Treaties, States Parties and Commentaries
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Commentary of 2020 
Article 55 : Medical supervision
Text of the provision*
(1) The fitness of prisoners of war for work shall be periodically verified by medical examinations at least once a month. The examinations shall have particular regard to the nature of the work which prisoners of war are required to do.
(2) If any prisoner of war considers himself incapable of working, he shall be permitted to appear before the medical authorities of his camp. Physicians or surgeons may recommend that the prisoners of war who are, in their opinion, unfit for work, be exempted therefrom.
* Paragraph numbers have been added for ease of reference.
Reservations or declarations
None
Contents

A. Introduction
2785  Article 55 aims to ensure that prisoners of war are physically and mentally fit for the work to which they have been assigned. This provision needs to be read together with Article 49(1) on the guiding principles governing the labour of prisoners of war and Article 31 on the obligation on the Detaining Power to conduct monthly medical inspections. Under the present article, the physical fitness of prisoners for work must be determined by qualified medical personnel. Such examinations must take place at least once a month but also whenever prisoners consider themselves physically incapable of working.
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B. Historical background
2786  During the First World War, the labour of British and French prisoners of war on starvation rations in 1917–1918 severely undermined their health. Doctors were under pressure to pass them as fit to work and very seldom declared otherwise, despite the very high rate of illness among the prisoners.[1]
2787  These abuses prompted the drafting of Article 29 of the 1929 Geneva Convention on Prisoners of War, according to which ‘[n]o prisoner of war may be employed on work for which he is physically unsuited’. However, this provision was frequently violated during the Second World War.[2]
2788  When it came to the adoption of the present Convention, it was therefore felt necessary not only to recall the obligation of the Detaining Power to utilize only the labour of prisoners of war who are physically and mentally fit, but also to put in place a mechanism to enforce this obligation.[3] At the Conference of Government Experts in 1947, the ICRC suggested that the capacity of prisoners to work should be checked periodically by a medical commission.[4] This proposal was raised again by the Italian delegation at the Diplomatic Conference in 1949[5] but was not included in the general observations on the labour of prisoners of war in Article 49,[6] as the majority of States felt that this point was covered sufficiently in both Article 31 on medical inspections and Article 55.[7]
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C. Paragraph 1: Periodic medical examinations
2789  Article 55(1) provides that ‘[t]he fitness of prisoners of war for work shall be periodically verified by medical examinations’. This obligation on the Detaining Power specifies the conditions and frequency of these medical examinations: while they must take place ‘at least once a month’, the Detaining Power should arrange for more frequent inspections if required, for instance, by the prisoners’ state of health or the changing nature of the work they have to carry out.[8]
2790  The ‘fitness’ of prisoners for work needs to be verified. This implies that their overall state of health, both physical and mental, must be checked during the medical examination, taking account of the nature of the work and the working conditions of each prisoner.[9] Determining fitness for work involves not only assessing a prisoner’s general state of health, including, when available, any medical evidence regarding their state of health prior to capture, but also conducting examinations in relation to specific activities, such as tests for eye function and colour-blindness for those operating machinery or doing electrical wiring. The primary purpose of the medical examination is therefore to promote and protect the health of the prisoners at work. This medical examination should apply the principles and practice of occupational health in the context of detention and internment.[10]
2791  Article 31 also provides for medical inspections to be carried out at a similar frequency. Those inspections are primarily aimed at monitoring the general state of health of prisoners of war and at detecting contagious diseases.[11] As discussed above, the medical examinations required under Article 55 have a different purpose. Depending on the context, the duration of internment and the type of work, the monthly medical examinations prescribed by Articles 31 and 55 could be carried out at the same time and by the same medical personnel.[12] However, when their work might expose prisoners of war to particular risks to their health or safety, an examination by specialized medical professionals is recommended.
2792  Article 55 does not specify who should determine the fitness of prisoners of war for work. Paragraph 2 speaks only of the ‘medical authorities’ of the camp. The Detaining Power remains fully responsible for deciding who carries out the medical examination pursuant to this article. It can choose to provide its own medical personnel capable of making this determination or use retained medical personnel of the enemy’s military medical services, pursuant to Articles 30(3), 32 and 33, or persons who, without being attached to these services, have medical qualifications and depend on the same Power.[13] Relying on medical personnel of the Power on which the prisoners depend or of the same nationality as the prisoners facilitates communication.[14] Moreover, in determining who concretely may perform such medical examinations, it is also important to take into account the desire of individual prisoners of war not to be examined by medical personnel of a certain sex. This may mean, for instance, making special arrangements to accommodate, as far as possible, the preference of a woman prisoner to be inspected by a woman rather than a man.[15]
2793  While there is a clear obligation on the Detaining Power to carry out these medical examinations, particular challenges may arise when prisoners of war refuse to undergo them. This is because, like any other medical procedure, medical inspections or examinations conducted by medical professionals must comply with other applicable rules of international humanitarian law and standards of medical ethics, including the principle of voluntary and informed consent, unless the person concerned is unable to give valid consent.[16]
2794  If a refusal of consent is simply taken note of and a medical examination does not take place, the prisoner’s condition may worsen or lead to their death, where the need for urgent medical treatment could have been detected through an examination. As a consequence, the Detaining Power may face allegations of violating its obligations under Articles 13, 15, 29 and/or 30. In any event, consent or refusal, together with the grounds for refusal, should be noted in the prisoner’s medical records.[17] A prisoner who refuses to undergo a medical examination risks being found fit to work and therefore assigned a particular work by the Detaining Power.
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D. Paragraph 2: Medical examinations and the responsibility of medical authorities
2795  Article 55(2) establishes a prisoner’s right to appear before the medical authorities of the camp, if they consider themselves incapable of working. The UK representative at the 1949 Diplomatic Conference pointed out that a monthly examination, as provided for in paragraph 1, might not be sufficient to give prisoners adequate protection. It was felt necessary to allow prisoners to request to be examined as often as required by the nature of their work and their state of health.[18] Article 30(4) provides for a similar right for prisoners to present themselves to the medical authorities for examination. In neither instance may the Detaining Power prevent a prisoner from attending these examinations.
2796  It is up to the Detaining Power to make the appropriate arrangements for medical examinations to take place, for example by setting up a daily clinic at a fixed time known to the prisoners. This would allow the prisoners to attend whenever they wish. The doctors or surgeons carrying out the examinations would need to be provided with the necessary means of transport and facilities for the task.[19]
2797  The personnel carrying out the medical examinations should preferably belong to the Power on which the prisoners depend, and if possible be of the same nationality.[20] An earlier version of this paragraph used the term ‘retained doctors’, before being changed to ‘physicians or surgeons’, a term also used in Article 113.[21]
2798  A physician or surgeon can recommend that a prisoner deemed unfit for work be exempted therefrom. The recommendation might comprise such details as whether the prisoner is fit for the particular type of work; whether they require some specific measures to be able to carry out the work; or whether they have a health condition that could endanger co-workers. However, these will just be recommendations; the final decision will be taken by the camp authorities.[22] If the Detaining Power disregards the recommendation of the medical authorities, it would bear full responsibility if the prisoner suffers a work-related injury or illness as a result.
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Select bibliography
Jones, Heather, ‘The Final Logic of Sacrifice? Violence in German Prisoner of War Labor Companies in 1918’, The Historian, Vol. 68, No. 4, Winter 2006, pp. 770–791.
Levie, Howard S., ‘The Employment of Prisoners of War’, American Journal of International Law, Vol. 57, No. 2, April 1963, pp. 318–353.
Pocar, Fausto, ‘L’emploi des civils et des prisonniers de guerre à des fins militaires devant le TPIY’, in Marcelo Kohen, Robert Kolb and Djacoba Liva Tehindrazanarivelo (eds), Perspectives of International Law in the 21st Century: Liber Amicorum Professor Christian Dominicé in Honour of his 80th Birthday, Martinus Nijhoff Publishers, Leiden, 2012, pp. 371–382.

1 - For more details, see Jones, pp. 787–791. This pressure to work arose despite the existence of health-oriented provisions in bilateral agreements concerning the employment of prisoners of war that authorized prisoners to request work dispensation based on medical conditions; see Agreement between Austria-Hungary and Italy concerning Prisoners of War and Civilians (1918), Article 96.
2 - Pictet (ed.), Commentary on the Third Geneva Convention, ICRC, 1960, pp. 288–289.
3 - See the commentary on Article 49(1), section C.
4 - See Report of the Conference of Government Experts of 1947, p. 171.
5 - See Minutes of the Diplomatic Conference of Geneva of 1949, Committee II, Vol. I, 9th meeting, pp. 50–51.
6 - For more details, see the commentary on Article 49, para. 2670.
7 - See Final Record of the Diplomatic Conference of Geneva of 1949, Vol. II-A, p. 348.
8 - See the commentary on Article 31, paras 2287–2292, citing United Kingdom, Joint Doctrine Captured Persons, 2015, pp. 3-9–3-10, para. 309(d) and (e), and Japan, Act on the Treatment of Prisoners of War and Other Detainees in Armed Attack Situations, 2004, Article 32.
9 - The second sentence of Article 55(1) was suggested by the UK delegation to the 1949 Diplomatic Conference; see Final Record of the Diplomatic Conference of Geneva of 1949, Vol. II-A, p. 276.
10 - For medical ethics in occupational health, see International Commission on Occupational Health, International Code of Ethics for Occupational Health Professionals, 3rd edition, 2014, in particular p. 20, paras 9–10.
11 - See the commentary on Article 31, section C.
12 - Levie, pp. 219–220.
13 - As to their differences in status, see the commentaries on Article 32, section C.3, and on Article 33, section C. See also Japan, Act on the Treatment of Prisoners of War and Other Detainees in Armed Attack Situations, 2004, Articles 33–37, which regulate recognition of professional medical qualifications among prisoners of war.
14 - For more details, see the commentary on Article 30, para. 2265.
15 - See the commentary on Article 30, para. 2230.
16 - For States party to the Additional Protocols, see, in particular, Articles 11 and 16 of Additional Protocol I and Article 10 of Additional Protocol II. Article 11(1) and (5) of Additional Protocol I provides that any medical procedures must be carried out in the patient’s interest and comply with generally accepted medical standards, and recognizes the right of patients to refuse any surgical procedure, even where this would be justifiable from a medical point of view. See e.g. Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies (2014), Principle 6, and World Medical Association (WMA), WMA Regulations in Times of Armed Conflict and Other Situations of Violence, adopted at the 10th World Medical Assembly in Havana, Cuba, in October 1956, last revised at the 63rd World Medical Assembly in Bangkok, Thailand in October 2012.
17 - For guidance, see e.g. United Kingdom, Joint Doctrine Captured Persons, 2015, p. 3-13, para. 310(k), and pp. 3-20–3-22, paras 319–323, and United States, Medical Support to Detainee Operations, 2007, p. 1-16, paras 1-66–1-68. See also ICRC, Health Care in Danger: The Responsibilities of Health-Care Personnel Working in Armed Conflicts and Other Emergencies, ICRC, Geneva, 2012, pp. 75–78. For more details on the consequences of a further refusal by the prisoner of war, see the commentary on Article 31, paras 2297–2298.
18 - See Minutes of the Diplomatic Conference of Geneva of 1949, Committee II, Vol. I, 10th meeting, p. 45.
19 - See Pictet (ed.), Commentary on the Third Geneva Convention, ICRC, 1960, p. 290.
20 - See para. 2792 of this commentary.
21 - See Minutes of the Diplomatic Conference of Geneva of 1949, Committee II, Vol. III, 29th meeting, p. 82, and Final Record of the Diplomatic Conference of Geneva of 1949, Vol. II-A, p. 382.
22 - See Pictet (ed.), Commentary on the Third Geneva Convention, ICRC, 1960, p. 290.