Violent non-state actors may recruit under-18s into their forces. · Medical

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2 Violent non-state actors may recruit under-18s into their forces. What are the duties of medical personnel towards 'children' as combatants?

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: Violent non-state actors may recruit under-18s into their forces. What are the duties of medical personnel towards 'children' as combatants?

• List the Issues that arise from the scenario.

• Identify Critical Information required and Assumptions to be made:

The issues that arise from this scenario include the ethical responsibility of medical personnel toward child combatants, the legality of determining age through dental examination, and the risk of facilitating interrogations of minors, which is prohibited under international law. Medical personnel must avoid participating in non-clinical examinations used for intelligence purposes. Critical information needed includes the legal status of child soldiers, the proper medical procedures for minors, and international humanitarian law regarding the treatment and protection of children in conflict. Assumptions include that minors must be treated as vulnerable individuals.

Step 2 – ANALYSE

Patient: The primary duty of medical personnel is to protect and treat the patient, especially when dealing with vulnerable groups like child soldiers. These individuals are often victims of coercion or manipulation by armed groups and should be treated as such. The examination process must focus on their physical and mental well-being, and healthcare professionals must ensure that minors are not exposed to harmful processes like interrogation. According to the WMA International Code of Medical Ethics, patient care must always prioritize the individual's best interests, particularly when dealing with minors https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/.

Clinical: All captured combatants should undergo a standard medical examination to assess their physical condition and determine immediate treatment needs. When it comes to child soldiers, additional care is required to address the psychological trauma they may have experienced. Dentists may be asked to perform age assessments, using dental development as a metric. However, dental age assessments can be inaccurate, especially in adolescents, as dental maturity does not always correspond with chronological age (International Dental Journal) https://onlinelibrary.wiley.com/journal/1875595x. Therefore, these exams must be conducted carefully and used solely for clinical purposes, avoiding any decisions that might lead to the interrogation of children.

Legal: Interrogating minors is illegal under international law. Protocol I, Article 77 of the Geneva Conventions provides specific protections for children, ensuring that they are not subject to coercion or interrogation (ICRC Protocol I) https://ihl-databases.icrc.org/en/ihl-treaties/api-1977/article-77. Child soldiers, even if captured as combatants, must not be treated as adults and should be given protections reflective of their age and vulnerability. Medical personnel are prohibited from being complicit in actions that could lead to the unlawful interrogation of minors, including age verification solely for military purposes.

Societal/Military: From a military perspective, there may be pressure to gather intelligence from captured individuals, but it is crucial that healthcare professionals maintain their neutrality and adhere to international standards. Child soldiers are seen as victims, often forcibly recruited, and their treatment should reflect their unique status under international law. Any decision to interrogate these individuals must be made by legal experts, not by medical personnel, who should focus solely on the health and welfare of the child (ICRC on Child Soldiers) https://www.icrc.org/en/document/international-legal-protection-children-armed-conflict.

Step 3 – FUSE

• Summarise conclusions

• Insert citations to key reference sources for your analysis

• Determine the exact Decision(s) to be made

Medical personnel must remain neutral, focusing solely on the clinical care of child soldiers, who are protected under international law as vulnerable individuals. The interrogation of minors is prohibited, and any decision to do so must be made by legal experts, not healthcare providers. References such as Protocol I, Article 77 of the Geneva Conventions (https://ihl-databases.icrc.org/en/ihl-treaties/api-1977/article-77) and the ICRC on Child Soldiers (https://www.icrc.org/en/document/international-legal-protection-children-armed-conflict) highlight the legal protections that forbid using medical assessments to facilitate military objectives.

Step 4 – DECIDE

• What is your Decision?

• Why (can you justify it)?

• Residual uncertainly, need for review?

As a medical professional, your decision should be to refuse participation in non-clinical age verification or any action that could lead to the interrogation of child soldiers. This is justified by international humanitarian law, including Protocol I, Article 77 of the Geneva Conventions (https://ihl-databases.icrc.org/en/ihl-treaties/api-1977/article-77), which prohibits the interrogation of minors. Medical professionals are bound by ethical guidelines that prohibit involvement in non-medical tasks, especially those that could harm the patient or violate their rights. The uncertainty of dental age estimation also makes it an unreliable tool for determining combatant status. Protecting minors is a priority under both legal and ethical frameworks. Medical professionals are advised to strictly separate military and healthcare duties. Involving dentists in age estimations crosses into military intelligence, which violates medical ethics, as their primary duty is patient care https://healthcareindanger.org/wp-content/uploads/2021/03/4504_002-ebook.pdf. In cases of uncertainty, legal experts should be consulted to ensure that actions remain compliant with international law.