Ensuring the Protection of Wounded and Sick Persons in All Circumstances

The protection of wounded and sick persons must be ensured in all situations. Humanitarian law establishes that such persons are a separate category of protected persons, within which any distinction between combatant and civilian is abolished and all must be treated alike (GCI–IV Common Art. 3, API Art. 10 and 11, and APII Art. 7).

This protection is established in Common Article 3 to the four Geneva Conventions. This article establishes the minimum standards of protection that must be applied at all times, whether in international or internal armed conflicts, or even internal disturbances or tensions. This article contains the minimum customary guarantees applicable at all times to any individual, without discrimination based on his or her status.

Persons taking no active part in the hostilities, including members of armed forces who have laid down their arms and those placed hors de combat by sickness, wounds, detention, or any other cause, shall in all circumstances be treated humanely, without any adverse distinction founded on race, colour, religion or faith, sex, birth or wealth, or any other similar criteria. . . .

The wounded and sick shall be collected and cared for. An impartial humanitarian body, such as the International Committee of the Red Cross, may offer its services to the Parties to the conflict. (GI-IV Common Art. 3)These minimal provisions are completed by the two Additional Protocols, which provide that

all the wounded, sick and shipwrecked, whether or not they have taken part in the armed conflict, shall be respected and protected. In all circumstances they shall be treated humanely and shall receive to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. There shall be no distinction among them founded on any grounds other than medical ones. (APII Art. 7; API Art. 10)

▸ Wounded and sick persons

Ensuring That the Medical Services Function

In practice, the wounded and sick are protected by the guarantees established by humanitarian law to ensure that medical services continue operating in times of conflict. The law grants special protection to medical units, personnel, and means of transportation and posits that medicine and medical relief must be guaranteed free passage. This means, specifically, that

• medical personnel and installations may not be the object of attacks,
• medical installations are authorized to carry the distinctive emblem of the Red Cross,
• medical personnel and material must be protected from requisition, and
• the delivery of medical supplies must always be ensured.

▸ Medical personnel ▸ Medical services ▸ Requisition

Searching and Caring for the Wounded and Sick

To ensure that the wounded and sick are searched for, transported, and cared for, humanitarian law establishes a special protection status for medical personnel and means of transportation. It authorizes them to wear a distinctive emblem and guarantees their freedom of movement:

• Medical personnel must always be respected and protected.
• Members of medical personnel may not be requisitioned.
• They can undertake activities to search for the wounded and sick members of the parties to the conflict and facilitate their transportation. Such activities can only be limited on a temporary basis and only because of imperious military necessity.
• They must always be granted access to the places where their services are needed.
• They may not be required to give priority to any one or group of persons.
• In providing care to the sick and wounded, no discrimination may be made on the basis of grounds other than medical ones.
• Medical personnel may not be compelled to carry out acts contrary to the rules of medical ethics.
• Members of medical personnel may not be punished for activities carried out, no matter what the circumstances may have been, as long as their actions were compatible with medical ethics.

▸ Distinctive (protective) emblems, signs and signals ▸ Medical ethics ▸ Medical personnel ▸ Medical services ▸ Requisition ▸ Right of access

In Occupied Territories, Detention, or Internment

In certain situations, such as occupied territories, detention, or internment, the guarantees granted to medical duties must be reinforced so as to avoid the specific risks incurred by both the sick person and the person providing the care. Humanitarian law decrees specific rules for the following:

• Wounded and sick prisoners of war (GCIII Arts. 29–33): in certain cases, the patients must be cared for or hospitalized in a neutral country (GCIII Art. 132).
• Detained or interned persons (GCIV Arts. 91, 92): the possibility of releasing certain categories of persons from the places of detention or arranging for their accommodation in a neutral country is also foreseen (GCIV Art. 132).
• Occupied territories: the occupying power must not hinder the functions of medical services and must ensure that they are carried out in sufficient amount. The protecting powers of other humanitarian organizations are entitled to verify the condition of food and medical supplies at all times (GCIV Arts. 55–57 and 59–63).
• Persons deprived of their liberty for reasons related to the armed conflict, whether they are interned or detained (APII Arts. 5.1.a, 7).
• Finally, humanitarian law establishes specific rules for medical personnel and medical installations belonging to armed forces and for the wounded and sick persons in their care (GCI Arts. 12–37).

▸ Detention ▸ Internment ▸ Occupied territory ▸ Prisoners of war ▸ Wounded and sick ▸ persons

Medical Ethics in Times of War

Humanitarian law seeks to reinforce the strength and resilience power of medical ethics in situations of conflict. It raises medical ethics to the position of an international rule of law that is mandatory for all States. Without defining and codifying the entire content of medical ethics, the Geneva Conventions establish the framework of constant and consistent minimum rules within which medical activities must take place.

The aim is to clarify the obligations and prohibitions that international law imposes on the practitioner to help him or her withstand the national context of pressure, constraint, and violence. Humanitarian law hence sets forth:

• the medical behavior that is prohibited: these include medical acts and omissions that are not justified by the state of health of the patient and in conformity with medical ethics;
• the medical behavior that authorities may not prohibit;
• the principle that no person may be punished for medical activities he or she carried out, no matter what the circumstances may have been, as long as his or her actions were compatible with medical ethics; and
• it protects medical secrecy in times of conflict.

▸ Medical ethics

Prohibition of Medical Acts Not Justified by the State of Health of the Patient

Humanitarian law endorses the obligation to care for the wounded and sick and to respect the medical ethics surrounding these acts. Any willful act or omission that seriously endangers the physical or mental health or integrity of any person is a grave breach of the Geneva Conventions and hence a war crime (GCI Art. 50, API Art. 11). The fact of subjecting persons who are in the power of another party to the conflict to physical mutilation or to medical or scientific experiments of any kind that are neither justified by the medical, dental, or hospital treatment of the person concerned nor carried out in his or her interest, and which cause death to or seriously endanger the health of such person or persons, constitutes a war crime under the Statute of the International Criminal Court (Art. 8.2.e.xi). This provision calls into question the ethical framework of medical activity in detention facilities in times of conflict. It also raises the issue of individual criminal responsibility of medical personnel in charge of detained patients in times of conflict in case they disregard this specific legal framework for medical practice.

▸ Detention ▸ Ill treatment ▸ Medical ethics

Rules of Customary International Humanitarian Law

The study on the rules of customary international humanitarian law published by the International Committee of the Red Cross in 2005 enshrines the minimum guarantees of treatment for civilians, wounded, and sick in times of conflict provided for in the Geneva Conventions. They are applicable in international and non-international armed conflicts.

• Rule 6. Civilians are protected against attack, unless and for such time as they take a direct part in hostilities.
• 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.
• Rule 27. Religious personnel exclusively assigned to religious 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.
• 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.
• Rule 29. Medical transports assigned exclusively to medical transportation 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.
• Rule 30. Attacks directed against medical and religious personnel and objects displaying the distinctive emblems of the Geneva Conventions in conformity with international law are prohibited.
• Rule 109. Whenever circumstances permit, and particularly after an engagement, each party to the conflict must, without delay, take all possible measures to search for, collect, and evacuate the wounded, sick, and shipwrecked without adverse distinction.

• Rule 110 . The wounded, sick, and shipwrecked must receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. No distinction may be made among them founded on any grounds other than medical ones.
• Rule 111 . Each party to the conflict must take all possible measures to protect the wounded, sick, and shipwrecked against ill treatment and against pillage of their personal property.

▸ Medical ethics ▸ Medical personnel ▸ Medical services ▸ Wounded and sick persons