A Ukrainian service member walks, as the Russian invasion continues, in a destroyed village on the frontline in east Kyiv, March 21, 2022. Photo: Reuters/Gleb Garanich
- If a military doctor encountered an injured enemy soldier, they had a duty under the Geneva Convention to render medical assistance if it was requested and feasible.
- The Geneva Convention, which took shape at the end of World War II, established the principles of humanitarian and health assistance in times of war.
- Lt. Col. N. Mukundan, a retired cardiac anesthesiologist of the Indian Army, has noted that during his tenure in Kashmir, enemy combatants would be treated for their injuries in a separate ward.
As a physician in the Indian military, my father would occasionally tell me that it was his duty to treat Indian soldiers as well as enemy soldiers on the battlefield. Having grown up in military areas in times of the Pakistan and China wars, I found his statements to be at odds with the general prevailing opinion.
In further conversations, he was very clear that the role of a doctor in battle was different from that of others in the military. If he encountered an injured enemy soldier, he said he had a duty under the Geneva Convention to render medical assistance if it was requested and feasible.
At the end of World War II, the Geneva Convention established the principles of humanitarian and health assistance in times of war. The treaties assure protection to the wounded and sick and civilians in and around a war zone. The 1997 Convention on Human Rights and Biomedicine, also known as the ‘Oviedo Convention’, is an international and legally binding text that states that the interests of human beings must come before the interests of science or society. The language of the text is designed to preserve human dignity, rights and freedoms through a series of principles and prohibitions.
While the thrust of the convention was against the misuse of medical advances, it sets the principle that everybody has the right to be treated, if sick, and that every physician must treat anyone in need without moral judgment. While such principles may sound grand and pontificatory, they also raise a few ethical questions.
Should enemy supply lines carrying medical aid and equipment be targeted? No, because the first Geneva Convention states that there should be no “obstacle to the humanitarian activities” and that wounded and sick “shall be respected and protected in all circumstances.” Article 19 in particular demands that hospitals and mobile medical facilities, may in no circumstances be attacked.
The rules protect the wounded soldier on and off the battlefield, as well as civilians in a country involved in the war. The US Medical Neutrality Protection Act 2011 calls to create the position of a UN Special Rapporteur on the ‘Protection and Promotion of Medical Neutrality’ and for investigations of violations of medical neutrality. It also limits military aid from the US to countries that have engaged in violating medical neutrality and bans their governments’ officials from obtaining visas to the US.
Violations of medical neutrality have occurred in many countries and war zones. Recent examples include the attacks on Ukrainian hospitals by Russia, on Médecins sans Frontières clinics in Gaza (by Israel) and Afghanistan (by the US), on medical personnel in protest zones in Chile, Thailand and Myanmar, and guerrilla attacks on field hospitals in El Salvador. In India, Dr Binayak Sen, a physician who advocated non-violent political engagement, was convicted of sedition by Indian courts for allegedly supporting outlawed Naxalites while working with the rural poor in Chhattisgarh.
Should sanctions be imposed on the healthcare of aggressor nations? No. This question has arisen in the Russian war on Ukraine, over whether the international medical community should cut ties with Russia, thus preventing medical supplies and goods. The Geneva Convention protects civilians in a country at war, and cutting ties with the healthcare system will aggravate the already unequal access to healthcare in addition to the shortage of vital drugs created by economic sanctions.
What about the treatment of injured terrorists? Médecins Sans Frontières notes that the term ‘terrorism’ has political and ideological connotations that blur the boundary between terrorists and freedom fighters. The UN defines terrorism as “criminal acts, including against civilians, committed with the intent to cause death or serious bodily injury, or taking of hostages, with the purpose to provoke a state of terror in the general public or in a group of persons or particular persons, intimidate a population or compel a government or an international organization to do or to abstain from doing any act.”
The Commissioner for Human Rights of the Council of Europe notes that:
“… while action by states is necessary to prevent and effectively sanction terrorist acts, not all means are justifiable. There is a compelling duty for states to protect the general interest of public security and the rule of law without jeopardizing the core of human rights, which are enshrined notably in the European Convention on Human Rights.”
However, operations conducted by several states in the so-called “war on terror” in recent years included “rendition programmes”, the establishment of “black sites” and mass surveillance. A wide range of human rights is potentially affected by such counter-terrorism measures, including the right to life, prohibition of torture, inhuman or degrading treatment, the right to liberty, security and a fair trial, and respect for private and family life.
The Terrorism Prevention Branch of the UN Office on Drugs and Crime believes that effectively combatting terrorism while respecting human rights and fundamental freedoms is both possible and necessary. Their Terrorism Prevention Branch works with criminal justice officials involved in the investigation, prosecution, and adjudication of terrorism cases to strengthen their capacity to implement counter-terrorism legislation.
Lt. Col. N. Mukundan, a retired cardiac anesthesiologist of the Indian Army, has noted that during his tenure in Kashmir, both enemy soldiers and terrorists would be treated for their injuries in a separate ward set up for this purpose. Examples of medical aid to the enemy combatants in the Mahabharata include the well-known provision of water by Arjuna to the dying Bhishma. In the Sikh-Mughal war of 1704, Bhai Kanhaiya was known to provide water to combatants of both sides. When asked, he said that he “saw no Mughal or Sikh on the battlefield. I only saw human beings who all have the same God’s spirit.”
The Hippocratic oath which all physicians take upon graduation states: “In honor of the knowledge I’ve received from my teachers, I swear to care for anyone who suffers, prince or slave.” In the fog of war, it is all too easy to forget such an oath, but the consequences of forgetting constitute a serious threat to human rights and democracy.
V. Ramana Dhara is a physician who explores the links between health and the environment. He is a former member of the International Medical Commission on Bhopal. He tweets at @RamanaDhara.