Civil-military cooperation is crucial for crisis management. It creates the conditions for a state to coordinate its capabilities to effectively respond to disasters, support the civilian society, and deter an adversary from attempting to create civil or military disorder. It also serves as planning and preparation in the event that the state goes to war.
Conflicts bring complex societal challenges, often extending far beyond the battlefield. Even if they occur in the vicinity, in neighbouring countries, they will undermine stability, for example through refugee flows. This affects the economy, infrastructure, and creates social disruptions. Through joint efforts across multiple societal sectors and countries, it is possible to prepare for these challenges. This builds trust and resilience and prevents the spread of the opposite.
Joining NATO is often described as a “whole-of-society approach”; in other words, it is Sweden that has joined NATO, not just the Swedish Armed Forces. This is particularly relevant when handling large flows of allied patients, for example from Finland and the Baltics, expected to transit through Sweden and further west into Europe. It involves both sectoral and regional authorities as well as business sectors.
As part of this work, Sweden has played an active role in NATO's Casualty Move (CAMO) 2024, a scenario-driven staff exercise, conducted at the Command Regiment's leadership training facility in Enköping (central Sweden) from 9th to 13th September 2024. Although the Swedish Armed Forces hosted the exercise, it was planned and conducted by the Multinational Medical Coordination Centre – Europe (MMCC – E). The exercise gathered 100 participants and an exercise leadership with an additional 50 people.
Participants from 16 nations formed national civil-military cells to tackle the challenges presented as “playing cards.” The solutions often lay in inventorying available processes and capabilities, either military or civilian, or approaching neighbouring countries. Supranational EU and intergovernmental NATO served over time as a backdrop to create civil-military interoperability.
CAMO is not an isolated event but an exercise series that started in 2020 in Germany. Since then, Hungary, Estonia, and Sweden have hosted, and next year the exercise will be held again in Germany. In April 2024, NATO signed the “Patient Flow Management Guideline” which describes what they want to achieve. The exercise series aims to create knowledge, experience, and awareness of how to move forward together with member countries, the EU, and other organisations.
In the Swedish national cell during CAMO24, representatives from the Swedish Armed Forces (General Medical Department, Operations Command, and National Home Guard Staff) participated. Additionally, civilian representatives from the Swedish Civil Contingencies Agency (MSB), the National Board of Health and Welfare (SoS), and the Centre for Disaster Medicine were involved. There is experience here of evacuating Ukrainian patients for care within the EU, including through the Nordic Svalbard Group.
As Sweden hosted the CAMO24 exercise, an opportunity arose to further utilise the occasion. Under the leadership of MSB together with SoS and the Swedish Armed Forces, a parallel exercise was planned at the same location, the National Seminar Exercise (NSÖ). The exercise gathered 60 Swedish participants from sectoral authorities, regions, county administrative boards with civil areas, and military regions. This was possible due to the good contacts established between the authorities and several individual initiatives.
NSÖ served as support to the Swedish cell in CAMO24 but also had the task of identifying development areas for managing national and international patient flows. During the preparations, France also considered this a good idea and similarly gathered additional participants via link from Paris.
The exercise provided insights into necessary future defence planning focusing on legal aspects and access. Additionally, an inventory of necessary capabilities for the future was conducted. Command principles, the need for infrastructural redundancy, protection, and displacement effects were also highlighted.
In an initial evaluation of the exercise, it was noted, among other things, that more and cross-border knowledge is needed about individual countries' civil-military cooperation and national systems. This also applies to how NATO and the EU function in their respective organisations. The exercise was also found to serve as an effective forum for networking, learning, and planning both within and between countries. It fosters trust and confidence for future collaborations.