Specific Topic(s): application of humanitarian principles – humanity, neutrality, impartiality, and operational independence; and protection of medical personnel and facilities.

Key references:

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

Geneva Conventions:

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….. Equipment of medical personnel with light individual weapons - State practice indicates that the protected status of medical personnel does not cease if they are equipped with light individual weapons solely to defend their patients or themselves against acts of violence, for example, against marauders. If they use such weapons in combat against enemy forces acting in conformity with the law of war, notably to resist capture, they forfeit their protection. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule25

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

Humanitarian principles: UN General Assembly Resolution 46/182 Strengthening the co-ordination of humanitarian emergency assistance of the United Nations. At: https://undocs.org/A/RES/46/182

Discussion:

Review of the question: this question examines the humanitarian principle of ‘neutrality’ through the restriction of allowing the carriage of weapons inside medical facilities alongside the need for protection of medical facilities and personnel – possibly including the carriage of arms.

Interpretation of the principles/policy from the references:

• It is common practice to insist on a policy of ‘no weapons’ within medical facilities in order to emphasise the neutrality of the medical facility and independence from armed actors.

• There is provision under International Humanitarian Law (IHL) for military medical personnel to be armed with light individual weapons to protect themselves and their patients. This also extends to protecting their own facility with pickets or guards.

Framework for answering the scenario/question:

• What is the threat to the medical facility or personnel? – is it necessary for the facility to be guarded (including the threat of lethal force – weapons), is it necessary for medical personnel to be protected?

• Is there any threat to the facility or personnel from the behaviours of anyone inside the facility? – e.g. prisoners, visitors, terrorists, ‘enemies’ – e.g. insider threat from partnered military forces

• Who might be armed to protect against these threats? – e.g. guards for prisoners, ‘guardian angels’ against insider threats

• Who might have a legal authority to carry arms wherever they are? E.g. local security personnel, bodyguards for VIPs

Further issues for consideration:

• How might local armed actors be persuaded not to enter medical facilities with weapons?

• What arrangements should be in place if visitors are expected to leave their weapons outside?

• What security activities inside medical facilities are specifically excluded under IHL – see further reading

Humanitarian principles. Wikipedia. At: https://en.wikipedia.org/wiki/Humanitarian_principles#:~:text=Humanitarian%20principles%20are%20a%20set,humanitarian%20response%20is%20carried%20out.&text=The%20four%20guiding%20principles%20are%20Humanity%2C%20Neutrality%2C%20Impartiality%20and%20Independence.

IHL and humanitarian principles. Advanced IHL Learning Series. ICRC. At: https://www.icrc.org/en/ihl-and-humanitarian-principles

Broussard, G., Rubenstein, L.S., Robinson, C. et al. Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review. Int J Humanitarian Action 4, 15 (2019). https://doi.org/10.1186/s41018-019-0063-x

Commission of Inquiry on the assault on medical care in Syria. Assault on medical care in Syria. UN Human Rights Council A/HRC/24/CRP.2 dated 13 Sep 2013. At: https://www.refworld.org/pdfid/523c24704.pdf

Afghanistan: Special Forces Raid Medical Clinic. Human Rights Watch. 12 Jul 2019. At: https://www.hrw.org/news/2019/07/12/afghanistan-special-forces-raid-medical-clinic