Treaties, States Parties and Commentaries
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Commentary of 2016 
Chapter III : Medical units and establishments
1763  The rationale for the protection of medical units and establishments used by the armed forces’ medical service is the same as for medical personnel, material and transports: they are protected on account of the functions they perform, i.e. providing medical care to wounded and sick soldiers, which is a central aim of the First Convention.
1764  Article 19 deals with medical establishments and units used by the armed forces’ medical service. The first paragraph outlines the protection granted to these establishments and units and prescribes the treatment to be accorded to their personnel if they fall into enemy hands. The second paragraph sets out a specific obligation to take precautionary measures to protect these establishments and units from the effects of attacks against military objectives.
1765  Article 21 lays down the conditions under which military medical establishments and units covered by Article 19 lose their protection, i.e. if they are ‘used to commit, outside their humanitarian duties, acts harmful to the enemy’. It also regulates the stringent criteria that must be met before such loss of protection occurs: a warning must be given, providing, in all appropriate cases, a reasonable time limit. Protection ceases only ‘after such warning has remained unheeded’.
1766  Article 22 supplements Article 21 by listing five ‘conditions’, i.e. specific factual scenarios, which must not be regarded as acts harmful to the enemy, in spite of certain appearances which may lead to the opposite conclusion or at least create some doubt. Consequently, conduct falling within the list of acts specified in Article 22 does not lead to a loss of protection of the military medical establishment or unit in question.
1767  Article 20 prohibits any attacks launched from land against hospital ships at sea. Article 20 goes hand in hand with Article 23 of the Second Convention: the former prohibits attacks from land against hospital ships entitled to the protection of the Second Convention, while the latter prohibits attacks from the sea against land-based establishments entitled to the protection of the First Convention.
1768  Lastly, Article 23 provides for the establishment of hospital zones and localities outside areas where fighting is taking place, in order to enhance the protection of the wounded and sick from the effects of war. Together with the safety zones and neutralized zones regulated in Articles 14 and 15 of the Fourth Convention, Article 23 forms part of a wider system of protected zones laid down in the Geneva Conventions and further developed in Additional Protocol I.
1769  This chapter is further complemented by a number of provisions contained in Part II, Section I, of Additional Protocol I.