World Health Organization · 1st edition, 2025 · 44 pages
Guidance document with themes, challenges, and good practices for establishing and strengthening civilian-military collaboration to improve health emergency preparedness
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Public health stakeholders, military service personnel, governmental authorities engaged in emergency preparedness, WHO regional and country offices, UN agencies, regional organizations
- Evidence
- Expert consensus based on Member State consultation (surveys, interviews, focus groups) across 51 countries, six WHO regions, 2018-2020; validated at June 2023 global technical consultation
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guidance document, developed in partnership with Johns Hopkins Center for Health Security and Chatham House, complements the 2021 National Civil-Military Health Collaboration Framework (NCF) by providing practical evidence from Member States across all six WHO regions on how to implement and strengthen civilian-military collaboration for health emergency preparedness. Based on extensive consultations including surveys, interviews and focus groups with civilian and military officials from 51 Member States conducted 2018–2020, it identifies lessons learned, challenges and good practices.
The compendium identifies five key thematic areas for stakeholder consideration: institutional infrastructure; capabilities and capacities; communication and advocacy; legal frameworks; and funding. For each theme, it provides specific challenges, considerations and generalized examples of good practice. The document emphasizes that while civilian-military collaboration has often been utilized ad hoc during emergency response (as during COVID-19), greater attention should be paid to preparedness activities before emergencies occur.
Ten high-level considerations are presented for developing and improving civilian-military collaboration at country and regional levels, ranging from regularly mapping capacities to committing dedicated funding. The guidance stresses that there is no one-size-fits-all approach; countries must tailor implementation to their unique socioeconomic, geopolitical and geographic contexts, including public acceptance of military involvement. In some contexts, civilian-military collaboration may have significant challenges or negative implications; in others it may not be possible at all.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Countries should regularly map capacities and capabilities of both civilian and military sectors to understand how collaboration can occur before, during and after health emergencies
- Military contributions extend beyond medical services to include engineering, logistics, communications, transport, supply chains, stockpiling, mapping, veterinary services and command/control systems
- Consistent communication between sectors is essential to build trust; formalize pathways through standard operating procedures, focal points, cross-sectoral frameworks or joint preparedness plans
- Develop appropriate legislation, legal frameworks or memoranda of understanding to formalize collaboration, clearly outlining mandates, roles, responsibilities and liability
- Commit dedicated funding to civilian-military collaboration in preparedness efforts; establish ring-fenced budgets, commitment to stockpiling and procurement contracts for immediate drawdown
- Conduct joint training and exercises annually, including multi-agency participation from Ministry of Health, relevant civilian departments and military, at national and regional levels
- Embed military personnel in civilian health systems and provide opportunities for civilian medical personnel to participate in military reserve activities to improve understanding and communication
- Address public perception of military involvement, which varies by national context; advocacy initiatives can help educate the public on benefits while respecting historical and political sensitivities
Functional areas of military for civilian-military collaboration
Table extracted from the guideline
| Functional area | Examples | Example of use in preparedness planning |
|---|---|---|
| Static military medical services | Static hospitals and laboratories, medical centres | May be included in plans for expanding medical capacity in emergency when surge is needed; part of national surveillance system |
| Mobile military medical services | Field hospitals, medical battalions, field hygiene and mental health teams | Provision of step-down facilities alongside civilian hospitals; temporary vaccination centres; mobile training of additional health ancillary personnel |
| Specialist military medical teams | Mobile laboratories, mobile public health teams | Use at points of entry for screening |
| Military ambulance fleet, helicopters and fixed-wing assets | Surge transportation between hospitals and other health-care facilities; used to repatriate stranded nationals during an emergency | Incorporate into plans for collection of sick or redistribution of patients |
| Engineering capabilities | Earth moving, construction, provision of potable water, piping for water/sewerage, electricity generation and distribution | Plans for new or temporary health facilities; backup power generation reserve; rescue teams in natural disasters |
| Stockpiling/warehousing | Personal protective equipment (PPE), storage of medical equipment and pharmaceuticals | May be of value for response to chemical, nuclear and radiation emergencies, as well as for the beginning stages of outbreaks before production can be ramped up |
| Command, control, communications and information | Military system for managing the entire system, both static and mobile | May provide an integrated communication system not otherwise available, but issues of compatibility and security will need addressing as part of preparedness |
Source: World Health Organization, Compendium of practice to inform regional and national civilian-military collaboration for health emergency preparedness. Reproduced in summary form.
From the guideline
Verbatim
“Civilian–military collaboration must be built on trust and mutual understanding. Civilian–military collaboration must also continue to evolve as new needs and threats are identified.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked closely with WHO on health security in the South Caucasus, I recognize that this guidance addresses a critical gap in our region's preparedness architecture. Georgia and neighbouring countries have capable military medical services and disaster response units that remain underutilized in routine health emergency preparedness, largely due to historical sensitivities and lack of formal frameworks. The recommendation I would emphasize to Georgian colleagues is the systematic mapping of military capabilities beyond just field hospitals—our armed forces possess logistics, communications, engineering and laboratory capacities that could significantly strengthen surveillance at points of entry and rapid response in remote mountain regions where civilian infrastructure is sparse. The realistic implementation caveat is that formal legislative frameworks require sustained cross-ministerial political commitment and must carefully navigate public perception; in our context this means starting with technical-level relationship building through joint exercises on politically neutral scenarios like earthquake response or cross-border zoonotic disease surveillance before expanding to broader health security collaboration.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, this guidance is highly relevant given the geopolitical context, experience with natural disasters (earthquakes, floods), and ongoing health security challenges. Countries in the region should consider their unique historical relationships between civilian populations and military forces when designing collaboration frameworks. National programmes would need to assess existing legislation (emergency preparedness laws may focus on natural disasters and require adaptation for infectious disease threats), map current military health capacities (including military hospitals that may serve civilian populations), establish formal communication channels between Ministries of Health and Defence, and determine appropriate levels of public engagement to build trust. Regional collaboration opportunities exist through existing mechanisms in the South Caucasus and with neighbouring Black Sea and Caspian states for cross-border health emergency preparedness, surveillance and response.
Questions this guideline answers
Quick answers
What does 'military' mean in the context of this guidance?
Official national military actors or civil defence units (national guard, emergency management agencies, gendarmeries) involved in crisis preparedness and response, including both health and logistics personnel. This extends beyond military health services to include national armed forces, defence forces and national guards. It does not include non-state military groups, paramilitary organizations, emergency responders, civilian law enforcement or foreign military groups.
What if public perception of the military is negative in my country?
Public opinion of the military is a key challenge. In countries with suspicion or fear of the military due to past negative experiences, military collaboration may not always be appropriate or beneficial, particularly when interacting with communities negatively impacted in the past. The timing and visibility of military support matters—it can be perceived as political action or repressive, or positively as whole-of-government effort. Countries with regular civilian-military engagement (e.g., military hospitals serving the public) tend to have better understanding and acceptance. Advocacy initiatives, consistent public engagement, and transparent communication can help build trust where appropriate.
How can we address the challenge of staff turnover affecting civilian-military relationships?
While collaboration relies partly on personalities of leadership, sustainability requires systemizing the structure rather than depending on individuals. Formalize communication pathways through standard operating procedures, identify focal points based on position rather than personality, create cross-sectoral frameworks, and develop joint preparedness plans with clearly identified communication channels. Implement succession planning for critical departments, conduct regular joint training and exercises to build institutional knowledge, and embed personnel across sectors (military in civilian systems, civilians in military reserve roles) to maintain continuity.
What legal issues need to be addressed for civilian-military collaboration?
Key legal considerations include: establishing clear mandates, jurisdiction and mission spaces for each sector; developing relevant, up-to-date legislation fit for health emergency preparedness (not just natural disaster response); ensuring organizations are aware of existing legislation; clarifying liability questions (who is responsible if military personnel are negligent while supporting civilian health services, or if civilian professionals work with non-standard military health personnel); addressing professional liability issues; and creating formal frameworks (legislation, MoU, cooperative agreements) that outline roles, capabilities, limitations, chains of command and definitions of terms. High-level political endorsement is essential for sustainability.
Related on GMJ
Interconnected resources
Dictionary of Public Health
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- WHO Assembly Approves $6.83 Billion Budget to Combat Health Emergencies and AMRMay 2026
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- Issuer
- World Health Organization
- Type
- Guidance (normative)
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2026-01-26
- Languages
- English
- Scope
- Global; applicable to all Member States for domestic civilian-military collaboration
- Audience
- Public health stakeholders, military service personnel, governmental authorities engaged in emergency preparedness, WHO regional and country offices, UN agencies, regional organizations
- Pages
- 44
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-011862-1
- Evidence
- Expert consensus based on Member State consultation (surveys, interviews, focus groups) across 51 countries, six WHO regions, 2018-2020; validated at June 2023 global technical consultation
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
World Health Organization. Compendium of practice to inform regional and national civilian-military collaboration for health emergency preparedness: guidance document. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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