Captain Tamara J. Worlton, MD, FACS
Lieutenant Colonel Carl A. Beyer, MD, FACS
Military global surgery or surgical global health engagement (GHE) is a unique field that intersects academic global surgery, humanitarian assistance and disaster relief, and Department of War (DoW) GHE.
While professional development exists for all these fields, there is a persistent gap for the military global surgery community. In addition to long-standing missions, combatant commands (CCMDs) are expanding recognition of military global surgery’s role in surgical system strengthening and surgical readiness. The Excelsior Surgical Society (ESS) Global Surgery Subcommittee was formed to address this gap and establish a community of practice.
A tenet of military GHE is to engage alongside partner nations to practice interoperability, build system capabilities, and enhance system capacity. Surgical GHE runs the spectrum from short-term, direct patient care missions to long-term, embedded surgical teams working on trauma system strengthening. Many surgeons may have first encountered military global surgery while engaged in Iraq and Afghanistan. Deployed with NATO medical units, US military surgeons worked side by side with our colleagues to save lives and create enduring relationships. Another aspect of military global surgery during this time was humanitarian care for Iraqi and Afghan civilians. Finally, military surgeons leaned into the education and training spaces, teaching and learning from local medics and doctors key skills and best practices for trauma evaluation and resuscitation.
Historically, surgical GHE took shape during the Vietnam War when military medical providers started working with Vietnamese civilians in Medical Civic Action Programs (MEDCAP). The objective was to use medical care to advance political aims and increase civilian confidence in their government.
The first iteration of this, or MEDCAP I, focused on local healthcare infrastructure by offering training and supplies to the Vietnamese. This evolved to MEDCAP II where US physicians directly treated Vietnamese civilians to gain their trust and cooperation. By the end of the Vietnam War, US military providers had almost 40 million patient encounters with Vietnamese civilians. This inspired the controversial “Winning Hearts and Minds” concept employed in counterinsurgency efforts in Iraq and Afghanistan.
Although surgical GHE activities such as these were personally fulfilling for the surgeons involved, studies found that these efforts holistically undermined local healthcare providers. The MEDCAP-style engagements created local dependency on the US healthcare services and created confusion between the actions of US forces and humanitarian entities, which placed aid workers at risk for attack. This strategy was ultimately abandoned in 2014.
Based on the ad hoc nature of these efforts, best practices were drafted as Department of Defense Instruction (DoDI) 2000.30, Global Health Engagement Activities, released in 2017. This focused on the link between security and health, noting that engagements designed to strengthen partner nation healthcare systems are a key mechanism to achieve health security cooperation strategic objectives.
The Air Force has had a professional track for GHE since 2000 with its International Health Specialist Program with Special Experience Identifier in three levels of expertise. The Navy established an additional qualification designator in 2017 which is currently being restructured to three levels of expertise from the initial two-tier program. The Army has been working on a three-tier professional GHE pathway, but it has not been rolled out yet.
The newly established National Institute for Defense Health Cooperation (NIDHC) maintains the GHE Training Continuum, in support of the Uniformed Services University (USU) Office of the President, comprising a breadth of courses for individuals wishing to further develop their expertise in the GHE field.
The GHE Continuum is designed and delivered in coordination with the Service GHE and Health Security Cooperation offices to meet DoW GHE personnel competencies, ensuring the readiness of US military personnel and enhancing the strategic and operational effectiveness of GHE activities. This training begins with an asynchronous awareness-level course, followed by the foundational-level Fundamentals of DoW Global Health Engagement, offered virtually and at requesting CCMDs or unit locations.
For practitioner-level individuals, NIDHC offers the DoW Global Health Engagement Operations Course; this is an in-person, weeklong course offered twice a year in the National Capital Region, as well as at requesting geographic CCMDs. Additionally, USU NIDHC develops and teaches Global Health, DoW Global Health Engagement, and Disaster Medicine graduate courses within the USU Master of Public Health, Master of Health Administration and Policy, and Global Health Graduate Certificate programs.
A unique opportunity for military global surgery is the Global Health Engagement Research Initiative Program, which is a funding opportunity for military medical and public health research. The specific areas of interest are honed by CCMD priorities and, while not surgery specific, often include trauma care and blood availability. Further information can be found in the fiscal year (FY) 2027 call for white papers currently anticipated for fall 2026.
On the civilian side, the American College of Surgeons Health Outreach Program for Equity in Global Surgery (ACS H.O.P.E.®) offers surgeons opportunities to expand their knowledge and networking in global surgery.
The 1-day didactic course, “Global Health Competencies for Surgeons: Key Concepts, Evidence, and Practical Approaches for Responsible and Effective Engagement,” is offered every year at the ACS Clinical Congress. This is intended to be an introductory course, and ACS H.O.P.E. offers 10 Resident Scholarship Awards for residents to attend
New this year, ACS H.O.P.E. launched the “Global Health in Surgery Certificate Program,” which currently has its inaugural class enrolled. This yearlong, virtual-blended course includes a capstone project, expert mentorship, and modules focused on leadership, advocacy, and sustainable surgical care. Applications for the next cohort are open through October 5.
While surgical humanitarianism is not a new field, the recognition of surgery as an essential part of global health is relatively new. In 2015, The Lancet Commission on Global Surgery (LCoGS) released a landmark paper highlighting that an estimated 5 billion people lack access to safe, affordable surgical care
LCoGS defined global surgery as “the study, research, practice, and advocacy that seeks to improve health outcomes and achieve health equity for all people who need surgical and anesthesia care, with a special emphasis on underserved populations and populations in crisis”. Later that year, the World Health Assembly passed resolution WHA68.15 “Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage.” This resolution was the first worldwide governmental recognition of surgery and anesthesia as critical pillars for health system strengthening, and it details a globally integrated approach to addressing the lack of safe, affordable, and accessible surgical care.
The economic burden of untreated surgical disease is estimated to be a loss of 12.3 trillion USD in low- and middle-income countries between 2015 and 2030. Relieving a country's surgical burden and strengthening their surgical healthcare system has a direct impact on a country's economy. This aligns directly with DoW health security cooperation as increased health and prosperity create resilience to extremist organizations and other destabilizing elements.
The importance of healthcare system strengthening for regional stability and medical readiness is highlighted in the National Defense Authorization Act FY2025 Section 735 establishing an Indo-Pacific Medical Readiness Program. NIDHC Director, Dr. Jeffrey Freeman will be discussing this and national preparation for large-scale combat operations at the ESS Annual Meeting on September 26.
The ESS Global Surgery Subcommittee had its inaugural meeting in April 2026 with more than 30 surgeons virtually connecting to discuss and network. The initial work of the committee will be to define military global surgery and explore how this new community of practice can best drive the mission forward. The committee serves as a clearinghouse of information for ongoing GHE opportunities and a connection point across military Services to align efforts and share best practices. Future work could include improving military-surgeon specific training opportunities, developing specific tools for use in surgical GHE environments, and conducting research to understand and maximize the impact of military global surgery.
Military global surgery occupies a distinct place at the intersection of academic global surgery, humanitarian assistance, and DoW GHE, but has historically lacked a dedicated professional community and standardized framework
Drawing on lessons from Vietnam-era MEDCAP programs and the conflicts in Iraq and Afghanistan, the field is maturing from ad hoc direct patient care missions toward a more sustainable model focused on strengthening partner nation surgical systems and increasing combat casualty care interoperability. Expanding CCMD recognition and a growing ecosystem of training and funding opportunities have created fertile ground for military surgeons to make meaningful and lasting contributions worldwide, but military surgeon-specific gaps remain. The formation of the ESS Global Surgery Subcommittee is a timely and important step toward addressing these gaps and developing a robust community of practice.
Disclaimer: The opinions and assertions expressed herein are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the DoW.
