At the start of the operation, the U.S. used Army helicopters in Kuwait and Iraq for medical evacuation, but then moved them due to concerns about Iranian drone and missile strikes. 

“Most evacuations during [Operation Epic Fury] were ultimately conducted by ground,” according to the report. In addition to the drone threat, the United States had the additional hurdle of relying on host country hospitals for what’s called “advanced, hospital level care” for particularly severe injuries, since establishing such hospitals on U.S. bases would require a large and more targetable footprint.

The move follows warnings from medical officials that future conflicts would be more dangerous for U.S. troops, as adversaries develop more advanced weapons—particularly drones. A 2022 Army University Press article by Lt. Col. Matthew Marsh and Capt. Ryan Hampton eerily forecasts the situation described in the inspector general report: “Medical personnel will experience intermittent air and ground evacuation with medical logistics constraints,” it reads.

Just as new technology has allowed some adversaries to become more dangerous and inflict higher casualties, other pressures led to cutbacks in medical evacuation capability, particularly in the Middle East. A July 2025 Pulse of Army Medicine article by Sgt. Maj. Sandra Johnson describes how, across U.S. Central Command, “Due to competing requirements, many of these bases only have one medic on post and no medical provider. A medic may have to care for a patient for several hours until they arrive at a local national hospital.” 

She noted specifically the problem of “no Medical Evacuation (MEDEVAC) by flight or ground capability, or only ground Casualty Evacuation (CASEVAC) options,” across CENTCOM.

An April U.S. Naval Institute report explains: “Drone warfare [in Ukraine] has disrupted casualty movement from the point of injury throughout the combat casualty continuum of care.”

The IG report acknowledges that CENTCOM officials worked to rapidly develop new plans and strategies when faced with Iranian drone capabilities, moving troops and materiel.. “During OEF, USCENTCOM shifted personnel, assets, and storage facilities as locations came under Iranian and proxy attacks,” it reads.

The report carries a strong recommendation: To find and fix “the gaps in [Department of Defense counter-drone] interoperability, and the corrective actions needed to standardize” those capabilities.