diseases among civilians and soldiers, form specific work conditions of the military health care system in a crisis period.

Let us dwell in more detail on the organizational aspect. Given the fact that a major problem of the covert confrontation period consists in pinpointing the moment the state becomes a target of hybrid aggression, the possibilities of repulsing the latter depend on coordinated activity of control bodies, and a quick and appropriate response to the emerging threats.

Disruption of the system of health care control in a crisis period may practically paralyze the work of some preventive medicine organizations and make it impossible to meeting the growing demand for medical assistance.

A similar result can be obtained if some health care facilities are put out of operation or their general resource supply system is disrupted.

A change in the size and composition of patient flows can directly influence the conditions of medical staff carrying out their professional functions. The potential risk of mass sanitary consequences is due to the likely destruction of facilities that are chemical and radiation hazards. The medical and sanitary consequences in that case would be considerably more difficult to mitigate, owing to shortages of means of protecting the population from the impact of damaging factors. On the other hand, not just the public, but quite often the staffs of military medical organizations as well, have not been told what to do in the event of chemical or radiation contamination. Up to a point, the same is true of the RF AF medical service, too, which is an inalienable part of the state health care system.

One should predict considerable changes in the profile of infection pathology thanks to outbreaks of infections atypical for a specific locality. It is hardly a secret that some states bordering the Russian Federation host considerable numbers of laboratories with stocks of pathogenic biological agents that, given the right conditions, could become the source of infectious disease outbreaks. In addition, the sanitary-epidemiological situation could worsen as a result of an influx of contingents who are unprotected in terms of immunization when migration processes are encouraged, and also by disabled life-support systems and disrupted utility services.

Eventually, one cannot rule out the effect of technologies based on genetic engineering methodologies (cultivation of genetically modified foods, use of specific biological agents of a viral etiology, etc.), which can aim, among other things, to provoke certain exotic diseases, and form set parameters of physical and mental health at the population level. This requires devising in advance measures to respond to such threats.

Owing to the large-scale information-psychological impact, there will be mass psychotic disorders provoked among the public, while the target groups, which first and foremost include military formations, will experience socially conditioned mental disorders, primarily borderline disorders (including addictive, suicidal, and hetero-aggressive behavior). The said factor is not only effective for a certain time period, but also ultimately determines the mental health of future generations and, according to leading experts, constitutes an immediate threat to the country’s national security.

One more extremely important circumstance should be borne in mind. During the covert confrontation of new-type warfare, the probability of the disrupted work of the civil health care system is very high. Therefore, military medical organizations should be prepared to render aid to civilians – primarily to involve medical service formations in providing medical-sanitary relief in emergency situations and to work in conditions of an onslaught of mass casualties.

Obviously, the RF AF medical service should response to the challenges from new-type wars with efficient, coordinated actions in line with those of federal executive bodies and other departments aimed at neutralizing the emerging threats.

Of special importance during the covert period is implementation of measures of information confrontation in the media space; some of these tasks can be performed by the RF AF medical service. These tasks include the following:

• interaction between authorized officials of the medical service and information support bodies aimed at the wide and dominant dissemination of positive information about military medical service efforts

• continuous monitoring of the information environment, and prompt response to emerging information threats to reduce reputation damage and image losses for the RF AF medical service during publicly significant events and to refute false (fake) information

• formation of favorable public opinion with regard to the medical service acting in crisis situations.

All in all, the essence of information confrontation measures include the preemption of adverse effects on the mental, physical, and social well-being of the individual, social groups, and the public at large; prevention of information threats to public health; the strengthening of the information environment; and the training of specialists in the information support of medical service efforts.

It is necessary to focus on preparing the medical support control system for work under these condition so that it could promptly respond to emerging hybrid warfare threats, ensure that decisions are taken in time and with good reason, and also that control at all levels of the medical service remains stable and uninterrupted. Within the framework of the objective stated here, the top priority measures are the following:

• training personnel reserve experts in RF AF medical service control

• organizing and maintaining interaction with executive bodies, power ministries and departments, and local government agencies regarding continuous information exchange, use of the resource base, development and implementation of coordinated measures to counter overt or covert threats.

• improving communication channels and information interaction (above all, in the secure segment), including by setting up systems of decision-making support involving artificial intelligence technologies

• providing protection against information leaks, and also unauthorized access and distortion, jointly with authorized services.

The essence of information confrontation measures include the preemption of adverse effects on the mental, physical, and social well-being of the individual, social groups, and the public at large; prevention of information-related threats to public health; the strengthening of the information environment; and the training of specialists in information support of medical service efforts.

The combined impact from the adversary during covert confrontation may result in the disruption of power and water supply systems of military medical organizations as a consequence of subversion and terrorist acts. Coupled with provoked mass riots and a disrupted transport system, this will necessitate support of an autonomous mode for the functioning of medical service facilities under something like siege conditions. The latter necessitates support for the continuous functioning of military medical organizations and medical service formations, and also making sure that they can provide medical support in conditions of hybrid warfare. This can be done by:

• accumulating the required material stock

• supplying personal and group protective equipment against chemical, radiation, and biological factors

• creating and properly maintaining the necessary number of protective installations (shelters)

• having technical equipment that enables autonomous work in case the life-support systems of military medical organizations are disrupted

• fully implementing the set of antiterrorist measures to protect, guard, and defend facilities.

Readiness to perform the tasks under conditions of massive casualties stemming from the destruction of hazardous industrial facilities in the covert period of hybrid warfare presupposes not only devising, producing, and accumulating in advance stocks of antidotes, radioprotectors, antibacterial and antiviral medicines, but also training personnel to act in emergencies.

Work of the medical service to counter the use of hybrid warfare methods aimed at fostering diseases among the public and military, apart from constant health monitoring and taking traditional prevention measures, should follow several lines.

Firstmethodologies need to be developed to detect deliberate outbreaks of infectious and psychosomatic diseases, and to prevent, diagnose, and treat such pathologies.

Second, the response of medical support forces and equipment to changes in the situation with the establishment of additional mobile medical formations must be expedited; the latter should be equipped with modern medical equipment capable of starting to meet treatment objectives in casualty hotbeds in a minimum amount of time. As part of implementing these activities, measures should be taken to expand the professional skills of medical service specialists through more efficient professional-official and specialized training.

Thirdmeans of detecting genetically modified products and microbiological agents that can affect public health need to be developed.

Fourthmethodologies of group and individual information-psychological protection need to be developed in order to prevent psychogenic disorders. The latter, with regard to soldiers, presupposes, along with the ideological component, professional counterpropaganda and active work in the area of information hygiene, so to speak, as well as carrying out tasks oriented toward the following:

• optimizing the system of selecting candidates for military service

• creating a system of actively identifying informationally vulnerable persons

• effectively monitoring the psychological health and professional reliability of soldiers.

A separate problem is the development of effective methods of information hygiene and medical and psychological protection against destructive information (including countermeasures), as well as mitigation measures.

How opportunely, appropriately, and successfully the measures of countering hybrid warfare threats are implemented in the covert period will ultimately determine the efficiency of RF AF medical support during the overt period of military confrontation.

It must be borne in mind that should the conflict grow into a “hot” phase, hybrid methods of new-type warfare will be used alongside the classical methods of armed struggle. Also, in certain conditions, in the course of hostilities, use of conventional weapons may turn into the use of weapons of mass destruction, which, among other things, is determined by nongovernmental entities obtaining access to technologies for making weapons of mass destruction and the means of transporting them. The said circumstance determines the need to teach medical service specialists to assist victims of radiation, poisonous and chemically hazardous substances and biological weapons.

As analysis of early-21st century wars showed, fighting in present-day conditions has a number of features that affect the organization of medical support of troops/forces.

Typically, when aggression is committed by technologically advanced states, military operations tend to be brief, with critically important facilities attacked simultaneously involving precision-guided weapons into the entire depth of the defending troops’ formation. This increases the risk of the disablement of medical support forces and equipment and heavy losses among medical service personnel. Simultaneously, there is evidence of the casualty composition tending to change toward a greater share of concomitant injuries, which, in turn, increases the number of serious and very severe wounds requiring a broad set of urgent specialized medical aid.

A separate problem is the development of effective methods of information hygiene and medical and psychological protection against destructive information (including countermeasures), as well as mitigation measures. How opportunely, appropriately, and successfully the measures of countering hybrid warfare threats are implemented in the covert period will ultimately determine the efficiency of RF AF medical support during the overt period of military confrontation.

In the context of local wars, the last few decades have demonstrated an increasing transition away from positional methods of combat, when a clear-cut line of contact with the adversary is formed, to mission performance by individual formations that are generally in isolation from the main forces. Moreover, the tactical situation, which largely determines the architecture of the medical evacuation support system, shifts rapidly.

Obviously, during the overt armed confrontation period in a new-type war, efforts should focused primarily on forming an adequate grouping of medical support forces and assets, and setting up reserves of medical equipment and materiel. The traditional system of stage-by-stage treatment of the wounded with their evacuation as intended should be flexibly adjusted to the specific conditions and nature of combat actions. The flexibility of this adjustment, in turn, is helped by equipping medical units and subunits with modern mobile and/or quickly constructible means of deploying medical evacuation stages. Among the more significant problems are those of supporting the survivability of medical evacuation stages, which strengthens the requirements of protection, guarding, defense, and camouflage. Also, it is necessary to seek to deploy medical formations in conditions ruling out any impact from the adversary, which, in turn, will help increase the amount of specialized medical aid. It is expedient to examine the issue of changing the organization and staff structure of medical units and organizations formed for the wartime period in order to match their potential and the prospects of adjusting the system of medical troop/force support to the conditions of new-type military conflicts.

In organizing assistance for the wounded during combat, the emphasis should be on improving the ability of soldiers to render first aid, and also on optimizing the system of medical evacuation in terms of expediting the transportation of the wounded to the stages of medical assistance. Implementation of the latter provision should be facilitated by equipping subunits with armored medical vehicles both for evacuating the wounded from the battlefield, and for the work of medical experts in combat conditions.

In the context of local wars, the last few decades have demonstrated an increasing transition away front positional methods of combat, when a clear-cut line of contact with the adversary is formed, to mission performance by individual formations that are generally in isolation from the main forces. Moreover, the tactical situation, which largely determines the architecture of the medical evacuation support system, shifts rapidly.

Thus, in new-type warfare, the effectiveness of the RF AF medical service and medical support of troops/forces will directly depend on the timely detection of covert, implicit hybrid threats, and prompt response to those threats based on the flexible adjustment of basic approaches of the medical support organization to the emerging conditions of oftentimes vague and unstable situations.

In conclusion, it would be expedient to specify the activity lines for ensuring the readiness of the RF AF medical service to operate under conditions of hybrid warfare.

1. The participation of RF AF medical service officials in measures of information confrontation within the framework of certain powers.

2. The preparation of the system of control over RF AF medical support for work in conditions of new-type warfare.

3. The preparation of military medical organizations to work in autonomous conditions, should the adversary resort to measures of impact during the covert hybrid warfare period.

4. The optimized organization and staff composition of medical units and organizations formed for wartime so that their potential matches the prospects of adjusting the system of medical support of troops/forces to the conditions of new-type military conflicts.

5. The improvement of methodologies of detecting damaging factors and preventing, diagnosing, and treating infectious and psychosomatic diseases whose emergence may be due to deliberate actions to impact people’s health.

6. The development of modern means of equipping personnel, medical equipment, materiel and means of deploying medical evacuation stages.

7. The tailored training of personnel to work under crisis conditions and the enhancement of professional-official and specialized training of medical service staff in order to expand professional skill sets.


1. Gerasimov, V.V., Mir na granyakh voiny [The World on the Brinks of War], Voyenno-promyshlenniy kurier, # 10 (674), March 15, 2017.

2. Safaryan, Ye.V., Voyenniye vyzovy i urgozy dlya Rossiyskoy Federatsiyi (na period 2030-2040 godov) [Military Challenges and Threats to the Russian Federation: 2030-2040], Voyennaya mysl, # 3, 2021, pp. 25-37.

3. Bartosh, A.A., “Seriye zony” kak klyuchevoy element sovremennogo operatsionnogo prostranstva gibridnoy voyny [Gray Zones as Key Elements of the Current Operational Space in Hybrid Warfare], Voyennaya mysl, # 2, 2021, pp. 6-20; # 3, pp. 25-37.

4. Gerasimov, V.V., Op. cit.

5. Gerasimov, V.V., Organizatsiya oborony Rossiyskoy Federatsiyi v usloviyakh primeneniya protivnikom “traditsionnykh” i “gibridnykh” metodov vedeniya voiny [Organizing the Defense of the Russian Federation in Conditions of the Adversary Employing Conventional and Hybrid Methods of Warfare], Vestnik Akademiyi voyennykh nauk, # 2(55), 2016, p. 20.

6. Zarudnitsky, V.B., Kharakter i soderzhaniye voyennykh konfliktov v sovremennykh usloviyakh i obozrimoy perspective [The Nature and Content of Military Conflicts in the Current Conditions and in the Foreseeable Future], Voyennaya mysl, # 1, 2021, pp. 34-44.

7. Speech by President of the Russian Federation Vladimir Putin at the session of the Russian FSS Board on February 24, 2021. URL: http://www.kremlin.ru/events/president/transcripts/65068 (Retrieved on March 20, 2021.)

8. Savin, L., Kto pridumal gibridnuyu voynu? [Who Invented Hybrid Warfare?]. URL: http://www.stoletie.ru/vzglyad/kto_pridumal_gibridnuju_vojnu_615.htm (Retrieved on March 18, 2021.)

9. Serzhantov, A.V., Transformatsiya soderzhaniya voiny: ot proshlogo k sovremennomu [Transformation of the Concept of War: From Past to Present], Voyennaya mysl, # 1, 2021, pp. 45-57.

10. Serzhantov, A.V., Smolovy, A.V., Dolgopolov, A.V., Transformatsiya soderzhaniya voyny: ot proshlogo k nastoyashchemu – tekhnologiyi “gibridnykh” voyn [Transformation of the Concept of War: from Past to Present – Hybrid Warfare Technologies], Voyennaya mysl, # 2, 2021, pp. 20-27.

11. Bartosh, A.A., Op. cit.

12. Gerasimov, V.V., Mir na granyakh…, p. 20.

13. Gerasimov, V.V., Organizatsiya oborony…

14. Gerasimov, V.V., Po opytu Siriyi. Gibridnaya voyna trebuyet vysokotekhnologichnogo oruzhiya i nauchnogo obosnovaniya [As Exemplified by Syria. Hybrid Warfare Requires High-Tech Weapons and Scientific Justification], Voyenno-promyshlenniy kurier, # 9(624), March 9, 2016.

15. Serzhantov, A.V., Op. cit, # 1, 2021, pp. 45-57.

16. Tikhanychev, O.V., Gibridniye voyny: novoye slovo v voyennom iskusstve ili khorosho zabytoye staroye? [Hybrid Warfare: A New Word in Military Art or Well-Forgotten Old?], Voprosy bezopasnosti, # 1, 2020, pp. 30-43.

17. Bartosh, A.A., Strategiya i kontrstrategiya gibridnoy voyny [The Strategy and Counterstrategy of Hybrid Warfare], Voyennayamysl, # 10, 2018, pp. 34-45, 5-20.

18. Serzhantov, A.V., Op. cit.

19. Serzhantov, A.V., Smolovy, A.V., Dolgopolov, A.V., Op. cit.

20. Serzhantov, A.V., Op. cit.