Policy Tag: Armed Conflicts

Adopted by the 226th WMA Council session, Seoul, Korea, April 2024
and adopted by the 75th WMA General Assembly, Helsinki, Finland, October 2024

 

PREAMBLE

In response to the ongoing conflict in Israel and Gaza, the WMA is gravely concerned by the deepening healthcare and humanitarian crisis in Gaza, the growing starvation and the lack of medical care and deeply concerned about the continued imprisonment and abuse of hostages.

 

RECOMMENDATIONS

The WMA Council and its constituent members call for:

  1. A bilateral, negotiated and sustainable ceasefire in order to protect all civilian life, secure the release and safe passage of all hostages and to allow the transfer of humanitarian aid for all those in need.
  2. The immediate and safe release of all hostages.
  3. Pending their release, humanitarian aid and healthcare attention to be provided to the hostages.
  4. All parties to abide by international humanitarian law and the principle of medical neutrality to safeguard the rights and protection of healthcare facilities, healthcare personnel and patients from further threat, interference and attack.
  5. Unimpeded and accelerated humanitarian access throughout all of Gaza, including the entry of humanitarian aid and safe passage of medical personnel. This also includes the evacuation of urgent medical cases to reduce secondary morbidity and mortality, public health risks, and alleviate pressure on hospitals inside Gaza.
  6. The re-establishment of access to healthcare and the creation of a safe working environment for healthcare personnel to work in through the restoration of medical capacity and essential services.
  7. Verified investigations into alleged gross violations and abuses of human rights and international humanitarian law including attacks on healthcare staff and facilities and the misuse of those facilities for military purposes.
  8. The upholding by physicians of the principles in the WMA Declaration of Geneva and other documents that serve as guidance for medical personnel during times of conflict.

 

 

Adopted by the 223rd WMA Council, Nairobi, Kenya, April 2023
Revised and adopted by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

Violent fighting has broken out since April 2023 in Khartoum and in several cities of Sudan between the Sudan Armed Forces (SAF) and Rapid Support Forces (RSF), an independent paramilitary force.

Amnesty International reports extensive war crimes with mass civilian victims in both deliberate and indiscriminate attacks by the conflicting parties as well as sexual violence against women and girls. Rampant looting has affected hospitals, medical facilities, and humanitarian warehouses across various regions. This widespread looting has exacerbated an already dire situation by depriving communities of essential medical and humanitarian resources. Even if supplies manage to enter Sudan, the challenge lies in safely delivering them to conflict-affected regions, where they are critically required [1].

The WMA and its constituent members join the United Nations Security Council in condemning in the strongest terms all attacks on the civilian population, United Nations and associated personnel and humanitarian actors, as well as civilian objects, medical personnel and facilities, and the looting of humanitarian supplies [2].

 

RECOMMENDATIONS

  1. The WMA supports the call by the UN Security Council to conflicting parties to immediately cease hostilities, facilitate humanitarian access and establish a permanent ceasefire arrangement and to resume the process towards reaching a lasting, inclusive and democratic political settlement in Sudan.
  2. The WMA calls upon all parties in conflicts to:
    • Respect the ethical principles of health care, including medical neutrality, to guarantee the safety of patients and health personnel, and take immediate steps to ensure that they are not targeted or affected by the fighting, including the provision of safe passage of health care personnel and patients where evacuation is required;
    • Ensure that hospitals and healthcare facilities have adequate supplies and staffing to provide care to those in need and facilitate humanitarian aid;
    • End immediately gender-based violence, including sexual violence as a tactic of war to terrorize people.
  1. The WMA urges the Sudanese authorities to ensure impartial and independent investigations into all alleged gross violations and abuses of human rights and serious violations of international humanitarian law; and for perpetrators to be held accountable.

[1] Sudan: “Death came to our home”: War crimes and civilian suffering in Sudan – Amnesty International

[2] Security Council Press Statement on Sudan | UN Press, 02.06.2023

Adopted by the 68th General Assembly, Chicago, United States, October 2017

PREAMBLE

1.          The duties of physicians in times of armed conflict are set out in the WMA Statement on Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies and WMA Regulations in Times of Armed Conflict and Other Situations of Violence.

2.          Physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequences, including the impact on health, of their decisions on the commencement or continuation of armed conflict.

3.          Armed conflict damages the health of individuals and of populations as well as critical infrastructure including health care facilities, housing, potable-water supplies and sewerage. It also leads to environmental degradation. Such destruction of critical infrastructure may lead to adverse health consequences including malnutrition, and infectious or waterborne diseases, such as cholera and typhoid. Warfare also destroys work-related infrastructure, including factories and manufacturing centres as well as agriculture. Repair to damaged infrastructure cannot proceed until cessation of the conflict.

4.          Wars start for many different reasons.   Efforts to avoid conflicts are often insufficient and inadequate and country leaders may not seek all alternatives. Avoiding war and seeking constructive alternatives is always desirable.

5.          It is essential that those claiming that a war us a “just war” understand that this is a rare and extreme circumstance, which must not be overcited.  The concept of a “just” war must not be used to legitimize violence.

6.          Warfare and other forms of armed conflict are likely to worsen the suffering of the poorest and to contribute to the development of large numbers of Internally Displaced Persons and refugees.

7.          Physicians should seek, during conflicts, to influence parties in order to alleviate the suffering of populations.

RECOMMENDATIONS

8.          The WMA believes that armed conflict should always be a last resort.  Physicians and NMAs should alert governments and non-state actors of the human consequence of warfare.

9.          Physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequence of their decisions related to armed conflict.

10.       The WMA recognizes that armed conflict always produces enormous human suffering. States and other authorities, including non-state actors, who enter into armed conflict must accept responsibility for the consequences of their actions, and be prepared to answer for their consequences including to international courts and tribunals and recommends that authorities recognize and cooperate to ensure this occurs.

11.       The WMA recognizes that the impact of armed conflict will be most significant upon women and vulnerable populations, including children, the young, the elderly and the poorest members of society. Physicians should seek to ensure that allocation of medical care resources does not have a discriminatory impact.

12.       Physicians must continually remind those in power of the need to provide essential services to those within areas damaged and disrupted by conflict.

13.       After a conflict ends, priority must be given to rebuilding the essential infrastructure necessary for a healthy life, including shelter, sewerage, fresh water supplies, and food provision, followed by the restoration of educational and occupational opportunities.

14.       The WMA demands that parties to a conflict respect relevant Humanitarian Law and do not use health facilities as military quarters, nor target health institutions, workers and vehicles, and respect established International Humanitarian Law (IHL) and do not use health facilities as military quarters, nor initiate attacks against health institutions, workers and vehicles, or restrict the access of wounded persons and patients to healthcare, as set out in the WMA Declaration on the Protection of Health Workers in Situations of Violence.

15.       Physicians should work with aid and other agencies to seek to ensure that parties protect family integrity and, wherever possible, remove people from direct and immediate danger.

16.       Physicians should be aware of the likely prevalence of Post-Traumatic Stress Disorder (PTSD) and other post-conflict psychosocial and psychosomatic problems and provide appropriate care and treatment to combatants and civilians.

17.       Physicians, including forensic medicine specialists, should help families ensure that efforts to identify the missing and the dead are not subverted by security forces.

 

Adopted by the 191st WMA Council Session, Prague, April 2012

The WMA recognises that attacks on health care facilities, health care workers and patients are an increasingly common problem and the WMA Council denounces all such attacks in any country.

These often occur during armed conflict and also in other situations of violence, including protests against the state.  Patients, including those injured during protests, often come from the poorest and most marginalised parts of the community and suffer a higher proportion of serious health problems than those from wealthier backgrounds.

Governments have an obligation to ensure that health care facilities and those working in them can operate in safety and without interference either from state or non-state actors, and to protect those receiving care.

Where services are not available to patients due to government action or inaction, the government, not the health practitioners, should be held responsible.

Noting that recent and ongoing conflicts in Bahrain and Syria have seen physicians, other health care personnel and their patients attacked while in health care facilities, the WMA demands:

That states fulfill their obligations to all their citizens and residents, including political protestors, patients and health care workers, and protect health care facilities and their occupants from interference, intimidation or attack.
That governments enter into meaningful negotiations wherever such attacks are possible, likely or already occurring to stop the attacks and protect the institutions and their occupants, and
That governments consider how they can contribute positively to the work of the International Committee of the Red Cross on promoting the safety of health care provision through awareness of the concepts within their project Health Care in Danger.

Adopted as a Council Resolution by the 189th WMA Council Session, Montevideo, Uruguay, October 2011 and
adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

The WMA General Assembly notes that

A number of doctors, nurses and other health care professionals in the Kingdom of Bahrain were arrested in March 2011 after the civil unrest in that country and tried under emergency powers before a special court, led by a military judge.  Twenty of this group were found guilty of a number of charges, on 29 September 2011 and sentenced to fifteen, ten or five years imprisonment.

These trials failed to meet international standards for fair trials, including the accused not being allowed to make statements in their own defence, and their lawyers not being allowed to question all the witnesses.  Allegations from the accused and their lawyers of mistreatment, abuse and other human right violations during arrest and while in detention have not been investigated.

While various criminal charges were brought it appears that the major offence was treating all the patients who presented for care, including leaders and members of the rebellion. Other charges appear to be closely related to providing such treatment and were, in any case, not proven to the standard expected in court proceedings. In treating patients without considering the circumstances of their injury these health care professionals were honouring their ethical duty as set out in the Declaration of Geneva.

The WMA welcomes the announcement by the government of Bahrain of 6 October 2011 that all twenty will be re-tried before a full civil court.

Therefore, the WMA requires that no doctor or other health care professional be arrested, accused or tried for treating patients, regardless of the origins of the patient’s injury or illness.

The WMA demands that all states understand, respect and honour the concept of medical neutrality. This includes providing working conditions which are as safe as possible, even under difficult circumstances, including armed conflict or civil unrest.

The WMA expects that if any individual, including health care professionals, are subject to trial that there is due process of law including during arrest, questioning and trial in accordance with the highest standards of international law.

The WMA demands that states investigate any allegations of torture or cruel and inhumane treatment by prisoners against its agents, and act quickly to stop such abuses.

The WMA recommends that independent international assessors are allowed to observe the trials and meet privately with the accused, so that the state of Bahrain can prove to the watching world that the future legal proceedings follow fair process.

The WMA recognises that health care workers and health care facilities are increasingly under attack during wars, conflicts and civil unrest.  We demand that states throughout the world recognise, respect and honour principles of medical neutrality and their duty to protect health care institutions and facilities for humanitarian reasons.

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and revised by the 73rd WMA General Assembly, Berlin, Germany, October 2022

PREAMBLE

The right to health and medical assistance is a basic human right that should be guaranteed at all times; ethical principles of healthcare remain the same in times of emergencies and in times of peace. Healthcare personnel must be duly protected.

Various international agreements, including the Geneva Conventions (1949), Additional Protocols to the Geneva Conventions (1977, 2005) and the Basic Principles on the Use of Force and Firearms by Law Enforcement Officials of the United Nations, must guarantee safe access to medical assistance as well as the protection of healthcare personnel.

The United Nations Security Council Resolution 2286 (2016) condemns attacks and threats against health care personnel, demands an end to impunity for those responsible, and that all parties to armed conflict comply fully with their obligations under international law.

Despite recognized international standards and the mobilization of humanitarian and human rights stakeholders over the last years denouncing the surge of violence against healthcare worldwide, the WMA notes with great concerns persistent attacks and misuses of hospitals and other medical facilities, as well as threats, killings and other violence against patients and healthcare personnel in emergency contexts.

The WMA condemns in the strongest terms this scourge of violence against healthcare personnel and facilities, which has disastrous humanitarian implications with critical impacts on the capacity of the health system to provide the care needed, resulting in unjustifiable suffering and death. Violence against healthcare personnel constitutes an international emergency, requiring urgent actions.

Recalling its Statement on Armed Conflicts, the WMA reaffirms that armed conflicts should always be a last resort and that States and other authorities who enter into armed conflict must accept responsibility for the consequences of their actions.

The safety and personal security of physicians and other healthcare personnel are essential in enabling them to provide care and save lives in situations of conflicts. They must always be respected as neutral and should never be prevented from fulfilling their duties. Healthcare personnel and facilities should never be instrumentalised as means of war.

Recalling its Regulations in Times of Armed Conflict and Other Situations of Violence, the WMA reaffirms that the primary obligation of physicians and other healthcare personnel is always to their patients; they have the same ethical responsibilities in situation of violence or armed conflicts as in peacetime, the same duty of preserving health and saving lives; they shall at all times act in accordance with the ethical principles of the profession, relevant international and national law, and their conscience.

 

RECOMMENDATIONS

The WMA calls upon all parties involved in situations of violence to:

1.Fully comply with their obligations under international law, including human rights law and international humanitarian law, in particular with their obligations under the Geneva Conventions of 1949 and the obligations applicable to them under the Additional Protocols of 1977 and 2005;

2. Ensure the safety, independence and personal security of healthcare personnel at all times, including during armed conflicts and other situations of violence, in accordance with the Geneva Conventions and their additional protocols;

3. Respect and promote the principles of international humanitarian and human rights law which safeguard medical neutrality in situations of conflict;

4. Protect medical facilities, medical transport and the people being treated in them, provide the safest possible working environment for healthcare personnel, and protect them from threats, interference and attack;

5. Never misuse hospitals and other health facilities for military purposes and dedicate them exclusively to health care;

6. Enable healthcare personnel to treat injured and sick patients, regardless of their role in a conflict, and to carry out their medical duties freely, independently and in accordance with the principles of their profession without fear of punishment or intimidation;

7. Ensure that safe access to adequate medical facilities for the injured and others in need of medical aid is not unduly impeded;

8. Ensure that the equipment, including personal protection equipment, necessary for the safety of healthcare workers, is available to them as needed, and that the staffing is adequate;

9. Support and strictly respect the ethical rules of the medical profession as defined, among other documents, in the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies and in the WMA Regulations in Times of Armed Conflict and Other Situations of Violence, and to never require from physicians or force them to breach or renounce these rules, in particular:

  • privileges and facilities afforded to physicians and other health care professionals in times of armed conflict and other situations of violence must never be used for purposes other than health care;
  • physicians must at all times show appropriate respect for medical confidentiality;
  • physicians must never accept acts of torture or any other form of cruel, inhuman or degrading treatment under any circumstances; they must never be present at nor take part in such acts;
  • physicians have a duty to recognize and support vulnerable populations, including women, children, refugees, the disabled and displaced persons;
  • physicians and WMA constituent members should alert governments and non-state actors of the human consequences of warfare;
  • where conflict appears to be imminent and inevitable, physicians should ensure that authorities are planning for the protection of the public health infrastructure and for any necessary repair in the immediate post-conflict period.

The WMA calls upon governments to:

10. Establish efficient, secure and unbiased reporting mechanisms with sufficient resources to collect and disseminate data regarding assaults on physicians, other healthcare personnel and medical facilities;

11. Provide to the WHO the necessary support to fulfil its leadership role in documenting attacks on healthcare personnel and facilities[1];

12. Foster the mechanisms of investigating and bringing to justice those responsible for reported violations of the international agreements pertaining to the protection of healthcare personnel in armed conflicts and other situations of violence, and of enforcing the sanctions when such have been decided;

13. Develop and implement more efficient legal protection for medical and other healthcare personnel, so that whoever attacks a nurse, physician or another healthcare personnel knows that such actions will be severely penalised.

The WMA calls upon governments, its member organisations and the appropriate international bodies to:

14. Raise awareness of international norms on the protection of healthcare personnel and cooperate with different actors to identify strategies to tackle threats to healthcare and strengthen the mechanism of investigating the reported violations;

15. Raise awareness at both national and local level of the fundamental importance of protecting the healthcare personnel and of upholding their neutrality in times of conflict;

16. Support the development of pregraduate, postgraduate and continuous education for the healthcare personnel to ensure their competencies and their security and to minimize the psychological toll when confronted with armed conflicts and other situations of violence.

 

[1] The WMA recognizes that in some circumstances, documenting and denouncing acts of torture or other violence may put the physician, and those close to him or her, at great risk. Doing so may have excessive personal consequences. Physicians must avoid putting individuals in danger while assessing, documenting or reporting signs of torture and cruel, inhuman and degrading treatment and punishments.