Vigorous Warrior is one of NATO's biggest medical exercises and takes place across Estonia from June 8–20, bringing together approximately 2,000 participants from 32 allied and partner nations, including Japan and the Balkan Medical Task Force.

The "active phase" began last week and training will focus on cooperation between civilian and military medical systems, implementing the lessons from Russia's war in Ukraine and new medical solutions, the Estonian Defense Forces (EDF) said.

Among the activities, medics will learn how to protect themselves and their facilities, civilian hospitals will run through crisis management scenarios in Rakvere and Lääne-Viru County, and Germans and Swedish medics will train together in Tallinn's Muuga Harbor.

Estonia last hosted a similar exercise in 2002, while it was still a NATO partner nation, two years before it became a full-fledged alliance member. This year, the focus is on training to react to large-scale combat operations with mass casualties.

Olveti told ERR News the biggest benefits of hosting the event in 2026 are that allies gain first-hand knowledge of the eastern flank and how to defend Estonia – a frontline country – from a potential future attack.

"Train as you fight — that's the main principle for the infantry units and the very same for the medical units as well," he said.

The lieutenant colonel said it is important for both the EDF and Estonia to rehearse crisis cooperation with the civilian sector, international partners, as well as units "who might potentially come here during wartime."

"As a frontline country, for us, it's also really important to show the NATO allies — and also to our potential enemy as well — that we have a really well-functioning medical system," Olveti said.

Non-frontline allies also get to see the Russian border up close, understand the threat "coming from the other side" and better understand the situation on the eastern flank.

The surgeon general stressed the importance of training together before a crisis to achieve a good outcome, as there is little time in a crisis to get to know each other's procedures or equipment.

No more 'luxury'

And this year, there's a lot to learn.

Olveti, who served with NATO troops in Afghanistan, said the wars fought in the Middle East are completely different from what the alliance is preparing for at Vigorous Warrior.

For 20 years, the allies dealt with asymmetric warfare, low casualty rates and medics mostly living away from the frontlines.

But Russia's full-scale invasion of Ukraine, with its high number of dead and wounded, is on another scale. Medics are also closer to the combat zone.

Olveti said the exercise is a "really good opportunity" to show medics how their work on the battlefield has changed.

"We are facing really new challenges, high-intensity battles, high casualty flow and, of course, treating the casualties in order to make them return to duty faster," he said.

Asked what he wanted participants to take away from the exercise, he said: "First of all, it's a large-scale combat operation that we are preparing for. Don't expect the kind of luxury that we had in Afghanistan, in Iraq. There will be a high flow of casualties and you must be able to treat them."

'Medics are targets for the enemy'

A core part of exercise Vigorous Warrior is implementing lessons learned from Russia's full-scale invasion of Ukraine.

The surgeon general said a "key message" is that "medics are targets for the enemy" as Russia does not obey the Geneva Convention, which states that deliberately targeting medics, medical facilities and medical vehicles is strictly prohibited.

Now, medics must understand that they are under "constant threat" and commanders must find ways to protect them.

"Protection of medical units saves lives, not the Red Cross anymore, unfortunately," Olveti said. "Medical units must be able to cover themselves, to camouflage themselves well, to even use trenches."

"We use the drones to observe them to show that if you're not camouflaged properly, you will be really easily targeted," he added, outlining part of the training exercise.

Another lesson is mental resilience. "Currently, you must be able to survive on the battlefield and still must be able to provide medical support to your troops," Olveti said.

The surgeon general said he did not have a "magical solution" but believes medics must be included in every training exercise.

"Yes, I know it's quite uncomfortable to wear body armor and your helmet while performing procedures. Yes, you must be able to do it during the nighttime, in any weather," he said, adding that combat operations do not stop when capacity is reached.

Another issue is that battlefield injuries and treatments have changed.

Olveti said at the start of the war, it was quite common to see gunshot wounds, but now blast injuries, caused by direct or indirect exposure to an explosion, are the most common. He said these are the "most complex" and "challenging" types to treat because there will be multiple problems stemming from the blast wave and shrapnel fragments.

It has also become clear that all medics, whatever their level of experience, must be able to correctly carry out a tourniquet conversion, something that was previously only done by senior medical workers.

"Everybody must be able to do it properly, otherwise you have really unnecessary amputations," Olveti said.

Unmanned ground drones to evacuate casualties, which have been used in Ukraine, as well as drones for medical purposes, are being tested at the exercise.

Avoiding 'awkward' situations

Olveti, who also works in Põlva Hospital's ER department in south Estonia, said the general attitude of the civilian system has changed for the better over the past 10–15 years.

Back then, highlighting the Swedish experience, the surgeon general explained that the systems rarely cooperated and that in a crisis, military and civilian medics worked separately.

But attitudes started to change after Russia invaded Georgia in 2008 as it "clearly showed" that civilian hospitals must be prepared for crises, as military casualties will arrive quickly.

"And if you're not prepared for that, well, it might be a really awkward situation for you," he said.

In Estonia, tabletop medical exercises and workshops have been carried out with the EDF and hospitals and the Health Board now has an understanding of military planning processes.

He gave one example of cooperation: in the event of a potential future conflict, hospitals and the wounded may have to be relocated as Estonia lacks strategic depth.

"That we must get our casualties, civilian ones, military ones, to somewhere else in order to decompress the civilian medical system," Olveti said.

Message to Russia

This exercise is also a "good opportunity" to send a message to "our potential enemies". 

The surgeon general said Estonia's main military base in Tapa is around 100 kilometers from the Russian border and "it's really obvious that the Russians are observing what we're doing."

Among the 29 allied nations in attendance, both the Germans and Americans have sent sizeable medical teams to the exercise, Olveti said.

"We are preparing. We are ready. And also, despite all the rumors about the health of  NATO, we have 29 nations here, "he said, "So, NATO's health is not in bad condition."

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