SOVIET CIVIL DEFENSE: MEDICAL PLANNING FOR POST ATTACK RECOVERY

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP85T00313R000200030007-2
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 29
• Document Creation Date: December 22, 2016
• Document Release Date: July 29, 2009
• Sequence Number: 7
• Publication Date: July 1, 1984
• Content Type: REPORT

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Directorate of Secret
Intelligence
Soviet Civil Defense:
Medical Planning
for Postattack Recovery
A Research Paper
NGA Review
Completed
Secret
SOV 84-10101X
July 1984
Copy 2 4 9
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Directorate of Secret
Intelligence
Soviet Civil Defense:
Medical Planning
for Postattack Recovery
This paper was prepared by
Office of Soviet Analysis. Comments and queries are
welcome and may be directed to the Chief,
Strategic Forces Division, SOYA, on
Secret
SOV 84-10101 X
July 1984
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Soviet Civil Defense:
Medical Planning
for Postattack Recovery
Key Judgments Medical planning for the period following a nuclear attack is part of the
Information available Soviets' overall civil defense effort and includes various measures for the
as of I April 1984 treatment of the leadership, essential work force, and general population.
was s used in this report.
According to Soviet unclassified writings, it emphasizes the training and
protection of medical personnel, stockpiling of medical reserves, mobiliza-
tion of the Civil Defense Medical Service for wartime operations, and
evacuation and relocation of urban medical facilities
in the preattack period, medical and paramedical 25X1
personnel would be mobilized by the Civil Defense Medical Service, and
urban medical facilities would relocate or evacuate their patients. The
Medical Service would then deploy to exurban areas to assist in the
evacuation of the work force and general population. Medical assistance in
the postattack period would consist of a two-stage evacuation of casualties
from target areas-during the first stage, emergency treatment would be
given by first aid detachments deployed close to the areas targeted, and
during the second stage, more specialized treatment would be given in base
hospitals located farther away. 25X1
Soviet medical planning and Soviet 25X1
civil defense medical texts indicates that:
? Emergency relocation and evacuation plans exist for many medical
facilities.
? Extensive measures have been taken to provide trained medical and
paramedical personnel for the Civil Defense Medical Service.
? Measures have been taken to facilitate mobilization of personnel,
transportation, and equipment for civil defense medical use during
wartime.
? Large stockpiles of medical supplies for civil defense exist throughout the
USSR.
? The USSR has 44 underground medical treatment and storage facilities,
primarily in urban areas and designed to provide for limited treatment of
patients and protection of some medical stockpiles.
? The Soviets routinely conduct civil defense training and exercises for
medical personnel.
? Shelters, designed to protect medical personnel from the immediate
effects of nuclear weapons, exist at many urban medical facilities.
Secret
SOV 84-10101 X
July 1984
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The Soviets have invested heavily in planning, training, conducting limited
exercises, and in providing personnel for the Civil Defense Medical Service.
Nonetheless, they still face uncertainties about the ability of the Service to
carry out its mission. We have seen no major integrated exercises that
would demonstrate the effectiveness of the system. Moreover, the length of
time medical stockpiles could last under conditions of nuclear war and the
circumstances in which nuclear war might occur remain intractable issues.
In 1979 we estimated that Soviet wartime casualties would range from 35
million to 125 million depending upon civil defense preparations and other
factors. (The figures will be updated in an interagency study to be
completed later this year.) Although medical preparations for civil defense
are extensive, the Civil Defense Medical Service could easily be over-
whelmed by casualties if the Soviets had little time to prepare or decided
not to implement civil defense measures before an attack.
The Soviet leadership probably believes that civil defense medical planning
enhances the prospects for the USSR's postattack recovery, as it would
reduce fatalities among all segments of the population, given adequate
warning time.
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Contents
Key Judgments
Peacetime Planning
Training
Sanitary-Epidemiological Operations 7
Underground Medical Facilities 10
A. Medical Facilities With Emergency Plans
B. Civil Defense Medical Storage Locations
C. Underground Medical Facilities
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Soviet Civil Defense:
Medical Planning
for Postattack Recovery
Introduction
In a nuclear war the number of surviving injured is
likely to equal or exceed the number of those killed
immediately. Tens of millions of casualties could
require medical treatment in the postattack period.
According to Soviet unclassified writings, the stated
objective of the Soviet civil defense program is to
provide sufficient medical resources for the protection
of the population and treatment of the massive num-
ber of civilian casualties expected. Civil defense mea-
sures designed to "eliminate the medical conse-
quences" of nuclear, biological, or chemical weapons
are:
? Mobilization of civil'defense medical personnel and
facilities for treating mass casualties.
? Special civil defense training for all medical
personnel. .
? Provision of emergency medical supplies and
transportation.
? Organization of sanitation and epidemic control
teams to prevent the onset of infectious diseases.
? Medical evacuation of casualties from urban areas
to relocated hospitals.
? Protection of medical personnel through sheltering.
Soviet medical manuals on civil defense estimate that
the total loss of life in urban areas could reach 50 to
60 percent without sheltering. We have no reliable
information, however, on what the Soviets estimate
the total number of civilian casualties could be in a
nuclear war. In 1979 we simulated the effects on the
Soviet population of a hypothetical retaliatory attack
by US forces under different alert conditions.' The
primary purpose of the simulation, which we are
updating, was to assess the effectiveness of Soviet civil
defense in reducing the magnitude of Soviet casualties
in a nuclear war. For the purpose of analysis, we
assumed three different levels of civil defense prepara-
tion: little to none, sheltering only, and full sheltering
and evacuation of urban centers. The population was
neither specifically targeted nor avoided. Our assess-
ment indicated that estimated Soviet casualties from
prompt nuclear weapons effects and fallout would
range from about 35 million (including 14 million
fatalities) to 125 million (with 105 million fatalities)
depending on the level of civil defense implementation
and stage of US alert. Casualties from long-term and
secondary effects were not included (see table 1).
The Soviets' recovery from a nuclear war is heavily
dependent upon their ability to provide postattack
medical support to all sectors of the population. Our
analysis of the available information indicates that
the Soviets have invested heavily in planning, train-
ing, conducting limited exercises, and in providing
personnel for the Civil Defense Medical Services.F_
This paper discusses Soviet plans for mobilizing, 25X1
protecting, and deploying medical resources for civil
defense and assesses their potential effectiveness. It
includes recent information on the scope of emergency 25X1
planning for individual medical facilities, the role of
military commissariats in medical resource allocation,
protection of medical personnel, medical storage loca-
tions, and underground medical facilities
Peacetime Planning
Soviet civilian medical resources are controlled in
peacetime by both the Ministry of Health and the
Ministry of Medical Industry. The Ministry of Health
manages treatment facilities-hospitals, polyclinics,
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Table 1
Estimate of Soviet Casualties and Fatalities
From a Hypothetical US Retaliatory Attack
Civil Defense Preparations US Forces on
Generated Alert
Shelters and best protective structures
occupied
Full sheltering; evacuation of 90
percent of 300 cities
and small dispensaries-through departments of
health at different administrative levels. It also super-
vises the extensive network of sanitary and epidemio-
logical stations located throughout the USSR. The
Ministry of Medical Industry is responsible for the
manufacture of pharmaceuticals and medical equip-
ment and supervises medical stockpiles (see figure 4).
US Forces on
Day-to-Day Alert
115 75
95 55
35 14
medical manpower, training, and transportation re-
quirements of the military with those of the Civil
Defense Medical Service. We believe they are at-
tempting to resolve this problem by combining mili-
tary commissariats and civil defense staffs.
Military commissariats are administrative organiza-
tions subordinate to the administration of the military
district within which they are located. Their activities
include supervising preinduction military training and
indoctrination, issuing callups for military service and
reserve training, maintaining records on reservists,
and issuing deferments. They also are responsible for
registering national economic resources suitable for
military needs, conducting partial or general mobili-
zation, and allocating civilian transportation for mili-
The Civil Defense Medical Service is one of several
services under the Defense Ministry's Main Director-
ate of Civil Defense. In peacetime the Medical Serv-
ice consists primarily of staff personnel responsible for
coordinating the civil defense efforts of the Ministries
of Health and of Medical Industry. At all administra-
tive levels of the Ministry of Health and probably the
Ministry of Medical Industry are Second Depart-
ments responsible for integrating plans for conversion
to wartime operations, formulating doctrine, and con-
ducting civil defense medical exercises. Soviet medical
facilities also have a Second Department headed by a
physician responsible for planning and coordinating
civil defense training and mobilization. Upon mobili-
zation, the medical assets of the Ministry of Health
would become part of the Civil Defense Medical
Service.
Because medical personnel and resources are limited,
both the armed forces and the Civil Defense Medical
Service compete for many of the same resources. The
Soviets, therefore, face the problem of balancing the
tary purposes during mobilization.
military commissariats
also play a role in the civil defense training, classifica-
tion, and assignment of medical personnel and in the
allocation of civilian transportation for civil defense
needs. In 1978 the civil defense staffs of the Baltic
republics, for example, were placed under the control
of military commissariats. If such subordinations are
the norm, they may be intended to balance the
mobilization requirements of the armed forces with
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those of civil defense, including eliminating the possi-
bility of conflicting assignments of medical resources
that might occur with separate civil defense and
commissariat staffs.
The Central Military Medical Directorate of the
Ministry of Defense's Rear Services controls active
duty and reserve medical personnel distinct from
those allocated to the Civil Defense Medical Services
by the military commissariats. Unclassified Soviet
civil defense medical texts discuss the use of military
medical resources for civil defense purposes in the
postattack period. Although the primary mission of
the military medical service is to support the military,
we believe that some of its personnel and medical
stocks may be available for civil defense. Military
civil defense regiments also have limited medical
treatment capabilities and could treat some civilian
casualties in wartime. The Civil Defense Medical
Service probably coordinates the use of military medi-
cal resources with the Central Military Medical Di-
rectorate during wartime.
Training. Almost all Soviet medical personnel receive
extensive military and civil defense instruction at
medical training institutes. A four-year combined
military and civil defense training program at the
State Medical Institute of Alma Ata is typical. Civil
defense training at the Institute is mandatory for both
males and females, and the courses include combined
instruction in basic military subjects and civil defense
topics. Among the civil defense topics taught are the
treatment of nuclear, biological, and chemical casual-
ties and the use of protective clothing. In some cases
traditional military instruction is emphasized for men,
while training for women concentrates on civil defense
topics
Civil defense medical training also is given at other
specialized institutes. an
extensive mandatory training program for nurses at
the Vilnius Pedagogical Institute. The program fea-
tured two semesters of civil defense training and three
semesters of medical training. Upon graduation, stu-
dents were assigned to the military reserves as nurses
by the military commissariat. A similar program also
exists at the University of Uzhgorod. In addition,
military commissariats generally supervise first aid,
civil defense, and premilitary training of Soviet youths
in the Voluntary Society for the Cooperation of the
Army, Air Force, and Navy (DOSAAF).
Postgraduate civil defense training of medical person-
nel is usually provided for by military commissariats
and civil defense staffs. For example, some medical
personnel are assigned to a course for resident physi-
cians taught at the Balashikha civil defense school in
Moscow Oblast. The course is taught twice a year and
lasts about six weeks.
between 40 and 50 physicians graduate from the
course each year. They probably are then assigned to
military civil defense units. In some areas, military
commissariats recall medical personnel to active duty
every five years to receive two weeks of civil defense
training. The training normally is conducted at the
commissariat headquarters by full-time personnel
from the commissariat's medical section.
Civil defense medical training also is given at urban
medical facilities the
amount of civil-defense-related medical training given
at Soviet medical facilities varies; however, the report-
ed norm is between 50 and 60 hours a year. The
training is planned by the hospital civil defense chief
and usually consists of classroom instruction on the
organization of the Civil Defense Medical Service and
general topics dealing with treatment of injuries
associated with nuclear, biological, and chemical war-
fare. In addition, medical training for civil defense
paramedical personnel in factories, schools, institutes,
and similar enterprises usually is given by hospital
civil defense instructors and Red Cross/Red Crescent
Society volunteers.
The general population also receives civil defense
medical training at workplaces, schools, and during
military service. This training usually includes basic
first aid, such as treatment for burns, artificial respi-
ration, splinting of broken bones, and treatment for
shock. Training for the general population also in-
cludes preventive measures to reduce casualties after
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a nuclear exchange-for example, how to use protec-
tive masks and radiological and chemical measuring
devices, decontamination, and general instruction on
the effects of nuclear weapons.
Exercises. Training through exercises appears to be
uneven. many medical
facilities do in fact hold semiannual or annual exer-
cises for paramedical teams. They are usually super-
vised by personnel from military commissariats and
civil defense staffs. a 30-
day mobilization exercise called by the Odessa mili-
tary commissariat. The exercise included setting up a
Civil Defense Medical Service first aid detachment
(OPM) and instruction on general civil defense topics.
a civil defense
medical exercise with about 1,000 participants in
Tokmak in the Kirghiz SSR.
medical facilities do not engage in field training
exercises. For example, the All-Union Oncology Re-
search Center of the Academy of Medical Science in
Moscow plans to relo-
cate to a state farm in Pyshlitsy-never has partici-
pated in civil defense exercises or practiced relocation.
Lack of field training at medical facilities could result
in severe problems with carrying out relocation plans
in wartime. Although we have evidence that small-
scale civil defense medical exercises are widespread
throughout the USSR, we have no information that
the Soviets have conducted a comprehensive integrat-
ed medical exercise to test the entire civil defense
medical network. Not having run such exercises, the
Soviets cannot be certain about the ability of the
system to accomplish its mission in wartime
Mobilization. Urban medical facilities,
are part of an elaborate mobilization-
alert notification system maintained by the local civil
defense staffs and operated in conjunction with mili-
tary commissariats. In Riga, for example, doctors on
duty in local hospitals are required to telephone the
Riga civil defense staff once an alarm in the hospital
duty office sounds. The duty doctor then alerts the
hospital civil defense chief and the rest of the hospital
staff. When alerted, the hospital civil defense chief
coordinates hospital mobilization with the civil de-
fense staffs, military commissariats, and those facili-
ties, institutes, and schools, which may augment the
mobilized hospital with paramedical personnel. We
believe that mobilization of Soviet medical facilities is
initiated by the military commissariats and, like other
civil defense activities, is governed by changes in
Soviet armed forces readiness levels]
Wartime Organization
Soviet unclassified literature devotes much attention
to the wartime organization of the Civil Defense
Medical Service. We think that the Medical Service
would exercise operational control in wartime over the
medical assets of the Ministry of Health, the Ministry
of Medical Industry, DOSAAF, and the Red
Cross/Red Crescent Societies. We believe it also
probably would coordinate the allocation of medical
resources with the Central Military Medical Director-
ate during wartime.
The wartime structure of the Civil Defense Medical
Service would be based on the organization and
personnel of the Public Health Departments and
medical facilities at each administrative level under a
system of dual subordination. During wartime the
director of the local Public Health Department would
become the head of the Civil Defense Medical Service
for the area concerned and a member of the local civil
defense staff.
Treatment and Evacuation of Casualties. The Civil
Defense Medical Service has developed an elaborate
plan for medical o erations in the event of a nuclear
attack. unclassified civil defense
literature disclose that the plan is based on two stages
of treatment and evacuation. During the first stage,
first aid and emergency treatment would be given in
or near zones of destruction; during the second stage,
evacuation to specialized hospitals in a hospital-base
area outside the target zone would take place (see
figure 1).
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Figure 1
USSR: Concept of Medical Treatment in the Period Following
Nuclear Attacka
99
(1) Zone of possible destruction
9 Evacuation receiving center JERCI
(2) Zone of light destruction
t7 Ambulance water transport
(3) Zone of average destruction
Ambulance motor transport
-
(4) Zone of severe destruction
V
= Motor transport casualty loading point
(5) Zone of total destruction
(6) First-stage medical evacuation
(7) Exurban zone
4r Ambulance train
(8) Second-stage medical evacuation
Lead hospital ILHI
(9) No 2 hospital collection point
Specialized hospital (neurosurgery)
Hygiene team
Medical distribution point [MDPI
4
Detachment of hygiene teams
~
~
y
P9
Rescue detachment [RD[
Hospital-base administration [HBA[
LJ
Medical platoon
+"r" Assembly point for the slightly wounded
L __J
Intact city hospital
Casualties sent from MDP to hospital
collection points
rr
L__.J
Intact city polyclinic
0 Transportable casualties sent from SEH
E
[screening-evacuation hospital[ (LH) screening
to specialized hospitals
O
Casualties needing immediate specialized
assistance, nontransportable casualties
? Screening-evacuation hospital screening area
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In the first stage, first aid detachments (OPMs) would
deploy to exurban areas after mobilization to consti-
tute medical treatment facilities. An OPM comprises
physicians, nurses, and paramedical personnel who
would sort casualties and provide emergency lifesav-
ing services, including decontamination of those ex-
posed to radiation and limited hospitalization for the
seriously injured. Casualties would be tagged accord-
ing to the extent of the injuries, treated, and then, if
their injuries required more specialized treatment,
evacuated to base hospitals. An OPM is designed to
handle about 300 casualties a day. OPMs would be
deployed in uncontaminated areas as close as possible
to target areas; they are heavily dependent upon
radiological reconnaissance to avoid areas that are
severely contaminated or in the path of fallout.
Soviet civil defense plans call for urban hospitals to
provide cadres for OPMs, each with approximately
150 personnel, of which 25 would be doctors. Large
hospitals would provide cadres sufficient for two
OPMs, while smaller hospitals and polyclinics would
provide cadres for one. Soviet planning also calls for
the OPM to be augmented by teams of paramedical
personnel from factories, institutes, and similar enter-
prises. In Kiev alone, we have reporting on 40 desig-
nated OPMs, each requiring augmentation by 125
paramedics.
The OPMs are to deploy and direct the operation of
the medical teams, each consisting of approximately
24 paramedics who are students, workers, and mem-
bers of the Red Cross/Red Crescent Societies. These
teams would deploy to severely damaged areas, where
they would receive casualties from civil defense rescue
detachments and give first aid; then they would
transport the seriously injured to the OPM, which
would give more extensive medical care. For example,
the All-Union Scien-
tific Research Institute for the Transport of Natural
Gas in Kiev had two medical teams, each with four
five-member squads. Upon mobilization one team
would report to the Leninskaya Regional Hospital in
Kiev; the other would aid evacuees and victims in or
near potential zones of destruction.
In the second stage, specialized medical care would be
given to casualties who had received emergency care
from OPMs. This care would be given in hospital
bases formed from the more specialized hospitals and
medical research and training institutes, which would
have relocated to exurban areas. These bases, with
specialized surgical sections for treating severe inju-
ries, would be directly subordinate to oblast or kray
civil defense medical services. Soviet unclassified
sources assert that these bases could be as far as 10 to
12 hours' travel time from OPMs.
A hospital base would include six to eight hospital-
collection points. Each hospital-collection point would
include a main hospital, casualty-collection points,
and hospitals that specialize in various categories of
injury. Collection points that are nearest the target
areas also would have a special sorting and evacuation
hospital. Less critically injured patients, who could be
discharged or transferred to their homes, probably
would be released upon order of the Civil Defense
Medical Service, freeing as many beds as possible.
Casualties would be received and sorted at the sorting
and evacuation hospital, medical distribution points,
and evacuee reception points along access routes to
the base area. After sorting according to injury and
verification of the information on medical tags pre-
pared at the OPM, casualties would be distributed
among the hospital-collection points. The Soviets
would attempt to colocate hospital-collection points so
patients could be evenly distributed among main
hospitals.
At the main hospital, the seriously wounded-that is,
those with multiple injuries including radiation expo-
sure-and those with contagious diseases would be
hospitalized and treated. The main hospital is essen-
tially a general hospital with additional assets for
nuclear decontamination and shock treatment. Pa-
tients requiring treatment not available at the main
hospital would be assigned to one of the specialized
treatment hospitals, which are the principal therapeu-
tic institutions of the collection point.
Although the OPMs probably could give rudimentary
first aid to large numbers of casualties, we believe
that the Soviets face significant uncertainties about
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the provision of more specialized medical care in the
postattack period. Delays in transporting casualties
from the OPMs to hospital bases could result in many
fatalities. Moreover, the collection points at hospital
bases could be overwhelmed with casualties during
the medical evacuation. Shortages of trained person-
nel, medical supplies, or equipment in hastily estab-
lished hospital bases could cause additional problems.
Sanitary-Epidemiological Operations. Sanitary-epi-
demiological units (sanepids) also would play a key
role in Soviet civil defense medical operations. Sane-
pids are administered in peacetime by the Ministry of
Public Health. Their peacetime responsibilities are
innoculating and vaccinating the general public; in-
sect and rodent control; water, dairy, and meat moni-
toring; and industrial and community hygiene. They
usually are equipped with mobile laboratory and
inspection equipment and are normally headed by a
physician.
would:
? Support OPMs and base hospitals in exurban areas
and provide preventive health care.
? Be responsible for mass immunizations of the popu-
lace to curb infectious diseases that could result
from radiation-induced suppression of the body's
immune system.
? Ensure that massive amounts of uncontaminated
water would be available for OPM and hospital base
operations.
? Supervise the disposal of corpses and of large
amounts of human waste to prevent the spread of
infectious diseases.
Sanepids from large urban areas would specialize.
For example, in Kiev the Shevchenko Rayon sane-
pid is to be the headquarters
for rayon epidemic control. Another sanepid would be
responsible for waste control, while a third would
manage the disposal of corpses.
Kiev sanepids maintain current deploy-
mentand sufficient equipment to carry out their
assigned wartime missions.
The Soviets face significant uncertainties about the
ability of these teams .to carry out their assigned
wartime tasks. For example, during the Sverdlovsk
anthrax epidemic of 1979, sanepids ultimately were
able to control the spread of disease, but the level of
effort was quite large for the size of the outbreak-
That sanepids would
have such large resources available to them in the
postattack period is unlikely. Similarly, sanepids have
been only partially successful in controlling epidemics
in Afghanistan. In the aftermath of large-scale nucle-
ar exchanges, sanepids might be of limited effective-
ness in coping with the outbreak of infectious diseases.
113 Soviet medical facili-
ties located in 26 cities plan to evacuate or relocate to
exurban areas in wartime. Of these, 37 plan to
evacuate while 76 plan to relocate. It is likely, howev-
er-because of the premium on trained medical per-
sonnel during a nuclear war-that all urban medical
facilities would provide cadres for first aid detach-
ments and hospital bases rather than merely evacuate
personnel together with the patients. The presence of
emergency relocation and evacuation plans at these
medical facilities indicates that the Soviets are active-
ly preparing for treatment and evacuation of casual-
ties and sanepid operations in wartime.
Soviet medical facilities appear to be accorded a
relatively high priority in evacuation and relocation
operations. Unclassified Soviet civil defense medical
manuals assert that relocated medical facilities would
assist in the dispersal or relocation of the essential
work force and the evacuation of the general popula-
tion. Given adequate warning time, we believe that
civil defense medical facilities probably would relo-
cate after the leadership had relocated to exurban
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command posts, but before the dispersal, evacuation, 25X1
or relocation of the other segments of the population
(see figure 2 and appendix A).
A major problem for the Soviets is providing suffi-
cient building space in which relocated medical facili-
ties could operate. some
schools, such as the Lopukhin pecia cool outside
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Figure 2
USSR: Medical Aid to the Population During Dispersion and
Evacuation'
(1) Train terminal
(2) Motor-transport center
(3) Plant
(4) Docks
(5) Exurban zone
(6) Oblast, kray, or republic boundary
First-aid station
Physician immediate aid station
Foot route No 1
Evacuation assembly point
Intermediate evacuation point
Evacuation receiving points
1. City
2. Zone of possible destruction
3. Regions for locating dispersed workers and
employees
4. Places for locating evacuated people
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Leningrad, have been designed for conversion to
emergency medical facilities during wartime. The
design includes special electrical wiring, garage areas
suitable for ambulances, and living areas that would
become patient wards. Dual-purpose design of educa-
tional and other buildings could provide a large
amount of space for relocated hospitals. We are
unsure how many buildings incorporate such designs,
however.
Personnel Allocation and Protection
In peacetime, medical personnel generally are either
inducted into the armed forces upon graduation or are
issued reserve military service booklets
Each booklet, issued by military commissari-
ats, contains a military specialty code, reporting loca-
tion upon mobilization, and other service-related in-
formation. Military medical personnel upon
completion of active duty are issued similar booklets.
Although the Soviet law on universal military service
varies the reserve retirement a e according to rank,
sex, and length of service
military commissariats generally carry male
medical reservists on military reserve rosters until age
55, when they are assigned permanently to civil
defense reserves. Female medical reservists usually
are assigned to civil defense reserves at age 50.1
We are uncertain as to the number of medical
personnel that would be allocated to the armed forces
and civil defense after mobilization, but some would
be available for civil defense after the needs of the
armed forces were met. Even though the primary
mission of medical personnel would be to support the
military, some medical
reserve personnel might be assigned to civilian hospi-
tals after mobilization
We estimate that the total number of medical person-
nel available to both the Soviet armed forces and civil
defense in wartime would be about 4.0 million. There
are approximately 1.1 million doctors in the USSR
(see table 2); there are about 2.9 million medical
personnel including feld'shers (physician's assistants),
nurses, midwives, laboratory technicians, medical or-
derlies, and other assistants. We have no reliable
figures for medical workers by category since those of
1975, when about 17 percent were Feld shers, 50
percent were nurses, and 33 percent were technicians,
Table 2 Thousand persons
Soviet Physicians, by Specialty
Surgery
115
Obstetrics/gynecology
62
Pediatrics
120
Ophthalmology
21
Ear, nose, and throat
21
Neurology
26
Psychiatry
25
Tuberculosis
23
Dermatology
18
Epidemiology
61
Stomatology
92
Dentistry
48
General practitioners
153
Total a
1,063
Medical personnel are a key resource for postattack
recovery. Consequently, protecting them in wartime
would be a priority of civil defense. We have identi-
fied or have reporting on 91 medical facilities with
personnel shelters. We believe that these shelters are
designed primarily to protect medical personnel when
warning time is inadequate to allow for relocation or
evacuation of the medical facility. In medical facili-
ties with limited shelter space, we believe that medical
personnel would have priority over patients.
Transportation
The military and civil defense compete for transport
as well as for medical personnel. During mobilization,
the Soviets plan to draw transportation assets from
the civilian economy to meet the needs of the armed
forces and civil defense; allocations of transport would
be made through the military commissariats
midwives, or other medical personnel.
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of Motor Transport would transfer 30 percent of its
heavy trucks, 30 percent of its lifting machinery, and
70 percent of its fuel-carrying vehicles to the military.
Most of the rest would be available for use in civil
defense. We believe that, on completion of mobiliza-
tion, the military commissariats would make addition-
al transportation assets available for the medical
evacuation and supply of civilians. Military commis-
sariats also maintain rosters of civilian ambulances to
be mobilized in wartime
We estimate that the USSR has approximately
681,000 buses; 86,000 were built in 1982 alone.
Although some of these buses would be used to
support the military, many probably would be avail-
able for civil defense. Modification kits for converting
buses to ambulances have been available since at least
1977, but we are uncertain as to the numbers and
locations of these kits. The conversion process, report-
edly requiring four to six hours, involves the addition
of litters and medical equipment and the painting of
windows. Once converted, a bus can accommodate 10
to 20 stretchers.
Soviet unclassified sources also mention the use of
special ambulance trains and water transport to evac-
uate casualties. However, we have no information on
the extent of planning for use of these transportation
assets by the Civil Defense Medical Service in war-
time
Medical Reserves
The Soviets have extensive stockpiles of medical
equipment and supplies for civil defense
These range
from simple first aid kits stored in personnel shelters
to wartime pharmaceutical stocks kept in medical
depots. Most of the first aid kits are A- 12 medical kits
that contain basic supplies, antibiotics, painkillers,
bandages, and stretchers. Such kits are carried by the
OPM medical teams. Many shelters are stocked with
first aid kits, but not all are equipped with medical
stocks. In the late 1970s, the Soviets apparently
changed shelter guidelines and deleted the require-
ment for medical kits. Those now in shelters may have
been there before the change in criteria; however, a
more likely explanation is that they are part of the
equipment that a medical team would carry when it
joins its designated OPM.
Medical treatment facilities are required to maintain
a two-to-three-day supply of medical stocks for emer-
gency use only. They are generally stored in hospital
basements and are required to be rotated periodically.
Warehouses and pharmacies also are required to
maintain emergency stocks for treatment of chemical
and biological casualties as well as other essential
wartime medicines; they probably have wartime plans
to provide medical supplies to relocated hospitals.
there are special civil defense
medical reserve supply depots only for wartime use.
Outside Odessa there are three groups of wartime
reserves capable of supporting 7,500 patients in relo-
cated hospitals. The Odessa stocks reportedly are
under the direct control of the civil defense depart-
ment of the Ministry of Public Health.
Although the Soviets maintain extensive medical
stockpiles, we are uncertain as to how long these
supplies would last under conditions of nuclear war.
Even during peacetime the Soviets experience periodic
shortages of medical supplies in certain areas, and
stockpiles in other areas are not inspected and rotated.
Also, Soviet medicines generally are of a lesser quality
than those commonly found in the West. Moreover,
certain drugs, available only from Western sources,
presumably would be unavailable to the Soviets dur-
ing wartime.
Underground Medical Facilities
44 underground medical facili-
ties located primarily in urban areas. Most are mod-
estly equipped dispensaries in special basement-type
shelters in hospitals and polyclinics. Others have
extensive underground facilities. The Odessa Region-
al Clinical Hospital's facility was constructed in 1967.
It reportedly has 25 to 30 small treatment rooms,
contains reserve medical supplies and equipment, is
connected to the main building by a network of
underground passageways, and is hermetically sealed.
underground portions of this hospital also are connect-
ed by subterranean passageways (see appendix C).
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some exurban underground
medical facilities designed to support the evacuated
urban population. For example, a
hospital under construction in a mountain outside
Dushanbe; it is to support the civilian population of
the city after evacuation. Other underground medical
facilities are designed as storage depots for wartime
medical reserves.
reserve hospitals, equipped with medical supplies
and underground facilities, are maintained by cadre
staffs solely for wartime use by the Civil Defense
Medical Service.
Although our evidence indicates that a large number
of urban hospitals plan to relocate or evacuate in
wartime, we believe that the urban underground
medical facilities are designed to provide limited
medical support for the leadership, essential work
force, and other personnel who must remain in these
areas during wartime. These facilities also serve as
shelters for medical personnel who may not be able to
evacuate or relocate in wartime. Exurban facilities are
designed to serve casualties who would be evacuated
from Soviet cities and to afford additional protection
against radioactive fallout. Although we have report-
ing on only 44 such facilities, we believe that many
more exist.
Implications
The available evidence indicates that the Soviets have
taken extensive measures to provide medical support
for the population during the postattack period. They
probably believe that these preparations enhance their
prospects for reducing fatalities should nuclear war
occur.
Although there appears to be a potential for conflict
between military and civil defense requirements in
time of war, the subordination of civil defense staffs to
military commissariats in some areas may have
helped to eliminate conflicting assignments of medical
personnel and civilian transportation assets. Never-
theless, the Soviets face significant uncertainties
about the ability of the Civil Defense Medical Service
to perform its wartime mission. We believe that these
uncertainties center on the:
? Amount of warning time available for mobilization
of the Civil Defense Medical Service.
? Lack of integrated medical exercises designed to
test the Civil Defense Medical Service's ability to
mobilize,' relocate, and operate medical facilities
during wartime.
? Shortages of appropriate medical supplies and
equipment-despite stockpiling-to treat the mas-
sive number of casualties expected.
? Shortages of medical personnel despite the emphasis
on civil defense training for large numbers of medi-
cal and paramedical personnel.
? Problems with sanepid operations in peacetime that
bring into question the ability of the sanepids to
accomplish their wartime mission.
? Uneven implementation of stated civil defense train-
ing goals and the consequent ability of medical
personnel to perform their wartime roles.
Despite these uncertainties, the civil defense medical
program continues to receive substantial emphasis.
The Soviets probably will continue to work to improve
their ability to provide postattack medical support to
the population. Subordination of civil defense staffs to
military commissariats in other regions could improve
medical mobilization and resource allocation in war-
time. The Soviets probably will continue to expand
medical stockpiles, to construct shelters at hospitals
and polyclinics, and to build underground medical
facilities. It also is likely that the Soviets will continue
to improve the quality and amount of civil defense
training for medical personnel.
Soviet civil defense medical planning has important
implications for the United States. Although we have
not estimated the total cost of the program, the
Soviets have clearly invested heavily in medical prepa-
rations for nuclear war. The scope of these activities
indicates that such preparations probably could re-
duce fatalities among all segments of the population,
given adequate warning time.
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Appendix A
Peacetime Location
Installation
Plan Type
Wartime Location
or Distance
From City
Baku
Institute of Genetics
Evacuation
An experimental station 4 km from
Mir Bashir
Batumi
Merchant Marine School and Hospital
Evacuation
Makharadze
Bendery
City Hospital
Relocation
Unknown
Railroad Hospital
Relocation
Unknown
Children's Hospital
Relocation
Unknown
Unidentified hospitals
Relocation
Hospitals in Kitsman and Zastavna
Dnestrovsk
City Hospital No. 2
Relocation
Unknown
Dushanbe
Republic Polyclinic
Relocation
Unknown
Institute for Advanced Stomatological
Training
Evacuation
Borisopol
25th City Hospital
Relocation
Kalinovskaya
Military Hospital No. 408
Relocation
Unknown
Public Health and Epidemiological Center
Evacuation
Unknown
Two Hospitals in Podolsky Rayon
Evacuation
Unknown
Children's Hospital
Relocation
150 km
City Hospital No. 2
Relocation
Outside city
Bacteriological Institute
Felocation
Near Gorenko
Institute of Medical Cosmetology
Relocation
In the direction of Zolotonosha
Scientific Research Institute of Common
and Municipal Hygiene
Evacuation
30 to 40 km
Scientific Research Institute of Microbiol-
ogy and Viruses imeni Academic Zabolot-
nogo
Evacuation
Scientific Research Institute for
Microbiology, Epidemiology, and Parasi-
tology
Evacuation
Unknown
Unidentified hospital in Darnitskiy Rayon
Relocation
Unknown
Two unidentified hospitals in Zhovtnevyy
Rayon
Relocation
Unknown
Three unidentified hospitals in Zhovtne-
vyy Rayon
Relocation
Unknown
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Medical Facilities With Emergency Plans (continued)
Peacetime Location
Installation
Plan Type
Wartime Location
or Distance
From City
Two hospitals in Zaliznychnyy Rayon
Relocation
Unknown
Hospital in Leninsky Rayon
Relocation
Unknown
Two hospitals in Moskovskiy Rayon
Relocation
Unknown
Three hospitals in Pecharskiy Rayon
Relocation
Unknown
Two hospitals in Podolskiy Rayon
Relocation
Unknown
Two hospitals in Radayanskiy Rayon
Relocation
Unknown
Two hospitals in Shevlenkovskiy Rayon
Relocation
Unknown
Psychiatric Hospital
Evacation
8 to 10 km
Second City Hospital
Relocation
Unknown
Railroad Hospital
Relocation
Unknown
Optical-Mechanical Union Hospital
Relocation
To a school in Tarashovo
First Aid Hospital No. 10
Relocation
School in Olgina
Children's Hospital No. 21
Relocation
Pskovskoye Ozero
Dental Clinic No. 26
Relocation
Unknown
Scientific Research Institute imeni Profes-
sor N. N. Petrov
Evacuation
Unknown
Public Health and Epidemiological Center
Evacuation
Roshchino
Oblast Hospital
Relocation
Agricultural school
Contagious Disease Hospital
Relocation
Gatchina
First Medical Institute
Evacuation
Podprozhye
Psychoneurological Clinic
Relocation
Vyritsa
Institute of Respiratory Diseases
Relocation
Krasnaya
Scientific Research Institute of Vaccines
Relocation
Krasnaya
Polyclinic No. 3 Smolenskiy Rayon
Relocation
Unknown
Medical Institute
Evacuation
Sosnovo
Pavlov Institute of Physiology
Relocation
Unknown
Chemical and Pharmaceutical Institute
Evacuation
Unknown
Lvov
Medical Institute
Relocation
Unknown
Minsk
Central Microbiology Laboratory for the
Frunshenskiy District sanitation and epi-
demiological station
Relocation
Buravaya
Second Moscow Medical Institute imeni
N. I. Pirgov
Relocation
To a small kolkhoz outside Moscow
Moscow Rescue and Transportation Base
Evacuation
Unknown
Moscow Medical Institute No. 1 and
Skilofsovskiy Institute
Relocation
Unknown
67th Moscow City Hospital
Relocation
Unknown
Consultation Polyclinic
Evacuation
Unknown
All-Union Oncology Research Center of
the Academy of Sciences
Relocation
Unknown
Central Hospital of the RSFSR Ministry
of Health
Relocation
Unknown
Central Institute of Tuberculosis of the
USSR
Evacuation
Unknown
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Medical Facilities With Emergency Plans (continued)
Peacetime Location
Installation
Plan Type
Wartime Location
or Distance
From City
Moscow Clinical Hospital No. 31
Relocation
Tolstopal'tsevo
State Institute of Oncology imeni P. A.
Gertsen
Relocation
Unknown
Institute of Bio-Organic Chemistry imeni
M. M. Shermyakin
Evacuation
100 km
Research Institute of Psychology
Evacuation
Unknown
Institute of Neurology of the Academy of
Medical Science
Evacuation
Udmurt ASSR
City Psychiatric Hospital No. 12
Evacuation
300 km
Institute of Human Morphology of the
Academy of Medical Science
Evacuation
Unknown
Central Research Institute for
Stomatology
Evacuation
Unknown
Institute of General Pedagogical
Psychology
Relocation
Unknown
All-Union Scientific Research Institute of
Technology and Blood Substitute and
Hormone Preparations
Evacuation
Mozhaysk
Institute of Higher Nervous Activity and
Neurophysiology
Evacuation
Dushina
Pirogov Medical Training Institute
Relocation
Unknown
City Tuberculosis Hospital
Evacuation
Unknown
Ilichevskiy Polyclinic
Evacuation
Unknown
Children's Clinic of the Medical Institute
of Odessa
Evacuation
100 km north of Odessa
Vsevolozhsk
Sixth City Hospital
Evacuation
Unknown
First City Clinical Hospital for
Emergency Treatment
Evacuation
Unknown
Institute of Microbiology, Epidemiology,
and Hygiene
Relocation
50 km
Central District Hospital
Relocation
Unknown
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Appendix B
Civil Defense Medical Storage
Locations
Civil Defense Medical Supply Depot Wartime reserves
Electronic Machinery Production Association Medical kits
Underground medical storage facility Wartime reserves
Republic Polyclinic Wartime reserves
Central Depot Warehouse Wartime reserves
Unidentified pharmaceutical warehouse Wartime reserves
Medical warehouse Wartime reserves
S. P. Korolev Radio Instrument Plant Medical kits
Research Institute UKRNIIPLASTMASH Medical kits
Design Institute GIPROKHLOR Medical kits
Automotive repair plant Medical kits
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Civil Defense Medical Storage
]Locations (continued)
Kishinev
Experimental factory of the Institute of Practical Physics of the
Academy of Sciences of the Moldavian SSR
Medical kits
Klaipeda
Republic Hospital
Wartime reserves
Kohtla-Jarve
City Hospital No. 1
Wartime reserves
Kuchiyeri
Military Civil Defense Unit
Wartime reserves
Kuybyshev
Medical section of general depot
Wartime reserves
Leningrad
First Aid Hospital No. 10
Wartime reserves
81st Polyclinic
Wartime reserves
Telephone Exchange
Medical kits
Syasstroi Cellulose and Paper Combine
Medical kits
Shipbuilding Institute and Admiralty
Medical kits
Scientific Research and Design Institute for Mechanical Processing
and Nonferrous Metals
Medical kits
Civil Defense Hospital storage facility
Wartime reserves
Volna Sewing Enterprise Branch
Wartime reserves
Special Planning, Designs, and Technology Bureau for Electrotreat-
ment
Medical kits
Scientific Research Institute imeni Professor N. N. Petrov
Medical kits
Planning Bureau for Computers
Medical kits
Krasnoye Selo medical warehouse
Wartime reserves
Experimental turbine construction plant
Medical kits
Central Scientific Institute of the Merchant Marine
Medical kits
Institute of Water Transportation
Medical kits
13th Stomatological Clinic
Wartime reserves
Production Association Azimut
Medical kits
First Medical Institute
Wartime reserves
All-Union Design and Technology Bureau
Medical kits
Baltic Shipyard imeni S. Ordzhonikidze
Medical kits
State Institute of Applied Chemistry
Medical kits
Central Civil Defense Railroad Storage Area
Wartime reserves
Equipment Assembly Plant imeni Molotova
Medical kits
Main plant of the "Elektron" Production Association
Medical kits
Pharmacy near City Clinical Hospital No. 1
Wartime reserves
Central microbiology laboratory of the Frushenskiy District sanitary
and epidemiological station
Wartime reserves
Polyclinic of the First City Clinical Hospital
Wartime reserves
First City Hospital
Wartime reserves
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Civil Defense Medical Storage
Locations (continued)
State Union Scientific Research Tractor Institute
Medical kits
Institute of Steel and Alloys
Medical kits
Regional Construction Directorate No. 12
Medical kits
Residential shelter at House No. 17 at Yermolovy
Wartime reserves
All-Union Oncology Research Center of the Academy of Sciences
Medical kits
Fourth City Clinical Hospital
Wartime reserves
KGB-Central Committee civil defense shelter and escape tunnel
Medical kits
Medical section of general depot
Wartime reserves
Pharmaceuticals Research Institute
Wartime reserves
Nakhodka
House of Culture of the Merchant Marine School
Medical kits
Novosibirsk
Medical section of general depot
Wartime reserves
Odessa
City Hospital No. 1
Wartime reserves
Cinema equipment plant Kinap
Medical kits
Electrotechnical Institute of Communications
Medical kits
Two underground hospitals near Ovidipol
Wartime reserves
Blood storage and transfer facility
Wartime reserves
Medical storage area at Rosa Luxembourg and Krasnyii Perelok
Wartime reserves
Medical storage area at Kirova and Karla Marxa
Wartime reserves
Medical storage area at Polevaya and Yubileinaya Salkez
Wartime reserves
Jute factory
Medical kits
City Hospital No. 1
Wartime reserves
Tool Research Department of the Odessa Planning and Design
Technical Institute
Medical kits
Special Design and Technology Bureau for Compression and
Refrigeration Machine Building (SKTBKKM)
Medical kits
Hospital No. 6
Wartime reserves
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Civil Defense Medical Storage
Locations (continued)
Sigulda
Slobodsky
Polytechnic Institute Medical kits
Central Statistical Administration Medical kits
Medical storage facility Wartime reserves
Medical warehouse Wartime reserves
Tashkent
Tbilisi
Tiraspol
Tokmak
Ulanade
Ussuriysk
Vladivostok
Vsavolozhsk
Vostochnyy
Yoegeva
Medical section of general depot Wartime reserves
Civil defense medical storage located at the 367th Military Hospital Wartime reserves
Electromash plant Medical kits
Construction Enterprise No. 3 Medical kits
Medical section of general depot Wartime reserves
Medical section of general depot Wartime reserves
Medical section of general depot Wartime reserves
Central district hospital Wartime reserves
Medical section of general depot Wartime reserves
Medical storage facility Wartime reserves
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Secret
Appendix C
Underground Medical Facilities
Alma Ata
Beltsy
Butovka-Donetsk
Donetsk
Dushanbe
Frunze
Irtyshsk
Karaganda
Kiev
Krasnovodsk
Krasnoyarsk
Leningrad
Unidentified hospital under construction
First Republic Hospital (Moldavia)
Hospital in coal mine
Medical facilities of rayon leadership
Hospital shelter in mountainside
Underground medical storage facility
City Hospital No. 7
County Hospital
Two unidentified underground hospitals
25th District Medical Hospital
Underground hospital
Medical Preparations Plant
Polyclinic No. 31
Volna Sewing Enterprise Branch Clinic
Children's Hospital No. 21
13th Stomatological Polyclinic
First Medical Institute
Scientific Research Institute of Vaccines and Serums
Unidentified military hospital
Central microbiology laboratory of the Frusheniskiy District sanitary and
epidemiological station
Unidentified hospital complex
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57th City Hospital
Institute of Poliomyelitis and Viral Encephalitis
First City Hospital
Unidentified hospital near Finland Metro Station
Central Blood Bank
Burdenko Hospital
67th City Hospital
Residential shelter with dispensary at House No. 17, Yermolovy
Central Hospital of the RSFSR Ministry of Health
Fourth City Clinical Hospital
Nemenchine Unidentified hospital on northeast side of city
Riga
Central Clinical Hospital
Regional Clinical Hospital
Hospital at W. Bogdana and Khmelnitskovo
Underground dispensary in Govtenyy Rayon
Two underground hospitals near Ovidipol
Underground patient transfer point
First City Hospital
Underground medical storage facility
Unidentified hospital with underground medical facilities at Artilerijas
Iela and Krasotain Iela
All-Union Scientific Research Antiplague Institute (MIKROB)
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Figure 4
USSR: Organization of Medical Resources for Civil Defense
Command
- - - Administrative Control
- - - - Coordination
IF-
Rayon Sanitary
I- - - Epidemiological
I Station
I J I
Main Administration DOSAAF, Red Cross/ -- - - - J
of Civil Defense Red Crescent -- - - - - - - - -
Societies(RCRCS) ----------
Civil Defense
Medical Service
Military Medical
Institutes
Military Medical
Academy
Chief
Epidemiologist
Central Military
Medical Directorate
Military Medical
Service
Scientific Medical
Council
Military Medical
Directorates of the
Military Districts
Civil Defense Military
r- Districts' Headquarters
Research Main Sanitary and
Institutes - Epidemiological
Administration
Union Republic Civil Republic Central Republic Sanitary
Defense Headquarters --Committee DOSAAF, - - - - - - Epidemiological
RCRCS Station
I I Oblast Sanitary
r - - Epidemiological
Oblast Civil Defense Oblast Central Station
Headquarters -- Committee DOSAAF, - - -I
RCRCS
Rayon Civil Defense Rayon DOSAAF,
Headquarters --RCRCS
City Civil Defense
Headquarters
City Sanitary
Epidemiological
Sanitary
Epidemiological
Service
Republic Minister
-I- of Health
-I-
Oblast Department
of Health
Rayon Department
-I- of Health
City Department
-I- of Health
City DOSAAF, RCRCS
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Central Military
Medical Commission
Pharmaceutical
Manufacturers
Medical Equipment
Manufacturers
------------
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