Response to Letter to the Editor: Medical Support to Irregular Warfare: A Systematic Literature Review, 2000-2024

Dear Dr. Rothwell, Thank you to Dr Joshua Lane for acknowledging the important work of Irregular Warfare Medicine in our study by Licina et al., “Medical Support to Irregular Warfare: A Systematic Literature Review, 2000-2024.” We agree with Dr Lane’s central assertion that while the capabilities, expertise, and enabling tactics for medical support to Irregular Warfare exist in some capacity, doctrine has not yet cohered into a deliberate, integrated framework commensurate with the demands of contemporary conflict. As highlighted in his letter, current medical practice in IW environments has evolved understandably through special operations medicine, joint enablers, and mission-specific adaptations rather than through explicit IW-focused policy and doctrine. This results in excellence at the tactical level but variability and fragility at operational and strategic levels. The DOTMLPF-P lens used in the systematic literature review was deliberately applied to inform capability development and underscore that IW medicine spans military, civilian, and humanitarian systems. Therefore, it must address governance, interoperability, workforce development, sustainment, and international collaboration alongside clinical innovation from tactical to strategic levels. We agree that counterterrorism medicine provides a strong intellectual and institutional foundation; however, the operational environments of Ukraine, the Indo-Pacific, and similar theaters demonstrate that IW medicine must mature beyond subspecialty practice into unifying strategy, policy, doctrine, and plans that deliberately link tactical excellence to operational endurance and strategic legitimacy. We view the response by Dr Lane as evidence the field is ready for that next step and welcome continued joint and international efforts to formalize IW medicine as an essential component of modern warfare.