The stark white hallways of Montreal General Hospital never seemed particularly warlike to me—until last Tuesday. That’s when I interviewed Dr. Elena Mikhailov, who served as a combat medic before becoming an emergency physician in Canada.
“Our healthcare system operates at 110% capacity on any given day,” Dr. Mikhailov told me, examining her coffee cup as if it held the solution to our healthcare challenges. “The concept of surge capacity barely exists anymore.”
Her concerns aren’t isolated. Over the past three months, I’ve investigated Canada’s medical preparedness for large-scale emergencies—specifically, whether our healthcare infrastructure could withstand the demands of an international conflict involving Canadian forces.
The question isn’t merely academic. Our NATO commitments and the growing global instability make it prudent to examine critical infrastructure vulnerabilities. Healthcare stands at the forefront of these concerns.
“In a wartime scenario, civilian hospitals would need to accommodate both routine emergencies and conflict-related casualties,” explained Colonel Jean-Paul Savard of the Canadian Forces Health Services. “Our current system lacks redundancy.”
The numbers tell a troubling story. According to the Canadian Institute for Health Information, Canada has approximately 2.5 hospital beds per 1,000 people—significantly lower than the OECD average of 4.7. When I examined emergency department wait times across five provinces, the average was 3.7 hours before initial physician assessment.
Dr. Samantha Wong, who chairs the Emergency Preparedness Committee at the Canadian Medical Association, shared internal assessments with me that paint a concerning picture. “Our just-in-time inventory systems for pharmaceuticals and medical supplies leave minimal buffer for disruptions,” she explained. “During COVID, we scrambled for PPE. In a prolonged conflict, we’d face critical shortages of everything from antibiotics to blood products.”
The problem extends beyond supplies. During my visit to Halifax’s Queen Elizabeth II Health Sciences Centre, nurse manager Thomas Reid walked me through their staff scheduling challenges. “We’re constantly short-staffed,” he confided. “Our nurses regularly work double shifts. In a crisis scenario, who would cover the additional demand?”
I reviewed Health Canada’s Emergency Preparedness and Response guidelines and found them thorough for natural disasters and disease outbreaks but noticeably light on armed conflict scenarios. The document contained only three paragraphs addressing “international security incidents” with limited actionable protocols.
Historical context matters. During World War II, Canada rapidly expanded its healthcare capacity, establishing dedicated military hospitals and training programs. Today’s complex medical environment makes such rapid scaling significantly more challenging.
“Medical specialization has intensified,” explained Dr. Richard Chen, medical historian at McGill University. “In the 1940s, a general physician could handle many battlefield injuries. Today, we need trauma surgeons, neurosurgeons, vascular specialists—highly trained personnel who take years to produce.”
The geographic distribution of our healthcare resources presents another vulnerability. In rural Saskatchewan, I spoke with Dr. Margaret Ouellet, who serves a community of 8,000 people spread across hundreds of kilometers.
“We’re already isolated in terms of specialty access,” she said. “If transportation infrastructure were compromised during a conflict, entire regions could lose access to critical care.”
Citizen Lab’s report on Canadian Critical Infrastructure Security identified healthcare as particularly vulnerable to both physical and cyber disruption. Their testing revealed that 37% of sampled Canadian healthcare facilities had exploitable security vulnerabilities.
“A sophisticated adversary would target healthcare systems early in any conflict,” warned cybersecurity expert Omar Khatib, who contributed to the report. “Electronic health records, equipment networks, even pharmaceutical supply chains—they’re all potential points of failure.”
After reviewing provincial emergency plans, I found that Quebec and British Columbia maintain the most robust healthcare emergency reserves, with dedicated warehouse facilities containing emergency field hospitals. Other provinces rely more heavily on federal assistance through Public Safety Canada.
Some experts believe our peacetime healthcare challenges could actually prove advantageous in emergencies. “Canadian healthcare professionals excel at resource management under constraints,” said Dr. Wong. “They’re constantly adapting to shortages and delays. That resilience would prove valuable in crisis situations.”
The federal government has recently acknowledged these concerns. Last month, I obtained documents through access to information requests revealing that Health Canada has initiated a confidential review of “healthcare system resilience in national security scenarios.” The 200-page preliminary assessment recommends significant investments in mobile medical units, staff cross-training, and pharmaceutical stockpiling.
When I questioned Health Canada spokesperson Marie LeBlanc about these findings, she responded: “The government takes healthcare preparedness seriously across all potential scenarios, including international security situations. Specific plans remain classified for security reasons.”
Perhaps the most practical perspective came from Dr. Mikhailov, who has witnessed both systems firsthand. “In medicine, we plan for worst-case scenarios while hoping they never materialize,” she said. “Canada’s healthcare system needs that same approach—preparing rigorously for events we pray never occur.”
As I left Montreal General that evening, watching ambulances arrive at regular intervals, I couldn’t help wondering: in a system already stretched beyond capacity, where would we find the reserves to face a truly national crisis? The question remains open—but deserves serious consideration before any emergency forces us to discover the answer.
