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Canada
Practice Relating to Rule 28. Medical Units
Canada’s LOAC Manual (1999) provides:
87. Medical units and establishments shall be respected, protected and shall not be the object of attack.
88. “Medical units” means establishments and other units, whether military or civilian, organized for medical duties. The term “medical units” is intended to have a broad meaning and includes:
a. hospitals and other similar units;
b. blood transfusion centres;
c. preventive medicine centres and institutes;
d. medical depots; and
e. the medical and pharmaceutical stores of such units.
89. Medical units may be fixed or mobile, permanent or temporary.
90. The protection to which medical units are entitled shall not cease unless they are used to commit, outside their humanitarian function, acts harmful to the enemy. Protection may only cease, however, after a warning has been given and after such warning has remained unheeded.
91. The following are not considered “acts harmful to the enemy” and do not deprive medical units of protection:
a. that the personnel of the medical unit are armed for their own defence or that of the wounded and sick in their charge;
b. that the medical unit is protected by a picket, sentries or escort;
c. that small arms and ammunition taken from the wounded and sick, and not yet handed to the proper service, are found in the medical unit;
d. that personnel and material of the military veterinary service are found in the medical unit, without forming an integral part thereof; and
e. that the humanitarian activities of medical units or of their personnel extend to the care of both civilian and military wounded and sick. 
Canada, The Law of Armed Conflict at the Operational and Tactical Level, Office of the Judge Advocate General, 1999, p. 4-9, §§ 87–91; see also p. 9-4, §§ 35–36.
[emphasis in original]
The manual further provides: “Use of a privileged building for improper purposes” constitutes a war crime. 
Canada, The Law of Armed Conflict at the Operational and Tactical Level, Office of the Judge Advocate General, 1999, p. 16-4, § 21(c).
The manual also states that “attacking a privileged or protected building” constitutes a war crime. 
Canada, The Law of Armed Conflict at the Operational and Tactical Level, Office of the Judge Advocate General, 1999, p. 16-4, § 21(d).
With respect to non-international armed conflicts in particular, the manual states:
Medical units … are to be respected and protected at all times and not be made the object of attack [and] … 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 Level, Office of the Judge Advocate General, 1999, p. 17-4, § 34.
Canada’s Code of Conduct (2001) provides: “Fixed and mobile medical units and establishments shall not be attacked … Such establishments and units should, if possible, be situated so that attacks against military objectives will not endanger them.” 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 4 June 2001, Rule 10, § 4.
The Code of Conduct further provides:
The protection provided to medical establishments and units shall only cease if they are used for purposes outside their humanitarian duties which are harmful to your forces. Even then, the protection shall cease only after due warning, and after a reasonable time period thereafter if the warning goes unheeded. 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 4 June 2001, Rule 10, § 4; see also § 6.
Canada’s LOAC Manual (2001) states in its chapter on targeting:
1. Medical units and establishments shall be respected, protected and shall not be made the object of attack.
2. “Medical units” means establishments and other units, whether military or civilian, organized for medical duties. The term “medical units” is intended to have a broad meaning and includes:
a. hospitals and other similar units;
b. blood transfusion centres;
c. preventive medicine centres and institutes;
d. medical depots; and
e. the medical and pharmaceutical stores of such units.
2. [sic] Medical units may be fixed or mobile, permanent or temporary.
3. The protection to which medical units are entitled shall not cease unless they are used to commit, outside their humanitarian function, acts harmful to the enemy. Protection may only cease, however, after a warning has been given and after such warning has remained unheeded.
4. The following are not considered “acts harmful to the enemy” and do not deprive medical units of protection:
a. that the personnel of the medical unit are armed for their own defence or that of the wounded and sick in their charge;
b. that the medical unit is protected by a picket, sentries or escort;
c. that small arms and ammunition taken from the wounded and sick, and not yet handed to the proper service, are found in the medical unit;
d. that personnel and material of the military veterinary service are found in the medical unit, without forming an integral part thereof; and
e. that the humanitarian activities of medical units or of their personnel extend to the care of both civilian and military wounded and sick. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 447.1–4.
[emphasis in original]
In its chapter on land warfare, the manual states that in the context of siege warfare:
All necessary steps must be taken to spare, as far as possible, buildings devoted to religion, art, science and charity, hospitals and places where the sick and wounded are collected, provided they are not used at the same time for military purposes. Either the residents or the opposing force in the besieged area should indicate the buildings or places to be protected by visible signs and should notify the attacking force of these signs. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 614.3.
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 [1949 Geneva] 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. The buildings, materials and stores of fixed medical establishments may not be diverted from their purpose so long as they are required for the care of the wounded and sick. Commanders in the field may use them in the event of urgent military necessity, so long as proper arrangements are made for the care of the wounded and sick nursed in them. 
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 states:
1. It is forbidden to attack civilian hospitals. The belligerents must provide them with certificates to the effect that they are civilian hospitals and that their buildings are not used for any purpose, which would deprive them of their protection as such. If so authorized by the State, civilian hospitals should be marked with the distinctive emblem, namely the Red Cross or the Red Crescent. Such marking, so far as military considerations permit, must be made clearly visible to the enemy forces. Civilian hospitals should be situated as far as possible from military objectives.
2. Civilian hospitals continue to enjoy protection so long as they are not made use of to commit acts harmful to the enemy. However, in the event of such misuse, the hospitals remain protected until due warning within a reasonable time limit has been given and remained unheeded. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 1111.1–2.
In its chapter on “War crimes, individual criminal liability and command responsibility”, the manual states that “use of a privileged building for improper purposes” and “attacking a privileged or protected building” constitutes war crimes. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, § 1609.3.c–d.
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’s Code of Conduct (2005) provides:
4. Fixed and mobile medical units and establishments shall not be attacked. The protection provided to medical establishments and units shall only cease if they are used for purposes outside their humanitarian duties which are harmful to your forces. Even then, the protection shall cease only after due warning, and after a reasonable time period thereafter if the warning goes unheeded. Such establishments and units should, if possible, be situated so that attacks against military objectives will not endanger them. The Red Cross/Red Crescent flag will only be used on medical establishments or units entitled to protection under the Geneva Convention.
6. Personnel of a medical unit or establishment may be armed with small arms and may use those arms in defence of themselves or of the wounded and sick under their charge. Pickets or sentries equipped with small arms consisting of non-medical personnel can be used without adversely affecting the protected status of the medical establishment or unit. 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 2005, Rule 10, §§ 4 and 6.
Canada’s Crimes against Humanity and War Crimes Act (2000) provides that the war crimes defined in Article 8(2) of the 1998 ICC Statute are “crimes according to customary international law” and, as such, indictable offences under the Act. 
Canada, Crimes against Humanity and War Crimes Act, 2000, Section 4(1) and (4).
In 2013, in the Peters case, Canada’s Immigration and Refugee Protection Board rejected an immigration request on grounds of complicity in crimes against humanity in Libya. The Board stated:
[W]hen the conflict began in February 2011 in Libya you were called upon [by Al-Saadi Gaddafi] to provide … security services for him in Libya. …
Now, with respect to specific examples of crimes against humanity perpetrated by the Gaddafi regime, there is quite extensive documentary evidence that has been put forward by the Minister, so I’m going to mainly focus on the atrocities committed between February and August 2011, …
… In April 2011 an attack by Gaddafi forces in the city of Misrata … targeted a medical clinic …
We also have reports of the regime attacking hospitals, destroying blood banks, …
I am … satisfied, based on the totality of the information before me, and the findings relating to both allegations, that there are reasonable grounds to believe that you are described pursuant to both paragraphs 35(1)(a) and 37(1)(b) of the Immigration Refugee Protection Act and I am therefore issuing deportation orders against you.
As per my explanation at the outset of the hearing on January 14th, 2013, and at the beginning of this decision today, the only avenue of recourse available to you is to seek judicial review from the Federal Court of Canada and that application must be filed with the courts within 15 days of today’s date. 
Canada, Immigration and Refugee Board, Peters case, Record of an Admissibility Hearing under the Immigration and Refugee Protection Act, 29 January 2013, pp. 4, 13–14 and 15–16.
In 2013, in the Sapkota case, Canada’s Federal Court dismissed a request for review of a decision denying refugee protection to the applicant on grounds of complicity in crimes against humanity in Nepal between 1991 and 2009. While reviewing the submissions of the respondent, Canada’s Minister of Citizenship and Immigration, the Court stated: “The Respondent notes that the Rome Statute of the International Criminal Court … is endorsed in Canada as a source of customary law.” 
Canada, Federal Court, Sapkota case, Reasons for Judgment and Judgment, 15 July 2013, § 28.
In 1994, during a debate in the UN Security Council on the situation in the former Yugoslavia, Canada stated:
The crimes committed in Goražde and elsewhere in Bosnia must not go unpunished. Those responsible for deliberate attacks on … hospitals … in violation of all the norms of international law, must be made to answer for their actions before the International Tribunal created for the purpose. 
Canada, Statement before the UN Security Council, UN Doc. S/PV.3370, 27 April 1994, p. 29.
In 2011, in a statement before the UN Security Council during an open debate in connection with the agenda item “Children and Armed Conflict”, made on behalf of the Group of Friends of Children and Armed Conflict, the deputy permanent representative of Canada stated:
The Friends Group is pleased with the work undertaken by the Security Council, in the last few years, in progressively strengthening the protection framework for children affected by armed conflict. …
Members of the Friends Group have reliably called on the Security Council to strengthen its protection framework even more and consistently called for all six grave violations committed against children in armed conflict to be included amongst the Security Council Resolution 1612 [of 2005] listing criteria. The Friends Group has supported a progressive approach in this regard and therefore commends the Security Council in filling an important gap in the child protection framework by including attacks against schools and hospitals as the latest trigger through the resolution it will adopt today [Resolution 1998(2011)].
For the Friends Group, a new trigger such as this not only includes in the annexes to the Secretary General’s reports on children and armed conflict those parties to armed conflict that, in contravention of applicable international law, engage in attacks against schools and hospitals, but also those who engage in threats or attacks against schoolchildren, patients, educational or medical personnel. 
Canada, Statement by the deputy permanent representative of Canada before the UN Security Council during an open debate in connection with the agenda item “Children and Armed Conflict”, made on behalf of the Group of Friends of Children and Armed Conflict, 12 July 2011.
On behalf of Canada, the deputy permanent representative also stated:
We strongly believe that the adoption today of a new resolution on children and armed conflict will increase the profile to the grave violation of attacks against schools and hospitals just as the adoption of Resolution 1882 raised the profile of rape and sexual violence against children and Resolution 1612 on the recruitment and use of children in hostilities. 
Canada, Statement by the deputy permanent representative of Canada before the UN Security Council during an open debate in connection with the agenda item “Children and Armed Conflict”, 12 July 2011.
In 2012, in a statement before the UN Security Council during an open debate on the protection of civilians in armed conflict, the permanent representative of Canada stated:
The Secretary General and the International Committee of the Red Cross highlight the fact that health care providers and facilities continue to come under attack in situations of conflict and violence. In too many contexts, hospitals are routinely targeted, and the wounded choose not to seek treatment for fear of detention, torture, or death. 
Canada, Statement by the deputy permanent representative of Canada before the UN Security Council during an open debate on the protection of civilians in armed conflict, 25 June 2012.
In 2012, in a statement before the UN Security Council during an open debate in connection with the agenda item “Children and Armed Conflict”, the permanent representative of Canada stated: “This year’s Secretary General’s report continues to document grave violations and abuses being committed against girls and boys – including … attacks against schools and hospitals … These despicable actions must be stopped.” 
Canada, Statement by the deputy permanent representative of Canada before the UN Security Council during an open debate in connection with the agenda item “Children and Armed Conflict”, 19 September 2012, p. 2.
In 2013, in a statement before the UN Security Council during an open debate on the protection of civilians in armed conflict, the permanent representative of Canada stated:
The brutal conflict in Syria represents a stark example of how much work remains to be achieved to better protect civilians who are routinely victims of deliberate and targeted attacks, as are hospitals, medical facilities and health care workers. The result is that people in desperate need are denied lifesaving humanitarian assistance. … Canada calls on all parties to the conflict in Syria to refrain from attacking civilians and other protected persons and facilities in conformity with their obligations under international law. 
Canada, Statement by the deputy permanent representative of Canada before the UN Security Council during an open debate on the protection of civilians in armed conflict, 19 August 2013, p. 1.