Practice Relating to Rule 29. Medical Transports

Geneva Convention I
Article 35 of the 1949 Geneva Convention I provides:
Transports of wounded and sick or of medical equipment shall be respected and protected in the same way as mobile medical units.
Should such transports or vehicles fall into the hands of the adverse Party, they shall be subject to the laws of war, on condition that the Party to the conflict who captures them shall in all cases ensure the care of the wounded and sick they contain.
The civilian personnel and all means of transport obtained by requisition shall be subject to the general rules of international law. 
Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field, Geneva, 12 August 1949, Article 35.
Geneva Convention IV
Article 21 of the 1949 Geneva Convention IV provides:
Convoys of vehicles or hospital trains on land or specially provided vessels on sea, conveying wounded and sick civilians, the infirm and maternity cases, shall be respected and protected in the same manner as the hospitals provided for in Article 18, and shall be marked, with the consent of the State, by the display of the distinctive emblem provided for in Article 38 of the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field of August 12, 1949. 
Convention (IV) relative to the Protection of Civilian Persons in Time of War, Geneva, 12 August 1949, Article 21.
Additional Protocol I
Article 21 of the 1977 Additional Protocol I provides: “Medical vehicles shall be respected and protected in the same way as mobile medical units under the Conventions and this Protocol.” 
Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts (Protocol I), Geneva, 8 June 1977, Article 21. Article 21 was adopted by consensus. CDDH, Official Records, Vol. VI, CDDH/SR.38, 24 May 1977, p. 85.
Additional Protocol II
Article 11(1) of the 1977 Additional Protocol II provides: “Medical … transports shall be respected and protected at all times and shall not be the object of attack.” 
Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), Geneva, 8 June 1977, Article 11(1). Article 11 was adopted by consensus. CDDH, Official Records, Vol. VII, CDDH/SR.51, 3 June 1977, p. 113.
Agreement on the Application of IHL between the Parties to the Conflict in Bosnia and Herzegovina
Paragraph 2.2 of the 1992 Agreement on the Application of IHL between the Parties to the Conflict in Bosnia and Herzegovina provides: “… medical transportation may in no circumstances be attacked, they shall at all times be respected and protected. They may not be used to shield combatants, military objectives or operations from attack.” 
Agreement between Representatives of Mr. Alija Izetbegović (President of the Republic of Bosnia and Herzegovina and President of the Party of Democratic Action), Representatives of Mr. Radovan Karadžić (President of the Serbian Democratic Party), and Representative of Mr. Miljenko Brkić (President of the Croatian Democratic Community), Geneva, 22 May 1992, § 2.2.
UN Secretary-General’s Bulletin
Section 9.5 of the 1999 UN Secretary-General’s Bulletin provides: “The United Nations force shall respect and protect transports of wounded and sick or medical equipment in the same way as mobile medical units.” 
Observance by United Nations Forces of International Humanitarian Law, Secretary-General’s Bulletin, UN Secretariat, UN Doc. ST/SGB/1999/13, 6 August 1999, Section 9.5.
Argentina
Argentina’s Law of War Manual (1969) restates Article 35 of the 1949 Geneva Convention I and Article 21 of the 1949 Geneva Convention IV. 
Argentina, Leyes de Guerra, RC-46-1, Público, II Edición 1969, Ejército Argentino, Edición original aprobado por el Comandante en Jefe del Ejército, 9 May 1967, §§ 3.016 and 4.006.
Argentina
Argentina’s Law of War Manual (1989) states, with respect to non-international armed conflicts in particular: “Medical means of transportation shall be respected and protected and may not be made the object of attack, provided they are not being used to commit hostile acts.” 
Argentina, Leyes de Guerra, PC-08-01, Público, Edición 1989, Estado Mayor Conjunto de las Fuerzas Armadas, aprobado por Resolución No. 489/89 del Ministerio de Defensa, 23 April 1990, § 7.07.
Australia
Australia’s Commanders’ Guide (1994) provides: “civilian medical … transports and supplies are not to be made the target of attack or unnecessarily destroyed. Military medical … facilities and equipment are also entitled to general protection under the Geneva Conventions.” 
Australia, Law of Armed Conflict, Commanders’ Guide, Australian Defence Force Publication, Operations Series, ADFP 37 Supplement 1 – Interim Edition, 7 March 1994, §§ 614–615.
Australia
Australia’s Defence Force Manual (1994) provides: “civilian medical … transports and supplies are not to be made the target of attack or unnecessarily destroyed.” 
Australia, Manual on Law of Armed Conflict, Australian Defence Force Publication, Operations Series, ADFP 37 – Interim Edition, 1994, § 963; see also § 902.
The manual defines medical transports as “any means of transportation, whether military or civilian, permanent or temporary, assigned exclusively to medical transportation and under the control of a competent authority of a party to the conflict”. 
Australia, Manual on Law of Armed Conflict, Australian Defence Force Publication, Operations Series, ADFP 37 – Interim Edition, 1994, Glossary.
Australia
Australia’s LOAC Manual (2006) states:
5.41 Medical units, materials and means of transportation are protected. This applies to any form of medical transportation, whether by sea, land or air …
5.43 Transports of wounded and sick or of medical equipment shall be respected and protected in the same way as mobile medical units. Should such transports or vehicles fall into the hands of the adverse party, they shall be subject to the laws of war, on condition that the party to the conflict who captures them shall in all cases ensure the care of the wounded and sick they contain.
9.68 … [C]ivilian medical … transports and supplies are not to be made the target of attack or unnecessarily destroyed.
9.79 Medical … transports are any means of transportation, military or civilian, permanent or temporary, assigned exclusively to medical transportation and under control of a competent authority of a party to the conflict. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, §§ 5.41, 5.43, 9.68 and 9.79.
The LOAC Manual (2006) replaces both the Defence Force Manual (1994) and the Commanders’ Guide (1994).
Belgium
Belgium’s Law of War Manual (1983) states: “Transport over land of the wounded and sick and medical material enjoys the same protection as medical units and material: it may not be made the object of attack.” 
Belgium, Droit Pénal et Disciplinaire Militaire et Droit de la Guerre, Deuxième Partie, Droit de la Guerre, Ecole Royale Militaire, par J. Maes, Chargé de cours, Avocat-général près la Cour Militaire, D/1983/1187/029, 1983, p. 48.
Belgium
Belgium’s Teaching Manual for Soldiers states:
The protection accorded to the wounded would be illusory if the civilian and military medical services which are specifically set up to treat them could be attacked. Hence, medical services, identified by the Red Cross (or Red Crescent in certain countries), are not considered combatants or military objectives even if they wear the enemy uniform or bear its insignia. Enemy medical transports … may not be attacked. 
Belgium, Droit de la Guerre, Dossier d’Instruction pour Soldat, à l’attention des officiers instructeurs, JS3, Etat-Major Général, Forces Armées belges, undated, p. 17; see also p. 8.
Benin
Benin’s Military Manual (1995) lists the military and civilian medical service as specially protected objects. 
Benin, Le Droit de la Guerre, III fascicules, Forces Armées du Bénin, Ministère de la Défense nationale, 1995, Fascicule I, p. 13.
The manual states: “Specially protected means of transport shall be authorized to carry out their mission as long as necessary. Their mission, content and actual use may be checked through an inspection.” 
Benin, Le Droit de la Guerre, III fascicules, Forces Armées du Bénin, Ministère de la Défense nationale, 1995, Fascicule II, p. 9.
Burkina Faso
Burkina Faso’s Disciplinary Regulations (1994) provides that, under the laws and customs of war, soldiers in combat must respect medical transports. 
Burkina Faso, Règlement de Discipline Générale dans les Forces Armées, Décret No. 94-159/IPRES/DEF, Ministère de la Défense, 1994, Article 35.
Burundi
Burundi’s Regulations on International Humanitarian Law (2007) states with respect to “units and means of medical transport”: “They must at all times be respected and protected.” 
Burundi, Règlement n° 98 sur le droit international humanitaire, Ministère de la Défense Nationale et des Anciens Combattants, Projet “Moralisation” (BDI/B-05), August 2007, Part I bis, p. 5; see also Part I bis, pp. 11, 15, 19, 25, 31, 35, 80 and 100.
The Regulations adds that units and means of medical transport “must not be made the object of attack”. 
Burundi, Règlement n° 98 sur le droit international humanitaire, Ministère de la Défense Nationale et des Anciens Combattants, Projet “Moralisation” (BDI/B-05), August 2007, Part I bis, p. 5; see also Part I bis, pp. 15, 25, 31, 35, 57, 58, 80 and 100.
The Regulations further states: “Such protection ceases if [medical units and means of transport] are used outside of humanitarian purposes in harmful acts against the adversary.” 
Burundi, Règlement n° 98 sur le droit international humanitaire, Ministère de la Défense Nationale et des Anciens Combattants, Projet “Moralisation” (BDI/B-05), August 2007, Part I bis, p. 35.
The Regulations also states: “Transportation of the civilian wounded and sick, the infirm, elderly, children and maternity cases in convoys of vehicles and hospital trains must be respected and protected in the same manner as provided for hospitals.” 
Burundi, Règlement n° 98 sur le droit international humanitaire, Ministère de la Défense Nationale et des Anciens Combattants, Projet “Moralisation” (BDI/B-05), August 2007, Part I bis, p. 35; see also Part I bis, p. 19.
Cameroon
Cameroon’s Disciplinary Regulations (1975) provides that, under the laws and customs of war, each soldier must respect medical transports. 
Cameroon, Règlement de discipline dans les Forces Armées, Décret No. 75/700, 6 November 1975, Article 31.
Cameroon
Cameroon’s Instructor’s Manual (1992) provides that medical transports exclusively used to transport wounded, sick and shipwrecked and medical material enjoy the protection granted thereto by the laws of war. 
Cameroon, Droit international humanitaire et droit de la guerre, Manuel de l’instructeur en vigueur dans les Forces Armées, Présidence de la République, Ministère de la Défense, Etat-major des Armées, Troisième Division, Edition 1992, p. 68, § 243.1.
Cameroon
Cameroon’s Instructor’s Manual (2006) states:
352.2 – Special protection: (persons and objects specially protected.)
Certain categories of persons and objects benefit from special protection under the law of armed conflict and international humanitarian law, both in the civilian domain and in the military domain.
352.20 Military medical services
The totality of land, air and sea means of transport dedicated to the transport of victims of armed conflicts (except for prisoners of war), medical and religious personnel and medical equipment or furniture constitute medical transports [and are specially protected]. 
Cameroon, Droit des conflits armés et droit international humanitaire, Manuel de l’instructeur en vigueur dans les forces de défense, Ministère de la Défense, Présidence de la République, Etat-major des Armées, 2006, p. 92, § 352.2 and p. 93, § 352.20; see also p. 135, § 412.20 and p. 188, § 492.B.
The manual also states: “Medical transport must not be used … in combat.” 
Cameroon, Droit des conflits armés et droit international humanitaire, Manuel de l’instructeur en vigueur dans les forces de défense, Ministère de la Défense, Présidence de la République, Etat-major des Armées, 2006, p. 222, § 221.
Cameroon
Cameroon’s Disciplinary Regulations (2007) states:
Article 31: Humanitarian rules
Every soldier must:
- respect medical units, establishments and transports, hospital zones and localities, places where the wounded and sick, civilian or military, are collected, the emblems of the Red Cross, the Red Crescent and national Red Cross and Red Crescent societies, which are protective signs as such, as well as medical personnel;
For the application of the rules addressed in the two preceding paragraphs,
it is evidently necessary that the structures and buildings are not being used for military purposes;
These rules apply to the extent possible to operations undertaken by aircraft and navy ships against targets on land or at sea. 
Cameroon, Règlement de discipline générale dans les forces de défense, Décret N° 2007/199, Président de la République, 7 July 2007, Article 31.
Canada
Canada’s LOAC Manual (1999) states:
92. Medical transports of all types (land, sea, air) are protected and must not be attacked.
93. Medical transports should not be armed (i.e. crew-served weapons) because of the danger that they be mistaken as fighting vehicles. Medical personnel in the medical transports can, however, retain their personal weapons. 
Canada, The Law of Armed Conflict at the Operational and Tactical Level, Office of the Judge Advocate General, 1999, p. 4-9, §§ 92–93; see also p. 9-4, §§ 35–36.
With respect to non-international armed conflicts in particular, the manual states: “Medical … transports are to be respected and protected at all times and not be made the object of attack.” 
Canada, The Law of Armed Conflict at the Operational and Tactical Level, Office of the Judge Advocate General, 1999, p. 17-4, § 34.
Canada
Canada’s Code of Conduct (2001) states:
Opposing forces transports for the wounded and sick, or of medical equipment, shall be respected as soon as they are identified as such and protected in the same manner as mobile medical units … As a general rule medical transports should not have any weapons “mounted” on them to avoid being mistaken for fighting vehicles. 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 4 June 2001, Rule 10, §§ 5–6.
Canada
Canada’s LOAC Manual (2001) states in its chapter on targeting:
1. Medical transports of all types (land, sea and air) are protected and must not be attacked.
2. Medical transports should not be armed (i.e., crew-served weapons) because of the danger that they may be mistaken as fighting vehicles. Medical personnel in the medical transports can, however, retain their personal weapons. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 448.1–2.
In its chapter on the treatment of the wounded, sick and shipwrecked, the manual states:
918. Protection of medical establishments, transport, aircraft and hospital ships
1. Medical establishments on land, hospital ships, medical aircraft, and medical transports must be respected and protected at all times and must not be attacked. If they are used for purposes hostile to the adverse party and outside their humanitarian purpose, protection may cease. Protection will only cease, however, following a clear warning which has remained unheeded.
919. Medical units, establishments, and transport
1. Medical units and establishments, whether military or civilian, organized for medical purposes, may be fixed or mobile, permanent or temporary. Medical transports are any means of transportation, military or civilian, permanent or temporary, assigned exclusively to medical transportation and under control of a competent authority of a party to the conflict. The rights guaranteed by the Conventions apply equally to both temporary and permanent personnel, units and transports.
2. The material of mobile medical units falling into enemy hands must be reserved for the care of wounded and sick. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, §§ 918–919.
In its chapter entitled “Treatment of civilians in the hands of a party to the conflict or an occupying power”, the manual provides:
Convoys of vehicles or hospital trains on land, and specially provided vessels at sea, conveying wounded and sick civilians, must be protected and respected in the same way as civilian hospitals. Subject to the consent of the State they must bear the distinctive Red Cross or Red Crescent emblem provided for hospitals. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 1112.1.
In its chapter on non-international armed conflicts, the manual states:
Medical units and transports are to be respected at all times and not be made the object of attack. This protection shall only cease if they commit hostile acts outside their humanitarian function. In such circumstances, a warning must be given, and protection only ceases if such warning remains unheeded. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 1719.2.
Canada
Rule 10 of Canada’s Code of Conduct (2005) states:
5. Opposing forces transports for the wounded and sick, or of medical equipment, shall be respected as soon as they are identified as such and protected in the same manner as mobile medical units. If captured the wounded and sick in the transports will be properly cared for.
6. … As a general rule medical transports should not have any weapons “mounted” on them to avoid being mistaken for fighting vehicles. 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 2005, Rule 10, §§ 5–6.
Central African Republic
The Central African Republic’s Instructor’s Manual (1999) states in Volume 2 (Instruction for group and patrol leaders) that “protection also extends to medical … means of transport”. 
Central African Republic, Le Droit de la Guerre, Fascicule No. 2: Formation pour l’obtention du certificat technique No. 2 (Chef de Groupe), du certificat Inter-Armé (CIA), du certificat d’aptitude de Chef de Patrouille (CACP), Ministère de la Défense, Forces Armées Centrafricaines, 1999, Chapter I, Fundamental Rules, § 3.
Also in Volume 2, the manual states: “Specially protected means of transport are authorized to carry out their mission as long as necessary. Their mission, content and actual use may be checked through an inspection.” 
Central African Republic, Le Droit de la Guerre, Fascicule No. 2: Formation pour l’obtention du certificat technique No. 2 (Chef de Groupe), du certificat Inter-Armé (CIA), du certificat d’aptitude de Chef de Patrouille (CACP), Ministère de la Défense, Forces Armées Centrafricaines, 1999, Chapter II, Section II, § 2.1.
In Volume 3 (Instruction for non-commissioned officers studying for the level 1 and 2 certificates and for future officers of the criminal police), the manual states: “Medical means of transport must not be used to gather or transmit military intelligence or to transport material to this end.” 
Central African Republic, Le Droit de la Guerre, Fascicule No. 3: Formation pour l’obtention du Brevet d’Armes No. 1, du Brevet d’Armes No. 2 et le stage d’Officier de Police Judiciaire (OPJ), Ministère de la Défense, Forces Armées Centrafricaines, 1999, Chapter II, Section II, § 2.1.
Central African Republic
The Central African Republic’s Disciplinary Regulations (2009) states: “In accordance with the international conventions signed or approved by the Central African Government, it is stipulated that during combat servicemen must: … respect … medical transports”. 
Central African Republic, Décret 09.411 portant règlement de discipline générale dans les Armées, Ministre de la Défense Nationale, des Anciens Combattants, des Victimes de Guerre, du Désarmement et de la Restructuration de l’Armée, 10 December 2009, Article 12(10).
Chad
Chad’s Instructor’s Manual (2006) states that it is prohibited to attack “medical … transport vehicles”. 
Chad, Droit international humanitaire, Manuel de l’instructeur en vigueur dans les forces armées et de sécurité, Ministère de la Défense, Présidence de la République, Etat-major des Armées, 2006, p. 36; see also pp. 78 and 88.
The manual also states: “An enemy medical transport vehicle (jeep, ambulance, lorry or helicopter) may not be requisitioned, taken captive or used for armed operations if it is transporting wounded people.” 
Chad, Droit international humanitaire, Manuel de l’instructeur en vigueur dans les forces armées et de sécurité, Ministère de la Défense, Présidence de la République, Etat-major des Armées, 2006, p. 88.
Colombia
Colombia’s Circular on Fundamental Rules of IHL (1992) states that the protection due to the wounded and sick “also covers, as such, … medical transports”. 
Colombia, Transcripción Normas Fundamentales del Derecho Humanitario Aplicables en los Conflictos Armados, Circular No. 033/DIPL-SERPO-526, Policía Nacional, Dirección General, Santafé de Bogotá, 14 May 1992, § 3.
Colombia
Colombia’s Basic Military Manual (1995) states that “attacks, misappropriation and destruction” of medical transports constitutes a “grave breach”. 
Colombia, Derecho Internacional Humanitario – Manual Básico para las Personerías y las Fuerzas Armadas de Colombia, Ministerio de Defensa Nacional, 1995, p. 26, § 4.
Congo
Congo’s Disciplinary Regulations (1986) provides that medical transports must be respected. 
Congo, Décret No. 86/057 du 14 janvier 1986 portant Règlement du Service dans l’Armée Populaire Nationale, 1986, Article 32.
Côte d’Ivoire
Côte d’Ivoire’s Teaching Manual (2007) provides in Book I (Basic instruction):
Lesson 3. Rules of behaviour in combat
14. Respect medical transports. 
Côte d’Ivoire, Droit de la guerre, Manuel d’instruction, Livre I: Instruction de base, Ministère de la Défense, Forces Armées Nationales, November 2007, p. 26.
In book III, volume 2 (instruction of second-year trainee officers), the Teaching Manual provides:
II.2.1. Protection of hospitals and material used by medical personnel
Hospitals must not be attacked and medical personnel must be spared. As long as they have to fulfil their special task, they must not be used for a different purpose. This equally applies to medical transports.
Medical transport means any means of transportation assigned exclusively to the conveyance by land, water or air of the wounded, sick, shipwrecked, medical and religious personnel or medical material … 
Côte d’Ivoire, Droit de la guerre, Manuel d’instruction, Livre III, Tome 2: Instruction de l’élève officier d’active de 2ème année, Manuel de l’instructeur, Ministère de la Défense, Forces Armées Nationales, November 2007, pp. 29–30.
In Book IV (Instruction of heads of division and company commanders), the Teaching Manual provides:
II.2.6. Means of medical transportation
Means of medical transportation of all kinds (land, sea and air) are protected and must not be made the object of attack. …
Medical transportation should not be armed (i.e. by collective weapons) because of the risk that they are considered as combat vehicles. The medical personnel of medical transportations can, however, keep their individual weapons. 
Côte d’Ivoire, Droit de la guerre, Manuel d’instruction, Livre IV: Instruction du chef de section et du commandant de compagnie, Manuel de l’élève, Ministère de la Défense, Forces Armées Nationales, November 2007, p. 39.
Croatia
Croatia’s Commanders’ Manual (1992) provides: “Medical transports may not be used to collect or transmit intelligence data.” 
Croatia, Basic Rules of the Law of Armed Conflicts – Commanders’ Manual, Republic of Croatia, Ministry of Defence, 1992, § 34.
Djibouti
Djibouti’s Disciplinary Regulations (1982) states: “Combatants must … respect medical … transports”. 
Djibouti, Décret no. 82-028/PR/DEF du 5 mai 1982 portant règlement de la discipline générale dans les Forces armées, Article 30(2).
Dominican Republic
The Dominican Republic’s Military Manual (1980) instructs soldiers not to attack medical vehicles, whether on land or in the air. 
Dominican Republic, La Conducta en Combate según las Leyes de la Guerra, Escuela Superior de las FF. AA. “General de Brigada Pablo Duarte”, Secretaría de Estado de las Fuerzas Armadas, May 1980, p. 4.
Ecuador
Ecuador’s Naval Manual (1989) states:
Medical vehicles … may not be deliberately bombarded. Belligerents are required to ensure that such medical facilities are, as far as possible, situated in such manner that attacks against military targets in the vicinity do not imperil their safety. 
Ecuador, Aspectos Importantes del Derecho Internacional Marítimo que Deben Tener Presente los Comandantes de los Buques, Academia de Guerra Naval, 1989, § 8.5.1.4.
The manual qualifies “deliberate attack upon … medical vehicles” as a war crime. 
Ecuador, Aspectos Importantes del Derecho Internacional Marítimo que Deben Tener Presente los Comandantes de los Buques, Academia de Guerra Naval, 1989, § 6.2.5.
Ethiopia
According to Ethiopia’s Standing Rules of Engagement (2007), ambulances do not constitute military objectives. 
Ethiopia, Standing Rules of Engagement, National Defense Force, Addis Ababa, 2007, § 8.4.5.
France
France’s Disciplinary Regulations (1975), as amended, provides that soldiers in combat must respect and protect medical transports. 
France, Règlement de Discipline Générale dans les Armées, Decree No. 75-675 of 28 July 1975, replacing Decree No. 66-749, completed by Decree of 11 October 1978, implemented by Instruction No. 52000/DEF/C/5 of 10 December 1979, and modified by Decree of 12 July 1982, Ministère de la Défense, Etat-Major de l’Armée de Terre, Bureau Emploi, Article 9 bis (1).
France
France’s LOAC Summary Note (1992) states: “Medical transports must not be used to collect military information.” 
France, Fiche de Synthèse sur les Règles Applicables dans les Conflits Armés, Note No. 432/DEF/EMA/OL.2/NP, Général de Corps d’Armée Voinot (pour l’Amiral Lanxade, Chef d’Etat-major des Armées), 1992, § 2.3.
France
France’s LOAC Manual (2001), with reference to Article 12 of the 1977 Additional Protocol I, includes medical means of transportation among objects which are specifically protected by the law of armed conflict. 
France, Manuel de droit des conflits armés, Ministère de la Défense, Direction des Affaires Juridiques, Sous-Direction du droit international humanitaire et du droit européen, Bureau du droit des conflits armés, 2001, p. 30.
Germany
Germany’s Military Manual (1992) states that “any transport of wounded, sick and medical equipment shall be respected and protected”. 
Germany, Humanitarian Law in Armed Conflicts – Manual, DSK VV207320067, edited by The Federal Ministry of Defence of the Federal Republic of Germany, VR II 3, August 1992, English translation of ZDv 15/2, Humanitäres Völkerrecht in bewaffneten KonfliktenHandbuch, August 1992, § 617.
Germany
Germany’s IHL Manual (1996) provides that medical vehicles “shall under no circumstance be attacked. Their unhampered employment shall be ensured at all times.” 
Germany, ZDv 15/1, Humanitäres Völkerrecht in bewaffneten Konflikten – Grundsätze, DSK VV230120023, Bundesministerium der Verteidigung, June 1996, § 503.
Germany
Germany’s Soldiers’ Manual (2006) states: “Fixed establishments, vehicles and mobile units of the medical service, without exception, may not be fought.” 
Germany, Druckschrift Einsatz Nr. 03, Humanitäres Völkerrecht in bewaffneten Konflikten – Grundsätze, Erarbeitet nach ZDv 15/2, Humanitäres Völkerrecht in bewaffneten Konflikten – Handbuch, DSK SF009320187, Bundesministerium der Verteidigung, R II 3, August 2006, p. 5.
Greece
The Hellenic Territorial Army’s Internal Service Code (1984), as amended, provides: “Members of the armed forces should: … Respect … the means of transport of medical services.” 
Greece, Hellenic Territorial Army Regulation of Internal Service Code, Presidential Decree 130/1984 (Military Regulation 20-1), as amended, Article 14(d).
Guinea
Guinea’s Soldier’s Manual (2010), under the heading “Distinctive signs”, shows an image of a car with a red crescent on a white ground and states: “Let these vehicles … move around and do not enter them.” 
Guinea, Soldier’s Manual, Ministry of National Defence, 2010, p. 14.
Guinea
Guinea’s Disciplinary Regulations (2012) states:
In accordance with the international agreements signed by the government of Guinea, military personnel in combat are required:
- to respect hospitals and places where the sick are collected, civilian or military wounded persons, … medical formations, buildings, equipment and transports[.] 
Guinea, Règlement de Service dans les Forces Armées, Volume 1: Règlement de Discipline Générale (Service Regulations in the Armed Forces, Volume 1: General Discipline Regulations), 2012 edition, Ministère de la Défense Nationale, approved by Presidential Decree No. D 293/PRG/SGG/2012, 6 December 2012, Article 12(a).
Hungary
Hungary’s Military Manual (1992) instructs soldiers to respect and protect medical transports, whether by land, sea or air. 
Hungary, A Hadijog, Jegyzet a Katonai, Föiskolák Hallgatói Részére, Magyar Honvédség Szolnoki Repülötiszti Föiskola, 1992, p. 19.
Israel
Israel’s Manual on the Rules of Warfare (2006) states that “ambulances and similar facilities” must not be used as military targets. 
Israel, Rules of Warfare on the Battlefield, Military Advocate-General’s Corps Command, IDF School of Military Law, Second Edition, 2006, p. 24.
The Manual on the Rules of Warfare (2006) is a second edition of the Manual on the Laws of War (1998).
Italy
Italy’s LOAC Elementary Rules Manual (1991) provides: “Medical transports may not be used to collect or transmit intelligence data.” 
Italy, Regole elementari di diritto di guerra, SMD-G-012, Stato Maggiore della Difesa, I Reparto, Ufficio Addestramento e Regolamenti, Rome, 1991, § 34.
Kenya
Kenya’s LOAC Manual (1997) states: “Protection from attack is given to … medical transports, e.g. ambulances”. 
Kenya, Law of Armed Conflict, Military Basic Course (ORS), 4 Précis, The School of Military Police, 1997, Précis No. 3, p. 9.
Lebanon
Lebanon’s Teaching Manual (1997) provides for respect for and protection of medical transports. 
Lebanon, Manuel de l’Instruction Nationale dans l’Armée Libanaise, 1997, p. 77.
Mali
Mali’s Army Regulations (1979) provides that, according to the laws and customs of war, soldiers in combat must respect medical transports. 
Mali, Règlement du Service dans l’Armée, 1ère Partie: Discipline Générale, Ministère de la Défense Nationale, 1979, Article 36.
Mexico
Mexico’s Army and Air Force Manual (2009), in a chapter on the 1949 Geneva Conventions, states: “The mobile medical units of the parties to the conflict in the field and fixed medical establishments must be respected and protected at all times. Vehicles used to transport the sick and wounded and medical supplies must be treated in the same way as mobile medical units.” 
Mexico, Manual de Derecho Internacional Humanitario para el Ejército y la Fuerza Área Mexicanos, Ministry of National Defence, June 2009, § 75.
In a section on the 1949 Geneva Convention I, the manual also states:
94. … mobile medical units of the medical service must not be attacked under any circumstances and must be respected and protected at all times by the parties to the conflict.
100. Land vehicles used for medical purposes (medical transports) must be respected and protected in the same way as mobile medical units.
101. Military medical vehicles that fall into the hands of the adverse party are subject to the laws of war, provided that the party to the conflict that captures them ensures the care of the wounded and sick being transported in them. 
Mexico, Manual de Derecho Internacional Humanitario para el Ejército y la Fuerza Área Mexicanos, Ministry of National Defence, June 2009, §§ 94 and 100–101.
Mexico
Mexico’s IHL Guidelines (2009), in a section entitled “Basic rules of conduct in armed conflict”, states: “Do not attack medical vehicles … Ensure their protection. 
Mexico, Cartilla de Derecho Internacional Humanitario, Ministry of National Defence, 2009, § 14(i).
Morocco
Morocco’s Disciplinary Regulations (1974) provides that, according to the laws and customs of war, soldiers in combat must respect medical transports. 
Morocco, Règlement de Discipline Général dans les Forces Armées Royales, Dahir No. 1-74-383 du 15 rejeb 1394, 5 August 1974, Article 25(1).
Netherlands
The Military Manual (1993) of the Netherlands states: “Medical transport and medical means of transportation (vehicles, ships and aircraft) must be respected and protected.” 
Netherlands, Toepassing Humanitair Oorlogsrecht, Voorschift No. 27-412/1, Koninklijke Landmacht, Ministerie van Defensie, 1993, p. VI-6.
The manual repeats this rule with respect to non-international armed conflicts. 
Netherlands, Toepassing Humanitair Oorlogsrecht, Voorschift No. 27-412/1, Koninklijke Landmacht, Ministerie van Defensie, 1993, p. XI-6.
Netherlands
The Military Handbook (1995) of the Netherlands provides: “Medical transports may not be attacked … Medical transports, whether on water, on land or in the air, must also be respected. Such transport may not, however, be used as normal military transport.” 
Netherlands, Handboek Militair, Ministerie van Defensie, 1995, pp. 7-40 and 7-41.
Netherlands
The Military Manual (2005) of the Netherlands states:
Section 6 - Medical transport
0624. Medical transport and medical means of transport (vehicles, vessels and aircraft) must be respected and protected. Medical means of transport form part of the equipment of medical units …
0625. A number of terms are important in this connection:
- medical transport covers the conveyance by land, water or air of the wounded, sick, medical personnel, religious personnel, medical equipment or medical supplies;
- medical transport means any means of transportation, whether military or civilian, permanent or temporary, assigned exclusively to medical purposes;
- medical vehicle means any medical transport by land;
- medical ships and boats mean any medical transports by water;
- medical aircraft means any medical transports by air.
0626. Medical transports should generally be permanently destined for medical purposes. It is also possible to allocate means of transport temporarily to medical transportation. In case of temporary allocation, clear instructions are required to prevent misuse of medical protection. In any case, the purpose of vehicles, ships and boats and aircraft must not change during an operation. In the course of an armed conflict, however, a change of purpose is possible. 
Netherlands, Humanitair Oorlogsrecht: Handleiding, Voorschift No. 27-412, Koninklijke Landmacht, Militair Juridische Dienst, 2005, §§ 0624–0626.
In its chapter on non-international armed conflict, the manual states:
Medical units and means of transport must be respected and protected. They may not be attacked. Their protection ends only when they are used to carry out hostile acts outside the scope of their humanitarian task. Even then, a warning must first be given. 
Netherlands, Humanitair Oorlogsrecht: Handleiding, Voorschift No. 27-412, Koninklijke Landmacht, Militair Juridische Dienst, 2005, § 1058.
In its chapter on peace operations, the manual states: “Attacks on medical facilities or transports are strictly prohibited.” 
Netherlands, Humanitair Oorlogsrecht: Handleiding, Voorschift No. 27-412, Koninklijke Landmacht, Militair Juridische Dienst, 2005, § 1223.
New Zealand
New Zealand’s Military Manual (1992) states:
Medical transports are any means of transportation, military or civilian, permanent or temporary, assigned exclusively to medical transportation and under control of a competent authority of a party to the conflict.
Convoys of vehicles or hospital trains on land, and specially provided vessels at sea, conveying wounded and sick civilians, the infirm, and maternity cases must be protected and respected in the same way as civilian hospitals. 
New Zealand, Interim Law of Armed Conflict Manual, DM 112, New Zealand Defence Force, Headquarters, Directorate of Legal Services, Wellington, November 1992, §§ 1007(1) and (2) and 1110(1).
With respect to non-international armed conflicts in particular, it states that “medical … transports are to be respected at all times and not made the object of attack”. 
New Zealand, Interim Law of Armed Conflict Manual, DM 112, New Zealand Defence Force, Headquarters, Directorate of Legal Services, Wellington, November 1992, § 1818(2).
Nicaragua
Nicaragua’s Military Manual (1996) states, with respect to international armed conflicts, that assistance to the wounded, sick and shipwrecked includes a requirement of “respect for and protection of means of transportation for the wounded and sick or medical material” and “respect for and protection of transportation over land … of civilian wounded and sick”. 
Nicaragua, Manual de Comportamiento y Proceder de las Unidades Militares y de los Miembros del Ejército de Nicaragua en Tiempo de Paz, Conflictos Armados, Situaciones Irregulares o Desastres Naturales, Ejército de Nicaragua, Estado Mayor General, Asesoría Jurídica del Nicaragua, 1996, Article 14(7) and (38).
Nigeria
Nigeria’s Manual on the Laws of War provides: “Convoys of wounded or medical equipment must be respected and protected as mobile medical units.” 
Nigeria, The Laws of War, by Lt. Col. L. Ode PSC, Nigerian Army, Lagos, undated, § 36.
Nigeria
Nigeria’s Military Manual (1994) provides:
Specifically protected … transports recognised as such must be respected … Specifically protected [transports] shall not be touched or entered, though they could be inspected to ascertain their contents and effective use. 
Nigeria, International Humanitarian Law (IHL), Directorate of Legal Services, Nigerian Army, 1994, p. 45, § (f).
Peru
Peru’s IHL Manual (2004) states:
a. Definitions
Medical transportation means the conveyance by land, water or air of the wounded, sick, shipwrecked, medical personnel, religious personnel, medical equipment or medical supplies.
Medical transports means any means of transportation, whether military or civilian, permanent or temporary, assigned exclusively to medical transportation and under the control of a competent authority of a party to the conflict.
Medical transports can be:
(1) permanent, when they are assigned exclusively to medical purposes for an indeterminate period;
(2) temporary, when they are devoted exclusively to medical purposes for limited periods.
It should be noted that all medical transports, whether permanent or temporary, must be assigned exclusively to medical purposes in order to be entitled to protection …
b. Respect and protection
Medical transports must be respected and protected. Respecting them means refraining from attacking or damaging them or preventing their passage. 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 87.a and b.
The manual further states “It is prohibited to move … medical transports … or take advantage of their presence to shield certain areas or military objectives from military operations.” 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 27.e.(10).
Peru
Peru’s IHL and Human Rights Manual (2010) states:
78. Medical means of transport
a. Definitions
Medical transportation means the conveyance by land, water or air of the wounded, sick, shipwrecked, medical personnel, religious personnel, medical equipment or medical supplies.
Medical transports means any means of transportation, whether military or civilian, permanent or temporary, assigned exclusively to medical transportation and under the control of a competent authority of a party to the conflict.
Medical transports can be:
(1) permanent, when they are assigned exclusively to medical purposes for an indeterminate period;
(2) temporary, when they are devoted exclusively to medical purposes for limited periods.
It should be noted that all medical transports, whether permanent or temporary, must be assigned exclusively to medical purposes in order to be entitled to protection …
b. Respect and protection
Medical transports must be respected and protected. Respecting them means refraining from attacking or damaging them or preventing their passage, that is to say allow them to carry out their designated task. Protecting them presupposes taking action to ensure their respect, which may mean to assist them against third parties or to defend them should this be necessary.
The obligation to respect medical means of transport does not ease unless they are used to commit acts harmful to the enemy (such as transporting soldiers in service or ammunition). 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 78, pp. 278–279.
The manual also states that it “is prohibited to move … medical transports … or take advantage of their presence to shield certain areas or military objectives from military operations.” 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 28(e)(3), p. 239.
Romania
Romania’s Soldiers’ Manual (1991) requires respect for medical vehicles and transports. 
Romania, Manualul Soldatului, Ghid de comportare în luptă, Asociaţia Română de Drept Umanitar (ARDU), 1991, p. 32.
Russian Federation
The Russian Federation’s Military Manual (1990) states that “attack, bombardment or destruction of … medical transports” is a prohibited method of warfare. 
Russian Federation, Instructions on the Application of the Rules of International Humanitarian Law by the Armed Forces of the USSR, Appendix to Order of the USSR Defence Minister No. 75, 1990, § 5(g).
Russian Federation
The Russian Federation’s Regulations on the Application of IHL (2001) states: “objects protected by international humanitarian law include … medical transports … Attacks against such objects are prohibited by international humanitarian law with the exception of cases stipulated by this law”. 
Russian Federation, Regulations on the Application of International Humanitarian Law by the Armed Forces of the Russian Federation, Ministry of Defence of the Russian Federation, Moscow, 8 August 2001, § 1.
With regard to internal armed conflict, the Regulations states: “Medical … transports shall be respected and protected at all times and shall not be the object of attack.” 
Russian Federation, Regulations on the Application of International Humanitarian Law by the Armed Forces of the Russian Federation, Ministry of Defence of the Russian Federation, Moscow, 8 August 2001, § 83.
Senegal
Senegal’s Disciplinary Regulations (1990) provides that soldiers in combat must respect and protect medical transports. 
Senegal, Règlement de Discipline dans les Forces Armées, Décret 90-1159, 12 October 1990, Article 34(1).
Senegal
Senegal’s IHL Manual (1999) states: “Medical means of transport (ambulances) shall be authorized to perform their function as long as necessary. Their mission, content and actual use may be verified by inspection.” 
Senegal, Le DIH adapté au contexte des opérations de maintien de l’ordre, République du Sénégal, Ministère des Forces Armées, Haut Commandement de la Gendarmerie et Direction de la Justice Militaire, Cabinet, 1999, p. 17.
Sierra Leone
Sierra Leone’s Instructor Manual (2007) states:
Any means of transportation, whether military or civilian, permanent or temporary, assigned exclusively for the transportation of medical personnel, wounded and sick and other facilities are referred to as medical transport. These may include aircraft, vehicles, ships etc.
Before any transport for medical purpose, it must be marked with the protective emblem which is the Red Cross on a white background.
Medical transport is not to be attacked but may lose its [protected] status if, for example, it carries arms or military equipment or the vehicle is used to gather intelligence about the location or deployment of the enemy.
It is a crime to attack a clearly marked medical transport or to use them for a non-medical purpose.
Medical transport, if captured, should be used to provide medical services to the wounded and sick. 
Sierra Leone, The Law of Armed Conflict. Instructor Manual for the Republic of Sierra Leone Armed Forces (RSLAF), Armed Forces Education Centre, September 2007, pp. 60–61.
South Africa
South Africa’s LOAC Manual (1996) provides:
53. All means of medical transport, whether permanent or temporary, must be assigned exclusively to medical purposes in order to be entitled to protection. A convoy carrying both wounded and able-bodied soldiers or arms would lose the right to protection to the detriment of the wounded. (Note: the presence of light arms which have just been taken from the wounded and not yet turned over to the proper authority is permitted.)
54. The term “respect” for the means of medical transport indicates that they may not be attacked or damaged, nor may their passage be obstructed; put positively, they must be permitted to carry out their assigned tasks. 
South Africa, Presentation on the South African Approach to International Humanitarian Law, Appendix A, Chapter 4: International Humanitarian Law (The Law of Armed Conflict), National Defence Force, 1996, §§ 53–54.
[emphasis in original]
South Africa
South Africa’s Revised Civic Education Manual (2004) states:
67. Medical Transportation. The following definitions are relevant under this heading:
a. “Medical transportation” means the conveyance by land, water or air of wounded, sick or shipwrecked persons, medical and religious personnel and medical material.
b. “Medical transports” cover any means of transport, military or civilian, permanent or temporary, assigned exclusively to medical transportation and under the control of a competent authority of a Party to a conflict.
68. All means of medical transport, whether permanent or temporary, must be assigned exclusively to medical purposes in order to be entitled to protection. A convoy carrying both wounded and able-bodied soldiers or arms would lose the right to protection to the detriment of the wounded. (Note: the presence of light arms which have just been taken from the wounded and not yet turned over to the proper authority is permitted).
69. The term “respect” for the means of medical transport indicates that they may not be attacked or damaged, nor may their passage be obstructed. They must be permitted to carry out their assigned tasks. Medical transports by land and medical ships and craft must be respected and protected in the same way as mobile medical units. Military ambulances falling into enemy hands are subject to the law of war on the condition that the Party capturing them assumes responsibility for the sick and wounded contained therein. 
South Africa, Revised Civic Education Manual, South African National Defence Force, 2004, Chapter 4, §§ 67–69.
South Africa
South Africa’s LOAC Teaching Manual (2008) states:
2.1 Basic Categories of Persons and Objects Recognised under the LOAC [law of armed conflict]
Specifically Protected Persons and Objects recognised under the LOAC
The following persons and objects fall within the specifically protected category under the LOAC:
- Medical transport;
Specifically Protected Persons and Objects
General Rule
The LOAC grants particular protection to specific categories of persons and objects[.] The reason for this special protection corresponds with the general aim of the LOAC, to wit, to allow commanders to wage war against the enemy with maximum effect, but at the same time to minimise the suffering of those who are caught up in a war without being any threat to the warring parties.
Persons who are specifically protected are persons who do not participate in hostilities and objects specifically protected are those that are not used for combat purposes. Such persons and objects are not used in attacks and cannot properly defend themselves against attacks.
2.2. Military Medical Services and Religious Personnel/objects
Military Medical and Religious Objects
What are Military Medical Objects?
- “Medical transport” is defined in [1977] Additional Protocol I article 8, read with [1949] Geneva Convention I article 35 and [1949] Geneva Convention II article 27. “Medical transport” means any means of transportation assigned exclusively to conveyance by land, air or water the:
- Wounded, sick or shipwrecked;
- Medical and religious personnel; or
- Medical material.
Nature of the Protection of Military Medical Objects (Buildings, Transport and Material) and Religious Objects
- All fixed military medical establishments, mobile medical units and transportation carrying wounded and sick, or medical equipment, may not be attacked but must at all times be respected and protected by the Parties to the conflict. (Geneva Convention I article 19.)
- The buildings, material and stores of fixed military establishments may not be diverted from the care of the wounded and sick. However, commanders of forces in the field may use it in cases of urgent military necessity, as long as they have made previous arrangements for the welfare of the enemy wounded and sick that are nursed in them (Geneva Convention I article 33). Military medical transport (excluding military medical aircraft and hospital ships) that are no longer needed for the sick and wounded becomes war booty.
- If a military medical establishment, unit or vehicle should fall into the hands of the enemy, the captor will be responsible for the care of the wounded and sick therein. The personnel of a captured military medical establishment, unit or vehicle must be permitted to continue with their duties until such time as the capturing Party assumes responsibility therefore. (Geneva Convention I article 19.)
- Military medical establishments and transport may be guarded by a picket, sentries or an escort who may protect the life of medical and religious personnel and the wounded and sick in such establishments … but may not oppose the capture thereof. (Geneva Convention I article 22.)
Loss of Protection (Geneva Convention I Article 21)
Geneva Convention 1 article 22, provides for specific aspects which do NOT cause medical institutions or units to lose their protection:
- Using Members of the Armed Forces to Guard a Military Establishment, Unit or Transportation
- Guards of [] medical establishments, units or transportation normally consist of the unit’s own (medical) personnel.
- However, where necessary, armed soldiers can be used as guards to protect it.
- They may use their weapons only in their own defence or in that of the medical personnel, wounded and sick in their charge.
Warning: Condition before Military Medical Personnel, Establishments, Units or Transport and Military Religious Personnel can forfeit their Protection (Geneva Convention I Article 21). Even if the abovementioned loses its right to protection, the following steps must be taken before such an establishment or unit can be attacked.
- Due warning must first be given to that institution or unit that it is to lose its protection and render it liable to attack;
- A reasonable time limit must be given for the institution or unit to put an end to its harmful acts; and
- The warning must remain unheeded.
Conclusion
Military medical and religious establishments, units and transport are also specifically protected, as long as they are exclusively used for medical purposes. They may not be attacked but must at all times be respected and protected by the Parties to the conflict. Reprisals against them are prohibited.
All Parties must ensure the safety of military medical and religious establishments, units and transport.
Captured military medical establishments, units or vehicles are the responsibility of the captor who must care for the wounded and sick therein. The captor must also allow the captured medical personnel to continue with their duties until such time as the capturing Party assumes the responsibility therefore.
Military medical and religious institutions, units and transportation can lose their right to protection if used to commit acts which are harmful to the enemy and which are outside their humanitarian duties. However, they do not forfeit their protection in the following instances:
- If they carry light weapons for personal protection.
- If small arms and ammunition of wounded and sick soldiers are found at or on the medical establishment, unit or transportation.
- If members of the armed forces are used to guard a military establishment, unit or transportation.
- The presence of a veterinary service in the military medical establishment or unit.
- If they are providing humanitarian services to civilian wounded and sick.
Before military medical establishments, units or transport can forfeit their protection, due warning must be given to that institution or unit that it is to lose its protection and render it liable to attack, a reasonable time limit must be given for the institution or unit to put an end to its harmful acts; and the warning must remain unheeded.
2.3 Specifically Protected Persons and Objects under:
a. Civilian Medical Services
Conclusion
The provisions governing military medical personnel, establishments and transport apply equally to civilian medical services. 
South Africa, Advanced Law of Armed Conflict Teaching Manual, School of Military Justice, 1 April 2008, as amended to 25 October 2013, Learning Unit 2, pp. 52–76.
[emphasis in original]
Spain
Spain’s LOAC Manual (1996) defines medical transports in accordance with Article 8 of the 1977 Additional Protocol I. 
Spain, Orientaciones. El Derecho de los Conflictos Armados, Publicación OR7-004, 2 Tomos, aprobado por el Estado Mayor del Ejército, Division de Operaciones, 18 March 1996, Vol. I, § 9.2.c.(1); see also § 4.5.b.(2)(b).
With reference to Article 21 of the 1977 Additional Protocol I, the manual states that medical transports over land “in general, enjoy the same protection and are subject to the same regulation as mobile medical units”. 
Spain, Orientaciones. El Derecho de los Conflictos Armados, Publicación OR7-004, 2 Tomos, aprobado por el Estado Mayor del Ejército, Division de Operaciones, 18 March 1996, Vol. I, § 9.2.c.(2); see also § 4.5.b.(2)(b).
Spain
Spain’s LOAC Manual (2007) states that attacks are prohibited against medical transports, which are defined in accordance with Article 8 of the 1977 Additional Protocol I. The manual adds that civilian medical transports “enjoy the same protection as their military counterparts, provided that they comply with the requirements entitling them to special protection”. 
Spain, Orientaciones. El Derecho de los Conflictos Armados, Tomo 1, Publicación OR7–004, (Edición Segunda), Mando de Adiestramiento y Doctrina, Dirección de Doctrina, Orgánica y Materiales, 2 November 2007, § 4.5.b.(2).(b); see also §§ 7.3.b.(4).(b) and 9.2.c.(1).
The manual further states that “the means of transport for the wounded and sick and medical supplies” become a military objective and may be attacked “when they transport troops or war material at the same time”. 
Spain, Orientaciones. El Derecho de los Conflictos Armados, Tomo 1, Publicación OR7–004, (Edición Segunda), Mando de Adiestramiento y Doctrina, Dirección de Doctrina, Orgánica y Materiales, 2 November 2007, § 4.5.b.(2).(a).
The manual also states: “In general, medical transports by land must be respected and protected in the same way as mobile medical units.” 
Spain, Orientaciones. El Derecho de los Conflictos Armados, Tomo 1, Publicación OR7–004, (Edición Segunda), Mando de Adiestramiento y Doctrina, Dirección de Doctrina, Orgánica y Materiales, 2 November 2007, § 9.2.c.(2).
Sweden
Sweden’s IHL Manual (1991) considers that Article 21 of the 1977 Additional Protocol I on the protection of medical vehicles has the status of customary law. 
Sweden, International Humanitarian Law in Armed Conflict, with reference to the Swedish Total Defence System, Swedish Ministry of Defence, January 1991, Section 2.2.3, p. 18.
Switzerland
Switzerland’s Basic Military Manual (1987) provides: “Transports of wounded and sick civilians, disabled, elderly, children and expectant mothers, by convoys and hospital trains, shall be respected and protected in the same way as hospitals.” 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 37.
The manual further provides that medical vehicles “shall be respected and protected. They shall not be attacked, nor harmed in any way, nor their functioning be impeded, even if they do not momentarily hold any wounded or sick.” 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 82.
Switzerland
Switzerland’s Aide-Memoire on the Ten Basic Rules of the Law of Armed Conflict (2005) states: “I spare and respect personnel and installations as well as equipment and means of transport of the medical services … without discrimination unless they open fire on my comrades or me.” 
Switzerland, The Ten Basic Rules of the Law of Armed Conflict, Aide-memoire 51.007/IIIe, Swiss Army, issued based on Article 10 of the Ordinance for Organization of the Federal Department for Defence, Civil Protection and Sports dated 7 March 2003, entry into force on 1 July 2005, Rule 7.
The Aide-Memoire further states with regard to the protective signs of the red cross and red crescent:
Correct behaviour
- Personnel, installations, material and means of transport of the medical services as well as carriers of signs or objects marked with distinctive signs must be respected and spared;
Prohibited is/are …
- Attacks against persons or objects carrying this sign[.] 
Switzerland, The Ten Basic Rules of the Law of Armed Conflict, Aide-memoire 51.007/IIIe, Swiss Army, issued based on Article 10 of the Ordinance for Organization of the Federal Department for Defence, Civil Protection and Sports dated 7 March 2003, entry into force on 1 July 2005, Chart of Protective Signs.
Switzerland
Switzerland’s Regulation on Legal Bases for Conduct during an Engagement (2005) states that, in application of the principle of distinction, a “[c]ivilian lorry marked with the red cross emblem” that “transports wounded soldiers” must not be shot at, explaining: “Transport of the wounded with the distinctive emblem: it is not a military objective”. 
Switzerland, Bases légales du comportement à l’engagement (BCE), Règlement 51.007/IVf, Swiss Army, issued based on Article 10 of the Ordinance on the Organization of the Federal Department for Defence, Civil Protection and Sports of 7 March 2003, entry into force on 1 July 2005, § 172.
The Regulation also states:
13 Protected persons
13.1 Behaviour with regard to the wounded, sick and shipwrecked and medical and religious personnel
176 Medical personnel, equipment and means of transport as well as localities used by the military service must be spared and must not be hindered in the fulfilment of their mission.
14 Protected objects
14.1 Medical establishments
203 All medical establishments must be respected and protected. They must not be attacked or damaged, nor prevented from pursuing their activities, even when no wounded or sick persons are currently being cared for therein. The right to protection applies to all fixed establishments, such as hospitals, medical posts and depots, as well as to all mobile medical units, such as medical vehicles, field hospitals and first-aid posts.
204 All medical establishments are signalled by means of a clearly visible distinctive emblem.
206 Medical material and means of transport must not be destroyed. Checks on the content of vehicles and containers of the medical services, however, are permitted. If no abuse of the distinctive emblem is found, they must be allowed to continue their journey, if the situation allows.
15 Methods of warfare
15.2 Prohibited methods of warfare
225 Indiscriminate attacks, i.e. attacks which cannot distinguish between protected persons/objects and military objectives, as well as attacks directed against protected persons/objects or acts of revenge are prohibited in any place and at any time.
17 Sanctions for violations of the international law of armed conflict
17.1 General provisions
237 The following in particular are criminal offences: … harmful acts against internationally protected persons and objects[.] 
Switzerland, Bases légales du comportement à l’engagement (BCE), Règlement 51.007/IVf, Swiss Army, issued based on Article 10 of the Ordinance on the Organization of the Federal Department for Defence, Civil Protection and Sports of 7 March 2003, entry into force on 1 July 2005, §§ 176, 203–204, 206, 225 and 237. The German language version of the third sentence of § 206 notes: “… , if the security situation [“Sicherheitslage“] allows”.
Togo
Togo’s Military Manual (1996) lists the military and civilian medical service as specially protected objects. 
Togo, Le Droit de la Guerre, III fascicules, Etat-major Général des Forces Armées Togolaises, Ministère de la Défense nationale, 1996, Fascicule I, p. 14.
The manual states: “Specially protected means of transport shall be authorized to carry out their mission as long as necessary. Their mission, content and actual use may be checked through an inspection.” 
Togo, Le Droit de la Guerre, III fascicules, Etat-major Général des Forces Armées Togolaises, Ministère de la Défense nationale, 1996, Fascicule II, p. 9.
Ukraine
Ukraine’s IHL Manual (2004) states: “‘Means of medical transportation’ means any transport used for medical (sanitary) transportation by land, sea or air … [M]eans of medical transportation may be escorted by guard or convoy.” 
Ukraine, Manual on the Application of IHL Rules, Ministry of Defence, 11 September 2004, § 1.2.35.
The manual further states: “Objects protected by international humanitarian law [include] means of medical transportation … Attacks against such objects shall be prohibited.” 
Ukraine, Manual on the Application of IHL Rules, Ministry of Defence, 11 September 2004, § 1.2.51.
United Kingdom of Great Britain and Northern Ireland
The UK Military Manual (1958) provides: “Vehicles equipped for the transport of wounded and sick, as well as their medical equipment, must be respected and protected in the same way as mobile medical units.” 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 356.
The manual further states: “Convoys of vehicles or hospital trains on land … conveying wounded and sick civilians, the infirm, and maternity cases must be protected and respected in the same way as civilian hospitals.” 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 33.
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Pamphlet (1981) provides: “Protection from attack is given … to medical transport, e.g. ambulances”. 
United Kingdom, The Law of Armed Conflict, D/DAT/13/35/66, Army Code 71130 (Revised 1981), Ministry of Defence, prepared under the Direction of The Chief of the General Staff, 1981, Section 6, p. 23, § 8(a).
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Manual (2004) states:
7.12. Medical transport means any means of transportation, whether military or civilian, permanent or temporary, assigned exclusively to the conveyance by land, water or air of the wounded, sick, shipwrecked, medical or religious personnel, medical equipment or medical supplies protected by the Geneva Conventions and Additional Protocol I and under the control of a competent authority of a party to the conflict. In Additional Protocol I, reference to “medical vehicles” expressly means “any medical transports by land”. Similarly, “medical ships and craft” means “any medical transports by water” and “medical aircraft” means “any medical transports by air”.
7.12.1. The assignment to medical purposes must be exclusive, although it may be permanent or temporary. The word “exclusive” is intended to restrict the definition of medical transport and its use so that the essential protection will not be eroded by abuses. “Permanent” means for an indeterminate period; “temporary” means limited periods but devoted exclusively to medical tasks during the whole of such periods.
Protection of Medical Units
7.13. Medical units are to be “respected and protected at all times and shall not be the object of attack.” Medical units, personnel and transport must not be used for non-medical purposes, otherwise their protection will be jeopardized. In addition, medical units must not “be used in an attempt to shield military objectives from attack” and, where possible, should be so sited that attacks against military objectives do not imperil their safety. The improper use of medical units to kill, injure or capture the enemy amounts to the war crime of perfidy.
7.13.1. Medical units are given this general protection to enable them to perform their humanitarian functions. Thus, the protection given to medical units ceases if “they are used to commit, outside their humanitarian function, acts harmful to the enemy”. Protection may only be withdrawn, however, after due warning has been given, setting, whenever appropriate, a reasonable time limit and after such warning has remained unheeded. 
United Kingdom, The Manual of the Law of Armed Conflict, Ministry of Defence, 1 July 2004, §§ 7.12–7.13.1.
With regard to internal armed conflict, the manual states:
15.29. It is prohibited to attack:
c. medical buildings, including hospitals and places where the wounded and sick are cared for, medical material, medical units, and transport.
15.29.1. The wounded, sick, and shipwrecked must be protected … Medical units, personnel and transports must be protected from attack and are entitled to display the protective emblem of the red cross or red crescent on a white background.
15.47. Medical units and transports “shall be respected and protected at all times and shall not be the object of attack”. However this protection may cease if “they are used to commit hostile acts, outside their humanitarian function”. Even then, the protection will only cease “after a warning has been given setting, whenever appropriate, a reasonable time limit, and after such warning has remained unheeded”. 
United Kingdom, The Manual of the Law of Armed Conflict, Ministry of Defence, 1 July 2004, §§ 15.29–15.29.1 and 15.47.
United States of America
The US Field Manual (1956) restates Article 35 of the 1949 Geneva Convention I and Article 21 of the 1949 Geneva Convention IV. 
United States, Field Manual 27-10, The Law of Land Warfare, US Department of the Army, 18 July 1956, as modified by Change No. 1, 15 July 1976, §§ 236 and 260.
United States of America
The US Air Force Commander’s Handbook (1980) provides that ambulances … “should not be deliberately attacked, fired upon, or unnecessarily prevented from performing their medical duties”. 
United States, Air Force Pamphlet 110-34, Commander’s Handbook on the Law of Armed Conflict, Judge Advocate General, US Department of the Air Force, 25 July 1980, § 3-2.
The Handbook further stresses that medical transports lose their special immunity if they are used to commit “acts harmful to the enemy outside their humanitarian functions”. In this respect, the manual gives the example of “firing at the enemy from an ambulance”. 
United States, Air Force Pamphlet 110-34, Commander’s Handbook on the Law of Armed Conflict, Judge Advocate General, US Department of the Air Force, 25 July 1980, § 3-2(d).
United States of America
The US Naval Handbook (1995) states: “medical vehicles … may not be deliberately bombarded. Belligerents are required to ensure that such medical facilities are, as far as possible, situated in such manner that attacks against military targets in the vicinity do not imperil their safety.” 
United States, The Commander’s Handbook on the Law of Naval Operations, NWP 1-14M/MCWP 5-2.1/COMDTPUB P5800.7, issued by the Department of the Navy, Office of the Chief of Naval Operations and Headquarters, US Marine Corps, and Department of Transportation, US Coast Guard, October 1995 (formerly NWP 9 (Rev. A)/FMFM 1-10, October 1989), § 8.5.1.4.
The manual qualifies “deliberate attack upon … medical vehicles” as a war crime. 
United States, The Commander’s Handbook on the Law of Naval Operations, NWP 1-14M/MCWP 5-2.1/COMDTPUB P5800.7, issued by the Department of the Navy, Office of the Chief of Naval Operations and Headquarters, US Marine Corps, and Department of Transportation, US Coast Guard, October 1995 (formerly NWP 9 (Rev. A)/FMFM 1-10, October 1989), § 6.2.5.
United States of America
The US Naval Handbook (2007) states that “medical vehicles … may not be deliberately bombarded. Belligerents are required to ensure that such medical facilities are, as far as possible, situated in such a manner that attacks against military targets in the vicinity do not imperil their safety.” 
United States, The Commander’s Handbook on the Law of Naval Operations, NWP 1-14M/MCWP 5-12.1/COMDTPUB P5800.7, issued by the Department of the Navy, Office of the Chief of Naval Operations and Headquarters, US Marine Corps, and Department of Homeland Security, US Coast Guard, July 2007, § 8.9.1.4.
The Handbook also states that examples of war crimes that could be considered as grave breaches of the 1949 Geneva Conventions include: “Deliberate attacks upon … medical vehicles.” 
United States, The Commander’s Handbook on the Law of Naval Operations, NWP 1-14M/MCWP 5-12.1/COMDTPUB P5800.7, issued by the Department of the Navy, Office of the Chief of Naval Operations and Headquarters, US Marine Corps, and Department of Homeland Security, US Coast Guard, July 2007, § 6.2.6(7).
Yugoslavia, Socialist Federal Republic of
The Socialist Federal Republic of Yugoslavia’s Military Manual (1988) restates Article 19 of the 1949 Geneva Convention I and extends the protection of military medical transports to civilian medical transports. 
Yugoslavia, Socialist Federal Republic of, Propisi o Primeri Pravila Medjunarodnog Ratnog Prava u Oruzanim Snagama SFRJ, PrU-2, Savezni Sekretarijat za Narodnu Odbranu (Pravna Uprava), 1988, §§ 184, 195 and 198; see also § 82 (conduct of hostilities).
Zimbabwe
Zimbabwe’s Code of Conduct for Combatants (1993) states: “Special protection is to be given to … medical transports”. 
Zimbabwe, Code of Conduct for Combatants, Joint publication of the Zimbabwe Defence Forces and the International Committee of the Red Cross Regional Delegation in Harare, 1993, p. 14.
Australia
Australia’s Criminal Code Act (1995), as amended to 2007, states with respect to other serious war crimes that are committed in the course of an international armed conflict:
268.66 War crimeattacking persons or objects using the distinctive emblems of the Geneva Conventions
(2) A person (the perpetrator) commits an offence if:
(a) the perpetrator attacks one or more buildings, medical units or transports or other objects; and
(b) the buildings, units or transports or other objects are using, in conformity with the Geneva Conventions or the Protocols to the Geneva Conventions, any of the distinctive emblems of the Geneva Conventions; and
(c) the perpetrator intends the buildings, units or transports or other objects so using such an emblem to be the object of the attack; and
(d) the perpetrator’s conduct takes place in the context of, and is associated with, an international armed conflict.
Penalty: Imprisonment for 20 years.
(3) Strict liability applies to paragraphs … (2)(b). 
Australia, Criminal Code Act, 1995, as amended to 2007, Chapter 8, § 268.66, p. 345.
The Act further states with respect to war crimes that are other serious violations of the laws and customs applicable in a non-international armed conflict:
268.78 War crimeattacking persons or objects using the distinctive emblems of the Geneva Conventions
(2) A person (the perpetrator) commits an offence if:
(a) the perpetrator attacks one or more buildings, medical units or transports or other objects; and
(b) the buildings, units or transports or other objects are using, in conformity with the Geneva Conventions or the Protocols to the Geneva Conventions, any of the distinctive emblems of the Geneva Conventions; and
(c) the perpetrator intends the buildings, units or transports or other objects so using such an emblem to be the object of the attack; and
(d) the perpetrator’s conduct takes place in the context of, and is associated with, an armed conflict that is not an international armed conflict.
Penalty: Imprisonment for 20 years.
(3) Strict liability applies to paragraphs (1)(b) and (2)(b). 
Australia, Criminal Code Act, 1995, as amended to 2007, Chapter 8, § 268.78, p. 355.
Bangladesh
Bangladesh’s International Crimes (Tribunal) Act (1973) states that the “violation of any humanitarian rules applicable in armed conflicts laid down in the Geneva Conventions of 1949” is a crime. 
Bangladesh, International Crimes (Tribunal) Act, 1973, Section 3(2)(e).
Belgium
Belgium’s Law relating to the Repression of Grave Breaches of International Humanitarian Law (1993), as amended in 2003, provides:
War crimes envisaged in the 1949 [Geneva] Conventions … and in the [1977 Additional Protocols I and II] … , as well as in Article 8(2)(f) of the [1998 ICC Statute], and listed below, … constitute crimes under international law and shall be punished in accordance with the provisions of the present title … :
8 ter intentionally directing attacks against … medical … transports. 
Belgium, Law relating to the Repression of Grave Breaches of International Humanitarian Law, 1993, as amended on 23 April 2003, Article 1 ter, § 1(8 ter).
Bosnia and Herzegovina
Bosnia and Herzegovina’s Criminal Code (2003) contains the following war crimes provision:
Whoever, in violation of the rules of international law in time of war or armed conflict, orders or perpetrates … any of the following acts:
(c) Unlawful and arbitrary destruction or large-scale appropriation of … means of medical transport … which is not justified by military needs,
shall be punished by imprisonment for a term of not less than ten years or long-term imprisonment. 
Bosnia and Herzegovina, Criminal Code, 2003, Article 174(c).
Burundi
Burundi’s Penal Code (2009) states:
“War crimes” means crimes which are committed as part of a plan or policy or as part of a large-scale commission of such crimes, in particular:
2. … [S]erious violations of the laws and customs applicable in international armed conflict, within the established framework of international law, namely, any of the following acts:
24°. Intentionally directing attacks against … medical transports. 
Burundi, Penal Code, 2009, Article 198(2)(24°).
Colombia
Colombia’s Emblem Decree (1998) provides: “All Colombian authorities and persons must protect … transports of medicine, food and humanitarian aid in situations of armed conflict or natural disaster.” 
Colombia, Emblem Decree, 1998, Article 10.
Croatia
Croatia’s Criminal Code (1997), as amended to 2006, states that a war crime is committed by:
Whoever, in violation of the rules of international law, in time of war or armed conflict, orders [or commits] … an illegal and wanton, large-scale destruction or appropriation of … medical vehicles … when there is no justification by military necessity. 
Croatia, Criminal Code, 1997, as amended in June 2006, Article 159.
Denmark
Denmark’s Military Criminal Code (1973), as amended in 1978, provides:
Any person who uses war instruments or procedures the application of which violates an international agreement entered into by Denmark or the general rules of international law, shall be liable to the same penalty [i.e. a fine, lenient imprisonment or up to 12 years’ imprisonment]. 
Denmark, Military Criminal Code, 1973, as amended in 1978, § 25(1).
Denmark’s Military Criminal Code (2005) provides:
Any person who deliberately uses war means [“krigsmiddel”] or procedures the application of which violates an international agreement entered into by Denmark or international customary law, shall be liable to the same penalty [i.e. imprisonment up to life imprisonment]. 
Denmark, Military Criminal Code, 2005, § 36(2).
Estonia
Under Estonia’s Penal Code (2001), “an attack against … a hospital ship or aircraft, or any other means of transport used for transportation of non-combatants” is a war crime. 
Estonia, Penal Code, 2001, § 106.
France
France’s Penal Code (1992), as amended in 2010, states in its section on war crimes common to both international and non-international armed conflicts:
Intentionally launching attacks against … medical transports displaying, in conformity with international law, the distinctive emblems provided for in the [1949 Geneva Conventions] or their [1977] Additional Protocols is punishable by 20 years’ imprisonment. 
France, Penal Code, 1992, as amended in 2010, Article 461-12.
Georgia
Georgia’s Criminal Code (1999) provides for the punishment of “wilful breaches of norms of international humanitarian law committed in an international or internal armed conflict … against … medical transports”. 
Georgia, Criminal Code, 1999, Article 411(2).
Germany
Germany’s Law Introducing the International Crimes Code (2002) provides:
Anyone who, in connection with an international or non-international armed conflict … carries out an attack against … medical units and transport designated with the distinctive emblems of the Geneva Conventions … in conformity with international humanitarian law, shall be liable to imprisonment for not less than three years. In less serious cases, particularly where the attack is not carried out with military means, the period of imprisonment shall be for not less than one year. 
Germany, Law Introducing the International Crimes Code, 2002, Article 1, § 11(1)(2).
Ireland
Ireland’s Geneva Conventions Act (1962), as amended in 1998, provides that any “minor breach” of the 1949 Geneva Conventions, including violations of Article 35 of the Geneva Convention I and Article 21 of the Geneva Convention IV, and of the 1977 Additional Protocol I, including violations of Article 21, as well as any “contravention” of the 1977 Additional Protocol II, including violations of Article 11, are punishable offences. 
Ireland, Geneva Conventions Act, 1962, as amended in 1998, Section 4(1) and (4).
Italy
Italy’s Law of War Decree (1938), as amended in 1998, states that the means of transportation of the military medical service must be “respected and protected”. 
Italy, Law of War Decree, 1938, as amended in 1998, Article 95.
Lithuania
Lithuania’s Criminal Code (1961), as amended in 1998, provides for the protection of medical transports. 
Lithuania, Criminal Code, 1961, as amended in 1998, 1961, Article 337.
Nicaragua
Nicaragua’s Military Penal Code (1996) provides for the punishment of any soldier who “knowingly violates the protection due to … medical transports … which are recognizable by the established signs or the character of which can unequivocally be distinguished from a distance”, provided that the protection due is not misused for hostile purposes. 
Nicaragua, Military Penal Code, 1996, Article 57(1).
Norway
Norway’s Military Penal Code (1902), as amended in 1981, provides:
Anyone who contravenes or is accessory to the contravention of provisions relating to the protection of persons or property laid down in … the Geneva Conventions of 12 August 1949 … [and in] the two additional protocols to these Conventions … is liable to imprisonment. 
Norway, Military Penal Code, 1902, as amended in 1981, § 108.
Peru
Peru’s Military and Police Criminal Code (2010), in a chapter entitled “Crimes against humanitarian operations and emblems”, states:
A member of the military or the police shall be punished with deprivation of liberty of not less than six years and not more than twenty-five years if, in a state of emergency and when the Armed Forces assume control of the internal order, he or she:
2. Attacks medical … means of transport which are identified with protective signs of the [1949] Geneva Conventions in accordance with International Humanitarian Law. 
Peru, Military and Police Criminal Code, 2010, Article 95(2).
Romania
Romania’s Penal Code (1968) provides for the punishment of:
The total or partial destruction of objects marked with the regular distinctive emblem, such as:
b) means of transport of any kind assigned to a medical service or the Red Cross or the organizations assimilated therewith which serve to transport the wounded, sick, or medical material [and/or] material of the Red Cross or of organizations assimilated therewith. 
Romania, Penal Code, 1968, Article 359.
Serbia
Serbia’s Criminal Code (2005) states that, in time of war, armed conflict or occupation, ordering or committing an attack “against … medical transportation” constitutes a war crime. 
Serbia, Criminal Code, 2005, Article 373.
Spain
Spain’s Military Criminal Code (1985) provides for the punishment of any soldier who “knowingly violates the protection due to … medical transports … which are recognizable by the established signs or the character of which can unequivocally be distinguished from a distance”, provided that the protection due is not misused for hostile purposes. 
Spain, Military Criminal Code, 1985, Article 77(3).
Spain
Under Spain’s Penal Code (1995), wilful violations of the protected status of medical transports are war crimes. 
Spain, Penal Code, 1995, Article 612.
Spain
Spain’s Penal Code (1995), as amended in 2003, states:
Anyone who [commits any of the following acts] during armed conflict shall be punished with three to seven years’ imprisonment:
1. Knowingly violating the protection owed to … medical means of transportation. 
Spain, Penal Code, 1995, as amended on 25 November 2003, Article 612(1).
Switzerland
Switzerland’s Military Criminal Code (1927), taking into account amendments entered into force up to 2011, states in a chapter entitled “War crimes”:
Art. 110
Articles 112–114 apply in the context of international armed conflicts, including in situations of occupation, and, if the nature of the offence does not exclude it, in the context of non-international armed conflicts.
Art. 112
1 The penalty shall be a custodial sentence of not less than three years for any person who in the context of an armed conflict directs an attack against:
d. medical units [and] buildings, material or vehicles marked with a distinctive sign provided for by international humanitarian law or whose protected character is recognizable even without a distinctive sign, hospitals and places where the sick and wounded are collected. 
Switzerland, Military Criminal Code, 1927, taking into account amendments entered into force up to 2011, Articles 110 and 112(1)(d). The word “and” in square brackets has been inserted to reflect the placement of “medical” in the official language versions of Article 112(1)(d).
Switzerland
Switzerland’s Penal Code (1937), taking into account amendments entered into force up to 2011, states under the title “War crimes”:
Art. 264b
Articles 264d–264j apply in the context of international armed conflicts, including in situations of occupation, and, if the nature of the offence does not exclude it, in the context of non-international armed conflicts.
Art. 264d
1 The penalty shall be a custodial sentence of not less than three years for any person who in the context of an armed conflict directs an attack against:
d. medical units [and] buildings, material or vehicles marked with a distinctive sign provided for by international humanitarian law or whose protected character is recognizable even without a distinctive sign, hospitals and places where the sick and wounded are collected. 
Switzerland, Penal Code, 1937, taking into account amendments entered into force up to 2011, Articles 264b and 264d (1)(d). The word “and” in square brackets has been inserted to reflect the placement of “medical” in the official language versions of Article 112(1)(d).
Tajikistan
Tajikistan’s Criminal Code (1998), in the section on “Serious violations of international humanitarian law”, provides for the punishment of “wilful breaches of norms of international humanitarian law committed in an international or non-international armed conflict, against … medical transports”. 
Tajikistan, Criminal Code, 1998, Article 403(2).
Uruguay
Uruguay’s Law on Cooperation with the ICC (2006) states:
26.2. Persons and objects affected by the war crimes set out in the present provision are persons and objects which international law protects in international or internal armed conflict.
26.3. The following are war crimes:
32. Intentionally directing attacks against medical … transport. 
Uruguay, Law on Cooperation with the ICC, 2006, Article 26.2 and 26.3.32.
Venezuela
Venezuela’s Code of Military Justice (1998), as amended, provides for the punishment of “those who should … attack … convoys of sick and wounded”. 
Venezuela, Code of Military Justice, 1998, as amended, Article 474(1).
Colombia
In 2007, in the Constitutional Case No. C-291/07, the Plenary Chamber of Colombia’s Constitutional Court stated that the obligation in the 1977 Additional Protocol II to protect medical transport “has attained customary status, mainly due to its impact on State practice and on conflicts in the last decades”. 
Colombia, Constitutional Court, Constitutional Case No. C-291/07, Judgment of 25 April 2007, p. 69.
Israel
In its judgment in the Physicians for Human Rights v Commander of IDF Forces in the Gaza Strip case in 2004, Israel’s High Court of Justice stated:
22. As for the shooting upon an ambulance, Col. Mordechai stressed that it was not intentional. There are clear instructions that shooting on ambulances is prohibited. “Ambulances are out of bounds” – so stated Col. Mordechai before us. Col. Mordechai informed us that tens of ambulances passed with no harm done to them. It is to be regretted if a single exception occurred …
23. There is no disagreement regarding the normative framework … In HCJ 2117/02 Physicians for Human Rights v. Commander of IDF Forces in the West Bank, Justice Dorner stated:
[I]nternational law provides protection for medical stations and personnel against attack by combat forces … [It is forbidden], under all circumstances, [to] attack stations and mobile medical units of the “Medical Service,” that is to say, hospitals, medical warehouses, evacuation points for the wounded and sick, and ambulances …. However, the “Medical Service” has the right to full protection only when it is exclusively engaged in the search, collection, transport and treatment of the wounded or sick …. [P]rotection of medical establishments shall cease if they are being “used to commit, outside their humanitarian duties, acts harmful to the enemy,” on condition that “a due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.”
It appears to us that the passage of ambulances to and from Rafah proceeded properly. This was made possible, among other means, by the contact between the IDF [Israel Defense Forces] – via officers of the DCO [District Coordination Offices] – and the ambulances. This contact was proper, and it was put into effect properly. In addition, ambulances move freely to and from the area … The single instance of shooting on an ambulance was an exception. We have been convinced that the instructions forbidding such activity are clear and unequivocal. 
Israel, High Court of Justice, Physicians for Human Rights v. Commander of IDF Forces in the Gaza Strip, Judgment, 30 May 2004, §§ 22–23.
Israel
In its judgment in Physicians for Human Rights v. Prime Minister of Israel in 2009, concerning the humanitarian situation in the Gaza Strip consequent to the start of Israeli military operations (“Cast Lead”) there in December 2008, Israel’s High Court of Justice stated:
[T]he Supreme Court emphasized in Physicians for Human Rights v. IDF Commander in West Bank [2002], at p. 29, that the abuse that is sometimes made of … ambulances requires the IDF [Israel Defense Forces] to act in order to prevent such activity, but it does not in itself permit a sweeping violation of the principles of humanitarian law, and that “this position is required not only by international law, on which the petitioners rely, but also by the values of the State of Israel as a Jewish and democratic state.” 
Israel, High Court of Justice, Physicians for Human Rights v. Prime Minister of Israel, Judgment, 19 January 2009, § 18.
South Africa
In 1987, in the Petane case, the Cape Provincial Division of South Africa’s Supreme Court dismissed the accused’s claim that the 1977 Additional Protocol I reflected customary international law. The Court stated:
The accused has been indicted before this Court on three counts of terrorism, that is to say, contraventions of s 54(1) of the Internal Security Act 74 of 1982. He has also been indicted on three counts of attempted murder.
The accused’s position is stated to be that this Court has no jurisdiction to try him.
… The point in its early formulation was this. By the terms of [the 1977 Additional] Protocol I to the [1949] Geneva Conventions the accused was entitled to be treated as a prisoner-of-war. A prisoner-of-war is entitled to have notice of an impending prosecution for an alleged offence given to the so-called “protecting power” appointed to watch over prisoners-of-war. Since, if such a notice were necessary, the trial could not proceed without it, Mr Donen suggested that the necessity or otherwise for giving such a notice should be determined before evidence was led. …
On 12 August 1949 there were concluded at Geneva in Switzerland four treaties known as the Geneva Conventions. …
South Africa was among the nations which concluded the treaties. … Except for the common art 3, which binds parties to observe a limited number of fundamental humanitarian principles in armed conflicts not of an international character, they apply to wars between States.
After the Second World War many conflicts arose which could not be characterised as international. It was therefore considered desirable by some States to extend and augment the provisions of the Geneva Conventions, so as to afford protection to victims of and combatants in conflicts which fell outside the ambit of these Conventions. The result of these endeavours was Protocol I and Protocol II to the Geneva Conventions, both of which came into force on 7 December 1978.
Protocol II relates to the protection of victims of non-international armed conflicts. Since the State of affairs which exists in South Africa has by Protocol I been characterised as an international armed conflict, Protocol II does not concern me at all.
The extension of the scope of art 2 of the Geneva Conventions was, at the time of its adoption, controversial. …
The article has remained controversial. More debate has raged about its field of operation than about any other articles in Protocol I. …
South Africa is one of the countries which has not acceded to Protocol I. Nevertheless, I am asked to decide, as I indicated earlier, as a preliminary point, whether Protocol I has become part of customary international law. If so, it is argued that it would have been incorporated into South African law. If it has been so incorporated it would have to be proved by one or other of the parties that the turmoil which existed at the time when the accused is alleged to have committed his offences was such that it could properly be described as an “armed conflict” conducted by “peoples” against a “ra[c]ist regime” in the exercise of their “right of self-determination”. Once all this has been shown it would have to be demonstrated to the Court that the accused conducted himself in such a manner as to become entitled to the benefits conferred by Protocol I on combatants, for example that, broadly speaking, he had, while he was launching an attack, distinguished himself from civilians and had not attacked civilian targets. …
… I am prepared to accept that where a rule of customary international law is recognised as such by international law it will be so recognised by our law.
To my way of thinking, the trouble with the first Protocol giving rise to State practice is that its terms have not been capable of being observed by all that many States. At the end of 1977 when the treaty first lay open for ratification there were few States which were involved in colonial domination or the occupation of other States and there were only two, South Africa and Israel, which were considered to fall within the third category of ra[c]ist regimes. Accordingly, the situation sought to be regulated by the first Protocol was one faced by few countries; too few countries in my view, to permit any general usage in dealing with armed conflicts of the kind envisaged by the Protocol to develop.
Mr Donen contended that the provisions of multilateral treaties can become customary international law under certain circumstances. I accept that this is so. There seems in principle to be no reason why treaty rules cannot acquire wider application than among the parties to the treaty.
Brownlie Principles of International Law 3rd ed at 13 agrees that non-parties to a treaty may by their conduct accept the provisions of a multilateral convention as representing general international law. …
I incline to the view that non-ratification of a treaty is strong evidence of non-acceptance.
It is interesting to note that the first Protocol makes extensive provision for the protection of civilians in armed conflict. …
In this sense, Protocol I may be described as an enlightened humanitarian document. If the strife in South Africa should deteriorate into an armed conflict we may all one day find it a cause for regret that the ideologically provocative tone of s 1(4) has made it impossible for the Government to accept its terms.
To my mind it can hardly be said that Protocol I has been greeted with acclaim by the States of the world. Their lack of enthusiasm must be due to the bizarre mixture of political and humanitarian objects sought to be realised by the Protocol. …
According to the International Review of the Red Cross (January/February 1987) No 256, as at December 1986, 66 States were parties to Protocol I and 60 to Protocol II, which, it will be remembered, deals with internal non-international armed conflicts. With the exception of France, which acceded only to Protocol II, not one of the world’s major powers has acceded to or ratified either of the Protocols. This position should be compared to the 165 States which are parties to the Geneva Conventions.
This approach of the world community to Protocol I is, on principle, far too half-hearted to justify an inference that its principles have been so widely accepted as to qualify them as rules of customary international law. The reasons for this are, I imagine, not far to seek. For those States which are contending with “peoples[’]” struggles for self-determination, adoption of the Protocol may prove awkward. For liberation movements who rely on strategies of urban terror for achieving their aims the terms of the Protocol, with its emphasis on the protection of civilians, may prove disastrously restrictive. I therefore do not find it altogether surprising that Mr Donen was unable to refer me to any statement in the published literature that Protocol I has attained the status o[f] customary international [law].
I have not been persuaded by the arguments which I have heard on behalf of the accused that the assessment of Professor Dugard, writing in the Annual Survey of South African Law (1983) at 66, that “it is argued with growing conviction that under contemporary international law members of SWAPO [South-West Africa People’s Organisation] and the ANC [African National Congress] are members of liberation movements entitled to prisoner-of-war status, in terms of a new customary rule spawned by the 1977 Protocols”, is correct. On what I have heard in argument I disagree with his assessment that there is growing support for the view that the Protocols reflect a new rule of customary international law. No writer has been cited who supports this proposition. Here and there someone says that it may one day come about. I am not sure that the provisions relating to the field of application of Protocol I are capable of ever becoming a rule of customary international law, but I need not decide that point today.
For the reasons which I have given I have concluded that the provisions of Protocol I have not been accepted in customary international law. They accordingly form no part of South African law.
This conclusion has made it unnecessary for me to give a decision on the question of whether rules of customary international law which conflict with the statutory or common law of this country will be enforced by its courts.
In the result, the preliminary point is dismissed. The trial must proceed. 
South Africa, Supreme Court, Petane case, Judgment, 3 November 1987, pp. 2–8.
South Africa
In 2010, in the Boeremag case, South Africa’s North Gauteng High Court stated:
In Petane, … Conradie J found that the provisions of [the 1977 Additional] Protocol I are not part of customary international law, and therefore are also not part of South African law.
Referring to the fact that in December 1986 only 66 of the 165 States party to the Geneva Conventions had ratified Protocol I, the Court [in Petane] stated:
This approach of the world community to Protocol I is, on principle, far too half-hearted to justify an inference that its principles have been so widely accepted as to qualify them as rules of customary international law. The reasons for this are, I imagine, not far to seek. For those States which are contending with “peoples[’]” struggles for self-determination, adoption of the Protocol may prove awkward. For liberation movements who rely on strategies of urban terror for achieving their aims the terms of the Protocol, with its emphasis on the protection of civilians, may prove disastrously restrictive. I therefore do not find it altogether surprising that Mr Donen was unable to refer me to any statement in the published literature that Protocol I has attained the status of customary international law.
Important changes with respect to certain aspects applicable at the time of Petane have taken place. The ANC [African National Congress] has become South Africa’s ruling party and in 1995 ratified Protocol I. The total number of States that have ratified it, is now … 162.
This last aspect forms the basis on which the First Respondent [the State] and the applicants agree that Protocol I forms part of customary international law as well as of South African law. As requested, this position is accepted for the purposes of the decision, without deciding on the matter.
Despite these changes, it remains debatable whether the provisions of Protocol I have become a part of South African law in this way.
The consensus of both parties to the conflict is required. See Petane … and Article 96 of Protocol I. …
Parliament’s failure to incorporate Protocol I into legislation in accordance with Article 231(4) of the Constitution in fact points to the contrary, and is indicative that the requirements of usus and/or opinio juris have not been met. See Petane. 
South Africa, North Gauteng High Court, Boeremag case, Judgment, 26 August 2010, pp. 21–22.
[footnotes in original omitted]
The Court also held:
If the [1977 Additional Protocol I] applies in South Africa as customary international law, the two requirements that form the basis of customary law must be met. It is arguable that the requirement of usus has been met by the vast number of States that have acceded or ratified it. By ratifying Protocol I the Republic of South Africa has indicated its intention to apply the Protocol, thereby fulfilling the requirement of opinio juris. 
South Africa, North Gauteng High Court, Boeremag case, Judgment, 26 August 2010, p. 66.
Argentina
In 1993, during a debate in the UN Security Council on the situation in the former Yugoslavia, Argentina stated that “the deliberate attacks on … ambulances” could not go on with impunity. 
Argentina, Statement before the UN Security Council, UN Doc. S/PV.3203, 20 April 1993, p. 57.
Djibouti
In 2010, in the History and Geography Textbook for 8th Grade, Djibouti’s Ministry of National Education and Higher Education, under the heading “Basic rules of IHLˮ and in a section on “Specific protection”, stated that “means of medical transport (… ambulances, etc.) … shall be respected and protectedˮ. 
Djibouti, Ministry of National Education and Higher Education, History and Geography Textbook for 8th Grade, 2010, p. 194.
Egypt
In a note submitted to the ICRC in 1967, Egypt accused Israel of “bombardment of hospitals and ambulances in spite of the distinct markings of them” in violation of Article 19 of the 1949 Geneva Convention I and Articles 18 and 21 of the 1949 Geneva Convention IV and condemned it as a “flagrant violation of the elementary principle of humanity, and a serious breach of the laws of war and the Geneva Conventions of 1949”. 
Egypt, Note to the International Committee of the Red Cross, 7 July 1967, annexed to Letter dated 17 July 1967 to the UN Secretary-General, UN Doc. S/8064, 17 July 1967, § 2(a).
Egypt
In its written comments submitted to the ICJ in the Nuclear Weapons case in 1995, Egypt stated that it was “prohibited to attack convoys of vehicles, hospital trains, hospital ships, aircraft exclusively employed for the removal of wounded and sick civilians, or the transport of medical personnel and equipment”. 
Egypt, Written comments on other written statements before the ICJ, Nuclear Weapons case, September 1995, p. 21, § 50.
France
Under the instructions given to the French armed forces for the conduct of Opération Mistral, simulating a military operation under the right of self-defence or a mandate of the UN Security Council, medical transports and material shall be protected. 
France, État-major de la Force d’Action Rapide, Ordres pour l’Opération Mistral, 1995, Section 6, § 62.
Hungary
In 1992, during a debate in the UN Security Council on the situation in the former Yugoslavia, Hungary stated: “It goes without saying that the international community cannot disregard the responsibility of those who violate international humanitarian law, who order attacks on … ambulances … to mention only a few examples of criminal atrocities.” 
Hungary, Statement before the UN Security Council, UN Doc. S/PV.3106, 13 August 1992, p. 32.
Islamic Republic of Iran
According to the Report on the Practice of the Islamic Republic of Iran, the Islamic Republic of Iran accused Iraq on several occasions of attacking Iranian Red Crescent vehicles during the Iran–Iraq war. The Islamic Republic of Iran claimed that Iraq had violated IHL by committing these acts. 
Report on the Practice of the Islamic Republic of Iran, 1997, Chapter 2.7.
Israel
In 2009, in a report on Israeli operations in Gaza between 27 December 2008 and 18 January 2009 (the “Gaza Operation”, also known as “Operation Cast Lead”), Israel’s Ministry of Foreign Affairs stated: “The operational order confirmed that medical … vehicles should be provided absolute protection from attack, unless they were being used by the enemy for military activities.” 
Israel, Ministry of Foreign Affairs, The Operation in Gaza 27 December 2008–18 January 2009: Factual and Legal Aspects, 29 July 2009, § 224.
The report further stated:
[The] IDF [Israel Defense Forces] trains forces at all levels to exercise extra caution to avoid harming medical crews and facilities. In the Gaza Operation, the IDF reinforced those instructions. In many cases IDF forces suspended their operations against legitimate military objectives when a medical vehicle … [was] in the vicinity. In some of these instances, the IDF refrained from attacking medical vehicles even in cases where Hamas and other terrorist organisations were using them for military purposes. Such restraint was not required under the Law of Armed Conflict, under which protection to medical vehicles may cease if the vehicles are being “used to commit, outside their humanitarian function, acts harmful to the enemy.” 
Israel, Ministry of Foreign Affairs, The Operation in Gaza 27 December 2008–18 January 2009: Factual and Legal Aspects, 29 July 2009, § 371.
Lebanon
In 1972, during a debate in the UN Security Council on the situation in the Middle East, the representative of Lebanon stated that the Lebanese Red Cross had reported that its ambulances, cars and volunteers had been attacked by Israeli forces. 
Lebanon, Statement before the UN Security Council, UN Doc. S/PV.2376, 8 June 1982, p. 2.
In a subsequent debate in 1984, Lebanon complained that an ambulance attendant of the Lebanese Red Cross had been detained while he and a colleague were transporting a wounded man to the hospital in a car belonging to the Red Cross. 
Lebanon, Statement before the UN Security Council, UN Doc. S/PV.2552, 29 August 1984, § 26.
Switzerland
Switzerland’s ABC of International Humanitarian Law (2009) states:
Civilian objects
International humanitarian law distinguishes between Civilian objects and Military objectives, prohibiting acts of violence against the former. Other provisions provide special protection for certain specific civilian objects, some of which are expected to bear distinctive signs: medical units and means of transport, … . Civilian objects are all objects which are not military objectives. 
Switzerland, Federal Department of Foreign Affairs, ABC of International Humanitarian Law, 2009, p. 12.
United Kingdom of Great Britain and Northern Ireland
At the CDDH, the United Kingdom welcomed “the humanitarian advances made in such fields as medical aircraft, the extension of protection to a wider group of medical units and transports and the improved provisions on relief”. 
United Kingdom, Statement at the CDDH, Official Records, Vol. VII, CDDH/SR. 58, 9 June 1977, p. 302, § 114.
United States of America
Upon signature of the 1977 Additional Protocols I and II, the United States declared:
It is the understanding of the United States of America that the terms used in Part III of [the 1977 Additional Protocol II] which are the same as the terms defined in Article 8 [of the 1977 Additional Protocol I] shall so far as relevant be construed in the same sense as those definitions. 
United States, Declaration made upon signature of the 1977 Additional Protocols I and II, 12 December 1977, § B.
United States of America
In 1987, in submitting the 1977 Additional Protocol II to the US Senate for advice and consent to ratification, the US President expressed the view that the obligations in the Protocol were “no more than a restatement of the rules of conduct with which US military forces would almost certainly comply as a matter of national policy, constitutional and legal protections, and common decency”. 
United States, Message from the US President transmitting the 1977 Additional Protocol II to the US Senate for advice and consent to ratification, Treaty Doc. 100-2, 29 January 1987, Comment on Article 10.
Yugoslavia, Socialist Federal Republic of
In 1991, in a document entitled “Examples of violations of the rules of international law committed by the so-called armed forces of Slovenia”, the Ministry of Defence of the Socialist Federal Republic of Yugoslavia included the following example: “Fire has been opened on medical vehicles in spite of their Red Cross signs.” 
Yugoslavia, Socialist Federal Republic of, Minister of Defence, Examples of violations of the rules of international law committed by the so-called Armed Forces of Slovenia, 10 July 1991, § 1(iii).
UN Security Council
In a resolution adopted in 1992, the UN Security Council expressed “grave alarm at continuing reports of widespread violations of international humanitarian law occurring within the territory of the former Yugoslavia and especially in Bosnia and Herzegovina including … deliberate attacks on … ambulances”. The Council strongly condemned such violations and demanded that “all parties and others concerned in the former Yugoslavia, and all military forces in Bosnia and Herzegovina, immediately cease and desist from all breaches of international humanitarian law”.  
UN Security Council, Res. 771, 13 August 1992, preamble and §§ 2 and 3, voting record: 15-0-0.
UN Commission on Human Rights
In a resolution adopted in 1992, the UN Commission on Human Rights stated that it was “appalled at the continuing reports of widespread, massive and grave violations of human rights within the territory of the former Yugoslavia and especially in Bosnia and Herzegovina”, including reports of deliberate attacks on ambulances. 
UN Commission on Human Rights, Res. 1992/S-1/1, 14 August 1992, preamble, adopted without a vote.
UN Commission on Human Rights
In a resolution adopted in 2003 on the question of the violation of human rights in the occupied Arab territories, including Palestine, the UN Commission on Human Rights:
Also strongly condemns again the opening of fire by the Israeli army of occupation on ambulances and paramedical personnel and the practice of preventing ambulances and vehicles of the International Committee of the Red Cross from reaching the wounded and the dead in order to transport them to hospital, thus leaving the wounded bleeding to death in the streets. 
UN Commission on Human Rights, Res. 2003/6, 15 April 2003, § 10, voting record: 33-5-15.
UN Commission on Human Rights
In a resolution adopted in 2004 on the question of the violation of human rights in the occupied Arab territories, including Palestine, the UN Commission on Human Rights:
Also strongly condemns once more the Israeli army of occupation’s practices of opening fire on ambulances and paramedical personnel and preventing ambulances and vehicles of the International Committee of the Red Cross from reaching the wounded and the dead in order to transport them to hospital, thus leaving the wounded bleeding to death in the streets. 
UN Commission on Human Rights, Res. 2004/10, 15 April 2004, § 10, voting record: 31-7-15.
UN Human Rights Council
In a resolution adopted in 2006 on human rights violations emanating from Israeli military incursions in the Occupied Palestinian Territory, the UN Human Rights Council affirmed that “under international humanitarian law, the medical personnel and means of transport of the Palestine Red Crescent Society must be protected and respected in all circumstances”. 
UN Human Rights Council, Res. S-3/1, 15 November 2006, preamble, voting record: 32-8-6.
UN Commission on Human Rights (Special Rapporteur)
In 1993, in a report on the situation of human rights in the territory of the former Yugoslavia, the Special Rapporteur of the UN Commission on Human Rights reported that, in March 1993, a group of UN relief workers escorted by two armoured personnel carriers from the UK Battalion of UNPROFOR were allowed to enter Konjevic Polje. The aim was to evacuate wounded persons who urgently required treatment and who had been identified on an earlier visit. However, Serb forces refused to allow UNHCR to bring in ambulances or trucks. A crowd of at least 2,000 civilians gathered around the two UNPROFOR vehicles. Both the crowd and the vehicles were deliberately shelled by the Serb forces. One of the carriers was destroyed by an almost direct hit just moments after its occupants had moved to the other carrier. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Former Yugoslavia, Periodic report, UN Doc. E/CN.4/1994/3, 5 May 1993, §§ 21–22.
In a later report, in a section entitled “Human rights violations”, the Special Rapporteur noted direct attacks on a UNHCR driver in a clearly marked armoured vehicle. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Former Yugoslavia, Fifth periodic report, UN Doc. E/CN.4/1994/47, 17 November 1993, §§ 67 and 96.
UN Commission on Human Rights (Special Rapporteur)
In 1996, in report on the situation of human rights in the Sudan under the title “Human rights violations – Abuses by parties to the conflict other than the Government of Sudan”, the Special Rapporteur of the UN Commission on Human Rights noted that Operation Lifeline Sudan had reported that, despite security assurances from local authorities, a UNICEF ambulance had been ambushed and one of the wounded persons it was transporting had been killed. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Sudan, Report, UN Doc. E/CN.4/1996/62, 20 February 1996, § 78.
UN Verification Mission in Guatemala
In 1995, in the context of the conflict in Guatemala, MINUGUA examined the case of an attack on a duly identified ambulance of the volunteer fire brigade that was evacuating a wounded soldier. The Unidad Revolucionaria Nacional Guatemalteca (URNG) command denied responsibility. MINUGUA acknowledged that the proximity of fighting made it difficult to judge whether the shot was intentional. The Director of MINUGUA recommended to the URNG that it “should issue precise instructions to its combatants to refrain from … endangering ambulances and duly identified health workers who assist such wounded persons”. 
MINUGUA, Director, First report, UN Doc. A/49/856, 1 March 1995, Annex, §§ 130 and 194.
No data.
International Conference for the Protection of War Victims
The Final Declaration adopted by the International Conference for the Protection of War Victims in 1993 urged all States to “make every effort” to protect medical means of transport. 
International Conference for the Protection of War Victims, Geneva, 30 August–1 September 1993, Final Declaration, § II (9), ILM, Vol. 33, 1994, p. 301.
No data.
ICRC
To fulfil its task of disseminating IHL, the ICRC has delegates around the world teaching armed and security forces that:
67. “Medical transport” means any means of transportation assigned exclusively to conveyance by land, water or air of the wounded, sick, shipwrecked, of medical and religious personnel, or of medical material.
78. The law of war grants the same status to civilian and military medical services … The provisions governing military medical … transports apply equally to the corresponding categories of the civilian medical service. 
Frédéric de Mulinen, Handbook on the Law of War for Armed Forces, ICRC, Geneva, 1987, §§ 67 and 78.
Delegates also teach that “specifically protected … transports recognized as such must be respected”. 
Frédéric de Mulinen, Handbook on the Law of War for Armed Forces, ICRC, Geneva, 1987, § 474.
ICRC
In a press release in 1992, the ICRC enjoined the parties to the conflict in Chechnya “to ensure that medical … vehicles are respected and protected”. 
ICRC, Press Release No. 1793, Chechnya: ICRC urges respect for humanitarian rules, 28 November 1994; see also Communication to the Press No. 96/10, Chechen conflict: ICRC appeal, 8 March 1996 and Communication to the Press No. 96/27, Russian Federation/Chechnya: ICRC calls on Federal Authorities to extend ultimatum, 21 August 1996.
National Society (Mexico)
In a declaration issued in 1994 in the context of the conflict between the Mexican Government and the Ejército Zapatista de Liberación Nacional (EZLN), the Mexican Red Cross stated: “Protection must be extended to health personnel in general and, in particular, to Mexican Red Cross personnel as well as their … transport facilities.” 
Mexican Red Cross, Declaración de la Cruz Roja Mexicana en torno a los acontecimientos que se han presentado en el estado de Chiapas a partir del 1° enero de 1994, 3 January 1994, § 2(C).
ICRC
In 1994, in a Memorandum on Respect for International Humanitarian Law in Angola, the ICRC stated: “Ambulances and other medical units and means of transport shall be protected and respected … Medical units and means of transport shall not be the object of attack.” 
ICRC, Memorandum on Respect for International Humanitarian Law in Angola, 8 June 1994, § III, IRRC, No. 320, 1997, p. 504.
ICRC
In a press release issued in 2000 following allegations that the Palestine Red Crescent Society had been targeted in shooting incidents, the ICRC stated: “Any attacks … on ambulances … indeed constitute a grave violation of IHL.” 
ICRC, Press Release, Israel and Occupied Territories: Respect for medical personnel, ICRC Tel Aviv, 1 November 2000.
ICRC
In a communication to the press issued in 2000 in connection with the hostilities in the Near East, the ICRC stated:
Ambulances … of the medical services must be respected and protected. They must be allowed to circulate unharmed so that they can discharge their humanitarian duties. All those who take part in the confrontations must respect the medical services, whether deployed by the armed forces, civilian facilities, the Palestine Red Crescent Society or the Magen David Adom in Israel. To date, dozens of Palestine Red Crescent ambulances and many of its staff have come under fire while conducting their medical activities in the occupied territories. Ambulances belonging to the Magen David Adom have also been attacked. The ICRC once again calls on all those involved in the violence to respect … ambulances [and] other medical transports.  
ICRC, Communication to the Press No. 00/42, ICRC appeal to all involved in violence in the Near East, 21 November 2000.
Americas Watch
In 1985, in a report on violations of the laws of war in Nicaragua, Americas Watch, noted, with respect to attacks against vehicles of the Ministry of Health, that the vehicles were escorted by military vehicles. It stated:
Although in such circumstances, the relevant law gives any clearly marked medical vehicle immunity from attack, that immunity is set alongside the risk that it may become a collateral casualty during a legitimate attack on the military vehicles with it. 
Americas Watch, Violations of the Laws of War by Both Sides in Nicaragua: 1981–1985, New York, March 1985, pp. 82–83.
Instituto de Derechos Humanos de la Universidad Centroamericano
In a report on the Farabundo Martí Front for National Liberation (FMLN) offensive in El Salvador in November 1989, the Instituto de Derechos Humanos de la Universidad Centroamericano stated: “Three ambulances of the Salvadoran Red Cross in San Salvador and three others inside the country were machine-gunned.” 
Instituto de Derechos Humanos de la Universidad Centroamericana (UCA), “Los derechos humanos y la ofensiva del 11 de noviembre de 1989”, Estudios Centroamericanos, Universidad Centroamericana José Simeón Cañas, Vol. XLV, Nos. 495–496, January–February 1990, p. 64.
Institute of International Humanitarian Law
The Rules of International Humanitarian Law Governing the Conduct of Hostilities in Non-international Armed Conflicts, adopted in 1990 by the Council of the Institute of International Humanitarian Law, provide: “The obligation to respect and protect … medical … transports in the conduct of military operations is a general rule applicable in non-international armed conflicts.” 
Institute of International Humanitarian Law, Rules of International Humanitarian Law Governing the Conduct of Hostilities in Non-international Armed Conflicts, Rule A5, IRRC, No. 278, 1990, p. 391.
Mouvement Révolutionnaire National pour le Développement et la Démocratie (MRND)
In 1993, in the context of the conflict in Rwanda, the MRND, a Rwandan political party, vigorously condemned an attack on a Red Cross ambulance. It appealed to all political forces in Rwanda to condemn such acts. 
Mouvement révolutionnaire national pour le développement (Rwanda), Official Declaration, 7 July 1993.