Policy Tag: War

Adopted by the 73rd WMA General Assembly, Berlin, Germany, October 2022

Preamble

The ongoing war in Ukraine has led to millions of refugees who have experienced trauma and an unprecedented mental health crisis situation. Aid workers and some physicians who are assisting the refugees may not be well prepared to treat this war-related trauma.

Through the Ukraine Medical Help Fund, the WMA is leading a successful effort to provide material aid to Ukrainian refugees. The longevity and brutality of the war now require even more dedication to this effort and the expansion of aid to include mental health personnel trained in war-related trauma.

 

Recommendations

  1. That the WMA, through the Ukraine Medical Help Fund and other appropriate means, its constituent members and the medical community, continue to send medical supplies to Ukraine and offer support to organizations providing humanitarian missions and medical care to Ukrainian refugees, resource permitting.
  2. That the WMA, its constituent members and the medical community, advocate for early implementation of mental health measures, including suicide prevention efforts, and for addressing war-related trauma and post-traumatic stress disorder when assisting Ukrainian refugees. Special attention should be paid to disadvantaged groups.
  3. That the WMA, its constituent members and the medical community, advocate for educational measures to enhance the understanding of war-related trauma in war survivors and promote broad protective factors for war-affected people such as employment, housing, and food stability, especially in disadvantaged groups.

 

Adopted as Council Resolution by the 220th WMA Council Session, Paris (hybrid), France, April 2022
and as Resolution by the 73rd WMA General Assembly, Berlin, Germany, October 2022 

 

PREAMBLE

Reminding that the World Medical Association was founded on the backdrop of the atrocities of war and how the medical profession was abused for violation of human rights and dignity;

Reaffirming the WMA Declaration of Geneva as a beacon of fundamental principles to which the world’s physicians are committed;

Deeply shocked by the Russian army’s bombing of Ukrainian civilians and hospitals, including maternity wards, thus infringing on medical neutrality in conflict zones. The WMA and its members express their solidarity with the Ukrainian people and provide their support for Ukrainian and international healthcare workers mobilized under extremely difficult conditions;

Recalling the WMA’s Statements on the Cooperation of National Medical Associations during or in the Aftermath of Conflicts, on Armed Conflicts, the Regulations in Times of Armed Conflict and Other Situations of Violence, the Statement on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence, the Declaration on the protection of healthcare workers in emergency situations and the Statement on Medical Care for Migrants;

Emphasizing the need to respect the Geneva Conventions and their protocols as the core of international humanitarian law, as well as the United Nations Security Council Resolution 2286;

Considering the suffering and human tragedy caused by the Russian invasion of Ukraine, including a refugee crisis on a massive scale;

 

RECOMMENDATIONS

  1. The Constituent Members of the WMA stand in solidarity with the Ukrainian Medical Association and all healthcare professionals.
  2. The WMA condemns Russia’s invasion of Ukraine and calls for an end to hostilities.
  3. The WMA considers that Russia’s political leadership and armed forces bear responsibility for the human suffering caused by the conflict.
  4. The WMA calls on Russian and Ukrainian doctors to hold high the principles in the WMA Declaration of Geneva and other documents that serve as guidance for medical personnel during times of conflict.
  5. The WMA demands that the parties to the conflict respect relevant Humanitarian Law and do not use health facilities as military quarters, nor target 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.
  6. The WMA stresses that the parties to the conflict must strive to protect the most vulnerable populations.
  7. The WMA underlines that it is essential that access to medical care be guaranteed to all victims, civil or military, of this conflict, without distinction.
  8. Physicians and all other medical personnel, both Ukrainian and international, involved in NGOs, must not under any circumstances be hindered in the exercise of their unwavering duty, in accordance with the international recommendations provided in the WMA declaration on the protection of healthcare workers in emergency situations, the WMA’s position on the protection and integrity of medical personnel in armed conflicts and other violent situations and in the declaration of the United Nations General Assembly on the rights and responsibility of individuals, groups and organs of society to promote and protect human rights and universally recognized fundamental freedoms.
  9. The WMA calls on the parties to ensure that essential services are provided to those within areas damaged and disrupted by conflict.
  10. The WMA calls on the international community and governments to come to the aid of all persons displaced by this conflict who may choose their country as a destination following their departure from Ukraine.
  11. The WMA urges all nations receiving persons fleeing the conflict to ensure access to safe and adequate living conditions and essential services to all migrants, including appropriate medical care, as needed.
  12. The WMA calls on the parties to the conflict as well as the international community to ensure that when the 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.

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 42nd World Medical Assembly Rancho Mirage, CA., USA, October 1990
and rescinded at the WMA General Assembly, Santiago 2005

The World Medical Association draws the attention of the medical profession throughout the world to the dangers presented by chemical and biological weapons. Among other, more obvious, dangers, it should be noted:

  1. The use of such weapons would have a devastating effect on civilian populations in addition to military personnel, and not only in the target area but also in distant places, perhaps beyond the national boundaries of the combatants.
  2. The effects of exposure to chemical and biological weapons present a continuing threat to the health of human beings on a long term basis, possibly causing illness, injury, disease and defects in the population over a long period of time.
  3. The effects of exposure to chemical and biological weapons may also result in permanent, complex and unpredictable changes in the natural environment, including animals, plant life and water supply, thus destroying the food source of human beings and resulting in extensive morbidity.
  4. Existing health care services, technology and manpower may be helpless to relieve the suffering caused by exposure to chemical and biological weapons.

The World Medical Association Declaration of Geneva asks physicians to consecrate their lives to the service of humanity, to pledge that the health of the patient will be the physician’s first consideration, and that the physician will not used medical knowledge contrary to the laws of humanity.

The World Medical Association Declaration of Helsinki states that it is the mission of the physician to safeguard the health of the people. The physician’s knowledge and conscience are dedicated to the fulfillment of this mission.

The World Medical Association Declaration of Tokyo begins with the following statement:

“It is the privilege of the medical doctor to practice medicine in the service of humanity, to preserve and restore bodily and mental health without distinction as to persons, to comfort and ease the suffering of his or her patients. The utmost respect for human life is to be maintained even under threat, and no use made of any medical knowledge contrary to the laws of humanity.”

Therefore, the World Medical Association considers that it would be unethical for the physician, whose mission is to provide health care, to participate in the research and development of chemical and biological weapons, and to use his or her personal and scientific knowledge in the conception and manufacture of such weapons.

Furthermore, the World Medical Association:

  1. Condemns the development and use of chemical and biological weapons.
  2. Asks all governments to refrain from the development and use of chemical and biological weapons.
  3. Asks all National Medical Associations to join WMA in actively supporting this Declaration.

Adopted by the 67th WMA General Assembly, Taipei, Taiwan, October 2016
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

The World Medical Association notes with great concern the repeated attacks on health care facilities, health personnel and patients since the beginning of the war in Syria in 2011. These attacks have killed and injured civilian people, and the most vulnerable among them, children and patients. The WMA recalls that health care facilities and personnel must, according to the international law, be protected by all parties of the conflict. 

Therefore, the WMA 

  • Deeply regrets and condemns the recurring attacks on health care facilities, health personnel and patients, considering these as a violation of human rights; 
  • Calls on all countries to fully implement the UN Resolution 2286 (2016) which demands all parties to armed conflicts to fully comply with their obligations under international law, to ensure the respect and protection of all health and humanitarian personnel exclusively engaged in medical duties, of their means of transport and equipment, as well as hospitals and other medical facilities; 
  • Demands an immediate and impartial enquiry into the attacks against health care facilities and personnel, and actions taken against those responsible in accordance with domestic and international law. 

 

Adopted as a Council Resolution by the 203rd WMA Council Session, Buenos Aires, April 2016,
adopted by the 67th World Medical Assembly, Taipei, Taiwan, October 2016,
and rescinded and archived by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

Currently, a very large number of people are seeking refuge and/or asylum; some are fleeing war zones or other conflicts, others are fleeing from desperate poverty, violence, and other injustices and abuses with potentially very harmful effects to mental and physical health.

The global community has been ill prepared for handling the refugee crisis, including addressing the health needs of those seeking refuge.

The WMA recognizes that mass migration will continue unless people are content to stay in their birth countries because they see opportunities to live their lives in relative peace and security and to offer themselves and their families the ability to live lives with opportunities for fulfilment of various sorts, including economic improvement.  The global community has a responsibility to seek to improve the lot of all populations, including those in countries currently with the poorest economies and other key factors.  Sustainable development will give all populations improved security, and economic options.

The WMA recognizes that warfare and other armed conflict, including continuous civil strife, unrest and violence, will inevitably lead to people movement.  The worse the conflict the higher the percentage of people who will want to leave the conflict zone.  There is a responsibility for the global community, especially its political leaders, to seek to support peace making and conflict resolution.

The WMA recognizes and condemns the phenomenon of forced migration, which is inhumane and must be stopped.  Such cases should be considered for referral to the International Criminal Court.

PRINCIPLES

1. The WMA reiterates the WMA Statement on Medical Care for Refugees originally adopted in Ottawa, Canada in 1998 which states:

  • Physicians have a duty to provide appropriate medical care regardless of the civil or political status of the patient, and governments should not deny patients the right to receive such care, nor should they interfere with physicians’ obligation to administer treatment on the basis of clinical need alone.
  • Physicians cannot be compelled to participate in any punitive or judicial action involving refugees, including asylum seekers, refused asylum seekers and undocumented migrants, or Internally Displaced Persons or to administer any non-medically justified diagnostic measure or treatment, such as sedatives to facilitate easy deportation from the country or relocation.
  • Physicians must be allowed adequate time and sufficient resources to assess the physical and psychological condition of refugees who are seeking asylum.
  • National Medical Associations and physicians should actively support and promote the right of all people to receive medical care on the basis of clinical need alone and speak out against legislation and practices that are in opposition to this fundamental right.

2. WMA urges governments and local authorities to ensure access to adequate healthcare as well as safe and adequate living conditions for all regardless of their legal status.

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.

Adopted by the 54th WMA General Assembly, Helsinki, Finland, September 2003
revised by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013 and
reaffirmed with minor revisions by the 224th WMA Council, Kigali, Rwanda, October 2023

PREAMBLE

Over the last three decades, forensic investigations into the whereabouts and fate of people killed and missing as a result of armed conflict, other situations of violence and catastrophes, have made an important contribution to humanitarian action on behalf of victims, including [the deceased and] bereaved families. Forensic investigations have also helped in achieving justice and reparations for victims.

In 2003 the International Conference on The Missing and Their Families, organized by the International Committee of the Red Cross (ICRC), adopted a set of recommendations to help prevent people going missing, and resolve the cases of those already missing, as a result of armed conflicts and other situations of violence. The recommendations include ethical, scientific and legal principles that must apply to forensic investigations in the search, recovery, management and identification of human remains. These principles have since been further developed and provide a framework for humanitarian forensic action in situations of armed conflicts, other situations of violence and catastrophes [1]. The principles also ensure the dignified and professional management of the dead [2], adherence to cultural and religious practices and help provide answers to the bereaved.

The WMA and its Constituent Members have a role in promoting these principles, encouraging compliance with them, and for ensuring the highest possible ethical, scientific and legal standards in forensic investigations aimed at addressing the humanitarian consequences of armed conflicts, other situations of violence and catastrophes.

RECOMMENDATIONS

  1. The WMA calls upon its Constituent Members to:
    • draw the attention of practitioners to the best practice guidelines produced by the ICRC, the United Nations and Interpol, and recommend or, where possible, require compliance with those standards;
    • help ensure that, when its individual physicians members take part in forensic investigations for humanitarian and human rights purposes, such investigations are established with a clear mandate based upon the highest ethical, scientific and legal standards, and conform with the principles and practice of humanitarian forensic action developed by the ICRC [3] and the United Nations [4];
    • acquire expertise in the principles collated by the different authorities on forensic investigations for humanitarian and human rights purposes, including those developed by the ICRC and the United Nations to prevent new cases and resolve those of existing missing persons, and to assist their members in applying these principles to forensic investigations worldwide;
    • disseminate those principles and support physicians refusing to take part in investigations that are ethically or otherwise unacceptable;
    • help ensure compliance by forensic medical practitioners with the principles enshrined in international humanitarian law for the dignified and professional management of the dead, including taking all measures to ensure their identification, while ensuring respect for their families.
  1. The WMA invites its Constituent Members to be mindful of academic qualifications and ethical understanding, ensuring that forensic physicians practice with competence and independence.

 

[1] The ICRC defines catastrophes as disasters beyond expectations. See: M. Tidball-Binz, Managing the dead in catastrophes: guiding principles and practical recommendations for first responders. International review of the Red Cross, Vol 89 Number 866 June 2007 p.p. 421-442.

[2] Management of the deceased (MotD) refers to a process encompassing different stages that begin with the information or report of death and finalizes with the return of the body to the bereaved, issuance of death certificates and final disposition.

[3] ICRC Guiding Principles for Dignified Management of the Dead in Humanitarian Emergencies and to Prevent them Becoming Missing Persons; Forensic Identification of Human Remains; Management of dead bodies after disasters: A manual for 1st responders; Guidelines for the use of Forensic Genetics in Investigations into Human Rights and International Humanitarian Law Violations

[4] UN Minnesota protocol applicable for the MotD in context of violations of human rights and criminal investigations.