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Baltics Left of Bang: The Role of NATO with Partners in Denial-Based Deterrence
By Robert M. Klein, Stefan Lundqvist, Ed Sumangil, and Ulrica Pettersson | Nov. 7, 2019


Baltics Left of Bang: The Role of NATO with Partners in Denial-Based Deterrence
Baltics Left of Bang: The Role of NATO with Partners in Denial-Based Deterrence
Baltics Left of Bang: The Role of NATO with Partners in Denial-Based Deterrence
Photo By: NDU Press
VIRIN: 191107-D-BD104-001

Key Points 

  • The North Atlantic Treaty Organization’s military contribution to deter Russian aggression in the Baltic region should begin with an overall strategic concept that seamlessly transitions from deterrence through countering Russia’s gray zone activities and onto conventional war, only if necessary.

  • NATO should augment its ongoing program to enhance the denial-based deterrence for the region with threats of punishment that demonstrate to Russian leaders they cannot achieve their aims at acceptable costs.

  • Rather than forward-position military forces in the Baltic states (Estonia, Latvia, and Lithuania), NATO should consider keeping forces further back to take advantage of strategic depth to limit vulnerability to Russian attack and increase operational flexibility.

  • To support the overall denial-based deterrence concept, the Baltics must commit wholeheartedly to the concept of total defense including significant increases to their active and reserves forces.


A Persistent Fire: The Strategic Ethical Impact of World War I on the Global Profession of Arms
By Timothy S. Mallard and Nathan H. White | Nov. 1, 2019

A Persistent Fire: The Strategic Ethical Impact of World War I on the Global Profession of Arms
A Persistent Fire
A Persistent Fire: The Strategic Ethical Impact of World War I on the Global Profession of Arms
Photo By: NDU Press
VIRIN: 191030-D-BD104-001

The profession of arms in the 21st century is at significant risk of losing its status as a profession due to several salient factors.1 Because of the rapid development of technology in relation to warfare, for instance, there are growing questions as to how much control human beings will retain of future combat, particularly given the speed of decisionmaking required for victory on the modern battlefield. As well, with the rise of new geopolitical and military coalitions, many are concerned as to how much war will remain an act of and in accordance with the political interests, values, and histories of individual nation-states, especially considering the thornier problem of developing the same for coalitions or allied forces. Furthermore, amid an increase in value-neutral societies (and the concomitant lack of personal moral formation of individual citizens), it may rightly be asked whether values-based institutions such as professional militaries can be adequately shaped to reflect any coherent national ethical consensus.

As a derivative of this problem, the increasing issue of strategic leader moral failure among professional military forces raises significant questions regarding the efficacy of standing programs for the ethical development of military leaders, not to mention the corrosion of trust in the institution by both their external clients (civic populations) and internal members (military formations) in the wake of such failures. Given the rise of fifth-domain warfare and multidomain battle (simultaneous, integrated combat action in and through land, sea, air, space, and cyberspace), there is basis to question whether traditional nation-state constructs such as land borders, the rule of law, and even regulating theories (for example, jus ad bellum, in bello, and post bellum) will allow militaries to retain control of warfare in concert with their national interests. In the aggregate, then, it may be candidly wondered whether the utility of the profession of arms has passed in its service to the post-Westphalian nation-state.

These are but a few of the major strategic questions facing the profession of arms today. Such questions, however, do not adequately address other challenges in contemporary warfare, such as transnational threats from weapons of mass destruction, terrorism, resource shortages, immigration, climate change, the rise of mega-urban population centers, or even the increasing costs of war—not only monetarily but also in the resulting moral and spiritual injury among combatants and noncombatants alike.2 But exploring such other challenges will not be the purpose of this edited volume. Rather, its purpose is to focus on the dominant strategic ethical challenges to the profession of arms in the first half of this century. In short, as a profession, what strategic questions should be answered for war to remain both under human control and guided by the exercise of the discreet, reflective judgment of morally formed military leaders? Answering that question is the specific purpose of this work.

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1 Don Snider, “Remarks on Acceptance of the Malham M. Wakin Lifetime Achievement Award,” speech before the Annual Meeting of the International Society of Military Ethics, Washington, DC, January 26, 2017. Snider’s concerns center around threats to the two central underpinnings to the maintenance of any profession: the retention of human control and the continuing exercise of human judgment in the discrete application of a profession’s expertise.

2 The words of World War I veteran Rifleman Fred White, 10th Battalion, King’s Royal Rifle Corps, evoke the continuing societal cost of moral and spiritual injury on warriors, their families, and their communities: “Us fellows, it took us years to get over it. Years! Long after when you were working, married, had kids, you’d be lying in bed with your wife and you’d see it all before you. Couldn’t sleep. Couldn’t lie still. Many and many’s the time I’ve got up and tramped the streets till it came daylight. Walking, walking—anything to get away from your thoughts. And many’s the time I’ve met other fellows that were out there doing exactly the same thing. That went on for years, that did.” See “Reflections,” in Max Arthur, We Will Remember Them: Voices from the Aftermath of the Great War (London: Orion Books, 2009), 157–158.

About the Contributors
By | Nov. 1, 2019

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Chaplain (Colonel) Timothy S. Mallard, USA, Ph.D., is a Minister of Word and Sacrament in the Evangelical Presbyterian Church. A member of the International Society of Military Ethics and the International Dietrich Bonhoeffer Society, he is a graduate and Grierson Prize recipient as Distinguished Army Master Strategist from the U.S. Army Command and General Staff College. He is also a graduate and former Eisenhower Fellow from the U.S. Army War College. Since 1988, Chaplain Mallard has deployed to combat as a battalion, brigade, and division chaplain, including with the 101st Airborne and 1st Infantry Divisions, and he holds the Bronze Star Medal (two awards) and the Combat Action Badge. Having served as the inaugural director of the Recruiting and Endorser Relations Directorate at the Office of the Chief of Chaplains, Washington, DC, he currently serves as the Command Chaplain for U.S. Army Europe and 7th Army. Chaplain Mallard holds a bachelor of arts from Stetson University, a master of divinity from the Southern Baptist Theological Seminary, a master of theology from Columbia Theological Seminary, a master of strategic studies from the U.S. Army War College, and a doctor of philosophy in Christian ethics from the University of Wales Trinity Saint David.

Chaplain (Major) Nathan H. White, USAR, Ph.D., is a chaplain and the executive director of the Institute for Faith and Resilience, a nonprofit research and community outreach organization. He holds degrees from Wheaton College and Samford University and holds a doctor of philosophy in applied theology from Durham University in the United Kingdom. Chaplain White’s assignments include with the 1st Infantry Division and the 101st Airborne Division (Air Assault), with deployments to Iraq and Afghanistan. He currently serves at the Office of the Chief of Chaplains, Washington, DC, and is a recipient of the Bronze Star Medal, Combat Action Badge, and Air Assault Badge. He has been published by Oxford University Press and Springer and is co-editor of the forthcoming book Biblical and Theological Visions of Resilience: Pastoral and Clinical Insights (Routledge).

Victoria J. Barnett, Ph.D., is director of the Programs on Ethics, Religion, and the Holocaust at the United States Holocaust Memorial Museum. She is a graduate of Indiana University, Union Theological Seminary in the City of New York, and George Mason University. She is the author of For the Soul of the People: Protestant Protest Against Hitler (Oxford University Press, 1992); Bystanders: Conscience and Complicity During the Holocaust (Praeger, 1999), “After Ten Years”: Dietrich Bonhoeffer and Our Times (Fortress Press, 2017); editor/translator of Wolfgang Gerlach’s And the Witnesses Were Silent: The Confessing Church and the Jews (University of Nebraska Press, 2000); and the new revised edition of Eberhard Bethge’s Dietrich Bonhoeffer: A Biography (Fortress Press, 2000). From 2004 to 2014, she served as one of the general editors of the Dietrich Bonhoeffer Works, the English translation series of Bonhoeffer’s complete works published by Fortress Press. She has written numerous articles and book chapters on the churches and the challenges of ethical leadership during the Holocaust.

Nigel Biggar, Ph.D., is the Regius Professor of Moral and Pastoral Theology at the University of Oxford, where he also directs the McDonald Centre for Theology, Ethics, and Public Life. He holds a bachelor of arts in modern history from Oxford University, a master of arts in Christian studies from Regent College Vancouver, and a master of arts and doctor of philosophy in Christian theology and ethics from the University of Chicago. Before assuming his current post, he occupied chairs in theology at the University of Leeds and at Trinity College Dublin. A former president of the Society for the Study of Christian Ethics in the United Kingdom, he has sat on the ethics committee of the Royal College of Physicians and on a Royal Society working party on population growth. He was appointed a member of the Pontifical Academy for Life in 2017. His publications include In Defense of War (Oxford, 2013), Behaving in Public: How to Do Christian Ethics (Eerdmans, 2011), Religious Voices in Public Places (Oxford, 2009), Aiming to Kill: The Ethics of Suicide and Euthanasia (DLT, 2004), Burying the Past: Making Peace and Doing Justice after Civil Conflict (Georgetown University Press, 2003), and Cities of Gods: Faith, Politics, & Pluralism in Judaism, Christianity, and Islam (Greenwood, 1986). His most recent book is Between Kin and Cosmopolis: An Ethic of the Nation (James Clarke/Wipf & Stock, 2014). He has written on the possibility of a Truth and Reconciliation Commission for Northern Ireland in the Irish Times, on the Iraq War in the Financial Times, on Scottish independence and on Rhodes, race, and empire in Standpoint magazine, on the ethics of Trident in The Scottish Review, on the British military’s action against the so-called Islamic State in Syria, and on Charlie Hebdo and freedom of speech in The Times. He has lectured at the Defence Academy of the United Kingdom, the U.S. Military Academy at West Point, and the Führungsakademie der Bundeswehr at Hamburg.

Paul Coyer, Ph.D., serves as a research professor at the Institute of World Politics, as well as an associate professor at the Ecole Speciale Militaire de Saint-Cyr, the French equivalent of the U.S. Military Academy at West Point, where he lectures on U.S. foreign and national security policy and on the role of religion and culture in international affairs. Dr. Coyer is a contributor to Forbes, writing on foreign and national security policy, and is a contributing editor of Providence: A Journal of Christianity and American Foreign Policy. His work has appeared in leading publications in the United States and around the world, including the Washington Times, Azeri Today (Azerbaijan), and the Kyiv Post (Ukraine), as well as policy-oriented journals, including Conflits: Revue de Geopolitique (France), and by academic publishers such as Oxford University Press. Dr. Coyer’s graduate degrees are from Yale University, where he earned a master of arts in theological ethics, and the London School of Economics and Political Science, where he earned a master of arts in the history of the international relations of East Asia and a doctor of philosophy in the history of Sino-American relations. Dr. Coyer is a member of the International Institute of Strategic Studies.

Graham Fairclough, D.Phil., is a research associate in the Changing Character of Warfare Centre and the Oxford Internet Institute at Oxford University, where he recently completed a doctor of philosophy in cyber security. Prior to commencing his studies, he was a career soldier in the British army, reaching the rank of colonel. Throughout his career, he was employed on intelligence and security duties, which included operational tours in Northern Ireland, Belize, the Balkans, Iraq, and Cyprus. Senior appointments include on the United Kingdom’s Permanent Joint Headquarters from 2007 to 2010, where he was responsible for the delivery of intelligence architecture and capability in Iraq and Afghanistan, and as the first chief of staff to the United Kingdom’s Chief of Defence Intelligence from 2010 to 2013. He has served in operational appointments with the Government Communications Headquarters and has worked closely in a number of roles with other elements of the United Kingdom’s intelligence community and its international partners. Dr. Fairclough possesses a master of science in knowledge management systems from Cranfield University and master of arts in defense studies from King’s College London. He is a participant in the North Atlantic Treaty Organization’s future Urbanisation Warfare Programme, where he provides specialist advice on the operational and tactical requirement for cyber capability and its potential employment by commanders. He is a member of Allied Command Transformation Innovation Team in a cyber capacity. In addition, he is a standing member of the United Kingdom’s Chief of Defence Staff Strategy Forum and an advisor to the Ministry of Defence’s Global Strategic Trends Programme.

Lieutenant Colonel Michael H. Hoffman, USA (Ret.), JD, is an attorney with extensive experience and publications in the field of international law. He is also an associate professor at the U.S. Army Command and General Staff College. He holds a bachelor of arts from The Ohio State University and a doctor of law from Southern Methodist University School of Law. His experience in the field of international law spans duty as a judge advocate, a delegate for the International Committee of the Red Cross, and an advisor to U.S. and nongovernmental delegations at international law conferences.

Chaplain (Lieutenant Colonel) Mark C. Lee, USA, D.Min., Ph.D., is an Episcopal priest, having served in ordained ministry for over 18 years. He has experience in parish ministry, academia, and banking and finance. Chaplain Lee is currently a certified educator candidate with Accredited Clinical Pastoral Education. Previously, he served as the curriculum developer and instructor at U.S. Army Medical Department Center and School, teaching courses on moral injury, combat/emergency medical ministry, and other topics. His previous military assignments include deputy garrison chaplain/resource manager at U.S. Army Garrison Yongsan; brigade chaplain at 1st Armored Brigade Command, 2nd Infantry Division, at Camp Hovey; 98th Medical Detachment (Combat Stress Control) at Joint Base Lewis-McChord, Washington; and operations chaplain at 14th Engineer Battalion, I Corps. Chaplain Lee has experienced two combat deployments. His formal education includes a doctor of philosophy from the University of Aberdeen, a doctor of ministry from Erskine Theological Seminary, a master of divinity from Princeton Theological Seminary, and a master of business administration and bachelor of science from the University of Southern California. Chaplain Lee is married to Kyo Young Park and father to Nicole and Lauren.

Marc LiVecche, Ph.D., is the executive editor of Providence: A Journal of Christianity and American Foreign Policy. He is also Scholar of Christian Ethics at the Institute on Religion and Democracy, research scholar at the Philos Project, and the McDonald Visiting Scholar at the McDonald Centre for Theology, Ethics, and Public Life in Christ Church College at Oxford University. Dr. LiVecche completed a doctor of philosophy in theological and political ethics at the University of Chicago. While at Chicago, Dr. LiVecche worked under the supervision of the political theorist Jean Bethke Elshtain until her death in 2013. His dissertation, titled “With Malice Toward None: The Moral Ground for Killing in War,” takes a classic just war view of the question of killing in its theological and ethical dimensions in part as a response to the crisis of moral injury. Prior to his work in Chicago, Dr. LiVecche completed a master of arts in theology from Wheaton College and, before that, spent 12 years doing a variety of things in Central Europe—including leading seminars on ethics onsite at the former Auschwitz II–Birkenau Nazi concentration camp in Poland, an experience that allowed him to continue his undergraduate study of the Shoah, a study that helped permanently inoculate him against pacifism.

Colonel John Mark Mattox, USA (Ret.), Ph.D., is a senior research fellow in the Center for the Study of Weapons of Mass Destruction, Institute for National Strategic Studies, at the National Defense University in Washington, DC, where he directs the Countering Weapons of Mass Destruction Graduate Fellowship Program. He was the inaugural General Hugh Shelton Chair in Ethics at the U.S. Army Command and General Staff College. Dr. Mattox is also the former dean of the Defense Threat Reduction University and commandant of the Defense Nuclear Weapons School. He served on three continents as a field artillery officer and is a veteran of the First Gulf War. He holds degrees from Brigham Young University, the U.S. Army Command and General Staff College, the U.S. Army War College, and a doctor of philosophy in philosophy and semiotic studies from Indiana University. He has served on the faculty of the U.S. Military Academy at West Point, the University of Maryland, and Missouri State University.

General James C. McConville, USA, currently serves as the 40th Chief of Staff of the Army. He previously served as the 36th Vice Chief of Staff of the Army from June 16, 2017 to July 26, 2019. General McConville served as commanding general of the 101st Airborne Division (Air Assault), where he also served as the commanding general of Combined Joint Task Force–101, Operation Enduring Freedom; deputy commanding general (Support) of Combined Joint Task Force–101, Operation Enduring Freedom; commander of 4th Brigade, 1st Cavalry Division, Operation Iraqi Freedom; commander of 2nd Squadron, 17th Calvary Regiment, 101st Airborne Division (Air Assault); and commander of C Troop, 2nd Squadron, 9th Cavalry Regiment, 7th Infantry Division (Light). His key staff assignments include the U.S. Army deputy chief of staff, G-1; chief of legislative liaison; executive officer to the Vice Chief of Staff of the Army; G-3 for 101st Airborne Division (Air Assault); J5 strategic planner for U.S. Special Operations Command; S-3 for 25th Combat Aviation Brigade; S-3 for 5th Squadron, 9th Cavalry; and S-3 for Flight Concepts Division. He holds a bachelor of science from the U.S. Military Academy at West Point and a master in aerospace engineering from the Georgia Institute of Technology. He was also a National Security Fellow at Harvard University in 2002.

Major Patrick Naughton, USAR, is a Medical Service Corps officer and a military historian. He is currently serving as a legislative liaison to the U.S. Senate and is a former interagency fellow. He holds a master of military arts and science from the U.S. Army Command and General Staff College, where he was an Art of War Scholar, and a bachelor of arts in history from the University of Nevada, Las Vegas.

Eric D. Patterson, Ph.D., is dean of the Robertson School of Government at Regent University and a research fellow in the Berkley Center for Religion, Peace & World Affairs at Georgetown University, where he previously served as a full-time faculty member. He holds degrees from the University of California at Santa Barbara, Evangel University, and the University of Wales at Aberystwyth. Dr. Patterson has served for more than 20 years in command positions in the Air National Guard, served as White House Fellow, and twice worked in the Bureau of Political-Military Affairs at the State Department. At the State Department, he worked on postconflict issues in, and traveled to, Afghanistan, Iraq, Turkey, Congo, Angola, and elsewhere. He is the author or editor of more than a dozen books, including Just American Wars: Ethical Dilemmas in U.S. Military History (Routledge, 2018), Ending Wars Well: Order, Justice, and Conciliation in Contemporary Post-Conflict (Yale University Press, 2012), Ethics Beyond War’s End (Georgetown University Press, 2012), Debating the War of Ideas, co-edited with John Gallagher (Palgrave MacMillan, 2009), Military Chaplains in Iraq, Afghanistan, and Beyond: Advisement and Leader Engagement in Highly Religious Environments (Rowman & Littlefield, 2014), Just War Thinking: Morality and Pragmatism in the Struggle against Contemporary Threats (Lexington Books, 2007), and Politics in a Religious World: Building a Religiously Literate U.S. Foreign Policy (Bloomsbury Academic, 2011).

Colonel C. Anthony Pfaff, USA (Ret.), Ph.D., is the Research Professor for the Military Profession and Ethics in the Strategic Studies Institute at the U.S. Army War College. Dr. Pfaff previously served as director for Iraq on the National Security Council staff and on the Policy Planning staff at the Department of State. Dr. Pfaff holds a bachelor of arts in philosophy and economics from Washington and Lee University, a master of arts in philosophy from Stanford University, a master of science in national resource management from the Industrial College of the Armed Forces, and a doctor of philosophy from Georgetown University. He is the author of “Proxy War Ethics,” Journal of National Security Law & Policy 9, no. 2 (August 2017), as well as numerous other works on the topic of military ethics.

The Reverend Dr. (Wing Commander) David Richardson is a British chaplain serving in the Royal Air Force (RAF). He was originally ordained into the Church of Ireland. A graduate of the universities of Edinburgh, Dublin, Belfast, and King’s College London, he is currently completing further study at Cardiff University. Recently appointed as staff chaplain to the Chaplain-in-Chief, he has served on a variety of RAF flying stations and training units, and has served as an instructor at the United Kingdom’s Armed Forces Chaplaincy Centre. His operational experience includes tours across Afghanistan and Iraq. Married to Ruth, a former teacher, since 1999, they have two sons.

Michael Snape, Ph.D., is the inaugural Michael Ramsey Professor of Anglican Studies at Durham University in the United Kingdom and is an ecumenical lay canon of Durham Cathedral. He earned a first-class bachelor of arts in history and theology and was awarded a doctor of philosophy from University of Birmingham. Since the late 1990s, he has specialized in the study of Christianity and conflict from approximately 1700 to the present. He was Reader in Religion, War, and Society at the University of Birmingham before being appointed to the Department of Theology and Religion at Durham in 2015. Professor Snape is the historian of the Royal Army Chaplains’ Department and a historical adviser to the Young Men’s Christian Association England and the Bible Society. Since 2009, he has co-organized the Amport Conference on Religion and War in the Modern World, which is held annually in the Armed Forces’ Chaplaincy Centre, a constituent college of the Defence Academy of the United Kingdom. His major publications include God and the British Soldier: Religion and the British Army in the First and Second World Wars (Routledge, 2007), The Royal Army Chaplains’ Department, 1796–1953: Clergy Under Fire (Boydell Press, 2008), and God and Uncle Sam: Religion and America’s Armed Forces in World War II (Boydell Press, 2015).

Commander Thomas J. Statler, USN, is the command chaplain in the Joint Forces Staff College at the National Defense University. He teaches a military ethics elective on the just war tradition and the profession of arms and is the faculty ethics advisor. Chaplain Statler earned a bachelor of science in secondary education, a master of divinity, and a master of theology. After receiving his naval professional code in ethics, he also taught two ethics electives at the Naval Postgraduate School from 2008 to 2011. Chaplain Statler is certified in Joint Professional Military Education Phase II and is a charter member of the Navy Chaplain Corps Ethics Community of Interest.

Padre Andrew Totten, MBE, was born in Belfast and educated at Queen’s University, Trinity College Dublin, and Cardiff University. Ordained as an Anglican priest in the Church of Ireland, he has been a British army chaplain since 1994. Serving at regimental, brigade, and divisional levels, his operational experience covers Bosnia, Kosovo, Ulster, Iraq, and Afghanistan. He graduated from the Royal College of Defence Studies in 2017 with the individual prize for strategic analysis. His current assignment is as principal at the Armed Forces’ Chaplaincy Centre, a constituent college of the Defence Academy of the United Kingdom. He is an Honorary Chaplain to the Queen.

17. Toward a Resilient Military Ethic
By Nathan H. White | Oct. 31, 2019

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As this volume of reflections on military ethics in light of World War I comes to a close, a framing of diverse insights is both necessary and beneficial. This evaluation may be accomplished, I suggest, by relating military ethics more broadly to the overall purpose of military action, as well as of human life. Within this schema, war may be understood as an attempt at resilience—a striving after societal flourishing that was as evident in the Great War as it is today. By situating discussion about military ethics in this way, we may achieve greater clarity regarding the purpose and nature of war as well as insight into possible present and future expressions of warfare and the place of ethics in them.

The Telos of War

Human beings, it would seem, have an innate drive toward life.1 Individuals and societies alike seek not only to survive but also to flourish despite forces that would undermine these efforts. Scholars have been contemplating this phenomenon for millennia. Aristotle, for instance, characterized the shared goal of human flourishing in this way: the telos (goal/purpose) of the socio-political establishment is to enable development “for the sake of the good life [eudaimonia].”2 Aristotle’s understanding of society is inextricably linked to his understanding of human nature; because human beings are political animals, naturally gathering into societies for the pursuit of mutual flourishing, human life is necessarily tied to ethical considerations such as the evaluation of what constitutes “the good life” and appropriate means to achieve this end—themselves always ethical and value-laden efforts.3 Therefore, as long as humans gather together in societies, they demonstrate the continued relevance of ethics, in the very least through the adoption of a common telos and hope for progress toward this end. In sum, humans are ethical beings because they are political beings. Furthermore, it follows that the state’s political activities are an extension of ethical action. Here, acts of warfare themselves become extensions of political action4—or, as Clausewitz famously put it, war is a “mere continuation of policy by other means.”5 In this respect, ethics cannot be untethered either from politics or warfare.

Donald Kagan, however, suggests that such a view is misplaced. He notes wryly, “It is a special characteristic of the modern Western world, as opposed to other civilizations and the premodern Western World, to believe that human beings can change and control the physical and social environment and even human nature to improve the condition of life.”6 Instead, for Kagan, the origin of war is found elsewhere. Though he acknowledges that many scholars have located motivation for war in “competition for power,”7 Kagan finds more insightful Thucydides’ claim that “people go to war out of ‘honor, fear, and interest.’”8 Each of these motivations is illuminating in its own regard, yet, irrespective of impetus, the existence of warfare itself is indicative of the human struggle to flourish. This demonstrates, as Kagan notes regarding war, that the “secret of the success of our species has been its ability to learn from experience and to adapt its behavior accordingly.”9

War, then, could be conceptualized as an attempt at resilience. In particular, through war human societies seek to ensure their own flourishing despite detractors. Within the arena of military ethics, the concept of resilience may therefore provide a helpful framework for assessing the pursuit of eudaimonia (or, alternatively, the motivations of honor, fear, and interest, as it may be) through war, at both individual and societal levels. This follows from Aristotle’s thought, where, because war is a political act, the aims of war (however conceived) and acts of warfare are themselves value-laden and therefore inherently concerned with ethics (right practice). Thus, ethics is vital to the waging of warfare inasmuch as it defines and delimits the motivations, scope, and means of war in its greater aim of supporting the flourishing of society at large.10

But some may consider this an outdated or limited viewpoint. Given a variety of recent societal and technological advances, is ethical reflection still necessary in warfare? Put another way, will the discipline of military ethics remain resilient despite winds of societal change?

A Viable Future?

Certainly, an implied question throughout this volume has been whether military ethics is and will remain a viable aspect of military operations. Does this discipline have sufficient adaptability and applicability to be utilized in the warfare of the 21st century and beyond? While by no means providing a conclusive answer, it is our hope that this volume is suggestive of ways in which military ethics remains an essential aspect of the profession of arms and will continue to be so for years to come. Many contributions to this volume have highlighted the significant role of ethics in warfare, where it serves as an integral component of military planning at all echelons. This volume’s retrospective look at the Great War has demonstrated that, though much in warfare has changed, much has also remained the same. Indeed, history may furnish valuable insight into the future of military ethics.

The Great War and Human Flourishing

World War I, a conflict resulting both in tremendous societal repercussions and widespread personal loss, has much to teach us. Although at first glance war may seem to be solely concerned with human conflict, war may in fact provide insight into human flourishing. Resilience, which history suggests may be both present and absent in war, is a key linkage between the two concepts.

In his classic The Great War and Modern Memory, Paul Fussell insightfully notes, “Every war is ironic because every war is worse than expected. Every war constitutes an irony of situation because its means are so melodramatically disproportionate to its presumed ends. . . . But the Great War was more ironic than any before or since. . . . It reversed the Idea of Progress.”11 The irony of World War I, in particular, is that the supposed advance of human civilization—technological and otherwise—led not to greater peace, but rather to a war unlike the world had before seen. A monumental shift had occurred in warfare, and this change did not seem to lead to greater human flourishing. At a societal level, the Great War evoked a distinct lack of resilience—regress instead of the hoped-for progress. This was evidenced perhaps nowhere more clearly than in the testament of individual lives, particularly of those lost and those irreparably marred.

Individual Resilience

Warfare is a complicated matter, involving a conglomeration of technological, political, and social considerations as well as the most sacred of human commitments. From its intensely physical nature to the unseen but powerful forces of personal and societal motivation, war not only involves but also challenges basic human needs, longings, and commitments. When the detritus of technological and political trappings is pushed aside, the simple fact remains that war is primarily concerned with human beings.12 Despite a variety of motivations for war, the actual waging of war is a very personal, and very human, matter.

Yet, ostensibly with the exponential industrialization of warfare in World War I and beyond, the human side of warfare gradually began to be displaced. The mechanization of weapons systems, defensive technologies, and means of communication increasingly sidelined what were once human-centric capabilities and tasks through enabling more effective warfare while also preserving one’s own safety. Indeed, the sanguine, earthy nature of much pre-industrial warfare, where close combat often entailed warriors being near enough to smell one another, was replaced by a “safe” distance removed from not only the smell of one’s opponent, but also the sight of their faces and sound of their cries.13 Through this monumental change, warfare’s essentially human character was still apparent, albeit a character somewhat distanced from the immediacy of many earlier types of warfare. But, despite changes, at the individual level of human warriors engaged in warfare, persons sought to press on despite obstacles in order to preserve human flourishing at its most basic level—that of survival.14

Yet war, inasmuch as it is a human endeavor, is often traumatizing.15 This was certainly the case in World War I where, as Martin Gilbert suggests, “individual suffering and distress were on a massive scale, particularly in the front-line trenches.”16 Indeed, in pursuing the flourishing of their society through warfare, nations can traumatize their inhabitants—the warriors who themselves become a part of the collateral damage of this quest—in what could be termed “personal wounding in pursuit of national resilience.” Nation-states often attempt to mitigate this damage through programs aimed at developing resilience among warriors. This, in itself, is an ethical move in support of an ethical dilemma and cannot be disentangled from ethical considerations. Because the resilience of human beings is significantly influenced by ethical and spiritual correlates,17 it seems likely that these factors will remain important within the human domain of warfare in the present and the future.18

Contributions to this volume have reflected on the importance of ethics in warfare from a variety of standpoints. Utilizing insights gained from the Great War, authors have addressed topics as diverse as chemical warfare, nationalism, technological advance, and human recovery from trauma. We may see each of these areas as being concerned with the proper ordering of human life within the context of war—what I have described as resilience—in its own way. Indeed, the appeal of the concept of resilience is evident throughout this volume. David Richardson calls for a renewed “spiritual resilience” grounded in a transcendent ethic to support war-
fighters, while Andrew Totten raises questions concerning the centrality of human resilience in warfare given the rise of autonomous warfare systems. Other contributions also trace various efforts to support the resilience of warriors such as the use of drugs (Pfaff), spiritual resources (Lee), and education (Statler) in the promotion of sustained well-being. Yet it is not a foregone conclusion that such considerations will be necessary in the warfare of the future. As Totten argues in this volume, “Resilience seems to be increasingly a matter of systems and networks, not human hearts and minds, let alone souls.” If the centrality of individual human resilience within warfare is in question, how much more so is the entire enterprise of military ethics?

Changing Paradigms?

At the center of these queries are two considerations: the changing nature of Western society—what has been termed a move toward a “post-Christian” society—and changes in fundamental relationalities between human beings and technology.

Societal Shifts

With the tradition of Western military ethics largely situated within a heritage of a Judeo-Christian culture that is waning in influence in the West, is this discipline still relevant to modern warfare, or is it merely a relic of the past? Will it remain resilient, surviving the monumental societal changes currently occurring so as to sustain applicability and efficacy for societies engaged in warfare and for those employed in promulgating it? Given the gravity of the taking of human life and the widespread destruction that often accompanies war, many would maintain that ethical reflection is needed in order to be responsible in this serious matter. Yet in a postmodern and computer-age society, ethics can often be regarded as passé—a hindrance to “What works” and “What makes me happy.” While changing societal currents are substantial, rather than being a detriment to the continued relevance of military ethics, its historical grounding within a particular tradition of thought provides a basis from which it may grow and develop as it reassesses contemporary situations in light of a rich history. This foundation, then, is not something to discard, but rather something upon which to build, especially during times of great change.

Technological Shifts

Beyond shifting ethical foundations, 21st-century conflicts evidence a change that some characterize as a fundamental shift in the character of war—a new paradigm in which warfare loses its human trappings.19 A number of contributions to this volume have highlighted this shift, suggesting that current and future conflicts may operate according to a profoundly different paradigm. That a seismic shift within human-technological relations is occurring cannot be doubted, but this change does not necessarily create a new paradigmatic understanding of warfare. Given that war, as a political activity, is concerned with the societal pursuit of human flourishing, even if the waging of war increasingly becomes less human-centric, the telos of war itself remains unchanged. Flourishing is still evaluated in terms of human flourishing. Computer systems do not wage war on their own behalf, but rather are utilized by human agents on behalf of a nation-state and its desired flourishing.20 Thus, even in a warfare environment characterized by non-human actors, the nature of warfare will necessarily remain human—and also ethical. Warfare is used in service of human communities, seeking their welfare and flourishing, and therefore ethical considerations remain relevant inasmuch as human beings are the authors of warfare (albeit perhaps increasingly not the agents of warfare) and the object of warfare’s telos.

A New Epoch of Warfare?

Are the societal and technological advances of our own time of sufficiently revolutionary character to require a new paradigm of warfare, and thus also of military ethics? Has the rapid development of artificial intelligence sidelined the human element in war altogether? Perhaps. “Time will tell,” as the saying goes, yet, as we have begun to explore in this volume, time may also give insight in an altogether different manner—through looking to the past.

Certainly, many view their own temporal-historical situation as unique. This was the case for many individuals during the First World War. In a sermon titled “The Armistice” that he preached in Westminster Abbey on November 10, 1918, the Archbishop of Canterbury and principal leader of the Church of England, Randall Thomas Davidson, suggested:

To say that we have never known such moments as these, whether of August 1914 or of November 1918, is far short of the reality. The world—the world—has known no such hours before. Centuries hence, people will look back upon them with eager and absorbed intent . . . [determined] to reproduce and to re-picture what it must have been, what it must have meant, to be alive just then.21

Undeniably, the Great War, up to that time, was without precedent. Yet merely decades later its supreme uniqueness was to be eradicated by a war of even greater magnitude. Moreover, the Great War was only an initial foray into the 20th century that would see, by one count, 240 million people dead due war, with a total of 26 wars that each individually resulted in more than 1 million dead.22

If many were mistaken in their assessment of changes in their own time following the end of World War I, by what standard are we to judge the changes of the modern sociopolitical climate? Will the assessments of our own age withstand the judgments of future generations? We do not fully know. We owe it to ourselves and to those who will follow us, however, to give serious thought to these considerations; we do not want to repeat the mistakes of the past.

A Resilient Military Ethic?

Warfare has changed drastically in the 100 years since the armistice of World War I, and warfare will continue to change. Due to technological advances and changing societal currents, warfare may be a much different experience for the modern warrior than it was for the soldier of the Great War, yet because of war’s essentially human nature, modern military leaders face many of the same challenges faced by military leaders of the First World War. Now warfare seems to be shifting once again, but will this result in the betterment of humanity?

In the conclusion to his magisterial treatment of the development of society and warfare over the last millennium, William McNeill suggests that in our own era:

wesome power and awful dilemmas have never been so closely juxtaposed. What we believe and how we act therefore matter more than in ordinary ages. Clear thinking and bold action, based as always on inadequate evidence, are all we have to see us through to whatever the future holds. It will differ from anyone’s intentions as radically as the actual past differed from our forefathers’ plans and wishes. But study of that past may reduce the discrepancy between expectation and reality, if only by encouraging us to expect surprises—among them, a breakdown of the pattern of the future suggested in this conclusion. For however horrendous it is to live in the face of uncertainty, the future, like the past, depends upon humanity’s demonstrated ability to make and remake natural and social environments within limits set mainly by our capacity to agree on goals of collective action.23

In a word, then, the future depends on our resilience. As we assess the challenges of future warfare, we must evaluate how we may successfully—and resiliently—face what is to come. What seems to be clear is that military ethics must remain an essential part of societal efforts to shape what McNeill calls “goals of collective action” and means of pursuing them in the promotion of human flourishing.

Thus, even if we are entering a new paradigm of less-human warfare, we will need all possible resources at our disposal to face the challenges of future war—which will still remain a paradigm of war, and therefore necessarily be concerned with the flourishing and resilience of human beings. As such, ethics will persist as a vital aspect of warfare, properly utilizing ways, ends, and means so as to ensure that the society we are intent on preserving through war is itself one worth preserving.24


1 See, for instance, Ilia N. Karatoreos and Bruce S. McEwen, “Annual Research Review: The Neurobiology and Physiology of Resilience and Adaptation across the Life Course,” Journal of Child Psychology and Psychiatry 54, no. 4 (April 2013), 337–347.

2 Aristotle, Politics I.2, 1252b30. Quotations are from Jonathan Barnes, ed., The Complete Works of Aristotle: The Revised Oxford Translation, vols. 1 and 2 (Princeton: Princeton University Press, 1984). Aristotle goes even further to claim that “a state exists for the sake of a good life, and not for the sake of life only” (III.9, 1280a32-3). Indeed, the “end of the state is the good life” (III.9, 1280b39–1281a4). Similarly, in the terms that the Founding Fathers used to frame the Constitution, the United States of America was founded in order to “establish Justice, insure [sic] domestic Tranquility, provide for the common defence [sic], promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity.”

3 Aristotle recognized that disagreement exists concerning what constitutes “the good life” (Nicomachean Ethics 1.4, 1095a21-5). Nonetheless, he still viewed eudaimonia as something that is inherently valuable, thereby being the proper telos of both human life and human society (Nicomachean Ethics I.7, 1097a35-b5).

4 For instance, Aristotle suggests that “the higher parts of states, that is to say, the warrior class, the class engaged in the administration of justice, and that engaged in deliberation . . . these are more essential to the state than the parts which minister to the necessaries of life” (Politics IV.4, 1291a26-9). Cf. Politics I.5, 1254b30; I.8, 1256b22-6. Commenting on Aristotle’s Politics, Alasdair MacIntyre draws together several of these themes by noting the necessity of the use of virtue in ethical living: “The courage and skill required in military actions, the temperateness required in respect of pleasures . . . all these may at different times have to be judged rightly if a just judgment is to be made.” Alasdair MacIntyre, Whose Justice? Which Rationality? (Notre Dame: University of Notre Dame Press, 1988), 106. I am grateful to Thomas Achord for his helpful discussion of these matters.

5 Carl von Clausewitz, On War, ed. and trans. Michael Howard and Peter Paret (Princeton: Princeton University Press, 1976), Bk. 1, Ch. 1, 24. John Keegan qualifies both Aristotle and Clausewitz’s claims, noting that war itself predates both nation-states and politics. He suggests regarding these thinkers, “Neither dared confront the thought that man is a thinking animal in whom the intellect directs the urge to hunt and the ability to kill.” See John Keegan, A History of War (New York: Vintage Books, 1994), 3. Keegan’s insight is worthy of serious consideration, but, in the end, it complements rather than detracts from my larger argument that war itself is indicative of an attempt at human resilience.

6 Donald Kagan, On the Origins of War and the Preservation of Peace (New York: Anchor Books, 1995), 3.

7 Ibid., 6.

8 Ibid., 8, citing Thucydides, 1.76.2.

9 Ibid., 11. On the factors leading to the First World War in particular, see Kagan, Origins of War, 81–214.

10 As Paul Coyer has argued in this volume, a healthy nationalism is one that balances national interest with genuine concern for the well-being of those who do not belong to the nation. This, too, is an ethical consideration. At one level, I argue that ethical considerations are an implicit aspect of human political activity, of which war is an integral part. But certainly a case could be made for ethical considerations impeding military expediency. This may seem to hold weight when considering short-term outcomes; in the last analysis, however, a reading of history would display that disposing of ethics is a self-defeating endeavor. From a purely utilitarian viewpoint, Nazi Germany, for instance, often relegated ethical concerns for the expediency of short-term outcomes—including and especially against civilian populations—that it deemed as suitable for achieving intended purposes, but this often undercut rather than supported war efforts through, among other things, galvanizing civilian populations and enemy combatants even more stalwartly against the regime.

11 Paul Fussell, The Great War and Modern Memory (Oxford: Oxford University Press, 2000), 7–8. Similarly, Fussell invokes John Keegan’s conclusion regarding the incomprehensibility of the Great War: “The First World War is a mystery. Its origins are mysterious. So is its course.” Fussell, The Great War, 339, citing John Keegan, The First World War (London: Hutchinson, 1998).

12 For this insight I am indebted to the Reverend David Barrett, CF.

13 The creation of distance between oneself and the enemy did not begin with industrialized warfare—the invention of the longbow, crossbow, and gunpowder, for instance, clearly increased lethal distance in warfare—but a strong case could be made for the exponential growth of this distance during World War I due to a number of industrial and technological advances, both offensive and defensive. Cf. William H. McNeill, The Pursuit of Power: Technology, Armed Force, and Society since A.D. 1000 (Chicago: University of Chicago Press, 1982), 330–336; and Robert L. O’Connell, Of Arms and Men: A History of War, Weapons, and Aggression (New York: Oxford University Press, 1989), 231–269. This shift is evident in the fascinating early account of the war by famed violinist Fritz Kreisler who fought for his ancestral “Fatherland,” Austria, on the Eastern front against Russia. Kreisler notes regarding his experience in the trenches, “it is astonishing how little actual hatred exists between fighting men. One fights fiercely and passionately, mass against mass, but as soon as the mass crystallizes itself into human individuals whose features one actually can recognize, hatred almost ceases. Of course, fighting continues, but somehow it loses its fierceness. . . . One still shoots at his opponent, but almost regrets when he sees him drop.” See Fritz Kreisler, Four Weeks in the Trenches: The War Story of a Violinist (Boston: Houghton Mifflin, 1915), 69. The eased tension between passionate fighting and sympathy for the enemy that is evident in Kreisler’s account is itself made possibly by physical distance from one’s opponent. Such emotional distance from the act of killing is, in part, a corollary of the increased space between opposing parties in World War I. For an incisive description and analysis of trench warfare in World War I, see John Keegan, The Face of Battle: A Study of Agincourt, Waterloo, and the Somme (New York: Vintage Books, 1977), 204–280.

14 In the 20th century, the study of human beings’ response to adversity has often been centered around research on war. This was true of the foundational understandings developed through studying soldiers returning from World War I and World War II (See Ann S. Masten, “Global Perspectives on Resilience in Children and Youth,” Child Development 85, no. 1 [January 2014], 7–8), but is also true of the more recent study of resilience within the context of conflicts in Iraq and Afghanistan. Cf. Rhonda Cornum, Michael D. Matthews, and Martin E.P. Seligman, “Comprehensive Soldier Fitness: Building Resilience in a Challenging Institutional Context,” American Psychologist 66, no. 1 (2011), 4–9; Peter Zimmermann et al., “Personal Values in Soldiers after Military Deployment: Associations with Mental Health and Resilience,” European Journal of Psychotraumatology, vol. 5 (May 2014); George A. Bonanno et al., “Trajectories of Trauma Symptoms and Resilience in Deployed U.S. Military Service Members: Prospective Cohort Study,” The British Journal of Psychiatry 200, no. 4 (April 2012), 317–323; S.B. Harvey et al., “The Long-Term Consequences of Military Deployment: A 5-Year Cohort Study of United Kingdom Reservists Deployed to Iraq in 2003,” American Journal of Epidemiology 176, no. 12 (November 2012), 1177–1184. In one respect, increased individual human resilience may be seen as a means of promoting societal resilience, including through the successful waging of war. To this end, the concept of resilience has itself been used widely within the U.S. Armed Forces. Cf. Army Doctrine Reference Publication 1-0, The Army Profession (Washington, DC: Headquarters Department of the Army, June 2015), 5-16, 6-11, 6-22, 7-1; Army Regulation 350-53, Comprehensive Soldier and Family Fitness (Washington, DC: Headquarters, Department of the Army, June 2014); Lisa S. Meredith et al., Promoting Psychological Resilience in the U.S. Military (Santa Monica, CA: RAND, 2011); see also contributions in this volume from Richardson, Totten, and Lee.

15 Cf. Rut Gubkin, “An Exploration of Spirituality and the Traumatizing Experiences of Combat,” Journal of Humanistic Psychology 56, no. 4 (July 2016), 311–330; R. Srinivasa Murthy and Rashmi Lakshminarayana, “Mental Health Consequences of War: A Brief Review of Research Findings,” World Psychiatry 5, no. 1 (2006), 25–30; Hanna Kienzler, “Debating War-Trauma and Post-Traumatic Stress Disorder (PTSD) in an Interdisciplinary Arena,” Social Science & Medicine 67, no. 2 (July 2008), 218–227; Karni Ginzburg, Tsachi Ein-Dor, and Zahava Solomon, “Comorbidity of Posttraumatic Stress Disorder, Anxiety and Depression: A 20-Year Longitudinal Study of War Veterans,” Journal of Affective Disorders 123, no. 1 (June 2010), 249–257; Alexander C. McFarlane, “The Impact of War on Mental Health: Lest We Forget,” World Psychiatry 14, no. 3 (2015), 351–353.

16 Martin Gilbert, The First World War: A Complete History (New York: Henry Holt and Company, 1994), xv. Gilbert, in particular, traces narratives of individual suffering through this comprehensive volume.

17 Cf. Christopher C.H. Cook and Nathan H. White, “Resilience and the Role of Spirituality,” in The Oxford Textbook of Public Mental Health, ed. Dinesh Bhugra et al. (New York: Oxford University Press, 2018), 513–520.

18 Here, too, we may learn from the past. Charles McMoran Wilson (Lord Moran), who served as the personal physician to Sir Winston Churchill, previously was a battalion surgeon for British forces in World War I. He later wrote regarding his experiences, “In those early days of the first German War we—the Company officers and I—did not bother about men’s minds; we did what we could for their bodies. We did not ask whether a man was wearing well or if he would last. Of course he would last, why shouldn’t he? Months later after the corrosion of nearly a year in the Ypres salient I was less certain . . . [men] were wearing badly under stress.” Lord Moran, The Anatomy of Courage (London: Constable, 1945), 3. Lord Moran continues to explain the profound effect that internal dispositions, such as courage, had on the well-being of the soldiers under his care. See also Edgar Jones, “Doctors and Trauma in the First World War: The Response of British Military Psychiatrists,” in The Memory of Catastrophe, ed. Peter Gray and K. Oliver (Manchester: Manchester University Press, 2004), 91–105; and T.W. Salmon, “Some Problems of Disabled Ex-Service Men Three Years after the Armistice,” Mental Hygiene, vol. 6 (1922), 1–10. Despite the increased distance of human beings from the actual conduct of warfare, it seems that we cannot fully escape the effects of this conduct. One has only to look at evidence, anecdotal and empirical, of drone pilots to understand that distance does not erase the psychological impact of killing another human being. Even with autonomous weapons systems, a human being is involved at some point in the decision matrix, necessarily involving an ethical assessment of warfare. When a target is nonhuman (as in an enemy computer system), the effects of waging war against such an enemy (even to the second and third order) are effects on human beings.

19 This change could even be characterized in terms similar to Thomas Kuhn’s model of paradigm shifts within the history of science. Cf. Thomas S. Kuhn, The Structure of Scientific Revolutions (Chicago: University of Chicago Press, 1962).

20 Some, indeed, have argued for the possibility of the future autonomy of artificial intelligence—a phenomenon often termed the singularity. This is a possibility that I do not seriously consider here, though it has been explored in various media. See “Artificial Intelligence Poses Questions for Nature of War: Mattis,”, February 18, 2018, available at <>. In this volume, see especially contributions by Patterson, Fairclough, and Totten.

21 Randall Thomas Davidson, “The Armistice,” in The Testing of a Nation (London: MacMillan, 1919), 156. Note also Archbishop Davidson’s comments at a memorial service for the fallen, held at Westminster Abbey on May 24, 1919: “Our solemn service to-day has no parallel or close precedent in the history of the world. For we are commemorating before God something which never happened until now among the sons of men. Many times there have been great wars. Many times has the world witnessed splendid fellowship and heroic devotion unto death. But now, now only, has there come to pass what you and I have seen” (211). McNeill comments regarding the paradigm-shattering experience of World War I for many, “Those who experienced the war were quite unable to fit what happened into any pattern of prior experience. Their initial intoxication with dreams of glory curdled into horror and a sense of helpless entrapment as the slaughter of the trenches persisted month after month,” McNeill, The Pursuit of Power, 308.

22 Nigel C. Hunt, Memory, War and Trauma (Cambridge: Cambridge University Press, 2010). Hunt helpfully suggests ways of healing from societal war trauma through collective remembrance and memorialization. In the same vein, McNeill argues that “[i]t is . . . no longer practicable to treat World War I as an unparalled [sic] catastrophe interrupting the ordinary course of historical development. If nothing else, World War II proved that the Great War was not unique.” See McNeill, The Pursuit of Power, 308.

23 McNeill, The Pursuit of Power, 386–387.

24 This was also the guiding principle that motivated the American founders: “In 1776, American leaders believed that it was not enough to win the war. They also had to win in a way that was consistent with the values of their society and the principles of their cause. . . . American leaders resolved that the War of Independence would be conducted with a respect for human rights, even of the enemy.” See David Hackett Fischer, Washington’s Crossing (New York: Oxford University Press, 2004), 375–376.

16. The Proper Marking of Medical Personnel and Equipment: Lessons from the Great War
By Patrick Naughton | Oct. 31, 2019

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In April 1917, after repeated attempts at diplomacy aimed at keeping itself out of the conflict raging in Europe, the United States declared war against Imperial Germany and later its allies. The 65th Congress authorized and directed that the President “employ the entire naval and military forces of the United States and the resources of the Government to carry on war against the Imperial German Government; and . . . bring the conflict to a successful termination all of the resources of the country are hereby pledged.”1 Thus, the United States entered into the first world conflict in which Allied nations truly attempted to undertake a whole-of-government approach, with the aim of achieving unity of effort between its joint military forces, interagency communities, and intergovernmental entities. In addition, the Allied nations attempted to extend this coordination not only within their own governments but also among their Allies as well.

The new multidomain operations (MDO) concept, and its efforts to prepare the U.S. military for the next 25 years of conflict and beyond, will require the coordination of military forces across allied nations like never before. World War I offers a number of lessons on how to anticipate future conflict and prepare forces to operate within a rapidly developing operational environment. As part of this understanding, the military medical community must determine how it will conduct operations within future war theories before the onset of hostilities. Five areas are examined in this chapter to appreciate the lessons that can be gleaned from the Great War. First, the newly developing MDO concept and its link to World War I are discussed. Second, the conceptual visualization of the Great War is compared with today’s operational understanding of the battlefield. Third, the proper employment and marking of medical personnel, units, and equipment that were implemented during the conflict are examined. Fourth, the impact these medical practices had on later conflicts and their steady decline over the past years are scrutinized. Lastly, how medical units could be employed within the future MDO concept and the ethical challenge that it presents to military leaders are considered.

After World War I, the Surgeon General of the Army, Major General Merritte Ireland, commented on the difficulty of providing medical support during major combat operations. Ireland wrote that medical support during the war

was a complex and sometimes desperate matter, often hampered by lack of transportation facilities, by the impassable condition of roads boggy with mud or crowded with other vehicles, and by the generally torn up condition of the combat areas. It required the prompt mobilization of every kind of vehicle, such as ambulances, motor trucks, lorries and other rolling stock attached to the sanitary formations which move forward with the fighting divisions, as well as the establishment of evacuation hospitals and rest stations on the line of communications and of base hospitals and convalescent camps in the zone of the interior, with their own type of transportation, including ambulance service, hospital trains, hospital barges and hospital ships.2

This passage could literally be plucked from history and used to describe the challenges now facing the military medical community as it grapples to understand how it will fit within the new MDO concept and possible large-scale combat operations (LSCO) against a peer competitor. World War I can thus offer leaders a valuable case study in major combat operations when considering the proper employment of medical personnel, units, and equipment within ethical guidelines and law of war guidance.

The MDO Concept and Its Link to World War I

General David Perkins, USA, in his first of a series of articles published in Military Review to explain his concept of MDO, opens his discussion with links to the “open warfare” concept stressed by American Army General John Pershing at the eve of the U.S. entry into World War I. He explains the disconnect between the proposed doctrine and battlefield realities that the United States and its Allies struggled with throughout the war. This disconnect resulted in such heavy casualties that it “forced the combatants to realize that the lethality of rapidly firing artillery, machine guns, mortars—and later, gas, tanks, and aircraft—made tactics such as those advocated by Pershing’s open warfare doctrine almost suicidal.”3 This later resulted in Pershing commenting that “perhaps we are losing too many men” when beginning to reexamine U.S. doctrine in World War I.4

Establishing direct connections between the development of doctrine during the Great War and the new MDO concept is easy. In fact, General Perkins makes that same correlation throughout his three-part series of articles on MDO. He also makes the valid point that, unlike what was undertaken during World War I, present-day doctrine must not have change forced on it as “[c]reating new doctrine in the midst of large-scale combat is a costly endeavor because doctrinal tactics are devised using trial and error and are paid for in blood.”5 Spearheaded by General Perkins and others, the American military, rather than waiting for the future commencement of LSCO with a peer competitor, is beginning to discuss what the next fight will look like now. Essentially, the MDO concept “calls for ready ground combat forces capable of outmaneuvering adversaries physically and cognitively through extension of combined arms across all domains.”6 Currently, the domains are understood as land, sea, air, space, and cyberspace.7

General Perkins is, of course, not the only senior U.S. Army leader to recognize that a shift in our understanding of potential future conflict is necessary. The 39th Chief of Staff of the Army, General Mark Milley, gave a speech on the same topic. General Milley also linked what is presently occurring directly to the First World War:

In all the past cases of significant change in the character of war, the elements were all present prior to the war, but few if any ever realized their significance. . . . All the elements of World War I were visible in the Civil War, the Franco-Prussian War, the Boer War, the Russo-Japanese War, but very few understood their profound impact in the summer of 1914, as Europe slid over the abyss.8

In addition, the MDO concept is not being embraced or developed by the Army alone, as evidenced by a recent article co-authored by General Perkins and General James M. Holmes, USAF. In it, they discuss attempts to integrate and converge “land and air domain capabilities in order to create the merged multidomain capabilities that will be required for success in future combat.”9

The MDO theory is unique because it is still a developing concept that has only recently been officially codified in doctrine.10 As MDO continues to evolve, it is important to remember that it mainly “offers a hypothesis to inform further concept development, war-gaming, experimentation, capability development and culture change.”11 Technology and its application within the different domains is evolving so quickly that military leaders are wrestling with the impact it will have on future war. Because of this, World War I is closely linked to today’s developing MDO concept in preparing for possible future LSCO. Though the concept did not exist then, it is easy to overlay today’s definition of the different domains onto the Great War. Just like today, new technologies in aircraft, machine guns, naval ships, and electronic communications developed quickly just prior to and during the First World War, so much so that military leaders from the time period struggled to connect strategic, operational, and tactical doctrine to battlefield realties, which unfortunately resulted in massive casualties and disastrous results. Thankfully, today’s military leaders have realized the folly of adjusting and creating doctrine on first contact and are attempting to prepare for future war now.

Visualizing the Battlefield

The theater of operations in the First World War was divided into three main sections. Starting with the area closest to the enemy and moving back toward one’s home country, the sections were called the Zone of the Advance, Lines of Communication, and the Service or Zone of the Interior.12 Military medical apparatus in the Zone of the Advance, also called the Military Zone, consisted of aid stations, field dressing stations, and field hospitals, with casualties evacuated through these roles of care in that order.13 Within the area dubbed the Lines of Communication, which served as the “connecting link between the service of the interior and the zone of the advance,” there was a further subdivision into advance and base sections.14 The advance section included evacuation hospitals, and the base area was where the base hospitals would be established in Hospital Zones.15 Casualties were evacuated through the roles of care via the aid stations, field dressing stations, evacuation hospitals, and then finally the base hospital, where the highest level of care was located.16 Lastly, the Service of the Interior, usually a nation’s home territory, provided convalescent and general hospitals focused on the recovery and mobilization of troops.17

To compare the World War I conceptualization of the battlefield to today, current military doctrine must be examined. Recently, the Army issued updated doctrine regarding the understanding of the “physical arrangement of forces in time, space, and focus” within an area of operation (AO).18 This new doctrine, published in October 2017 in Field Manual (FM) 3-0, Operations, breaks down the AO into five main parts. Listed in order from closest contact with the enemy, they include the deep, close, consolidation, joint security, and strategic support areas.19 Looking at modern day roles of care starting from closest to the forward line of troops, the close area consists of role one and two assets mostly found in Brigade Combat Teams and several Echelon Above Brigade (EAB) units that provide direct support to the modular division and support to other EAB units. The consolidation, joint security, and possibly some in the strategic support areas contain role three assets that provide the most definitive level of care in theater. Role four facilities are located within the continental United States.20

As medical planners consider the Health Service Support (HSS) plan and layout of medical units, it becomes important to understand the different domains and how the AO is divided within the new MDO concept. Regardless of how the battlefield is conceptually visualized, it is important to understand, as was noted in a British World War I FM that is still applicable today within the MDO concept, that the “presence of a number of sick and wounded proves an encumbrance to a Commander, and since his mobility will be handicapped by being compelled to carry a number of unfit men, every effort is made to remove them to the lines of communication with all despatch.”21 Like Surgeon General Ireland’s comment, this doctrinal statement from the Great War is timeless and will never change, no matter what future warfare theory is presented.

Employment of Medical Personnel, Units, and Equipment

Just like combat forces, the military medical community in World War I had to quickly adjust to the new realities of warfare. Due to the deadly effectiveness of these newly implemented killing technologies and weapons of mass destruction, combined with the lowered standards of ethical thresholds on all sides regarding their employment, warfare soon resulted in massive casualties at a level never before experienced. As such, all nations had to aggressively adjust their HSS systems to safely and quickly clear the battlefield of wounded and sick in order to maintain morale and free combat forces to conduct operations. During the war, the United States and its Allies refined the proper markings of medical equipment, personnel, and units, setting a precedent for the world to follow through to the next world war and beyond. Properly marked personnel with arm brassards, red crosses on medical equipment and units, combined with a system of displayed lanterns in low visibility, all sought to enhance the protected status of HSS structures and evacuation routes in order to improve the survivability of patients on the battlefield.

The 1918 update to the U.S. Army’s Manual for the Medical Department stated that “all persons belonging to the sanitary service . . . attached to the Army wear on the left arm a brassard bearing a red cross on a white ground, the emblem of the sanitary service of armies.”22 At the time, the sanitary service was how the Army’s Medical Department was referred to. In addition, the manual decreed that “All sanitary formations display during daylight (reveille to retreat) the Red Cross flag. . . . At night the positions of sanitary formations are marked by green lanterns.” Lastly, “All materiel pertaining to the sanitary service is also marked with the Red Cross emblem, a red cross on a white ground.”23 The manual contained packing lists for different types of medical units in the Army. All of the lists included “Flag, distinguishing, Red Cross.”24

The clear marking of medical units and personnel was a survival technique that was discovered under combat conditions during the war. “Appendix A: Report on Organization, Equipment, and Functions of the Medical Department,” found in The Medical Department of the United States Army in the World War, discusses this in detail.25 These books, 17 volumes in all, were published during the 1920s under the direction of Surgeon General Ireland. They contain a plethora of lessons learned and tactics, techniques, and procedures (TTP) from the war that the Army Medical Department could study as it prepared for its next conflict. The appendix states, “Every hospital should be provided with a cross of white canvas . . . to be pinned firmly to the earth, preferably on green grass-before any other detail is given attention. . . . The adoption of this expedient saved many hospitals from enemy fire.”26 It then addresses the criticality of this marking: “The importance of placing this white cross before any part of the unit is erected lies in the fact that aerial observers take photographs in the daytime and bombing planes discharge their missiles by night upon any point indicated in the picture, unless this cross is observed.”27 Volume eight of the set concludes “that many hospitals were spared by enemy airplanes because of their being marked in the way indicated . . . bombing planes discharged their missiles against points indicated . . . unless the cross marking a hospital site was plainly observable.”28

Proper medical markings were not limited to medical facilities alone. Evacuation platforms were also clearly marked to include field ambulances and hospital trains. A TTP learned during the war was that “Each machine [ambulance] should have a large white cross painted on its top and a red cross on the sides, the color of the ambulance being khaki, against which background the red and the white crosses are emphasized. The white cross on top is necessary for protection against enemy aircraft.”29 Properly marking hospital trains were also discussed; these specially constructed railcars were crucial for transporting patients from evacuation hospitals back to the Hospital Zones: “The exteriors of the cars are the color of Army khaki, with the Red Cross of the Medical Department imposed upon the sides, roof, and at each end of the cars.”30

In addition to learning the importance of properly marking medical units and equipment to avoid destruction, the Army Medical Department grew to understand that a hospital’s location was directly related to survivability. The Army realized that “care must be exercised to avoid crossroads, which are targets for enemy artillery, and the vicinity of ammunition dumps or aerodromes, or the vicinity of railheads, factories, or conspicuous buildings that are on ground recently vacated by the enemy.”31 Furthermore, “advantage should be taken of existing buildings which do not offer a target. All selected sites will be conspicuously marked with a large white cross upon the ground upon a dark background to preclude damage by indirect fire following aerial observation.”32

None of this is meant to imply that by simply displaying a large red cross, protection was guaranteed for a medical unit. World War I frequently saw the enemy disregard the protections this marking was meant to provide. In addition, this protection is not realistic for medical units close to actual combat. In the war, it was common practice for aid stations close to the front to be instructed that in “modern combat every available cellar, dugout, or cave affording protection from shell fire must be made use of, and if the terrain does not afford such shelter first aid must be rendered in the open and the evacuation to a sheltered location by litter made as quickly as possible.”33 This same concept is recognized today as the “proximity to combatant” notion, which essentially means that the closer medical personnel and units are to combat “gives no just cause for complaint. Medical and religious personnel are deemed to have accepted the risk of death or injury due to their proximity to military operations.”34

Despite the understanding that medical units close to the front were at risk, it was generally accepted on all sides that those medical units clearly marked in the rear areas were to be respected; of course, this did not always occur. War diaries and primary sources are riddled with examples of proper markings being ignored. In his war diary, one man from Canada described a conversation he had with another after the initial bombing of the hospital he worked in: “There wasn’t a bed left standing. Luckily, we had removed most of the patients into the cellar—but those who were left are still there, buried in the ruins. ‘The usual German respect for the Red Cross!’ I commented bitterly. ‘The flag makes a good mark for their artillery,’ he returned, with a smile; ‘they always look for us.’”35 An American in the war recorded in his memoir, “the Boche [Germans] had bombed the hospital two out of the last three evenings. At first, they thought it a mistake, but when they kept it up it became apparent that there was no mistake. This is a big field hospital in white tents and lots of red crosses plainly visible. I have myself seen it from the air and you can see it more distinctly than anything in the neighbourhood.”36

Though incidents like this did occur, however, according to General Ireland, “On the signing of the armistice (Nov. 11, 1918), we had available in France for an army of a mean total strength of nearly two million, 261,403 beds, in 153 base hospitals, 66 camp hospitals and 12 convalescent camps.”37 This massive amount of large medical facilities from the Americans alone, some with 1,000 beds each, would not have survived on the battlefield without adherence to the guidelines, that is, posting them away from military objectives and properly marking them with a clearly definable red cross.

The Impact of World War I on the Future

All these medical TTPs and lessons learned during the war still guide law of war and ethical guidance for the employment and emplacement of military medical facilities and evacuation platforms, which is codified in international law and official U.S. doctrine. The well-known Geneva Convention, which refers to a set of agreements signed by numerous countries after World War II that established rules of war, contains numerous articles directly related to medical forces on the battlefield. However, Articles 19, 24, 39, and 42 are critical because they speak to the proper employment and markings of medical units that have an impact on the new MDO concept and FM 3-0. Signatories to the Geneva Convention and its protocols agreed to the following:

  • 1st Convention, Article 19: Fixed establishments and mobile medical units of the Medical Service may in no circumstances be attacked, but shall at all times be respected and protected by the Parties to the conflict. . . . The responsible authorities shall ensure that the said medical establishments and units are, as far as possible, situated in such a manner that attacks against military objectives cannot imperil their safety.38
  • 1st Convention, Article 24: Medical personnel exclusively engaged in the search for, or the collection, transport or treatment of the wounded or sick, or in the prevention of disease, staff exclusively engaged in the administration of medical units and establishments, as well as chaplains attached to the armed forces, shall be respected and protected in all circumstances.39
  • 1st Convention, Article 39: Under the direction of the competent military authority, the emblem shall be displayed on the flags, armlets and on all equipment employed in the Medical Service.40
  • 1st Convention, Article 42: The distinctive flag [red cross or other recognized emblem] of the Convention shall be hoisted only over such medical units and establishments as are entitled to be respected under the Convention. . . . Parties to the conflict shall take the necessary steps, in so far as military considerations permit, to make the distinctive emblems indicating medical units and establishments clearly visible to the enemy land, air or naval forces, in order to obviate the possibility of any hostile action.41

Despite international protocols and guidance as well as internal U.S. regulations, however, the Department of Defense (DOD) has witnessed the steady degradation of the proper marking of medical personnel and equipment, while America’s allies have largely maintained this standard. The Department of Defense Law of War Manual, last updated in December of 2016, supports the Geneva Convention articles and codifies the guidance to all DOD branches, which can then be found in Service-specific law of war field manuals and doctrine.42 Though the manual supports the conventions, it does contain one crucial caveat:

The display of the distinctive emblem is under the direction of the competent military authority. Thus, the military command may authorize the removal or obscuring of the distinctive emblem for tactical purposes, such as camouflage. Similarly, it would be appropriate for the distinctive emblem to be removed if it is assessed that enemy forces will fail to respect the emblem and seek to attack medical personnel; display of the emblem in such circumstances would not be considered “feasible” because in that instance it would not result in a humanitarian benefit. In the practice of the United States, removal or obscuration of the distinctive emblem has generally been controlled by the responsible major tactical commander, such as a brigade commander or higher.43

This stipulation has dominated the past 18 years of employment of medical units and personnel due to the nature of the adversaries faced, who typically do not respect any international standards. Unfortunately, this thought process continues to direct military medical and nonmedical planners regarding the deployment of medical units in consolidation areas. Though the DOD Law of War Manual allows for this proviso, it does caution that the “absence of the distinctive emblem may increase the risk that enemy forces will not recognize the protected status of military medical . . . and attack them in error.”44

Lastly, no official guidance has ever been issued to stop wearing the red cross brassard for medical personnel in combat areas. Once a common accoutrement to all U.S. military medical personnel, it has been removed from usage, though all U.S. allied medical personnel still wear it. In fact, the medical red cross brassard is still authorized for wear per official U.S. Army uniform guidance.45 It has become another victim of the past 18 years of counterinsurgency operations where, rightfully so, many believe that the wearer presents a target, as seen in Iraq and Afghanistan. Despite this, DOD has begun to reexamine the proper marking of medical personnel. To adhere with the international Geneva guidance that all medical personnel shall “carry a special identity card bearing the distinctive emblem” and that the “card shall be water-resistant and of such size that it can be carried in the pocket,” DOD now includes the red cross on identification cards.46 Beginning July 2014, DOD began to permanently “issue the Geneva Conventions Common Access Card with a red cross emblem to military personnel and DOD civilian employees in certain medical, medical auxiliary or religious occupational specialties.”47 This is a step in the right direction and something not done until now; previously, this card was issued before deployment as a slip of paper, if at all.

The Ethical Challenge

World War I witnessed numerous ethical and law of war challenges that included the harnessing of industrial technologies and the use of poison gas, both intended to create massive casualties. President Woodrow Wilson, in his address to Congress to obtain a declaration of war in April 1917, directly referenced historical attempts at establishing international laws of war that

had its origin in the attempt to set up some law which would be respected and observed upon . . . where no nation had right of dominion. . . . By painful stage after stage has that law been built up, with meagre enough results, indeed, after all was accomplished that could be accomplished but always with a clear view, at least, of what the heart and conscience of mankind demanded.48

Wilson went on to describe in detail the various ethical and law of war violations that Germany had committed during the war and declared that the “challenge is to all mankind.”49 According to Wilson, its enemies’ erosion of ethical and law of war standards was a root cause of America’s entry into the conflict.

The war itself presented numerous ethical dilemmas at all levels. Unrestricted submarine warfare, blockades aimed at starving civilian populations, ethnic-driven atrocities, and the use of horrendous weapons at the tactical level all presented ethical challenges that leaders had to wrestle with during the conflict. Today, as the United States emerges from over 18 years of conflict, it is struggling to posture itself for the next big potential fight. As General Milley declared, “We have dedicated significant time and resources to thinking about drivers of change, and the future operational environment, how warfare is changing and how we must adapt our doctrine, our organizations, equipment, training, and leader development.”50 The MDO concept is the driving conceptual framework through which the future of warfare is being considered. With this thought process, senior leaders must again consider and anticipate the ethical challenges that may occur over the next 25 years before they happen, rather than during the conflict, as was witnessed in World War I.

As a part of this forward thinking, it is crucial that the military medical community participates in the discussion. Currently, as the MDO concept is being presented, many military leaders believe that all units on the battlefield “will likely have to be small. They will have to move constantly. They will have to aggregate and disaggregate rapidly. They’ll have to employ every known technique of cover and concealment. In a future battlefield, if you stay in one place for longer than two or three hours, you’ll be dead.”51 This concept of deploying units directly conflicts with doctrinal and law of war guidance on how medical Echelon Above Brigade units are employed in the consolidation areas to provide Health Service Support. Even the newly designed field hospitals could not follow these criteria.52 World War I and its HSS plans, combined with its marking of medical units, equipment, and personnel, offer the perfect vehicle to study the employment of medical units within the new MDO concept. This raises a core ethical question: Do lessons from the First World War—for example, clearly positioning, marking, and employing medical units to enhance their survivability—still hold merit? Or is this an outdated concept and the only protection from deep strikes comes from smaller, nimble units that are camouflaged?


As America emerges from this recent period of conflict, it must look forward toward what may come next. Though this appears challenging, the U.S. medical community has done it before. In 1956, the U.S. Army Center of Military History, working with the Army Medical Department, published an exhaustive history of medical activities in World War II. Like the earlier accounts published in the 1920s, this one sought to enlighten Army medical personnel “who daily face policy and management problems similar to those recounted here.”53 By 1956, the Army had fought three major large-scale combat operations in the first half of the century: World War I, World War II, and the Korean War. It faced an uncertain future in a Pentomic Age and the Army Medical Department once again found itself trying to define its role as new combat doctrine was being developed to counter Soviet nuclear threats.

Interestingly, this new history of medicine described a direct link back to World War I medical doctrine and the interwar years, claiming, “The Surgeon General and his associates, like many others in the Army and the Government at large, found it difficult to break peacetime habits of thought and action in order to plan imaginatively for a second World War.”54 It discussed many of the TTPs from World War II and linked their development directly back to World War I.55 It concluded that this direct historical continuity between doctrine development, practical application, and lessons learned is

merely a reminder that the full meaning . . . can only be grasped if it is read with some knowledge of earlier events. Even without this background, however, readers who now or in the future are engaged in the work of hospitalization and evacuation should find much in the account to help them build on the achievements and avoid the pitfalls of the past.56

Fortunately, today’s senior military medical leaders are embracing new discussions and ideas informed by history on how to better employ medical assets on the battlefield.

The future of warfare is ambiguous and multifaceted; however, even General Milley concedes that within this uncertainty and complexity, one of the few things that the military must still deliberately plan for is medical support.57 As America shifts its focus to LSCO and the MDO concept, it is important to reexamine, as was done in World War I, the Geneva Convention articles and law of war guidance when considering medical support for future conflicts over the next 25 years. When determining how military medicine will be employed in the future within the MDO concept, senior leaders encounter the core ethical question: Do we adopt the lessons of the First World War and clearly position, mark, and employ our medical units so there is no mistaking what they are? Or do we attempt to camouflage them in the hopes that this will protect them from enemy deep strikes extending into the consolidation area?

The MDO concept and the perceived posture of possible adversaries are forcing the United States and its allies to reexamine ethical imperatives and law of war guidance when considering medical support for future conflicts. The First World War and the actions taken on all sides to mark and protect medical units and personnel before, during, and after the conflict offer numerous lessons for the United States and its allies. It should be studied by military professionals to discover the links between the doctrinal and conceptual changes that occurred before, during, and after the interwar years to truly understand the shift occurring today.

Today’s threats present the most significant readiness challenge to U.S. forces since the Cold War. As the United States shifts from stability and counterinsurgency operations and begins to consider the threats posed by near-peer competitors, such as Russia and China, it must examine the proper markings of medical units and personnel per international agreements and law of war guidance and form a commensurate medical posture with its allies. For each threat, America must determine prior to the advent of hostilities what protected posture its medical units will adopt within the MDO concept and LSCO. Entering a conflict with inadequately marked medical units or personnel will, due to mistargeting, result in massive disruption to the ability to provide care. In addition, regardless of whom America faces, its medical posture must be coordinated with its allies. To avoid learning costly lessons in the opening phases of hostilities with a near-peer competitor, the U.S. military must have this conversation now.


1 Joint Resolution Declaring War Against Germany, Pub. L. No. 77-331, 55 Stat. 796 (1941).

2 Merritte W. Ireland, The Achievement of the Army Medical Department in the World War: In the Light of General Medical Progress (Chicago: American Medical Association, 1921), 8.

3 David G. Perkins, “Multi-Domain Battle, Driving Change to Win in the Future,” Military Review 97, no. 4 (July–August 2017), 6, available at <>.

4 Ibid.

5 David G. Perkins, “Preparing for the Fight Tonight: Multi-Domain Battle and Field Manual 3-0,” Military Review 97, no. 5 (September–October 2017), 7, available at <>.

6 Multi-Domain Battle: Combined Arms for the 21st Century (Fort Eustis, VA: U.S. Army Capabilities Integration Center, January 18, 2017), available at <>.

7 Cross-Domain Synergy in Joint Operations: Planner’s Guide (Washington, DC: The Joint Staff, 2016), 5.

8 Mark A. Milley, “AUSA Eisenhower Luncheon, October 4, 2016,” available at <>.

9 David G. Perkins and James M. Holmes, “Multidomain Battle: Converging Concepts Toward a Joint Solution,” Joint Force Quarterly 88, no. 1 (January 2018), 54, available at <>.

10 The term multidomain operation first entered official doctrine with the publication of Field Manual (FM) 3-0, Operations (Washington, DC: Headquarters Department of the Army, October 2017).

11 Demand Reduction: Setting Conditions to Enable Multi-Domain Battle White Paper (Fort Eustis, VA: U.S. Army Capabilities Integration Center, February 21, 2018), 1.

12 Manual for the Medical Department, United States Army (Washington, DC: U.S. Government Printing Office, 1918), 177.

13 Ibid., 204, 210–211.

14 Ibid., 224.

15 Ibid., 225.

16 Ibid., 226.

17 Ibid., 194–197.

18 FM 3-0, 1–30.

19 Ibid.

20 FM 4-02, Army Health System (Washington, DC: Headquarters Department of the Army, 2013), 1–7, 1–10.

21 G.R.N. Collins, Military Organization and Administration (London: Huge Rees, Ltd., 1918), 272.

22 Manual for the Medical Department, 184.

23 Ibid.

24 Ibid., 270, 275, 283, 301.

25 Joseph H. Ford, The Medical Department of the United States Army in the World War, vol. 2, Administration American Expeditionary Forces (Washington, DC: U.S. Government Printing Office, 1927).

26 Ibid., 855.

27 Ibid.

28 Charles Lynch, Joseph H. Ford, and Frank W. Weed, The Medical Department of the United States Army in the World War, vol. 8, Field Operations (Washington, DC: U.S. Government Printing Office, 1925), 170.

29 Ford, Medical Department, 853.

30 Ibid., 888.

31 Ibid., 878.

32 Ibid.

33 Ibid., 882.

34 Department of Defense Law of War Manual (Washington, DC: Department of Defense, 2016), 458.

35 F. McKelvey Bell, The First Canadians in France: The Chronicle of a Military Hospital in the War Zone (New York: George H. Doran Company, 1917), 177.

36 Paul B. Hoeber, History of the Pennsylvania Hospital Unit (Base Hospital No. 10, U.S.A.) in the Great War (New York: By the Author, 1921), 142.

37 Ireland, The Achievement of the Army Medical Department in the World War, 7.

38 International Committee of the Red Cross, “Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. Geneva, 12 August 1949, Article 19.”

39 Ibid., “Article 24.”

40 Ibid., “Article 39.”

41 Ibid., “Article 42.”

42 Department of Defense Law of War Manual.

43 Ibid., 496.

44 Ibid., 496–497.

45 Department of the Army, Pamphlet 670-1, Guide to the Wear and Appearance of Army Uniforms and Insignia (Washington, DC: Headquarters Department of the Army, 2017), 231–232.

46 International Committee of the Red Cross, “Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. Geneva, 12 August 1949, Article 40.”

47 Amaani Lyle, “DOD to Include Red Cross Emblem on Some Common Access Cards,” DOD News, June 11, 2014, available at <>.

48 Woodrow Wilson, Address to Congress to Request Declaration of War Against Germany (Washington, DC: U.S. Government Printing Office, 1917), 3, available at <>.

49 Ibid., 4.

50 Milley, “AUSA Eisenhower Luncheon, October 4, 2016,” 8.

51 Ibid., 15.

52 For a discussion on the new Army Field Hospital, see Ellen Crown, “Army Combat Support Hospitals Converting to New Modular Field Hospitals,”, July 11, 2017, available at <>.

53 Clarence McKittrick Smith, The Medical Department: Hospitalization and Evacuation, Zone of Interior (Washington, DC: U.S. Army Center of Military History, 1956), ix.

54 Ibid., 6.

55 Ibid., xi.

56 Ibid., xi.

57 Milley, “AUSA Eisenhower Luncheon, October 4, 2016,” 16.