Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario

The commander of a logistic convoy wishes to put food and water into the ambulance of the convoy. Should this be permitted?

• List the Issues that arise from the scenario

Vehicles protected under the Red Emblem should only be used for healthcare services to patients or to medical professionals themselves. Sometimes the Red Emblem is misused (to store military equipment for example).

• Identify Critical Information required and Assumptions to be made

Step 2 – ANALYSE

Patient: What are the views of the Patient? (and ‘patient group’)? How do 4 principles of : Autonomy, Beneficence, Non-maleficence and Justice apply? Other perspectives?

Beneficence - Food and water for patients stored in ambulance sustains them under physical stress.

Non-Maleficence - Any equipment or items stored in ambulance for other objectives other than for the health of injured patients or medical professionals can make patients feel unsafe. They may know that the red emblem is being misused and makes them target to attack by enemies.

Clinical: What are the clinical diagnosis, prognosis, treatment options? Is this scenario covered by professional regulation or guidance? What are the views of individual members of the clinical team? Other perspectives?

• The law states that vehicles which have function that is protected under the Red Cross must only be used for the purpose of providing aid to patients or medical personnel. So this does not include using ambulance as storage for food and water for healthy military personnel.

• Members of clinical team would likely be on board with these laws. As if emblem is used for functions other than for healthcare purposes, the vehicle will no longer be protected under IHL putting patients and clinical team at risk.

Legal: Is scenario covered by IHL, Geneva Conventions, military law, other law? Other perspectives?

Summary of laws:

Red Cross is a symbol that can be present on equipment, personnel, vehicles or buildings that gives that thing protection under international humanitarian law.

For example medical professionals working in armed conflict are protected in the sense that they cannot be legally targeted by enemies.

The personnel is protected in the sense that if there is violation, the country responsible for violation will face legislative consequence.

The purpose of the emblem is to let all parties know that whatever has the emblem is protected under IHL.

Just because someone or something does not have Red Cross, does not mean that it is not protected under international humanitarian law. As long as they meet the requirements of function, such as to help deliver healthcare during times of armed conflict, they are protected.

There are also times in which it might be inappropriate to wear Red Cross: like if the enemy are not respecting the protection afforded by the emblem, or display of the emblem would reveal location of military facilities).

The emblem can also be misused in three ways: invitation, improper use and perfidy. Invitation is when a sign, that looks like the emblem, is used on something or someone not authorized to wear the emblem. Improper use is when the emblem is used by unauthorized bodies. Perfidy is when the emblem is used to trick enemies into thinking that this equipment/building/personnel is protected under IHL when they are not.

Ethical Principles of Healthcare in Times of Armed Conflict and other emergencies

1. Healthcare personnel as well as healthcare 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.

2. In fulfilling their duties and where they have the legal right, healthcare 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:

The Use of Geneva Conventions is covered by the following International Humanitarian Law:

GC I, Art. 53; AP I, Arts 37–38 and 85; AP II, Art. 12; Customary IHL Study, Rule 59

Societal/Military: Is there a military necessity? Is this scenario covered by military regulation or military perspective? Is this scenario covered by public health or societal ethics? Other perspectives?

• If emblem is used for other functions other than for healthcare purposes, then the vehicle is no longer protected. Non-adherence of IHL might promote distrust from enemies. This distrust might lead to attack on other buildings, equipment or personnel that have emblem.

Step 3 – FUSE

• Vehicles protected under Red Emblem should only be used for authorized purposes, which includes for example improving the health of patients and military personnel.

• If vehicle does not have Red Emblem, this does not matter. It is the function of the vehicle that gives it protection not the label of the Red Emblem itself.

• Using the vehicle for unauthorized purposes regarding the Red Emblem, is not only illegal but also dangerous in a military context.

Step 4 – DECIDE

• What is your Decision?

If the food/water is for healthcare aid to patients or to medical personnel, then this is allowed.

If not, for example if ambulance is being used as storage of water and food for healthy military personnel, then no.

• Why (can you justify it)?

The law states that Vehicles which have function that is protected under Red Cross must only be used for the purpose of providing aid to patients and/or to medical personnel. Any other function is illegal.

Reviewed and formatted by: Yvonne Zhou MBBS Year 3 King’s College London Dec 2024