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The term medical services covers medical personnel, medical units, and medical transportation. It is a crucial element in bringing relief to the populations concerned. In situations of conflict, humanitarian law grants a special status and specific protection to medical services (GCIV Arts. 56, 57; API Arts. 8–31; and APII Arts. 7–12).
A medical unit is a military or civilian establishment or other unit organized for medical purposes—namely, the search for, collection, transportation, or treatment (including first aid treatment) of the wounded, sick, and shipwrecked or for the prevention of disease.
In other words, medical units are hospitals, clinics, pharmacies, laboratories, and other medical centers. Humanitarian law tries to maintain continuity between all the medical services during a conflict and therefore applies the term medical units to such places to ensure that they are granted the protective status common to all such establishments.
- Medical units include:
° hospitals and other similar units,
° blood transfusion centers,
° centers and institutes for preventive medicine,
° medical and pharmaceutical stores and materials, and
° stocks of medical material and pharmaceutical products.
- These medical units can be fixed or mobile, permanent or temporary, and are protected under humanitarian law from destruction, attacks, and requisitions (GCI Arts. 19–23, 33–35; GCIV Art. 18; API Arts. 8, 12–14; APII Art. 11). They are also entitled to the protection provided through the use of the distinctive emblem of the Red Cross (GCI Art. 38, 42; GCIV Art. 18; API Art. 18; APII Art. 12).
- Civilian hospitals that are organized to provide care for the wounded, the sick, the infirm, and maternity cases may in no circumstances be the object of attacks. They must be respected and protected, at all times, by the parties to the conflict (GCIV Art. 18, API Art. 12, and APII Art. 11).
- Civilian hospitals shall be marked, if the State authorizes it, by means of the emblem provided for in Article 38 of the first Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field of 12 August 1949, such as the Red Cross or Red Crescent (GCIV Art. 18).
- Parties to a conflict shall, insofar as military considerations permit it, take the necessary steps to make the distinctive emblems indicating civilian hospitals clearly visible to the enemy forces—land, air, and naval—to obviate the possibility of any hostile action (GCIV Art. 18).
- States Parties to a conflict shall provide all civilian hospitals with certificates showing that they are civilian hospitals and that the buildings they occupy are not used for any purpose that would deprive these hospitals of protection (GCIV Art. 18).
- In view of the dangers to which hospitals may be exposed by being close to military objectives, it is recommended that civilian hospitals be situated as far as possible from such objectives (GCIV Art. 18).
- Under no circumstances may medical units be used in an attempt to shield military objectives from attack. Whenever possible, the parties to the conflict shall ensure that medical units are situated so that attacks against military objectives do not imperil their safety (API Art. 12).
- Fixed establishments and mobile medical units of the military medical services may in no circumstances be attacked, and they must at all times be respected and protected by the parties to the conflict. Should they fall into the hands of an adverse party, their personnel shall be free to pursue their duties, unless the capturing power itself has ensured the necessary care of the wounded and sick provided in such establishments and units. The responsible authorities shall ensure that these medical establishments and units are, as much as possible, situated in such a manner that attacks against military objectives cannot imperil their safety (APII Art. 19).
Medical Material and Medicine
Medical material designates all the equipment and supplies necessary for the functioning of medical units, which must also benefit from the protection granted to medical units.
- Medical material is not a strategic product or object. International humanitarian law therefore forbids its destruction or requisition (GCIV Art. 55, API Art. 14).
- Parties to the conflict must not prohibit any action that consists of supplying medicine and medical materials (GCIV Arts. 23, 55; APII Art. 18).
- International humanitarian law further specifies that:
—an occupying power has the duty to ensure that food and medical supplies are provided for the population (GCIV Art. 55);
— each High Contracting Party is under the obligation to allow the free passage of all consignments of medicine and medical material that are intended solely for civilians of another party, even if the latter is its adversary (GCIV Art. 23);
— relief societies are authorized to undertake relief actions when a civilian population is suffering owing to a lack of supplies essential to its survival, such as foodstuffs and medical supplies (APII Art. 18);
— the protecting power is always at liberty to verify the state of the food and medical material in occupied territories, “except where temporary restrictions are made necessary by imperative military necessity” (GCIV Art. 55).
Protection May Be Withdrawn in Certain Cases
The protection to which fixed medical establishments and mobile medical units are entitled shall not cease unless they are being used to commit acts, outside their humanitarian duties, that are harmful to the enemy. Even in such cases, protection can cease only after due warning has been given and this warning has remained unheeded. Such a warning must, in all appropriate cases, give a reasonable time limit after which the protection will cease (GCI Art. 21, API Art. 13, and APII Art. 11).
The study on the rules of customary humanitarian law published by the ICRC in 2005 has recognized the binding nature of this protection in international and non-international armed conflicts. The customary IHL study provides that “medical units exclusively assigned to medical purposes” (Rule 28) as well as “medical transports assigned exclusively to medical transportation” (Rule 29) “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.”
Cases in Which Protection May Not Be Withdrawn
The Geneva Conventions and their Additional Protocols consider that certain acts may not be defined as being of a nature that would permit a party to the conflict to deny protection to a medical unit or establishment. This includes situations in which:
- the personnel of the unit or establishment is armed and uses the arms for its own defense or in defense of the wounded and sick in their charge;
- the unit or establishment is protected by a picket, by sentries, or by an escort, in the absence of armed orderlies;
- small arms and ammunition taken from the wounded and sick and not yet handed to the proper service are found in the unit or establishment;
- the humanitarian activities of medical units and establishments or their personnel extend to the care of civilian wounded or sick;
- members of the armed forces or other combatants are in the unit for medical reasons (GCI Art. 22, API Art. 13).
Medical transportation means the act of conveying the wounded, sick, shipwrecked, medical personnel, religious personnel, medical equipment, or medical supplies protected by the Geneva Conventions and their Additional Protocols, by land, water, or air. Medical transports refers to the means of transportation of such persons or supplies, whether military or civilian, permanent or temporary, assigned exclusively to medical transportation and under the control of a competent authority of a party to the conflict (API Art. 8).
- Means of transportation are protected by norms of international law and, under this status, may carry the emblem of the Red Cross (GCI Arts. 35–38; GCII Arts. 22–35, 38–41; GCIV Arts. 21, 22; API Arts. 12, 21–31; APII Arts. 11 and 12).
- Medical transportation—whether on land or sea or by air—must be respected and protected in the same way as mobile medical units (Rule 29 of the customary IHL study). This means that such transportation may not be attacked, and specific precautions identified by the Conventions must be taken to protect it (GCII Arts. 35, 36; GCIV Arts. 21, 22; API Arts. 12, 21; APII Art. 11). The precautions to be taken to protect such transportation include:
° identifying it as being entitled to such protection by bearing the appropriate protective emblem (e.g., the Red Cross or Red Crescent) and
° informing the authorities of its presence.
Protection May Be Withdrawn Following Certain Acts
The Conventions specify which acts may lead to the withdrawal of such protection for medical transportation and which acts may not (GCII Arts. 34, 35; API Art. 13):
- The protection to which means of medical transportation are entitled shall not cease unless they are being used to commit, outside their humanitarian duties, acts that are harmful to the enemy. Even in such cases, protection can cease only after due warning has been given (which gives, in all appropriate cases, a reasonable time limit) and after this warning has remained unheeded (GCII Art. 34).
- The following acts may not be considered harmful to the enemy and may therefore not lead to the protection granted to medical transportation being discontinued: the fact that the personnel of a medical unit is equipped with light individual weapons for their own defense; the fact that the unit is guarded by an escort; the act of transporting members of the armed forces or other combatants for medical reasons (API Art. 13).
The Conventions set out the specific measures that must be taken for the identification and notification of movements. These measures are particularly detailed in the case of hospital ships, coastal rescue craft, and other ships (GCII Arts. 22–36, 43; API Arts. 18, 22, 23) and medical aircraft (GCII Arts. 39, 40; API Arts. 18, 24–31), as well as medical units (GCI Arts. 42, 43; GCIV Art. 22) and medical transports (GCI Arts. 39, 44; GCIV Art. 21).
Precise rules also regulate the requisition of medical material and means of transportation (GCI Art. 35, GCIV Art. 57, API Art. 14). It is forbidden to requisition civilian medical units as long as these are needed to provide adequate medical services for the civilian population and to ensure the continuing medical care of any wounded and sick already undergoing treatment (API Art. 14.2).
If it is possible to carry out a requisition while respecting these principles, it is still subject to the following conditions (API Art. 14.3):
- The resources are being requisitioned because they are necessary for the adequate and immediate medical treatment of the wounded and sick members of the armed forces or of prisoners of war. Requisition may not be carried out for any other reason.
- The requisition must continue only as long as such necessity exists.
- Immediate arrangements must be made to ensure that the medical needs of the civilian population and those of any wounded and sick already under treatment continue to be satisfied.
Members of medical personnel are given a special status and protection by humanitarian law, as part of relief personnel. This protection is reinforced by the specific rights they are granted by virtue of their medical mission. This special status is addressed independently under the entry on ▸ Medical personnel.
▸ Distinctive (or protective) emblems, signs, or signals ▸ Humanitarian and relief personnel ▸ International Criminal Court ▸ Medical duties ▸ Medical personnel ▸ Protected objects and property ▸ Relief ▸ Requisition ▸ Wounded and sick persons
For Additional Information: Baccino-Astrada, Alma. Manual on the Rights and Duties of Medical Personnel in Armed Conflicts . Geneva: ICRC, 1982.
Dinstein, Yoram. The Conduct of Hostilities under the Law of International Armed Conflict . Cambridge: Cambridge University Press, 2004, esp. 166–72.
Henckaerts, Jean-Marie, and Louise Doswald-Beck, eds. Customary International Law . Vol. 1, The Rules . Cambridge: Cambridge University Press, 2005, esp. 79–104.