One of the most powerful war movies I've ever seen is Mel Gibson's 2016 film "Hacksaw Ridge." It's the true story of Army medic Desmond Doss who saved 75 men during a single battle on Okinawa in World War II without ever using or firing a weapon himself. Doss refused to carry a weapon because of his religious convictions, yet he still volunteered to go to war because he felt it was his moral duty. He trained as an Army medic, believing that the war itself was just, but that killing was wrong.

Ukraine is now fighting a similarly just war, one that has brought unimaginable suffering and in which, alongside the soldiers, tens of thousands of military medics fulfill their moral duty every day. Dr. Tiit Meren, have you seen "Hacksaw Ridge"?

Thinking back carefully, yes, I did see it quite a long time ago.

Is this kind of moral dilemma, where war itself can be justified, but carrying a weapon cannot, something that comes up often in human society? Are the people who wrestle with this question the ones who ultimately end up serving as military medics in wartime?

The simplest example is Afghanistan. When the situation became dangerous there, I had a pistol on my belt. The question is, if a doctor is working in a military hospital, under what circumstances can or should they use a weapon?

That's a very good question. Obviously not on a patient.

No, but it's not only the good guys who get injured. If one of the bad guys is captured and brought to the hospital, it's the medics' duty to save his life. After that, he's turned over to the appropriate authorities for questioning. But all kinds of incidents can happen in that setting, so it's difficult to answer the question of when a doctor should use a weapon if the bad guy gets loose.

The man I mentioned at the beginning, Desmond Doss, had religious convictions that prevented him from using a weapon. Even so, he became a medic to save lives. He simply didn't fight the enemy — his mission was to get his fellow soldiers out alive whenever possible. The Japanese were a secondary concern for him. How often does it actually happen in war that you have to treat the enemy as well?

When ordinary people watch movies or listen to interviews, they sometimes hear the phrase, "No prisoners were taken." Diplomatically speaking, that means the enemy's wounded were left where they fell. As I mentioned earlier, in Afghanistan, every wounded bad guy was picked up and brought to the hospital. These days, intelligence services want to get information from enemy fighters, so they're brought in. As medics, we do our job to the best of our ability, whether the patient is one of ours or one of theirs.

When were you in Afghanistan?

Twice, in 2007 and 2008.

At Camp Bastion?

Yes, at the British military hospital. As it happened, I was the first Estonian sent there to see whether Estonians could handle working in that kind of environment — surrounded by war and combat, while also meeting the British military's exacting standards and meticulous attention to detail.

Did you?

When my deployment ended, I made potato salad for the team on my last evening there. The British looked a bit puzzled at first, but in the end they said they were convinced the next Estonian could come.

Is the fact that you got along so well with the British — and that the entire Estonian mission did, not just the medics but the combat troops as well — the reason you're a member of a British military medics' association?

Yes. Trust and the bond between comrades-in-arms are earned in difficult situations. One of the British sayings was that one day you're a member of the team and the next you might be put in command of the unit. They also used to joke, "Damn Estonian — his gallows humor is sometimes even stronger than ours."

There were several reasons the British may have come to appreciate us, but in the end, both Estonian medics and Estonian soldiers earned a great deal of respect from the British and the Americans because they knew they could rely on them. When a combat unit was given an order, troops from some other countries would sometimes ask, "Wait, are we allowed to do this? Can we open fire?" Estonian troops, by contrast, were given maximum discretion. When they received an order, they carried out the mission, returned to their position and then people would say, "Look at the Estonians — no questions, no complaining. Mission accomplished."

In addition to being a member of a British military medics' association, you also represent Estonia in NATO's organization for military physicians. What is that organization and what are your responsibilities?

I joined it 20 years ago. Until 2022, whenever we tried to explain through the media how civilian hospitals could prepare for and respond to a crisis, people looked at us as if we were being alarmist. Today, however, it's widely accepted that different countries have different levels of preparedness for crises.

This NATO medical organization for reserve officers coordinates, briefs and trains civilian and military medical personnel from different countries so that they know how to respond effectively if a crisis breaks out.

The crisis is relatively close to us. Ukraine has now been fighting a full-scale war for four years and five months. It's often said that militaries prepare for the next war based on the lessons of the last one and that no one can truly prepare for the war of the future. That brings me to my question: How much has military medicine changed over the past four and a half years while Ukrainians have been fighting for their freedom?

Thinking of lessons military medics have drawn from the First and Second World Wars, the war in Afghanistan, the Gulf War or any other armed conflict, today — because Estonia is such a close ally of Ukraine — it appears that Ukrainian intelligence shares a considerable amount of military information with Estonia. Based on that, military medics are able to adjust their tactics every few weeks. From a learning perspective, the war in Ukraine has been enormously significant for us.

What I meant was how the nature of warfare has changed and with it the types of injuries, their treatment and everything that follows. World War I saw the widespread use of poison gas. World War II featured massive tank battles and bomb blasts caused countless gunshot and shrapnel wounds. The Vietnam War, among other things, saw the use of napalm. How do changes in the way wars are fought affect the kinds of injuries people sustain, the way they're treated and their evacuation?

In Ukraine, gunshot wounds are relatively uncommon. The injuries we see there are primarily caused by explosions and burns. Some explosions generate such extreme temperatures that the question becomes whether there even is a charred human body left to recover.

The injuries really are very different. When the international media shows a civilian building being hit — with windows shattering and glass flying everywhere — we refer to those as penetrating fragment injuries.

We tell people here, too, to stay between two walls and away from windows. Imagine an explosion sending shards of glass into someone's body — millions of tiny fragments embedded throughout. Saving a patient like that is extremely difficult. So the changes have been enormous.

One of the changes people talk about most is that modern warfare has become drone warfare. There is a constant buzzing overhead and that buzzing may be coming from a drone carrying an explosive that can be dropped on you. The traditional front line, where one side occupies one trench and the other side another trench 50 to 100 meters away, no longer exists. The distances have become much greater and the kill zone now extends 15 to 20 kilometers. How do medics operate in those conditions?

It is extremely difficult, extremely dangerous and comes with an extremely high casualty rate. When the conflict in Afghanistan came to an end, the medical community relied on the concept of the "golden hour." The idea was that if you could reach a casualty within the first hour, stop the bleeding and restore vital functions, the person would survive.

Today, with drones constantly buzzing overhead, calculations show that it can take nine to 10 hours before a medic reaches a wounded soldier. By that point, most casualties are likely to have died. Instead, medics have to adopt tactics more akin to those used by special operations forces — how to treat wounded personnel who have been left without assistance on the battlefield, or elsewhere, for eight to 10 hours. It is an entirely different approach. At the same time, it creates enormous opportunities for innovation in medical technology.

Combat troops could be equipped with electronic devices that continuously transmit information if they are wounded, allowing medics to know whether they are still alive and what injuries they have sustained. There is tremendous room for innovation.

So the "golden hour" is no longer a realistic concept today?

Unfortunately not.

We're really talking about a "golden day" instead. As I understand it, the priority is no longer getting the wounded person to a doctor as quickly as possible, but somehow stopping the bleeding and closing the wounds. That changes the role of paramedics operating on the front lines rather than in field hospitals.

It seemed like a tremendous revolution in Afghanistan when a helicopter could fly for half an hour, cover a considerable distance and, in many cases, begin giving a casualty a blood transfusion in the air before reaching the hospital. Today, when it takes eight, nine or 10 hours to reach the wounded, the blood has already been lost and there is little that can be done. The nature of both the injuries and the medical response has become much more improvised.

In the film we discussed at the beginning, when the hero Desmond Doss stopped a wounded soldier's bleeding and lowered him down the cliff with ropes, that was still possible. Today, those operating directly on the battlefield often cannot even reach the wounded. That means a soldier's own ability to deal with serious injuries has become much more important.

In the Estonian Defense Forces, there is the concept of battle buddies: each member of a pair looks out for the other. If one is wounded, the other immediately provides assistance.

It is also worth mentioning the Geneva Conventions. During World War I and World War II, medical personnel and equipment were generally respected. If there was a vehicle marked with a Red Cross, a medic's bag or a Red Cross armband, they typically were not fired upon. The same was true when a white flag was raised.

Today, the situation is the opposite. Even in Afghanistan, when a large Chinook helicopter flew with a Red Cross emblem on its underside, insurgents would try to shoot it down with a Stinger missile. From their perspective, taking out the helicopter meant eliminating an evacuation capability and killing multiple medics at once. These are entirely new circumstances in which the enemy employs tactics that are prohibited under the laws of war.

Medics can no longer reach wounded soldiers, but ground drones are now being used for evacuation and are operated remotely. That raises an obvious question: How is a wounded soldier who cannot move supposed to get onto the drone?

What I'm about to say may sound incomprehensible, inhumane or worse to the average civilian, but the reality is that if a ground drone is sent onto the battlefield and reaches a casualty who is so badly injured that they cannot climb onto its platform, then, unfortunately, that person remains there. No medic can go out to retrieve them.

That has become the dividing line between who survives and who does not. If, by summoning every last bit of strength, you can pull or roll yourself onto the drone's platform, you can be evacuated and survive. If you cannot, you are lost.

Given the nature of these injuries, I have a moral question. From the perspective of people who have lost their arms, legs and eyesight, is saving them always the right thing to do? It's a difficult question, but I imagine medics have to confront it regularly.

I wouldn't say it was an everyday occurrence in Afghanistan, but it happened quite often that our job was to breathe life back into bodies that had been torn apart by explosions. Thanks to modern technology, techniques and medical advances, we were often able to do that successfully. Quite frequently, at a satellite conference the following week, we'd hear: "The severely injured patient you kept alive and sent to Birmingham is actually doing quite well."

But when I spent time in England, I saw young people who weren't married but had girlfriends and perhaps a child. In those cases, it was important to keep these gravely wounded people alive long enough that they could be married in their hospital bed, allowing their spouse to qualify for social benefits. The young casualty might still die, but the family would receive those protections and the child would, at least legally, have a father.

These are difficult questions, but in war, decisions often have to be made very pragmatically.

How can war ever be justified or be considered just when killing and injuring people is inherently wrong?

As a physician, I found it interesting to observe how American and British military psychologists briefed their units on the subject of killing the enemy. They would tell soldiers that if they were assigned to capture a position and eliminate the enemy there, they should carry out the task without emotion. That is the best outcome both for the "victim" and for the person carrying out the mission.

When Saddam Hussein was executed, a group of Shiites was present at the execution and there was a great deal of celebration. The view expressed afterward was that this is not how an enemy, or even the leader of your adversary, should be killed. It may sound strange, but even killing can be done humanely.

That sounds rather inhumane. Even for those who are forced to kill another person in war, it cannot happen without leaving lasting scars. That's where post-traumatic stress and other psychological consequences come from. People say that, in addition to physical injuries, war inevitably causes mental and emotional wounds.

There was also a small Estonian camp at Camp Bastion. When I returned there in the evenings, as a medic, as we've discussed, I wasn't fighting on the battlefield — I was trying to treat and save the wounded, whether they were our own soldiers or the enemy. But the Estonian troops looked at me differently when the conversation turned, anonymously, to the circumstances in which particular casualties had been brought in. They would say that if someone was aiming at them from 20 or 200 meters away and they managed to pull the trigger first, they were the ones who would survive.

Medics and combat soldiers truly view the act of killing from very different perspectives. They represent different ways of confronting the reality of taking another person's life in order to ensure one's own survival.

Over the four years and five months of the war, Russia is estimated to have suffered around 1.4 million casualties. Of those, roughly half a million have been killed and another half a million seriously wounded. Ukraine's losses are estimated to be more than twice as low, although it is also a much smaller country. From the news reports and analyses I've read, I've gotten the impression that mortality among Russia's wounded troops is significantly higher. Why is that? Is it simply because their battlefield medicine is worse or because they don't care about their own people? What's the biggest difference?

It comes down to Russia's imperial ambitions. If the publicly available information reported in the international media is accurate, the Russian side places little value on the individual. What matters to them is completing the mission and achieving a political objective, regardless of the cost.

If we think back to the Winter War, enormous numbers of Soviet soldiers were killed then as well. The Finns simply shook their heads and said, "We would never send our own men into battle as cannon fodder like that." That still seems to be the Russian approach.

I once found myself in an interesting situation when I invited my superior — a well-known British military surgeon — to speak at the Pirogov Conference in Tartu. At the same event, there was also a young surgeon from the St. Petersburg Military Medical Academy who struck me as highly competent.

I have no doubt that the Russian military medical service itself is professionally capable. But if it's operating under a fundamentally different philosophy, then naturally the losses will be enormous. Given that broader approach, there's probably only so much military medics can do to change the outcome.

Russia is a large country with a much bigger population than Ukraine. But even so, having more than half a million people who have been seriously wounded, who have lost limbs or suffered traumatic brain injuries is still an enormous burden for society.

I think a useful comparison is China's one-child policy. The goal was for each family to have just one child, preferably a son. Today, however, China is dealing with the consequences, as many men are unable to find wives.

The situation on the Russian side is similar. If the conflict eventually ends, how will Russia make up for such an enormous shortage of young men in its society?

Those are challenges for which it's very difficult to see a good or effective solution.

The situation isn't any easier for the Ukrainians. Yes, they've had fewer soldiers seriously wounded, but it's still a tremendous challenge.

But it seems their approach is more humane in the sense that they care about their people and try to save them. Of course, that may not be entirely accurate. But when you look at reports of the so-called mobile crematoriums on the Russian side, where the dead are allegedly cremated so their families won't have to be paid compensation, it does reflect a certain underlying approach.

Another question is what happens to these people afterward, how society deals with them. Are they simply hidden away? The reality is that many people find it psychologically difficult and uncomfortable to see someone living with a severe disability. I remember from my youth — many years ago — when I was serving in the Soviet Army and ended up at a military hospital near St. Petersburg, then Leningrad, during the war in Afghanistan. There were several young men who had been brought back from Afghanistan with amputated limbs and no one wanted to interact with them. They themselves didn't want to interact with anyone either. They were young men who had suffered tremendous trauma, of course, but they somehow ended up being pushed aside. Is that even an option today? Maybe it is in Russian society. But how does a society cope with all of these people?

First, let me say a few words about what I saw in the United Kingdom. There, those living bodies without arms or legs were not alone — at every bedside there was either a wife or a fiancée. It became clear how much effort was being invested in rehabilitation, both psychological and physical. That said, no country — not the United States, not the United Kingdom — has been able to keep paying those treatment and rehabilitation costs indefinitely for many years. That's why, sooner or later, veterans in every country say they've been forgotten.

Even so, I believe Western societies show far greater humanity and compassion than Russia does.

Including here in Estonia?

I believe so. Of course, every injury and every trauma is different. Some people recover more easily than others, while those who struggle more may criticize the rehabilitation system in interviews and conversations, saying it's inadequate. And in many ways, it is inadequate, because it's extraordinarily difficult to help people fully recover from what they experience on the battlefield.

But again, based on my conversations with military medics from different NATO countries and the presentations I've heard, I believe the approach in Western societies is generally quite humane — as much as available resources permit.

When we talk about physical injuries, that's one thing. They're visible, they can be treated and people know how to show compassion. But the psychological side — people suffering from post-traumatic stress — is another matter. Estonian society has seen the consequences as well: veterans engaging in self-destructive behavior, whether alcoholism, suicide or, in the most tragic cases, murder-suicides. To me, helping society understand these people remains the greatest challenge. We can't simply say it's their own problem and stand by in silence. What should society as a whole be doing to prevent these kinds of extreme outcomes?

I would divide those who have served on deployments and experienced combat into two groups. There are some soldiers whose temperament is simply suited to that environment. Among Estonians, for example, it wasn't unusual for someone to be serving on a fifth, sixth or even seventh deployment. This may sound like good-natured humor, but there were wives who would go to their husbands' former commanders and say, "Please send my husband back to the front in Afghanistan because he becomes very restless in peacetime." Those are the people who manage to cope.

I've been asked myself what it was like to witness everything I saw in Afghanistan and whether I experienced post-traumatic stress. Well, it certainly wasn't like spending an evening at the Estonia Theater watching a ballet and waking up the next morning thinking about the wonderful music and beautiful choreography.

People understand why these things happen. I also remember that, because Estonia is such a small country, Estonian soldiers were often asked why they were serving in Afghanistan. An English-speaking journalist would ask, "Why are you here?" and an Estonian soldier would often reply, "I'm defending Estonia's independence here." The journalists would pause and say, "I see."

So our motivation for being there was somewhat different from that of an American, a Briton or a Dane.

The soldiers may understand that, but does our society?

As a surgeon and physician who works in this field, I often deal with veterans' injuries, rehabilitation and follow-up care. Even so, I believe you can see in veterans' eyes that they know people care about them.

Take a walk around Magdaleena Hospital and you'll see wounded Ukrainians walking proudly on one or even two prosthetic legs. You can spot them from a distance — the metal components are visible. It seems to me that those men, too, are grateful that society accepts them.

And if I happen to find myself in an elevator with one of them, I always say, "Stay strong, brother-in-arms. I've served in Afghanistan." That means a great deal to them.

Is that also a message for ordinary Estonians — that if they see a soldier, for example someone with a prosthetic limb, they should show their respect and let them know, "We appreciate what you've done for us"?

Absolutely. In fact, journalists have also relayed stories from Russia. If people see that someone has been wounded and realize they've returned from Ukraine, then — even though we strongly disagree with the cause they were fighting for — there is still a certain respect shown to the individual. People will say, "Honor to him." That seems to reflect a basic human instinct to acknowledge someone who has endured the hardships of war.

At the same time, social media is full of videos showing veterans returning from what Russia calls its "special military operation" demanding special treatment from members of the public — sometimes loudly and even with their fists.

If you don't demand respect, but instead show a measure of humility, you'll get much further than if you stomp your feet and insist on your rights.

It's been said that the war in Ukraine is likely to become Europe's largest rehabilitation effort for military veterans and patients with severe trauma since World War II, and that seems likely to be true. Its impact will probably last for decades after the war ends, however it ends. How long could that process take and how might it change the foundations of society, if at all?

As my British colleagues like to say, "Always look on the bright side of life." The sheer number of wounded people in Europe will probably drive an enormous wave of innovation in medical technology. There will be efforts to develop new prosthetics and assistive devices, improve treatment and rehabilitation methods and advance psychological support. So there is a positive side to it.

It also seems to me, based on the Ukrainians receiving treatment here in Estonia, that family support means an enormous amount. You see wives whose husbands have lost one or both legs and now use wheelchairs, yet the devotion is unmistakable. Their attitude is, "He's back. He's alive. He's here."

This may not sound particularly elegant, but it's a very human reality. In Afghanistan, when a helicopter brought in a soldier who had stepped on a landmine and lost both legs, the first question from a British or American soldier was often, "What about my balls?" In other words: Is everything down there still intact? Will I still be able to have children? The will to live and the motivation to carry on remain, no matter how severe the injuries and the support of family and society makes a real difference.

I could just as easily complain and say, "There are so many wounded people. Everything is terrible and difficult." But stockbrokers on Wall Street are unhappy all the time because they think they don't have enough money in their accounts, while to the average person it seems like more money than could fit in a truck. Happiness is always relative.

It's something of a paradoxical argument — that a large number of people wounded or killed in war could somehow have a positive effect on society.

Yes, but creating the illusion that eternal peace can last forever and that people should never do harm to one another is itself a false reality. When I talk with good friends of mine — Estonian writers with backgrounds in history — they all say the same thing in private: history is a progression from one war to the next. And as unpleasant as that sounds, every war has both negative and positive consequences.

The main point I'd make is that war has a way of restoring people's common sense very quickly. Ten or fifteen years ago, when I attended NATO meetings with officers from different countries, many of them said that prolonged prosperity dulls ordinary people's judgment and outlook. They would say that if Europe experienced even a week of war, people would realize there was no time left for complaining. Instead, they would have to focus on protecting themselves, their families, their villages, their cities or their hospitals. Once that realization sets in, common sense returns and people start acting accordingly.

It's simply not realistic to keep singing hosannas to the idea of everlasting peace — that mindset leaves people unprepared to defend themselves. That's why, when people ask why we talk so much about war and crisis today, the answer is that it isn't about creating war hysteria. It's about creating preparedness. If something does go wrong, people shouldn't panic. They should know the first, second and third steps: how to look after themselves and their families, where to go and what they need to do.

If people quietly prepare for a possible crisis — even one that may never come to Estonia — they remain constructive and focused. They don't spiral into fearful speculation about what might happen if things go wrong. Instead, they know to take the first step, then the second and then the third.

I imagine your last point would drive a committed pacifist or humanist completely up the wall. But there is, perhaps, a parallel with a forest fire: when an old forest burns down after a lightning strike, a new, young forest grows in its place, and in that sense the ecosystem is renewed. The difference, of course, is that war involves people and every human life has value.

But that raises a moral question: war versus peace, killing versus healing. For most people, navigating those opposing ideas must be extremely difficult. Do physicians, especially military doctors, see things differently, perhaps more pragmatically?

Certainly, because we've accepted that, whether we like it or not, human history moves from one catastrophe to the next. And when catastrophe strikes, you do what the British taught us: if everything initially seems chaotic and nothing appears to be working, you begin restoring order one step at a time. Military medics understand that.

I like telling the story of one occasion when the British invited me to Norway for a major NATO conference attended by the surgeons general of the alliance's armed forces. The British told me, "Tiit, stay quiet at first. But when we give you the signal, tell them what you're doing in Estonia's civilian hospitals to prepare for a possible crisis."

When the time came, I spoke as plainly as a country doctor, explaining what we were trying to do with Estonia's civilian hospitals — how they should organize themselves and operate if war were ever to break out. It was fascinating to watch all those NATO surgeons general looking at me as though I were telling a fairy tale: "Young man, go on, keep talking!"

But as I explained more about what we're trying to do in Estonia, they began asking, "Do you really prepare civilian doctors like this during peacetime?" There were British military physicians in the room as well, and they said, "Apparently you haven't worked with Estonians before. The closer a country is to the Russian border, the more aware it is of risk and the possibility of conflict."

In France, Spain or Portugal, the prospect of a military crisis in Europe is naturally met with a shrug and the same is true among many medical professionals. They said there was little point in trying to teach civilian medical personnel in Western Europe how to prepare for war and what to do if it came.

To my mind, Finland is the outstanding exception. The Finns have stayed quiet while preparing all along. They've built hundreds of kilometers of tunnels carved into bedrock where they could shelter millions of people as well as establish military hospitals and storage facilities. They never boasted about it or sought attention for it. When Finland joined NATO, some people assumed it wasn't prepared. In reality, it had prepared for everything. There is a great deal we can learn from the Finns.

Try to explain in simple terms for the average listener: What practical benefits does civilian medicine gain today from military medicine?

Again, I can say the benefits are enormous, even though many people dismiss it as nonsense or accuse me of promoting war.

When Estonian doctors and nurses began returning home from Afghanistan and went back to work in civilian hospitals, many of their colleagues reacted with surprise and even resistance. They would say, "We have academic standards and clinical guidelines that tell us how to treat patients." But we approached things more pragmatically and with a greater sense of urgency. In a critical situation, you might not even stop to put on a sterile surgical gown — you put your finger on the bleeding vessel first. We would tell them: when you see someone hemorrhaging in a combat zone, you stop the bleeding immediately, because that's what keeps the person alive.

Military medicine has introduced a great deal of innovation while also simplifying many of the traditional academic treatment protocols. Civilian patients benefit as well, because the care they receive becomes faster, more effective and ultimately better.

How do representatives of academic medicine respond to you and to what you're saying?

Let me be frank: I know that after I leave this studio, there will certainly be some people who would like to shoot holes in my arguments. But with all due respect to the academic community, yes, the methods, approaches and practices of military medicine can seem overly bold or even unacceptable at first glance. Even so, they save far more lives.

A typical example I often mention is the case of Swedish Foreign Minister Anna Lindh. After she was stabbed in central Stockholm, the Swedish media reported that surgeons had been operating for four hours in an effort to save her life. Then another update came six or seven hours later saying the operation was still ongoing. British military trauma surgeons reacted by saying, "The initial surgery should last only about an hour. Did something go wrong for the first operation to take that long?"

These are the kinds of things that initially seem counterintuitive to people from a traditional academic background. In military medicine, you first bring the most life-threatening injury under control, then send the patient to intensive care even if there are still open wounds. Once the patient has been stabilized, they're taken back to the operating room for the next stage of reconstruction. By carrying out surgery in stages, the patient is much more likely to survive the entire process. That's a major innovation — one that wasn't reflected in traditional academic treatment guidelines.

Does that mean every physician trained in academic medicine should, in one way or another, take part in military medicine exercises or training?

Fortunately, Estonian medicine has advanced to the point where, if you speak with a young resident or a newly qualified physician and ask, "Suppose a patient with this kind of injury comes into the emergency department while you're on call — what would you do?" they all know the answer. They'll explain exactly how they would handle it. Then they'll ask, "So what's different about military medicine?"

And I tell them, "My dear colleagues, you're already using NATO standards." So perhaps I was a little unfair to the academic community, because these young doctors have, after all, been trained by that very community.

In emergency departments across Estonia, damage control surgery is already common practice. Instead of trying to complete every aspect of the repair in a single operation, surgeons first control the most serious injuries, send the patient to intensive care for stabilization, then bring the patient back for the next stage of surgery, followed by intensive care again. That's already an established approach in Estonia.

I think back to that NATO meeting in Norway where representatives from other countries said they had no way of retraining their civilian hospitals along those lines. It seems that, in Estonia, we're actually succeeding in doing so.

You've said that Estonia's healthcare system is too heavily centered around large hospitals and that in a crisis, especially during a war, that poses a serious risk. All it would take is a single cruise missile or ballistic missile and one of those major medical centers could be gone. What would make Estonia's healthcare system more resilient?

Let me answer the first part of that question this way. I often listen to people from different sectors in Estonia talk about their long-term development plans and I sometimes get the impression they're assuming we have 50 years of perfect peace ahead of us.

But the world around us is so unstable and prone to conflict that Estonia has to take that into account as well. We all hope that war never reaches our territory, but we still have to prepare for the possibility. And if we've prepared properly, dealing with a crisis becomes much easier.

The usual counterargument is that it's much easier to organize healthcare efficiently in one large hospital. That was also one of the main reasons behind the proposed new Tallinn Hospital, although that project has now been put on hold.

Thank goodness! To be honest, we fought that idea with everything we had, because one of the fundamental principles of military planning is dispersion. If your resources, including hospitals, are spread out, they're much harder to destroy. But if you have just two major hospitals, Tartu University Hospital and the North Estonia Medical Center, then all it takes is the push of a button. An Iskander missile launched from the Pskov region can reach its target in less than half an hour and either Tartu's medical campus or the North Estonia Medical Center could be gone. Then what?

Everyone who argued that Tallinn Hospital was necessary had a point — if we could count on an exceptionally long period of uninterrupted peace. In that case, perhaps the discussion would make sense. But a building made largely of glass and steel...

Earlier in the interview, I talked about the kinds of injuries explosions cause. Just imagine an explosion in a structure like that — the sheer number of injuries from flying glass would be enormous. So thank goodness that hospital isn't being built.

People may later say we prepared for war unnecessarily. Perhaps in five or ten years we'll be able to say that no conflict ever reached Estonia. But at least we prepared and that's a far more responsible approach than making 10- or 20-year development plans as though nothing could possibly happen. Failing to prepare would be irresponsible.

Does that mean Estonia should really be investing more in hospitals like those in Haapsalu, Viljandi, Paide, Kuressaare or Kärdla instead?

As ministers like to say these days, I'd rather not be too specific, so as not to reveal our thinking to a potential adversary. But yes, the basic principle is that we need to spread out the risk. Ukrainian intelligence has been telling us the same thing all along: "Disperse, disperse. Don't concentrate everything in one place, because that makes it very easy to destroy."

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