Japan plans for the reality of war

While hypersonic missiles, drones and other new weapons systems dominate the news about Japan’s military build-up, the government is also stepping up its efforts to develop first-rate combat casualty medical care.

In a worst-case scenario, the government and Japan Self-Defense Forces (JSDF) want to be ready for the kind of serious injuries and post-traumatic stress disorder (PTSD) seen in Ukraine.

It hasn’t yet proved to be a catchy topic. Although Akahata (Red Flag), the newspaper of the Japan Communist Party, recently reported on the government’s plan to ask Japanese universities to conduct research on treatment of mass battlefield casualties, there’s been little reporting from the mainstream media.

Proposed research themes include penetrating and blunt trauma, encephalopathy (brain damage), long-term storable artificial blood, artificial organs, AI-powered prosthetics, vision restoration, bone regeneration, and PTSD.

Medical and biomedical engineering will be added to the list of research topics eligible for financial support under the Security Technology Research Promotion Program, which is operated by the Acquisition, Technology & Logistics Agency (ATLA) of Japan’s Ministry of Defense. This could provide up to ¥2 billion ($12.5 million) per project.

That amount of money would be a considerable incentive for university medical schools. It should also help overcome the traditional opposition to military-related research in Japanese academia.

In any case, treatment of PTSD, brain damage and serious bodily injuries, including shock from explosions and amputation of limbs, is “dual-use” technology. It has important civilian applications in cases such as rape and bad traffic accidents.

A combat injury treatment center was established at the National Defense Medical College Hospital following the revision of Japan’s Three Security Documents (National Security Strategy, National Defense Strategy and Defense Build-up Program) in December 2022. Before that, the SDF paid relatively little attention to combat casualty care because it did not undertake many high-risk missions and perhaps was not really expecting to fight.

That approach changed, however, with the outbreak of war in Ukraine. One of the aims of the revised National Defense Strategy was to “promote fundamental reforms to improve the combat trauma care capabilities.” This, according to an government source who wishes to remain anonymous, is still a work in process.

In the area of combat care, Japan works closely with the US military.

The US Air Force’s 374th Medical Group at Yokota Air Base west of Tokyo hosts an annual tour for Japanese nursing students from the National Defense Medical College, which is just 12 miles away in Tokorozawa City. The most recent tour was held in March of this year.

“The purpose of this tour,” said US Air Force Major Moshood Yinusa, “is to showcase the life and work of US active-duty nurses and foster engagement between Japanese nursing students and US culture and military medicine.”

Yokota Air Base is home to the 515th Air Mobility Operations Group of the US Air Force, which manages air mobility operations throughout the Western Pacific, and the Japanese Air Defense Command. 

JSDF personnel also participate in Tactical Combat Casualty Care (TCCC) training exercises with the US military. Watch this on video here.

Last January, at Camp Hansen, Okinawa, Japan, the Expeditionary Operations Training Group of III Marine Expeditionary Force (III MEF) ran JSDF cadets through trauma medicine scenarios to teach them how to provide medical care under the pressure of battle.

III MEF is the nucleus of a joint and coalition force that operates within the First Island Chain off the Asian mainland and across the Indo-Pacific.

Until the arrival of Donald Trump in the White House, the Japanese were careful to avoid getting dragged into American wars. Now, with China becoming more assertive and tensions having risen from Korea to Taiwan and the South China Sea, they are more concerned with keeping the US involved in East Asia and cooperating more closely with the US military while building up their own defense capabilities.

Furthermore, as Prime Minister Sanae Takaichi put it last January, “Learning from Russia’s aggression against Ukraine, countries are now urgently preparing for new forms of warfare, including the mass deployment of unmanned drones, and furthermore preparing for extended periods of fighting, under the assumption that once such conditions arise, there is a high likelihood of the situation becoming prolonged.”

Aside from the question of whether or not the example of Ukraine is relevant to Japan’s national security challenges, preparation for serious armed combat includes improvements in combat casualty care.

In April, Japan’s Ministry of Defense issued a policy presentation stating (in translation) that,

In a contingency, the incidence of Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) is expected to rise. Furthermore, the increased lethality of modern weaponry is likely to result in a greater number of cases involving traumatic brain injuries and musculoskeletal impairments caused by limb injuries, thereby driving up the demand for physical rehabilitation.

To ensure the capability to respond to various contingencies and a wide range of domestic and international missions, we will consolidate common medical functions across the Self-Defense Forces to promote integrated operations; establish a posture that mobilizes the full collective strength of SDF medical services – including the National Defense Medical College – and drive fundamental reforms to enhance capabilities in combat casualty care.

This is a big change from attitudes in the past, when the serious psychological and social effects of PTSD were largely ignored.

In August 2024, Japan’s Ministry of Health began its first comprehensive survey of PTSD among Japanese soldiers in WWII and its long-term impact. The results were presented in an exhibition that opened at the Shokei-kan in Tokyo in July 2025, just in time for the 80th anniversary of the end of the war.

The Shokei-kan is a museum that collects, preserves and showcases verbal testimony, historical materials, books and other information about the suffering of sick and wounded soldiers, and their families, during and after the war. Shokei here means to pass down, succeed or inherit. Kan means a building or hall. A short walk from Kudanshita Metro station, Shokei-kan is not far from Yasukuni Jinja, the shrine dedicated to Japan’s war dead.

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