Traités, États parties et Commentaires
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Commentaire of 2016 
Article 42 : Marking of medical units and establishments
Text of the provision*
(1) The distinctive flag of the Convention shall be hoisted only over such medical units and establishments as are entitled to be respected under the Convention, and only with the consent of the military authorities.
(2) In mobile units, as in fixed establishments, it may be accompanied by the national flag of the Party to the conflict to which the unit or establishment belongs.
(3) Nevertheless, medical units which have fallen into the hands of the enemy shall not fly any flag other than that of the Convention.
(4) Parties to the conflict shall take the necessary steps, in so far as military considerations permit, to make the distinctive emblems indicating medical units and establishments clearly visible to the enemy land, air or naval forces, in order to obviate the possibility of any hostile action.
* Paragraph numbers have been added for ease of reference.
Reservations or declarations
None
Contents

A. Introduction
2626  Article 42 details how, and under whose control, the emblem as a protective device should be displayed on military medical units and establishments that enjoy respect and protection by virtue of Article 19 of the First Convention.[1] In this respect, Article 42 builds on the provisions of Articles 39 and 44 of the First Convention dealing, respectively, with the use of the emblem as a protective device by the medical services of the armed forces as a whole and the differences between protective and indicative uses.
2627  Article 42 uses the term ‘distinctive flag’, which is one of the classic forms in which the emblem may be used as a protective device. It also deals with the question of whether or not the emblem may be accompanied by a national flag.
2628  Lastly, consistent with the purpose of the protective emblem as the visible manifestation of the protection of medical establishments and units provided for in the First Convention, Article 42 requires Parties to the conflict to ensure, subject to military considerations, that the emblem is clearly visible to the enemy armed forces.
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B. Historical background
2629  The marking of military medical establishments and units with the ‘distinctive flag’ was first provided for in the 1864 Geneva Convention.[2] The Convention further stipulated that the distinctive flag ‘should in all circumstances be accompanied by the national flag’. The 1906 Geneva Convention laid down the general rule that the national flag must accompany the distinctive flag on both mobile units and fixed establishments of the armed forces’ medical services.[3] The 1929 Geneva Convention on the Wounded and Sick maintained this rule for fixed establishments only, making it optional in the case of mobile medical units.[4] In the 1949 Convention, flying the national flag became optional for both fixed establishments and mobile medical units.
2630  The rule that medical units which have fallen into enemy hands are not entitled to fly any national flag alongside the distinctive flag was introduced in the 1906 Convention and subsequently retained.[5]
2631  The obligation of the Parties to a conflict to take the necessary steps to ensure the visibility of the emblem on medical units and establishments, in so far as military considerations permit, first found its way into international humanitarian treaty law by virtue of the 1929 Convention.[6]
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C. Paragraph 1: Use of the distinctive flag of the Convention
2632  By using the term ‘distinctive flag’, Article 42(1) reaffirms this traditional means of displaying the emblem of the red cross, the red crescent or, more recently, the red crystal as a protective device.[7] A number of States have also made reference to it as a protective device in their national legislation and military manuals following the adoption of the First Convention.[8] The word ‘flag’ must not be taken too literally. This is confirmed in the fourth paragraph of the present article, which spells out the purpose of displaying the emblem as a protective device, namely to make military medical units and establishments clearly visible to enemy armed forces. Moreover, Article 44(2), as an example of the difference between the protective and indicative uses of the emblem, explicitly reserves the placement of the emblem on the roofs of buildings to the protective use of the emblem.[9]
2633  Flags as such are not the only method of displaying the emblem as a protective device on medical units or establishments. Other manifestations, such as painting the emblem on the roof, are also possible, as long as the fundamental purpose of visibility is attained.[10] Consequently, the word ‘flag’ can simply be interpreted as the ‘emblem’ of the red cross, the red crescent or the red crystal, while leaving it to the discretion of the military authorities to decide on the means of displaying it.
2634  Article 42(1) contains an express limitation on the use of the emblem as a protective device, in that it ‘shall be hoisted only over such medical units and establishments as are entitled to be respected under the Convention’. In line with Article 19 of the First Convention, that entitlement is restricted to the fixed establishments and mobile medical units of the armed forces’ medical services, as well as to the medical units and establishments of National Red Cross and Red Crescent Societies or of other voluntary aid societies auxiliary to the medical services.[11]
2635  According to this limitation, medical units and establishments that have lost their protection under the First Convention are not entitled to use the emblem as a protective device.[12] Whenever and for as long as a medical unit or establishment loses its protection, it becomes necessary to remove the flag. Leaving it on would amount to an improper use of the emblem prohibited by international humanitarian law, or even, if the requisite conditions are fulfilled, to the war crime of perfidy.
2636  Article 42(1) also requires that the distinctive flag be used only ‘with the consent of the military authorities’. As is the case in Article 39, this provision does not specify who the competent military authorities are. Under the national legislation and regulations of many States, the minister of defence is designated as the competent military authority in this regard.[13] What is essential is that all armed forces are responsible for authorizing and exercising control over every use of the emblem as a protective device by medical units and establishments covered by this paragraph.[14]
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D. Paragraph 2: Use of the national flag
2637  As already mentioned, in 1949 it became optional for both fixed medical establishments and mobile medical units to fly the national flag of the State to whose military medical service they were attached.[15] This marked a change from the 1929 Convention, which had made it optional only for mobile medical units to fly the national flag but compulsory for fixed establishments. The justification for the differential treatment in the 1929 Convention was that requiring mobile military medical units to fly the national flag would essentially provide the adversary with a convenient aiming point and invite attack.[16] This rationale was subsequently put forward by the 1937 Commission of Government Experts[17] as applying to both fixed establishments and mobile medical units because the national flag was generally considered as a symbol of belligerency that would provoke attacks. The Commission accordingly proposed that the flying of the national flag be made optional in either case, a recommendation which was endorsed by the 1946 Preliminary Conference of National Societies and the 1947 Conference of Government Experts, and adopted in 1949 without further debate.[18] National military manuals mostly reaffirm this as an option rather than an obligation.[19]
2638  Therefore, it is within the discretion of the Parties to the conflict to decide whether the national flag is flown alongside the protective emblem on medical units and establishments. Although not specified in Article 42(2), those competent to take that decision are the same military authorities as the ones responsible for authorizing and controlling the use of the protective emblem itself.[20] Since the use of the emblem as a protective device by medical establishments and units of National Red Cross and Red Crescent Societies or other voluntary aid societies auxiliary to the armed forces’ medical services also falls within the scope of Article 42, the competent military authorities may also extend this option to such medical establishments and units.[21]
2639  Article 42 does not address the use of flags other than national ones alongside the protective emblem, for instance, the UN flag by medical establishments and units of troop contributing countries involved in peace operations under UN command and control. The United Nations as an international organization is not entitled as such to use the emblem. However, contributing States participating in UN operations retain their rights and obligations with respect to the emblem, such that the emblem itself may be used.[22] In such cases, should the emblem be displayed on military medical establishments or units in peace operations, care must be taken to avoid placing the emblem in close proximity to the UN flag (or that of any other international organization) and to avoid the use of a double emblem. The red cross, red crescent or red crystal emblems must in all cases retain their original form.[23]
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E. Paragraph 3: Medical units in enemy hands
2640  Article 42(3) excludes the use of the national flag alongside the protective emblem by medical units that have fallen into enemy hands.[24] The provision is a consequence of the rule contained in Article 19(1), whereby such units must be allowed to continue to treat the wounded and sick in their care until such time as the Power into whose hands they have fallen can take on this responsibility itself.[25] During this transitional phase, before the capturing Power has made use of the possibility of disposing of medical objects within the limits provided for in Articles 33 and 34, the question arises as to whether medical units should continue to fly the national flag of the State to which they belong or should switch to that of the Power into whose hands they have fallen.[26]
2641  Indeed, it would have been difficult to provide for the use of one or other national flag besides the distinctive flag of the Convention, as there are objections in either case.[27]
2642  Article 42(3) expressly refers only to ‘medical units’, in contrast to the other paragraphs of this article which refer to both medical establishments and units. On a strict literal reading, this could be taken to mean that the rule at issue only applies to mobile medical units and not to fixed medical establishments. A more nuanced interpretation was already put forward in relation to the identical wording contained in the 1929 Convention. In that Convention, a distinction between fixed establishments and mobile medical units of the armed forces was considered justified. However, such a distinction was not deemed appropriate for fixed establishments and mobile medical units of National Red Cross and Red Crescent Societies or other voluntary aid societies auxiliary to the medical services.[28]
2643  Since the adoption of the 1949 Convention, the expression ‘medical units’ has been interpreted as covering both fixed establishments and mobile medical units. This change in interpretation was justified by the fact that, when they fall into enemy hands, the position of fixed establishments and mobile medical units – regardless of whether they belong to the medical service of the armed forces or to National Red Cross or Red Crescent Societies or other voluntary aid societies auxiliary to the medical services – is so similar that a distinction with regard to their use of the flag would be unwarranted.[29]
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F. Paragraph 4: Visibility of the emblem as a protective device
2644  The obligation in Article 42(4) on the Parties to the conflict to ‘take the necessary steps’ to make the emblem as a protective device clearly visible to enemy armed forces is an obligation of conduct rather than of result. This is clear in the light of the provision’s ultimate objective to ‘obviate the possibility of any hostile action’. This depends not only on those displaying the emblem as a protective device but also on the enemy armed forces honouring their fundamental obligation to take all feasible precautions to verify that the target of an attack is indeed a military objective.[30]
2645  As regards the interpretation of the obligation to ‘take the necessary steps’, it is clear that if the emblem is to serve its purpose as the visible manifestation of protection and to ‘obviate the possibility of any hostile action’, it should be visible from as far away, from as many sides and as early as possible, both from the ground and from the air. Neither the distance from which the emblem should be clearly visible nor its size is specified. Indeed, it would be impossible to do so, as the visibility of the emblem as a protective device is highly contextual and depends on a variety of factors, such as the terrain, weather, time of day, and the types of weaponry and observation technology available to the adversary.[31]
2646  However, in 1936, in the 1970s, in 1989 and between 1993 and 1995, the ICRC, in cooperation with armed forces, conducted visibility tests from the air, from the ground and at sea, taking many of these variables into account. In terms of distance and size, the aerial tests in 1936 showed, for example, that in good weather conditions a red cross on a white ground, 5 metres square, placed on a roof, could hardly be distinguished from altitudes above 2,500 metres. This result was essentially confirmed in aerial tests conducted in 1989, with the flag no longer recognizable at a distance of 3,000 metres; a red cross flag measuring 10 metres across was no longer visible from 5,000 metres.[32] The 1989 aerial tests also found that the red crescent was less easily recognizable than the red cross.[33] In terms of ground visibility, the 1989 tests found that any emblem measuring more than 1 metre across was recognizable from up to a distance of 400 metres.[34]
2647  At night or in bad weather, one way of increasing visibility is by lighting or illuminating the emblem. The emblem is ‘lit’ when receiving light from a projector or a lamp; the white light projected onto it brings out its shape and colours. The emblem is ‘illuminated’ when red and white lights are placed on it in order to pick out the red emblem against the white ground. This may be done by placing strings of red electric bulbs along the contour of the emblem and white bulbs round the edge of the white ground.
2648  The added value of the tests conducted in the 1970s and thereafter, compared with the 1936 tests, was that they took into account technological developments in electronic observation techniques, including passive infrared, also known as thermal imaging,[35] and image intensifiers, such as night vision devices.[36] These techniques make it possible to identify targets when visibility is reduced, notably in poor weather or at night. The tests conducted in 1989 showed that when image intensifiers are used, the visibility of the emblem may be improved by using paint containing reflective materials.[37] Thermal imaging cameras, meanwhile, do not distinguish differences in colour but instead detect differences in temperature. Therefore, and following aerial, ground and maritime tests performed between 1993 and 1995, the use of special adhesive tapes with a high thermal reflection coefficient was recommended. Thus, the red cross or red crescent can be made up of these special tapes, providing a temperature contrast between the cross or the crescent and its white background. This contrast can then be detected by the thermal imaging camera.[38] Similar tests were carried out in 2000 and 2001 with what was to be adopted as the red crystal on a white ground.[39]
2649  Many findings of these tests have subsequently been incorporated into the Regulations concerning identification annexed to Additional Protocol I.[40] These regulations not only specify measures intended to ensure greater visibility of the protective emblem, but also provide for additional distinctive signals, such as radio and electronic identification, given that purely visual means of identification may be insufficient in circumstances of modern warfare enabling long-range targeting.[41] Parties may also wish to make the presence of medical facilities known by communicating their GPS coordinates to other Parties.
2650  The obligation contained in Article 42(4) is further qualified by the caveat ‘in so far as military considerations permit’, which recognizes that there may be circumstances in which the emblem as a protective device may not be displayed at all. Pursuant to Article 39, generally the emblem should be displayed, and this is the predominant doctrine and State practice in armed forces. However, a protective emblem does not in and of itself confer protection; it only serves as the visible manifestation of such protection and facilitates identification by enemy armed forces.[42] Therefore, failure to display the protective emblem neither automatically deprives a medical establishment or unit of protection, nor should it automatically lead to the conclusion that a medical establishment or unit has lost its protection.[43]
2651  A commander is accordingly permitted to decide that the emblem as a protective device on certain medical units should be removed or covered up (camouflaged) where military considerations so require. A commander must remove or unambiguously conceal the emblem if he or she considers it necessary to equip a medical unit with heavy weaponry to deter unlawful attacks.[44] Military doctrine and State practice recognize the validity of such a course of action in situations where armed forces are confronted with an enemy that systematically attacks medical units bearing a protective emblem, in clear violation of international humanitarian law.
2652  Moreover, military doctrine and State practice recognize that a Party may choose not to display the emblem where it is necessary to place medical units within or close to military objectives, such as in the case of mobile medical units, in order not to reveal the position and number of troops engaged.[45] In addition, it can be deduced from the purpose of the use of the emblem as a protective device, that where there is reason to conclude that medical units and establishments will be better protected if they are not marked with the emblem, the competent military authorities may decide that these medical units and establishments will not be marked.[46]
2653  While medical establishments and units of the medical services remain legally protected, regardless of whether or not they are marked with the emblem, in practice this protection will only be effective to the extent that the enemy can recognize them for what they are. Therefore, it is recognized in military doctrine that medical units should not be camouflaged any longer than is absolutely necessary.[47]
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Select bibliography
Bouvier, Antoine A., ‘The Use of the Emblem’, in Andrew Clapham, Paola Gaeta and Marco Sassòli (eds), The 1949 Geneva Conventions: A Commentary, Oxford University Press, 2015, pp. 855–886.
Cauderay, Gérald C., ‘Visibility of the distinctive emblem on medical establishments, units, and transports’, International Review of the Red Cross, Vol. 30, No. 277, August 1990, pp. 295–321.
de Mulinen, Frédéric, ‘Signalling and Identification of Medical Personnel and Material’, International Review of the Red Cross, Vol. 12, No. 138, September 1972, pp. 479–494.
Eberlin, Philippe, ‘Modernization of protective markings and signalling’, International Review of the Red Cross, Vol. 19, No. 209, April 1979, pp. 59–83.
Protective Signs, ICRC, Geneva, 1983.
Henckaerts, Jean-Marie and Doswald-Beck, Louise, Customary International Humanitarian Law, Volume 1: Rules, ICRC/Cambridge University Press, 2005, available at https://www.icrc.org/customary-ihl/eng/docs/v1.
Loye, Dominique, ‘Making the distinctive emblem visible to thermal imaging cameras’, International Review of the Red Cross, Vol. 37, No. 317, March–April 1997, pp. 198–202.
Vollmar, Lewis C., ‘Military Medicine in War: The Geneva Conventions Today’, in Thomas E. Beam and Linette R. Sparacino (eds), Military Medical Ethics, Vol. 2, Office of The Surgeon General, United States Army, Washington D.C., 2003, pp. 739–771.

1 - The use of the emblem on medical units, establishments and transports is also governed by Articles 18, 21 and 22 of the Fourth Convention and Article 18 of Additional Protocol I.
2 - Geneva Convention (1864), Article 7.
3 - Geneva Convention (1906), Article 21.
4 - Geneva Convention on the Wounded and Sick (1929), Article 22(1).
5 - Geneva Convention (1906), Article 21(2); Geneva Convention on the Wounded and Sick (1929), Article 22(2).
6 - Geneva Convention on the Wounded and Sick (1929), Article 22(3).
7 - Technically, the distinctive flag also includes the red lion and sun as one of the distinctive emblems recognized under Article 38(2) of the First Convention. This symbol, which has only ever been used by one State Party, is no longer in use. Additional Protocol III, adopted in December 2005, recognizes the red crystal as an additional emblem subject to the same conditions of use as those enshrined in the 1949 Geneva Conventions, including the First Convention, and, where applicable, the 1977 Additional Protocols.
8 - See e.g. Australia, Manual of the Law of Armed Conflict, 2006, para. 9.75; Colombia, Emblem Law, 2004, Article 2(3); Thailand, Red Cross Act, 1956, Section 5; United States, Army Health System, 2013, para. 3-23; and Uruguay, Emblem Decree, 1992, Article 7.
9 - See also Article 4 of the 1991 Emblem Regulations, which enjoin National Red Cross and Red Crescent Societies, when using the emblem as an indicative device, not to place it on roofs.
10 - See e.g. Colombia, Decree No. 138, 2005, Article 4(1); Uruguay, Emblem Decree, 1992, Article 8; and Uzbekistan, Law on the Use and Protection of the Red Crescent and Red Cross Emblems, 2004, Article 7.
11 - See the commentary on Article 19, sections C.1 and C.2. While Article 19 covers the medical establishments and units of National Societies or other voluntary aid societies both of States that are party to the conflict and of neutral States, only the medical establishments and units of the National Society of a Party to the conflict come within the scope of Article 42. Article 43 deals with the use of the emblem as a protective device by medical establishments and units of National Societies of neutral States; see the commentary on that article, para. 2655.
12 - On the scope of the loss of protection of medical units and establishments, see Articles 21 and 22 of the First Convention, and their commentaries. See also the commentaries on Article 19, paras 51 and 52, and Article 24, section F.
13 - See the commentary on Article 39, section B.1. See also e.g. Bosnia and Herzegovina, Emblem Law, 2002, Article 19; Central African Republic, Emblem Law, 2009, Article 7; Georgia, Emblem Law, 1997, Article 6; Mali, Emblem Law, 2009, Article 5; Philippines, Emblem Act, 2013, section 4; Uruguay, Emblem Decree, 1992, Article 4; and Yemen, Emblem Law, 1999, Article 4.
14 - This responsibility cannot be delegated to entities other than military authorities. See ICRC, Study on the Use of the Emblems: Operational and Commercial and Other Non-Operational Issues, ICRC, Geneva, 2011, pp. 60 and 64.
15 - Only the emblem as a protective device, i.e. a red cross, a red crescent, a red lion and sun or a red crystal on a white ground, referred to as the ‘distinctive flag’, can be the visible manifestation of the protection of medical units and establishments under the First Convention. Other flags, in particular national flags, do not have this significance. See, however, the commentary on Article 38 regarding the particular status of the Swiss national flag, of which the red cross emblem is considered to be the reversal.
16 - Des Gouttes, Commentaire de la Convention de Genève de 1929 sur les blessés et malades, ICRC, 1930, p. 165.
17 - This commission was convened by the ICRC and produced a report and a draft for revision of the 1929 Geneva Convention on the Wounded and Sick, which was adopted by the 16th International Conference of the Red Cross, London, 1938. It should have been discussed at a Diplomatic Conference convened by the Swiss Government in 1940, but the conference was postponed owing to the outbreak of the Second World War. The draft then formed the basis of further preparatory work in the run-up to the 1949 Diplomatic Conference. See Report of the Preliminary Conference of National Societies of 1946, p. 15.
18 - See Report of the Conference of Government Experts of 1947, p. 52.
19 - See e.g. Belgium, Law of Armed Conflict Training Manual, 2009, Course V, p. 16; Canada, LOAC Manual, 2001, para. 915.2; Switzerland, Basic Military Manual, 1987, Article 95; and United States, Army Health System, 2013, para. 3-23.
20 - This may be deduced from the context of this paragraph. Article 43(2) deals with the same issue of flying the national flag alongside the protective emblem for medical units of National Red Cross and Red Crescent Societies or other voluntary aid societies of neutral countries, and refers to the ‘responsible military authorities’ as competent to give certain orders in this regard. See the commentary on Article 43, section C.
21 - ICRC, Study on the Use of the Emblems: Operational and Commercial and Other Non-Operational Issues, ICRC, Geneva, 2011, pp. 144–146.
22 - See Article 5 of Additional Protocol III and its commentary.
23 - See ICRC, Study on the Use of the Emblems: Operational and Commercial and Other Non-Operational Issues, ICRC, Geneva, 2011, Chapter 27, pp. 161–166.
24 - Medical establishments and units of National Red Cross and Red Crescent Societies or other voluntary aid societies of neutral countries are excluded from the scope of this paragraph as they are governed by the specific rule contained in Article 43(2). On the notion of ‘falling into enemy hands’, see the commentary on Article 19, section C.3.
25 - See ibid.
26 - See the commentaries on Article 33 and Article 34 for further details on the treatment of fixed medical establishments, their material and stores, and of mobile medical units and their material belonging respectively to the armed forces and to National Red Cross and Red Crescent Societies or other voluntary aid societies.
27 - That objection had already been expressed in relation to the same wording used in this regard in the 1929 Convention. See Des Gouttes, Commentaire de la Convention de Genève de 1929 sur les blessés et malades, ICRC, 1930, p. 166.
28 - See ibid. pp. 166–167. The relevant difference between fixed establishments of the medical services of the armed forces and fixed establishments of National Red Cross and Red Crescent Societies or other voluntary aid societies auxiliary to the medical services was that only the former were subject to the law of war, which corresponds to the legal position in Articles 33 and 34 of the 1949 Convention.
29 - On the position of fixed medical establishments and mobile medical units under the 1929 Geneva Convention on the Wounded and Sick, see ibid. p. 166.
30 - Additional Protocol I, Article 57(2)(a)(i); see also Customary International Humanitarian Law (2005), Rule 16.
31 - See e.g. Sweden, IHL Manual, 1991, p. 156.
32 - Cauderay, p. 300.
33 - Ibid. pp. 300–308, 315 and 317.
34 - Ibid. p. 303.
35 - By this means, the electromagnetic energy emitted in the infrared band by objects is transformed into electrical signals which are then used to draw a map of the hot points on the landscape, thus forming an image which can be observed, for example, through field glasses or on a screen. See Cauderay, p. 297, note 3, and Loye, p. 198, note 1.
36 - These are electro-optical devices which amplify the light levels of objects lit by low light at night. The main component is a light amplification tube which converts a low-level polychromatic image (white light) into an electronic image, which is then electronically amplified and transformed into a more intense, usually dull green, monochromatic image; Cauderay, p. 297, note 4.
37 - Ibid. p. 310. See also Colombia, Decree No. 138, 2005, Article 4(6), which explicitly provides for the possibility of using reflective materials to ensure visibility at night.
38 - See Loye, pp. 198–202.
39 - Jean-François Quéguiner, ‘Commentary on the Protocol additional to the Geneva Conventions of 12 August 1949, and relating to the Adoption of an Additional Distinctive Emblem (Protocol III)’, International Review of the Red Cross, Vol. 89, No. 865, March 2007, p. 187, note 35.
40 - See Additional Protocol I, Annex I, Regulations concerning identification (as amended in 1993), Articles 4 and 5.
41 - Ibid. Articles 6–9. Parties may also wish to authorize the use of electronic markings in relation to computer networks and data, for example. See Tallinn Manual on the International Law Applicable to Cyber Warfare (2013), Rule 72, pp. 206–208.
42 - See the commentary on Article 39, section B.4. See also Additional Protocol I, Annex I, Regulations concerning identification (as amended in 1993), Article 1(2), and Additional Protocol III, Preamble, para. 4. The emblem’s fundamental purpose as the visible manifestation of protection is also recognized in the national legislation of numerous countries; see e.g. Bosnia and Herzegovina, Emblem Law, 2002, Article 2; Colombia, Emblem Law, 2004, Article 2(1); Mali, Emblem Law, 2009, Article 3; and Philippines, Emblem Act, 2013, section 3(f).
43 - See e.g. Australia, Manual of the Law of Armed Conflict, 2006, para. 9.3; United Kingdom, Manual of the Law of Armed Conflict, 2004, para. 7.25.1; and United States, Army Health System, 2013, para. 3-23. See also Vollmar, p. 748.
44 - For a discussion concerning the loss of specific protection if heavy weaponry is mounted on military medical units, see the commentary on Article 22, para. 1868.
45 - See e.g. Australia, Manual of the Law of Armed Conflict, 2006, para. 9.4 (stating that in order to ‘conceal a military deployment, a commander may choose not to display the red cross, red crescent or red crystal on field ambulances or medical facilities which by necessity must be located close to a military objective such as a medical transit post adjacent to a military airfield’); Germany, Military Manual, 2013, para. 652; Peru, IHL Manual, 2004, para. 30(t), Annex 10, Terms of Reference, points 25 and 98; and Philippines, LOAC Teaching File, 2006, pp. 5-7, 9-3 and 16-2. However, this course of action is subject to the obligation under Article 19(2) of the First Convention to ensure that medical establishments and units are, as far as possible, situated in such a manner that attacks against military objectives cannot imperil their safety. See the commentary on Article 19, section D.
46 - See also the commentaries on Article 39, sections B.2 and B.3, and Article 40, section C.2, regarding the use of the emblem on flags, emblems and medical equipment and the identification of medical and religious personnel.
47 - See NATO Standardization Agreement 2931 (1998) (providing that an order to camouflage medical facilities is to be temporary and local in nature only and must be rescinded as soon as the security situation on the ground permits. Furthermore, such an order may only be issued at a certain level of the military chain of command, i.e. brigade level or equivalent. However, this possibility is not foreseen for large, fixed medical establishments.) See also Belgium, Law of Armed Conflict Training Manual, 2009, Course V, p. 17; United Kingdom, Manual of the Law of Armed Conflict, 2004, para. 7.25.2; and United States, Army Health System, 2013, para. 3-23.