Step 1 – IDENTIFY THE PROBLEM(S)

Briefly state the Scenario - Is it acceptable to allow firearms into a medical facility? If so, who may carry them? – MME Cards Jack Hearts

List the Issues that arise

• Medical facilities are ‘neutral areas’ and so firearms should not be present – see ICRC Healthcare in Danger Prevention of entry of weapons into health facilities campaign - https://healthcareindanger.org/no-weapons/ .

• The presence of firearms in a medical facility may cause anxiety to the patients.

• Firearms may impact upon the provision of clinical care.

• ‘anyway - why would anyone wish to care a firearm into a medical facility?’

• Some patients or visitors may pose a specific threat which has to be mitigated by the presence of armed personnel in a medical facility.

List Critical Information Requirements (CIRs), and Assumptions to be made

CIRs:

• Why is this question being posed – what is the specific threat e.g. are the enemy planning to attack a medical facility?

• Is the facility able to hold weapons in a secure environment? (it may not be practical for very small field medical units to take weapons away from staff/visitors)

Assumptions:

• The question relates to a military medical unit, in which medical personnel may be issued with weapons.

• There is no local threat of direct attack to the unit.

• The compound in which the medical unit is located is secure.

Step 2 – ANALYSE:

Patient:

What are the views of the Patient? (and ‘patient group’)?

How do: Autonomy, Beneficence, Non-maleficence and Justice apply?

Other important factors?

Patients should not carry weapons (including outpatients). The patient’s environment should be sanitised from military/combat artefacts as much as is reasonable. Personal protective equipment should be available if there is a threat (e.g. helmets, body armour, gas masks etc).

Clinical:

Diagnosis, Prognosis, Treatment options?

Is scenario covered by professional regulation/guidance?

What are the views of the clinical team?

Other important factors?

Members of the clinical team may have opinions on the carriage of weapons within a medical facility.

Personnel with clinical duties should not carry weapons whilst on these duties

Clinical staff may refuse to treat patients or to see relatives if they are carrying weapons

Legal:

Is the scenario covered by IHL including GCs, military law, other law?

Other important factors?

Medical units and personnel should be protected, and not subject to attack. Geneva Conventions 1,2, 4 and AP1.

ICRC Healthcare in Danger Campaign – Prevention of entry of weapons into health facilities – strong humanitarian view that medical facilities should be free of weapons

There may be legal rights for designated individuals to carry weapons (e.g. security services, personal security personnel for VIPs)

Societal:

Is military necessity involved?

Is the scenario covered by military regulation?

Is the scenario covered by public health or societal ethics?

Other important factors?

There may be specific military circumstances where weapons are needed:

Part of a medical screening team on a security gate

Guarding of prisoners

Protection of against a definite threat of attack – e.g. ‘insider threats’ if working within insecure facilities

Designated quick response force against attack

Carefully consider the implications of military medical personnel visiting civilian medical facilities/meetings etc with their personal weapons

or senior VIPs visiting the military medical facility

Step 3 – FUSE

• Summarise conclusions

• Determine the exact Decision(s) to be made

In principle, the clinical areas of a military medical unit should be a ‘weapons free’ zone. This requires clear communication. It may be necessary to provide secure storage facilities for weapons if there is a high frequency of carriage of weapons by visitors (especially in a military environment when all personnel are likely to be carrying weapons). There are specific circumstances where weapons may be overtly or covertly carried inside a medical facility. These should be codified as rules/procedures. All individuals carrying weapons in a medical facility to be trained and authorised to do so with oversight by the senior leadership.

Step 4 – DECIDE

• What is your Decision?

• Why (can you justify it)?

Weapons should not be routinely allowed into the clinical areas of a military medical facility.

Rules/procedures should be put in place for specific individual circumstances if this principle has to be broken.

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?

• What arrangements are in place in civilian hospitals for the security/protection of patients at high risk of being attacked or attacking staff? Consider how this applies within prison medical facilities?

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