Specific Topic(s):

• Carriage of arms by military medical personnel.

• Protection and duties of medical personnel under the Geneva Emblems.

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ –

2. Health-care personnel shall at all times act in accordance with relevant international and national law, ethical principles of health care and their conscience. In providing the best available care, they shall take into consideration the equitable use of resources.

10. Health-care personnel, as well as health-care facilities and medical transports, whether military or civilian, must be respected by all. They are protected while performing their duties and the safest possible working environment shall be provided to them.

12. In fulfilling their duties and where they have the legal right, health-care personnel are identified by internationally recognized symbols such as the Red Cross, Red Crescent or Red Crystal as a visible manifestation of their protection under applicable international law.

Geneva Conventions:

Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. Geneva, 12 August 1949.

ARTICLE 7. Wounded and sick, as well as members of the medical personnel and chaplains, may in no circumstances renounce in part or in entirety the rights secured to them by the present Convention, and by the special agreements referred to in the foregoing Article 8, if such there be. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=7C6EB1D1D7A71575C1257F7D0035EAB5

ARTICLE 19. Fixed establishments and mobile medical units of the Medical Service may in no circumstances be attacked, but shall at all times be respected and protected by the Parties to the conflict. Should they fall into the hands of the adverse Party, their personnel shall be free to pursue their duties, as long as the capturing Power has not itself ensured the necessary care of the wounded and sick found in such establishments and units. The responsible authorities shall ensure that the said medical establishments and units are, as far as possible, situated in such a manner that attacks against military objectives cannot imperil their safety. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=BBF9A4E655C90872C1257F7A0054937B

ARTICLE 22. The following conditions shall not be considered as depriving a medical unit or establishment of the protection guaranteed by Article 19:

(1) That the personnel of the unit or establishment are armed, and that they use the arms in their own defence, or in that of the wounded and sick in their charge. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=0A624DBBE851EBECC1257F7A0054D4BF

ARTICLE 24. Medical personnel exclusively engaged in the search for, or the collection, transport or treatment of the wounded or sick, or in the prevention of disease, staff exclusively engaged in the administration of medical units and establishments, as well as chaplains attached to the armed forces, shall be respected and protected in all circumstances. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=8BB42A7717B581D5C1257F15004A199F

ARTICLE 40. The personnel designated in Article 24 [ Link ] and in Articles 26 [ Link ] and 27 [ Link ] shall wear, affixed to the left arm, a water-resistant armlet bearing the distinctive emblem, issued and stamped by the military authority. Such personnel, in addition to wearing the identity disc mentioned in Article 16 [ Link ] , shall also carry a special identity card bearing the distinctive emblem. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Comment.xsp?action=openDocument&documentId=98D0C970CF68F688C1257F7A005696E8

Customary IHL:

Rule 25. Medical personnel exclusively assigned to medical duties must be respected and protected in all circumstances. They lose their protection if they commit, outside their humanitarian function, acts harmful to the enemy. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule25

Practice Relating to Rule 25. Medical Personnel

Section B. Equipment of medical personnel with light individual weapons. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v2_rul_rule25_sectionb

Rule 28. Medical units exclusively assigned to medical purposes must be respected and protected in all circumstances. They lose their protection if they are being used, outside their humanitarian function, to commit acts harmful to the enemy. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule28

Ethical principles:

World Medical Association CODE OF CONDUCT: DUTIES OF PHYSICIANS WORKING IN ARMED CONFLICT AND OTHER SITUATIONS OF VIOLENCE – must ‘Not take part in any act of hostility’ https://www.wma.net/policies-post/wma-regulations-in-times-of-armed-conflict-and-other-situations-of-violence/

Discussion:

Review of the question: this question tests understanding of the duties of medical personnel, protected under the Geneva Conventions, and the limitations on their employment outside their medical duties. This is a common issue, especially in small units where medical personnel are part of the team.

Interpretation of the principles/policy from the references: the provisions of the Geneva Convention and accepted humanitarian law are explicit: medical personnel may only be armed with light-individual weapons for the protection of themselves or their patients; they may not ‘commit acts harmful to the enemy’ including providing area protection or other military activities. Protected persons (healthcare professionals, chaplains, personnel temporarily assigned to medical duties – holders of a designated identity document) may NOT guard anything other than medical units.

Framework for answering the scenario/question:

• Understand the exact prohibitions on the use of medical personnel for military tasks.

• Consider if the medical component of the force (within the perimeter) should be placed outside the military perimeter and have a separate boundary that could be guarded.

• Consider if ‘off-duty’ medical personnel could undertake other tasks that could release more combatants to guard the perimeter (e.g. feeding, cleaning, sanitation duties).

• Consider if the request is reflection of other tensions regarding the volume of work across the military force.

Further discussion points

• What are the differences under IHL between those ‘permanently’ assigned to a medical role and those ‘temporarily’ assigned to a medical role – is there flexibility for ‘medics’ rather than ‘regulated professionals’ (i.e. doctors, nurses, paramedics)?

• What is the ethical threshold for medical professionals undertaking ‘intelligence’ work?

• Can health professionals ‘denounce’ their profession to undertake combatant activities?

Author: Professor Martin Bricknell

Further reading:

Section 2A Protection of medical capabilities. Chp 1 Page 15. Allied Joint Medical Support Doctrine. AJP 4-10 https://www.coemed.org/resources/stanag-search