Rule 110. The wounded, sick and shipwrecked must receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. No distinction may be made among them founded on any grounds other than medical ones.
State practice establishes this rule as a norm of customary international law applicable in both international and non-international armed conflicts.
The duty to care for wounded and sick combatants without distinction is a long-standing rule of customary international law already recognized in the Lieber Code and codified in the 1864 Geneva Convention.[1] This subject is dealt with in more detail by the 1949 Geneva Conventions.[2] It is now codified in Article 10 of Additional Protocol I.[3]
The numerous military manuals which contain this rule are phrased in general terms covering all wounded, sick and shipwrecked.[4] Sweden’s IHL Manual, in particular, identifies Article 10 of Additional Protocol I as a codification of customary international law.[5] To deny medical care to the wounded, sick and shipwrecked is an offence under the legislation of many States.[6]
In the context of a non-international armed conflict, this rule is based on common Article 3 of the Geneva Conventions, which provides that “the wounded and sick shall be collected and cared for”.[7] It is codified in a more detailed manner in Additional Protocol II.[8] In addition, it is set forth in a number of other instruments pertaining also to non-international armed conflicts.[9]
The duty to care for wounded and sick combatants without distinction is set forth in a number of military manuals which are applicable in or have been applied in non-international armed conflicts.[10] Under the legislation of many States, it is an offence to deny medical care to the wounded, sick and shipwrecked.[11] Respect for this rule was required by Argentina’s National Court of Appeals in the Military Junta case in 1985.[12] Furthermore, there are official statements and other practice supporting this rule in the context of non-international armed conflicts.[13]
No official contrary practice was found with respect to either international or non-international armed conflicts. States and international organizations have generally condemned violations of this rule.[14] The ICRC has called on parties to both international and non-international armed conflicts to respect this rule.[15]
The obligation to protect and care for the wounded, sick and shipwrecked is an obligation of means. Each party to the conflict must use its best efforts to provide protection and care for the wounded, sick and shipwrecked, including permitting humanitarian organizations to provide for their protection and care. Practice shows that humanitarian organizations, including the ICRC, have engaged in the protection and care of the wounded, sick and shipwrecked. It is clear that in practice these organizations need permission from the party in control of a certain area to provide protection and care, but such permission must not be denied arbitrarily (see also commentary to Rule 55).
In addition, the possibility of calling on the civilian population to assist in the care of the wounded, sick and shipwrecked is recognized in practice. Aid offered by the civilian population is recognized by the 1864 Geneva Convention, the First Geneva Convention and Additional Protocols I and II.[16] This possibility is also recognized in a number of military manuals.[17]
The rule that no distinction may be made among the wounded, sick and shipwrecked except on medical grounds is often expressed in international humanitarian law as a prohibition of “adverse distinction” (see also Rule 88). This means that a distinction may be made which is beneficial, in particular by treating persons requiring urgent medical attention first, without this being discriminatory treatment between those treated first and those treated afterwards. This principle is set forth in many military manuals.[18] It is also supported by the requirement of respect for medical ethics, as set forth in Additional Protocols I and II (see also Rule 26), to the effect that medical personnel may not be required to give priority to any person, except on medical grounds.[19]
[1] Lieber Code, Article 79 (cited in Vol. II, Ch. 34, § 205); 1864 Geneva Convention, Article 6 (ibid., § 191).
[2] First Geneva Convention, Article 12, second paragraph, and Article 15, first paragraph (ibid., §§ 193–194); Second Geneva Convention, Article 12, second paragraph, and Article 18, first paragraph (ibid., §§ 193 and 196); Fourth Geneva Convention, Article 16, first paragraph (ibid., § 198).
[3] Additional Protocol I, Article 10 (adopted by consensus) (ibid., §§ 199 and 346).
[4] See, e.g., the military manuals of Argentina (ibid., §§ 215 and 355), Australia (ibid., §§ 216–217 and 357), Belgium (ibid., §§ 218–219), Benin (ibid., §§ 220 and 359), Bosnia and Herzegovina (ibid., § 221), Burkina Faso (ibid., § 222), Cameroon (ibid., §§ 223–224), Canada (ibid., §§ 225–226), Colombia (ibid., §§ 227–229), Congo (ibid., § 230), Croatia (ibid., §§ 231 and 233), Ecuador (ibid., § 234), El Salvador (ibid., § 235), France (ibid., §§ 236–238), Germany (ibid., §§ 239–240), Hungary (ibid., § 241), India (ibid., § 243), Indonesia (ibid., § 244), Israel (ibid., § 245), Italy (ibid., § 246), Kenya (ibid., §§ 247 and 367), Lebanon (ibid., § 248), Madagascar (ibid., §§ 249 and 368), Mali (ibid., § 250), Morocco (ibid., § 251), Netherlands (ibid., §§ 252–254 and 370), New Zealand (ibid., §§ 255 and 371), Nicaragua (ibid., § 256), Nigeria (ibid., §§ 257–260), Philippines (ibid., §§ 261–264 and 374), Romania (ibid., § 375), Rwanda (ibid., § 267), Senegal (ibid., § 268), South Africa (ibid., § 269), Spain (ibid., § 270), Sweden (ibid., §§ 271–272), Switzerland (ibid., §§ 273 and 379), Togo (ibid., §§ 274 and 380), Uganda (ibid., § 275), United Kingdom (ibid., §§ 276–277) and United States (ibid., §§ 278–281).
[5] Sweden, IHL Manual (ibid., § 272).
[6] See, e.g., the legislation of Azerbaijan (ibid., § 283), Bangladesh (ibid., § 284), China (ibid., § 285), Colombia (ibid., § 286), Cuba (ibid., § 287), Czech Republic (ibid., § 288), Estonia (ibid., § 290), Ireland (ibid., § 291), Norway (ibid., § 292), Slovakia (ibid., § 293), Spain (ibid., § 294), Ukraine (ibid., § 295), Uruguay (ibid., § 296), Bolivarian Republic of Venezuela (ibid., § 297) and Viet Nam (ibid., § 298); see also the draft legislation of Argentina (ibid., § 282) and El Salvador (ibid., § 289).
[7] Geneva Conventions, common Article 3 (ibid., § 192).
[8] Additional Protocol II, Articles 7–8 (adopted by consensus) (ibid., §§ 201–202).
[9] Cairo Declaration on Human Rights in Islam, Article 3(a) (ibid., § 208); Hague Statement on Respect for Humanitarian Principles, §§ 1 and 2 (ibid., § 209); Memorandum of Understanding on the Application of IHL between Croatia and the Socialist Federal Republic of Yugoslavia, § 1 (ibid., §§ 210 and 351); Agreement on the Application of IHL between the Parties to the Conflict in Bosnia and Herzegovina, § 2.1 (ibid., §§ 211 and 352); Comprehensive Agreement on Respect for Human Rights and IHL in the Philippines, Part IV, Article 4(2) and (9) (ibid., § 212).
[10] See, e.g., the military manuals of Argentina (ibid., §§ 215 and 355), Australia (ibid., §§ 216–217 and 357), Belgium (ibid., § 218), Benin (ibid., §§ 220 and 359), Bosnia and Herzegovina (ibid., § 221), Cameroon (ibid., § 224), Canada (ibid., §§ 225–226), Colombia (ibid., §§ 227–229), Croatia (ibid., §§ 231 and 233), Ecuador (ibid., § 234), El Salvador (ibid., § 235), Germany (ibid., §§ 239–240), India (ibid., §§ 242–243), Italy (ibid., § 246), Kenya (ibid., §§ 247 and 367), Lebanon (ibid., § 248), Madagascar (ibid., §§ 249 and 368), Netherlands (ibid., §§ 252–253 and 369), New Zealand (ibid., § 255), Nicaragua (ibid., § 256), Nigeria (ibid., §§ 257–258 and 260), Philippines (ibid., §§ 261–264 and 374), Rwanda (ibid., § 267), South Africa (ibid., § 269), Spain (ibid., § 270), Sweden (ibid., § 271), Togo (ibid., §§ 274 and 380), Uganda (ibid., § 275), United Kingdom (ibid., § 277) and United States (ibid., § 278).
[11] See, e.g., the legislation of Azerbaijan (ibid., § 283), Bangladesh (ibid., § 284), Colombia (ibid., § 286), Estonia (ibid., § 290), Ireland (ibid., § 291), Norway (ibid., § 292), Spain (ibid., § 294), Ukraine (ibid., § 295), Bolivarian Republic of Venezuela (ibid., § 297) and Viet Nam (ibid., § 298); see also the legislation of the Czech Republic (ibid., § 288), Slovakia (ibid., § 293) and Uruguay (ibid., § 296), the application of which is not excluded in time of non-international armed conflict, and the draft legislation of Argentina (ibid., § 282) and El Salvador (ibid., § 289).
[12] Argentina, National Court of Appeals, Military Junta case (ibid., § 299).
[13] See, e.g., the statements of Australia (ibid., § 300), Rwanda (ibid., § 311), Uruguay (ibid., § 314) and Yugoslavia (ibid., § 315), the practice of Honduras (ibid., § 304) and the reported practice of Jordan (ibid., § 307), Malaysia (ibid., § 308) and Philippines (ibid., § 309).
[14] See, e.g., the statements of South Africa (ibid., § 312) and Yugoslavia (ibid., § 315); UN Commission on Human Rights, Report of the Special Rapporteur on the Situation of Human Rights in Burundi (ibid., § 320); ONUSAL, Report of the Director of the Human Rights Division (ibid., § 322).
[15] See, e.g., ICRC, Memorandum on the Applicability of International Humanitarian Law (ibid., §§ 329 and 397), Press Releases Nos. 1658 and 1659 (ibid., § 330), Press Release, Tajikistan: ICRC urges respect for humanitarian rules (ibid., § 331), Press Release No. 1700 (ibid., §§ 332 and 398), Communication to the Press No. 93/17 (ibid., § 333), Press Release No. 1764 (ibid., § 334), Memorandum on Respect for International Humanitarian Law in Angola (ibid., §§ 336 and 399), Memorandum on Compliance with International Humanitarian Law by the Forces Participating in Opération Turquoise (ibid., §§ 337 and 400), Press Release No. 1793 (ibid., § 338), Press Release No. 1797 (ibid., § 339) and Communication to the Press No. 00/42 (ibid., § 340).
[16] 1864 Geneva Convention, Article 5; First Geneva Convention, Article 18 (ibid., § 195); Additional Protocol I, Article 17(2) (adopted by consensus) (ibid., § 200); Additional Protocol II, Article 18(1) (adopted by consensus) (ibid., § 203).
[17] See, e.g., the military manuals of Argentina (ibid., § 214), Cameroon (ibid., § 224), Canada (ibid., §§ 225–226), Croatia (ibid., § 232), Germany (ibid., § 240), Kenya (ibid., § 247), New Zealand (ibid., § 255), Russian Federation (ibid., § 266), Sweden (ibid., § 272), Switzerland (ibid., § 273), United Kingdom (ibid., §§ 276–277) and United States (ibid., §§ 278–279).
[18] See, e.g., the military manuals of Argentina (ibid., §§ 354–355), Australia (ibid., §§ 356–357), Belgium (ibid., § 358), Canada (ibid., §§ 360–361), Colombia (ibid., § 362), Ecuador (ibid., § 363), France (ibid., § 364), Germany (ibid., § 365), Hungary (ibid., § 366), Netherlands (ibid., §§ 369–370), New Zealand (ibid., § 371), Nigeria (ibid., §§ 372–373), Senegal (ibid., § 377), Spain (ibid., § 378), Switzerland (ibid., § 379), United Kingdom (ibid., § 381), United States (ibid., §§ 382–384) and Yugoslavia (ibid., § 385).
[19] Additional Protocol I, Article 15(3) (adopted by consensus) (ibid., § 347); Additional Protocol II, Article 9(2) (adopted by consensus) (ibid., § 349).