You suspect the host-nation base guards are refusing some people acces · Medical

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6 You suspect the host-nation base guards are refusing some people access to healthcare because they are from the 'wrong' area or tribe. What do you do?

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: You suspect the host-nation base guards are refusing some people access to healthcare because they are from the 'wrong' area or tribe. What do you do?

• List the Issues that arise from the scenario.

• Identify Critical Information required and Assumptions to be made:

The primary issue in this scenario is ensuring non-discriminatory access to healthcare, which is being impeded by host-nation guards allegedly refusing access to individuals based on their area or tribe. The behaviour poses ethical, legal, and reputational risks to the medical unit and the broader mission. Additionally, determining the validity of the allegation and the appropriate course of action requires a careful, evidence-based investigation to uphold professional standards while mitigating potential fallout.

Step 2 – ANALYSE

Patient: The primary duty of healthcare personnel is to provide care to all patients based on clinical need without discrimination, as emphasized in 'Ethical principles of health care in times of armed conflict and other emergencies.' Non-discrimination is also a central tenet of international humanitarian law and medical ethics. Refusing healthcare based on tribal or geographic origin violates these principles, as highlighted in the WMA International Code of Medical Ethics (https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/) and Geneva Conventions Articles.

Clinical: Discriminatory access risks denying life-saving or necessary care to individuals, exacerbating harm and suffering. It undermines the credibility and neutrality of the medical mission and can deter vulnerable populations from seeking healthcare. Clinical priorities, not external biases, should determine resource allocation, as outlined in Customary IHL Rule 88 (Customary IHL, Rule 88).

Legal: Discrimination violates legal obligations under the Geneva Conventions, which mandate non-discriminatory access to care for all individuals in conflict settings (First Geneva Convention, Article 12; Additional Protocol II, Article 4(1); Geneva Conventions Protocol I, Article 75(1)). International law prohibits adverse distinctions based on race, ethnicity, religion, or similar criteria.

Societal/Military: Such behaviour undermines trust in military and medical operations, potentially fuelling tension between local populations and international forces. It also risks reputational damage to the medical unit and broader mission. The WMA Statement on Armed Conflicts (https://www.wma.net/policies-post/wma-statement-on-armed-conflicts/) highlights the importance of ensuring equitable care for vulnerable groups. An investigation must be conducted impartially, involving the chain of command, local authorities, and potentially professional regulatory bodies to ensure transparency and accountability.

Step 3 – FUSE

• Summarise conclusions

• Insert citations to key reference sources for your analysis

• Determine the exact Decision(s) to be made

The conclusion is that discriminatory access to healthcare is both ethically and legally impermissible. Immediate action is required to investigate the allegation, ensuring decisions are based on evidence and conducted transparently. The Geneva Conventions (https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/vwTreaties1949.xsp) and the WMA International Code of Medical Ethics (https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/) mandate equitable access to care and prohibit adverse distinction based on non-clinical factors. The investigation must identify whether guards are acting under explicit orders or personal biases, and measures should be implemented to prevent further incidents. Clear communication with stakeholders is critical to mitigate reputational and operational risks.

Step 4 – DECIDE

• What is your Decision?

• Why (can you justify it)?

• Residual uncertainly, need for review?

The decision is to launch an impartial investigation into the allegations, gathering evidence to validate the claims. If discrimination is confirmed, appropriate corrective actions must be taken, including retraining or replacing the guard force and reinforcing policies against discrimination. This decision is justified by the ethical and legal obligations to provide equitable healthcare and the need to preserve the medical unit's reputation and trustworthiness. Residual uncertainty includes the potential backlash from removing guards and the need to manage relations with host-nation authorities. A review mechanism should be implemented to monitor ongoing access to healthcare, ensuring compliance with non-discriminatory practices and maintaining the integrity of the mission.