You are deployed to a conflict where the enemy are deliberately and co · Medical

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4 You are deployed to a conflict where the enemy are deliberately and consistently violating the rules of war. You have been tasked to send an ambulance on a very dangerous mission to collect enemy casualties. Should your own personnel be put in harms’ way to save the life of someone who would not reciprocate?

Specific Topic(s):

• This is a specific scenario in the spirit of the general ‘risk to life’ question posed by 3 hearts

Key references:

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

3. The primary task of health-care personnel is to preserve human physical and mental health and to alleviate suffering. They shall provide the necessary care with humanity, while respecting the dignity of the person concerned, with no discrimination of any kind, whether in times of peace or of armed conflict or other emergencies.

7. In armed conflict or other emergencies, health-care personnel are required to render immediate attention and requisite care to the best of their ability.

Geneva Conventions:

Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), 8 June 1977. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Treaty.xsp?documentId=AA0C5BCBAB5C4A85C12563CD002D6D09&action=openDocument

Art 1 Material field of application

1. This Protocol, which develops and supplements Article 3 common to the Geneva Conventions of 12 August 1949 without modifying its existing conditions of application, shall apply to all armed conflicts which are not covered by Article 1 [https://www.icrc.org/en/doc/assets/files/other/icrc_002_0321.pdf] of the Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts (Protocol I) and which take place in the territory of a High Contracting Party between its armed forces and dissident armed forces or other organized armed groups which, under responsible command, exercise such control over a part of its territory as to enable them to carry out sustained and concerted military operations and to implement this Protocol.

Art 7 Protection and care:

1. All the wounded, sick and shipwrecked, whether or not they have taken part in the armed conflict, shall be respected and protected.

2. In all circumstances they shall be treated humanely and shall receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. There shall be no distinction among them founded on any grounds other than medical ones.

Article 9 Protection of medical and religious personnel

1. Medical and religious personnel shall be respected and protected and shall be granted all available help for the performance of their duties. They shall not be compelled to carry out tasks which are not compatible with their humanitarian mission.

Customary IHL:

Rule 110. The wounded, sick and shipwrecked must receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. No distinction may be made among them founded on any grounds other than medical ones. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule110

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS - https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

A PHYSICIAN SHALL give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care.

Discussion:

Review of the question: the balance of risk to a healthcare provider versus the benefit to the patient from having access to healthcare is at the heart of the role of military medical personnel. This question poses two issues: the risk to life is associated with a very specific medical task ‘casualty collection’, and the casualties are the ‘enemy’ who, in general terms, have not respected IHL.

Interpretation of the principles/policy from the references: Institutionally, the armed forces are required to provide the same level of medical care for prisoners as for their own personnel on the basis of non-discrimination. Medical personnel are obliged to provide emergency medical care as a humanitarian duty. However, they are not required to risk their life to meet these obligations.

Framework for answering the scenario/question:

• Consider the obligations of the parties. Although the enemy might be violating the rules of war, there is an obligation to provide medical care for injured prisoners of war. Medical personnel are obligated to provide this.

• There should be no discrimination on the provision of emergency healthcare except for clinical need.

• Consider the level of risk. Are the risks associated with this casualty evacuation mission higher or different to a mission that would be required to collect friendly forces or civilians?

• Are there ways to mitigate the risk to the casualty evacuation mission – negotiated truce, armoured protection, military escort etc.?

• Is the mission a legitimate military order?

Further discussion points:

• This question also links to discussions about the duties of medical personnel towards prisoners and individuals deprived of their liberty – Queen and Ace Clubs.

• What is the difference under IHL between state-on-state conflict, non-international armed conflict, the obligations of non-state armed groups, and international security operations? Does this affect the duties of medical personnel?

• What obligation do warring parties have towards understanding and protection of the medical services of their enemies? How might casualties amongst non-state armed actors receive medical care?

• How might military medical services encourage adversaries to respect the ‘rules of war’?

Author: Professor Martin Bricknell