Policy Tag: Geneva Conventions

Adopted by the 10th World Medical Assembly, Havana, Cuba, October 1956,
edited by the 11th World Medical Assembly, Istanbul, Turkey, October 1957,
revised by the 35th World Medical Assembly, Venice, Italy, October 1983 and the 55th WMA General Assembly, Tokyo, Japan, October 2004,
editorially revised by the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006, and
revised by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012 and the 74th WMA General Assembly, Kigali, Rwanda, October 2023*

*The WMA Regulations of the WMA in times of armed conflict and other situations of violence adopted in 1956 were reclassified as a ‘Statement’ by the 63rd General Assembly, Kigali, Rwanda, October 2023.

 

 

PREAMBLE

The primary task of the medical profession is to promote health and save life; the primary obligation of the physicians is to their patients; in all their professional activities, physicians should adhere to international conventions on human rights, to international humanitarian law and to the WMA’s Declaration of Geneva, International Code of Medical Ethics and other relevant WMA declarations on medical ethics[1], as well as to the Ethical Principles of Health Care in Times of Conflict and Other Emergencies, elaborated by civilian and military healthcare organisations, including the WMA, under the initiative of the International Committee of the Red Cross.

In situations of armed conflict and other situations of violence, governments, belligerent armed forces and others in positions of power must comply with their obligations in accordance with international law, including, as applicable, Geneva Conventions (1949) and the Additional Protocols to the Geneva Conventions (1977, 2005).

This obligation includes a requirement to protect healthcare personnel and facilities (see e.g. the WMA Declaration on the protection and integrity of healthcare personnel in armed conflicts and other situations of violence, 2022), including any means of transportation devoted to the wounded and sick, to health personnel or medical equipment.

This obligation also includes condemning the targeting of health care facilities and personnel and using denial of medical services, including as a tactic or strategy in war, by any party, wherever and whenever it occurs.

The WMA supports efficient, secure and unbiased reporting mechanisms with sufficient resources to collect and disseminate data regarding assaults on physicians, other healthcare personnel and healthcare facilities, and to provide to the WHO and other relevant agencies the necessary support to fulfill their role in documenting attacks on healthcare personnel and facilities.

Assaults against healthcare personnel must be investigated and those responsible must be brought to justice; to this end, adequate enforcement mechanisms must be used, or where relevant, developed, and necessary resources must be guaranteed.

Physicians must be granted access to all persons in need of care, including those deprived of liberty.

Physicians have a responsibility to press governments and other authorities for the provision of the infrastructure and equipment that is a prerequisite to health and healthcare, including potable water, adequate food and shelter, proper infrastructure, clinical equipment and available healthcare personnel, and the necessary personal protection equipment (PPE).

Where conflict appears to be imminent and inevitable, relevant authorities are responsible for guaranteeing the protection of the health infrastructure and for planning any necessary repair in the immediate post-conflict period.

Respect of professional ethical rules

During times of armed conflict and other situations of violence, the ethical standards of the medical profession apply as in times of peace. The professional duty to treat people with humanity and respect applies to all patients. The physician must always act in accordance with medical neutrality and give the necessary care impartially and without discrimination.

Physicians must never be persecuted for complying with any of their ethical obligations, and may not be compelled by governments, armed forces or others in positions of power, to undertake any action that contravenes the medical profession’s ethical rules.

The privacy of the sick, wounded and dead must always be respected and confidentiality duly respected.

Health care given to the sick and wounded, civilians or combatants, cannot be used for publicity or propaganda.

Physicians must not spread disinformation, or manipulate facts for the public, for the media, or for the social media outlets.

Ethics training on the issue of medical treatment of prisoners of war and detainees should be provided in medical schools and during postgraduate training.

 

RECOMMENDATIONS

In situations of armed conflict and other situations of violence, the physician must:

General principles

  1. Not take part in any act of hostility and refuse any illegal or unethical order;
  2. Neither commit nor assist in violations of international law;
  3. Not abandon the wounded and sick, while considering the physician’s own safety and competence and the availability of other viable options for care;
  4. Promote medical neutrality by advocating for and providing effective and impartial patient care without discrimination; no distinction must be made between patients except based upon clinical facts;
  5. Give special consideration to the most vulnerable or marginalized parts of the population in need of care (e.g. women, children, older persons, people with specific healthcare needs, and displaced persons) and to their specific healthcare needs while adhering to triage principles;
  6. Respect the individual wounded or sick person´s autonomy, trust and dignity;
  7. Respect confidentiality, in line with the Declaration of Geneva and the International Code of Medical Ethics;
  8. Give careful consideration to any dual loyalties that the physician may be bound by or conflicts of interest that may be present.

Detention

  1. Provide healthcare to anyone taken as a prisoner;
  2. Advocate for regular visits to prisons and prisoners by physicians;
  3. Never condone, facilitate or participate in the practice of torture or any form of cruel, inhuman or degrading treatment, nor in any form of abuse, including forced feeding, human trafficking or human organ trafficking;
  4. In line with the WMA International Code of Medical Ethics, the WMA Declaration of Tokyo, the WMA Statement on the Responsibility of Physicians in the Documentation and Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment, the Istanbul Protocol and the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), denounce acts of torture or cruel, inhuman or degrading treatment and punishments.

Forbidden activities

  1. Never use the situation and the vulnerability of the wounded and sick for personal advantage;
  2. Never make use of healthcare privileges and facilities contrary to their intended purposes;

Public Health

  1. Report to the appropriate authorities if healthcare needs are not met;
  2. Respect the legal obligations to report to the appropriate authorities in matters of epidemiology;
  3. Respect the WMA Declarations of Helsinki and the WMA Declaration of Taipei on research and data management;
  4. Denounce and intervene against any unscrupulous practices, including distribution of poor quality or counterfeit medicines and materials;
  5. Be aware of war-related mental health trauma when caring for patients, internally displaced persons and refugees.

 

 

[1] WMA Declaration on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence / WMA Statement on Armed Conflicts

 

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.