The Practical Guide to Humanitarian Law

« Calling things by the wrong name adds to the affliction of the world. » Albert Camus.

Wounded and Sick Persons

The wounded and sick, as defined in humanitarian law, are individuals, either military or civilian, who are in need of medical care (whether because of trauma, disease, or other physical or mental disorder or disability) and who refrain from any act of hostility (API Art. 8). Humanitarian law forbids any adverse distinction between them for reasons other than medical ones. If the individual in question is a combatant, his or her status as a wounded or sick person takes precedence over that of combatant. This lasts as long as the wound or disease keeps the person out of combat ( hors de combat ) and in need of medical care. A combatant who recovers while in the hands of an adverse party then becomes a prisoner of war, at which point he or she comes under the provisions protecting such persons.

The general principle concerning the wounded and sick of any party to a conflict is that they must be treated humanely in all circumstances and given the medical care required by their condition, to the fullest extent practicable and with the least possible delay. No distinction may be made among them, except ones founded on medical grounds (GCI–IV Common Art. 3; API Arts. 8, 10; APII Arts. 7, 8).

This is one of the oldest principles of humanitarian law, enshrined in the first Geneva Convention of 1864.

Protection of, and Obligations of, Medical Personnel

Humanitarian law protects the independence and integrity of doctors by reaffirming the rules of medical ethics. It specifies which medical acts are permitted and which are not—namely, when the wounded and sick persons are at the mercy of an authority of which they are not a national, due to a situation of occupation or detention (GCI–IV Common Art. 3; API Arts. 10, 11, and 16; APII Arts. 9, 10). ▸ Medical ethics

Humanitarian law also protects medical installations from attacks (GCIV Art. 18, API Art. 12, and APII Art. 11) and requisitions (GCIV Art. 57, API Art. 14) and allows the use of the distinctive emblem of the red cross to protect such installations (GCI Arts. 38–44, GCIV Art. 18, API Art. 18, APII Art. 12). Finally, it authorizes the free passage and delivery of medicine and medical supplies, including to besieged areas (GCIV Art. 23). ▸ Distinctive (or protective) emblems, signs, and signalsMedical servicesRequisition;Siege

Humanitarian law imposes the obligation to search for, collect, and care for the wounded and sick (GCI–IV Common Art. 3, GCIV Art. 16, and APII Art. 8). Members of medical personnel are entitled to special protection in order to facilitate their movement and access to any place where their services are needed (GCI Art. 15; API Arts. 15, 23). ▸ Medical personnelRight of access

Pregnant women, maternity cases, newborn infants, and infirm persons are included in the humanitarian law definition of wounded and sick, for the purpose of increasing the protection to which they are entitled (API Art. 8). This provision reinforces the responsibility of humanitarian and medical organizations with respect to these members of the civilian population.

Wounded or Sick Prisoners of War

Wounded or sick prisoners of war who are suffering from certain serious injuries or diseases are entitled to special measures of protection under humanitarian law. These provisions take into account the vulnerability and the risks of abuse faced by such seriously ill or injured persons, and the advantages that may be gained by treating them in a peaceful and safe environment (GCIII Arts. 109–117). The Geneva Conventions and their Additional Protocols establish the conditions under which seriously sick or wounded prisoners of war may be evacuated or hospitalized in a neutral State, rather than continuing to treat them in the hospitals of the detaining power and continuing to consider them prisoners of war.

Article 110 of the Third Geneva Convention sets forth the list of diseases and illnesses that require a prisoner of war to be repatriated directly or accommodated in a neutral country. Those whose diseases or wounds warrant a direct repatriation are:

  • the incurably wounded or sick whose mental or physical fitness seems to have been gravely diminished;
  • the wounded or sick who have recovered but whose mental or physical fitness seems to have been gravely and permanently diminished;
  • the wounded or sick who, according to medical opinion, are not likely to recover within one year.

Those who may be accommodated in a neutral State are:

  • wounded and sick whose recovery may be expected within one year, or sooner if treated in a neutral country;
  • prisoners of war whose mental or physical health, according to medical opinion, is seriously threatened by continued captivity but whose accommodation in a neutral country might remove such a threat.

Certain prisoners of war accommodated in a neutral country can be directly repatriated following their treatment, under an agreement between the powers concerned, if:

—their state of health has deteriorated so as to fulfill the conditions laid down for direct repatriation;

—their mental or physical powers remain considerably impaired, even after treatment.

Prisoners of war

Such measures may also be implemented for civilian internees who are seriously ill or injured (GCIV Art. 132).

Authorities are responsible for the health and physical integrity of the persons in their power. They therefore cannot refuse to provide necessary care to a person under their authority, or deliberately endanger the person’s health.

Both Additional Protocols of the Geneva Conventions reinforce the protection that must be provided to victims of conflict, in general, and the wounded and sick, in particular. “The physical or mental health and integrity of persons who are in the power of the adverse Party or who are interned, detained or otherwise deprived of liberty as a result of a [conflict] shall not be endangered by any unjustified act or omission.” Any such act or omission constitutes serious violations and crimes (API Art. 11, APII Art. 5).

This provision emphasizes the responsibility of humanitarian and medical organizations in terms of monitoring the state of health of the civilian population and the fate of the wounded and sick.

Guarantees Provided by Customary International Humanitarian Law

The study on the rules of customary international humanitarian law published in 2005 by the ICRC makes provisions for the protection of wounded, sick, and shipwrecked persons, which are applicable in international and non-international armed conflicts. Those rules are as follows:

  • 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.

DetentionMedical dutiesMedical ethicsMedical personnelMedical servicesPrisoners of warRelief

For Additional Information: Dinstein, Yoram. The Conduct of Hostilities under the Law of International Armed Conflict . Cambridge: Cambridge University Press, 2004.

Henckaert, Jean-Marie, and Louise Doswald-Beck, eds. Customary International Law . Vol. 1, The Rules . Cambridge: Cambridge University Press, 2005, 396–405.

Rezek, Jose-Francisco. “Wounded, Sick and Shipwrecked Persons.” In International Dimensions of Humanitarian Law , 153–66. Geneva: Henri Dupont Institute, 1988.

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