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

4 You are deployed to a conflict area where the enemy are deliberately and consistently violating the laws of armed conflict. 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?

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario

You are deployed to a conflict area where the enemy are deliberately violating the laws of armed conflict. You have been tasked to send an ambulance on a very dangerous mission to collect enemy casualties.

Should your own personnel be put in harm’s way to save the life of someone who would not reciprocate?

• List the Issues that arise from the scenario

The balance between helping patients but also protecting yourself as a medical professional.

• 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?

Patients who belong to enemy forces or are prisoners of armed conflict have a right to receive medical treatment.

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 clinical team may feel that the task is too dangerous and might refuse to go.

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

Care for the Wounded and Sick (Geneva Convention I, Article 12) states that medical professionals working in the military must treat all patients based on clinical need, regardless of their allegiance (belonging to enemy forces).

Medical Care for POWs (Geneva Convention III, Article 30) states that prisoners of war are entitled to medical care too.

Although the Laws of Armed Conflict apply to international and non-international conflicts, it is harder to implement in non-international conflicts. Non state-armed forces have not technically signed the Laws of Armed Conflict which can make it more difficult to hold them accountable.

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?

Violating the laws of Armed Conflict in this scenario could increase the risk of the mission since the enemies could be directly targeting vehicles with the red cross.

There are ways to mitigate risk of such a mission. Examples include using an ambulance that has more built in protection against fire from enemy attacks. Medical professionals could be ordered to wear body protection gear. A safe route could be planned with least likelihood of being attacked by enemies and drones could be used to monitor the route. A military escort could be used to protect medical professionals in case of enemy attack.

Adherence to IHL amongst enemy forces can be increased through neutral parties like the International Committee of the Red Cross. They act a neutral party who could potentially contact an enemy force to educate them (through workshops for example) on the importance of adhering to the laws of armed conflict.

Step 3 – FUSE

· Summarise conclusions

· Insert citations to key reference sources for your analysis

· Determine the exact Decision(s) to be made

Under the Geneva Conventions, patients, including enemy forces or prisoners of war (POWs), have the right to receive medical treatment based on clinical need (Geneva Convention I, Article 12; Geneva Convention III, Article 30). In non-international conflicts, enforcement of these rights is more difficult, as non-state armed groups may not adhere to IHL. Violating IHL can increase mission risks, as enemy forces might target medical vehicles. Risk mitigation includes using armored ambulances, body protection for medical staff, and planning safe routes. The ICRC plays a role in educating combatants on IHL compliance, fostering greater adherence.

Step 4 – DECIDE

Provided that the considerations for protection for this mission have been considered, and that the benefits of the mission are seen to outweigh the risks of the mission, then this order is legitimate.

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