Practice Relating to Rule 28. Medical Units

Hague Regulations (1899)
Article 27 of the 1899 Hague Regulations provides:
In sieges and bombardments all necessary steps should be taken to spare as far as possible … hospitals, and places where the sick and wounded are collected, provided they are not used at the same time for military purposes. The besieged should indicate these buildings or places by some particular and visible signs, which should previously be notified to the assailants. 
Regulations concerning the Laws and Customs of War on Land, annexed to Convention (II) with Respect to the Laws and Customs of War on Land, The Hague, 29 July 1899, Article 27.
Hague Regulations (1907)
Article 27 of the 1907 Hague Regulations provides:
In sieges and bombardments all necessary steps must be taken to spare, as far as possible, … hospitals, and places where the sick and wounded are collected, provided they are not being used at the time for military purposes. It is the duty of the besieged to indicate the presence of such buildings or places by distinctive and visible signs, which shall be notified to the enemy beforehand. 
Regulations concerning the Laws and Customs of War on Land, annexed to Convention (IV) respecting the Laws and Customs of War on Land, The Hague, 18 October 1907, Article 27.
Hague Convention (IX)
Article 5 of the 1907 Hague Convention (IX) provides:
In bombardments by naval forces all the necessary measures must be taken by the commander to spare as far as possible … hospitals, and places where the sick or wounded are collected, on the understanding that they are not used at the same time for military purposes. 
Hague Convention (IX) concerning Bombardment by Naval Forces in Time of War, The Hague, 18 October 1907, Article 5.
Geneva Convention I
The 1949 Geneva Convention I provides:
Article 19
Fixed establishments and mobile medical units of the Medical Service may in no circumstances be attacked, but shall at all times be respected and protected by the Parties to the conflict. Should they fall into the hands of the adverse Party, their personnel shall be free to pursue their duties, as long as the capturing Power has not itself ensured the necessary care of the wounded and sick found in such establishments and units.
The responsible authorities shall ensure that the said medical establishments and units are, as far as possible, situated in such a manner that attacks against military objectives cannot imperil their safety.
Article 21
The protection to which fixed establishments and mobile medical units of the Medical Service are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after a due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.
Article 22
The following conditions shall not be considered as depriving a medical unit or establishment of the protection guaranteed by Article 19:
1. That the personnel of the unit or establishment are armed, and that they use the arms in their own defence, or in that of the wounded and sick in their charge.
2. That in the absence of armed orderlies, the unit or establishment is protected by a picket or by sentries or by an escort.
3. That small arms and ammunition taken from the wounded and sick and not yet handed to the proper service, are found in the unit or establishment.
4. That personnel and material of the veterinary service are found in the unit or establishment, without forming an integral part thereof.
5. That the humanitarian activities of medical units and establishments or of their personnel extend to the care of civilian wounded or sick. 
Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field, Geneva, 12 August 1949, Articles 19, 21 and 22.
Geneva Convention IV
The 1949 Geneva Convention IV provides:
Article 18
Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack but shall at all times be respected and protected by the Parties to the conflict.
In view of the dangers to which hospitals may be exposed by being close to military objectives, it is recommended that such hospitals be situated as far as possible from such objectives.
Article 19
The protection to which civilian hospitals are entitled shall not cease unless they are used to commit, outside their humanitarian duties, acts harmful to the enemy. Protection may, however, cease only after due warning has been given, naming, in all appropriate cases, a reasonable time limit and after such warning has remained unheeded.
The fact that sick or wounded members of the armed forces are nursed in these hospitals, or the presence of small arms and ammunition taken from such combatants and not yet been handed to the proper service, shall not be considered to be acts harmful to the enemy. 
Convention (IV) relative to the Protection of Civilian Persons in Time of War, Geneva, 12 August 1949, Articles 18 and 19.
Additional Protocol I
The 1977 Additional Protocol I provides:
Article 12
1. Medical units shall be respected and protected at all times and shall not be the object of attack.
2. Paragraph 1 shall apply to civilian medical units, provided that they:
a) belong to one of the Parties to the conflict;
b) are recognized and authorized by the competent authority of one of the Parties to the conflict; or
c) are authorized in conformity with Article 9, paragraph 2, of this Protocol or Article 27 of the First [Geneva] Convention.
3. The parties to the conflict are invited to notify each other of the location of their medical units. The absence of such notification shall not exempt any of the Parties from the obligation to comply with the provisions of paragraph 1.
4. Under no circumstances shall medical units be used in an attempt to shield military objectives from attack. Whenever possible, the Parties to the conflict shall ensure that medical units are so sited that attacks against military objectives do not imperil their safety.
Article 13
1. The protection to which civilian medical units are entitled shall not cease unless they are used to commit, outside their humanitarian function, acts harmful to the enemy. Protection may, however, cease only after a warning has been given setting, whenever appropriate, a reasonable time-limit, and after such warning has remained unheeded.
2. The following shall not be considered as acts harmful to the enemy:
a. that the personnel of the unit are equipped with light individual weapons for their own defence or for that of the wounded and sick in their charge;
b. that the unit is guarded by a picket or by sentries or by an 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 units;
d. that members of the armed forces or other combatants are in the unit for medical reasons. 
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, Articles 12–13. Article 12–13 were adopted by consensus. CDDH, Official Records, Vol. VI, CDDH/SR.37, 24 May 1977, pp. 69–70.
Additional Protocol II
Article 11 of the 1977 Additional Protocol II provides:
1. Medical units and transports shall be respected and protected at all times and shall not be the object of attack.
2. The protection to which medical units and transports are entitled shall not cease unless they are used to commit hostile acts, outside their humanitarian function. Protection may, however, cease only after a warning has been given, setting, whenever appropriate, a reasonable time-limit, and after such warning has remained unheeded. 
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. CDDH, Official Records, Vol. VII, CDDH/SR.51, 3 June 1977, p. 113, Article 11 of the 1977 Additional Protocol II was adopted by consensus.
ICC Statute
Pursuant to Article 8(2)(b)(ix) and (e)(iv) of the 1998 ICC Statute, “[i]ntentionally directing attacks against … hospitals and places where the sick and the wounded are collected, provided they are not military objectives” constitutes a war crime in both international and non-international armed conflicts. 
Statute of the International Criminal Court, adopted by the UN Diplomatic Conference of Plenipotentiaries on the Establishment of an International Criminal Court, Rome, 17 July 1998, UN Doc. A/CONF.183/9, Article 8(2)(b)(ix) and (e)(iv).
Optional Protocol on the Involvement of Children in Armed Conflict
The 2000 Optional Protocol on the Involvement of Children in Armed Conflict provides in its preamble: “Condemning the targeting of children in situations of armed conflict and direct attacks on objects protected under international law, including places generally having a significant presence of children, such as schools and hospitals.” 
Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict, adopted by the UN General Assembly, Res. 54/263, 25 May 2000, Annex I, Preamble.
Brussels Declaration
Article 17 of the 1874 Brussels Declaration provides:
In such cases [of bombardment of a defended town or fortress, agglomeration of dwellings, or village] all necessary steps must be taken to spare, as far as possible, … hospitals, and places where the sick and wounded are collected provided they are not being used at the time for military purposes.
It is the duty of the besieged to indicate the presence of such buildings by distinctive and visible signs to be communicated to the enemy beforehand. 
Project of an International Declaration concerning the Laws and Customs of War, Brussels, 27 August 1874, Article 17.
Oxford Manual
The 1880 Oxford Manual provides:
In case of bombardment all necessary steps must be taken to spare, if it can be done, … hospitals and places where the sick and wounded are gathered on the condition that they are not being utilized at the time, directly or indirectly, for defense.
It is the duty of the besieged to indicate the presence of such buildings by visible signs notified to the assailant beforehand. 
The Laws of War on Land, adopted by the Institute of International Law, Oxford, 9 September 1880, Article 34.
The manual further provides: “The neutrality of ambulances and hospitals ceases if they are guarded by a military force; this does not preclude the presence of police guard.” 
The Laws of War on Land, adopted by the Institute of International Law, Oxford, 9 September 1880, Article 37.
Report of the Commission on Responsibility
Based on several documents supplying evidence of outrages committed during the First World War, the 1919 Report of the Commission on Responsibility lists violations of the laws and customs of war which should be subject to criminal prosecution, including the “deliberate bombardment of hospitals”. 
Report submitted to the Preliminary Conference of Versailles by the Commission on Responsibility of the Authors of the War and on Enforcement of Penalties, Versailles, 29 March 1919.
Hague Rules of Air Warfare
Article 25 of the 1923 Hague Rules of Air Warfare provides:
In bombardment by aircraft, all necessary steps must be taken by the commander to spare as far as possible … hospitals and other places where the sick and wounded are collected, provided such buildings, objects or places are not at the time used for military purposes. Such buildings, objects and places must by day be indicated by marks visible to aircraft …
A belligerent who desires to secure by night the protection for the hospitals and other privileged buildings above mentioned must take the necessary measures to render the special signs referred to sufficiently visible. 
Rules concerning the Control of Wireless Telegraphy in Time of War and Air Warfare, Part II, drafted by a Commission of Jurists, The Hague, December 1922–February 1923, Article 25.
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: “Hospitals and other medical units … 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.
The same paragraph further states that such protection shall not cease “unless they are used to commit military acts. However, the protection may only cease after due warning and a reasonable time limit to cease military activities.” 
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
The 1999 UN Secretary-General’s Bulletin provides:
The United Nations force shall not attack medical establishments or mobile medical units. These shall at all times be respected and protected, unless they are used, outside their humanitarian functions, to attack or otherwise commit harmful acts against the United Nations force. 
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 9.3.
UNTAET Regulation No. 2000/15
The UNTAET Regulation No. 2000/15 establishes panels with exclusive jurisdiction over serious criminal offences, including war crimes. According to Section 6(1)(b)(ix) and (e)(iv), “[i]ntentionally directing attacks against … hospitals and places where the sick and the wounded are collected, provided they are not military objectives” constitutes a war crime in both international and non-international armed conflicts. 
Regulation on the Establishment of Panels with Exclusive Jurisdiction over Serious Criminal Offences, UN Doc. UNTAET/REG/2000/15, Dili, 6 June 2000, Section 6(1)(b)(ix) and (e)(iv).
Argentina
Argentina’s Law of War Manual (1969) restates Article 27 of the 1907 Hague Regulations, Articles 19 and 21–22 of the 1949 Geneva Convention I and Articles 18–19 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, §§ 1.010, 3.007 and 4.004(1) and (2).
Argentina
Argentina’s Law of War Manual (1989) states: “Civilian and military medical units shall be respected and protected in all circumstances and may not be made the object of attack.” 
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, § 2.11; see also § 2.03.
This rule is repeated with respect to non-international armed conflicts. 
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.
The manual further states:
The protection of medical units ceases only when they are used to commit acts hostile to the enemy, for example, the accommodation of healthy soldiers and the installation of observation posts, etc. The protection ceases only after a warning, setting a reasonable time-limit, has remained unheeded. 
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, § 2.12.
Australia
Australia’s Commanders’ Guide (1994) provides: “Civilian medical facilities … 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.
The manual further provides:
Military medical personnel, facilities and equipment are also entitled to general protection under the Geneva Conventions. However, they may lose this protection if they engage in acts harmful to the enemy. Before the protection of medical personnel and facilities is lost, a warning will normally be provided and reasonable time allowed to permit cessation of improper activities. In extreme cases, overriding military necessity may preclude such a warning. 
Australia, Law of Armed Conflict, Commanders’ Guide, Australian Defence Force Publication, Operations Series, ADFP 37 Supplement 1 – Interim Edition, 7 March 1994, § 615.
Australia
Australia’s Defence Force Manual (1994) states: “Medical facilities on land … must be respected and protected at all times and must not be attacked … Medical units are establishments, whether military or civilian, organised for medical purposes, and may be fixed or mobile, permanent or temporary.” 
Australia, Manual on Law of Armed Conflict, Australian Defence Force Publication, Operations Series, ADFP 37 – Interim Edition, 1994, §§ 972–973; see also §§ 538 and 964.
The manual further states:
Military medical personnel, facilities and equipment are also entitled to general protection. However, they may lose this protection if they engage in acts harmful to the enemy. Before the protection of medical personnel and facilities is lost, a warning will normally be provided and reasonable time allowed to permit cessation of improper activities. In extreme cases, overriding military necessity may preclude such a warning. 
Australia, Manual on Law of Armed Conflict, Australian Defence Force Publication, Operations Series, ADFP 37 – Interim Edition, 1994, § 964; see also § 972.
Australia
Australia’s LOAC Manual (2006) states: “Medical facilities on land … must be respected and protected at all times and must not be attacked”. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, § 9.78; see also §§ 5.41, 9.68–9.69 and 9.79.
The manual’s Glossary defines “medical units” as follows:
Establishments and other units, whether military or civilian, organised for medical purposes, namely the search for, collection, transportation, diagnosis or treatment including first aid treatment of the wounded, sick and shipwrecked or for the prevention of disease. The term includes hospitals and other similar units, blood transfusion centres, preventative medicine centres and institutes, medical depots and the medical and pharmaceutical stores of such units. Medical units may be fixed or mobile, permanent or temporary. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, Glossary.
The manual also states: “Among other war crimes generally recognised as forming part of the customary LOAC are … attacking a privileged or protected building”. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, § 13.30.
The manual further states that loss of protection from attack may occur under the following circumstances:
Military medical personnel, facilities and equipment are also entitled to general protection. However, they may lose this protection if they engage in acts harmful to the enemy. Before the protection of medical personnel and facilities is lost, a warning will normally be provided and reasonable time allowed to permit cessation of improper activities. In extreme cases, overriding military necessity may preclude such a warning. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, § 9.69; see also § 5.42.
The manual states that, in the context of siege warfare: “hospitals and places where the sick and wounded are collected, should not be made the specific subject of attack unless they are being used for military purposes, subject to warning requirements”. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, § 7.36.
The manual further states: “Among other war crimes generally recognised as forming part of the customary LOAC are … use of a privileged building for improper purposes”. 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, § 13.30.
The LOAC Manual (2006) replaces both the Defence Force Manual (1994) and the Commanders’ Guide (1994).
Belgium
Belgium’s Law of War Manual (1983) provides: “Medical units and material may not be made the object of attack under any circumstances, even when located near military buildings.” 
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 … establishments and units 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.
The manual further states:
The prohibition to attack hospitals remains applicable even if it is guarded by sentries or its personnel carry light individual weapons for their own defence or for the defence of the wounded in their charge, the establishment or material. In order to ensure that friendly medical units enjoy the same protection, their use in support of combat operations (medical personnel taking part in hostilities, ambulances transporting weapons or combatants, armed troops housed in a hospital, etc.) should be avoided. 
Belgium, Droit de la Guerre, Dossier d’Instruction pour Soldat, à l’attention des officiers instructeurs, JS3, Etat-Major Général, Forces Armées belges, undated, pp. 18–19.
Benin
Benin’s Military Manual (1995) lists the military and civilian medical services 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 establishments shall remain untouched and no [armed] person may enter them. Their 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. 8.
Bosnia and Herzegovina
Bosnia and Herzegovina’s Military Instructions (1992) provides: “Permanent medical facilities and mobile units of the medical services of armed forces must not be attacked, but have to be respected and protected.” 
Bosnia and Herzegovina, Instructions on the Implementation of the International Law of War in the Armed Forces of the Republic of Bosnia and Herzegovina, Official Gazette of ABiH, No. 2/92, 5 December 1992, Item 15, § 1.
The instructions further state:
Medical facilities and units lose their right to protection when they offer resistance in order not to fall under the enemy’s authority. They are allowed to put up armed and other kinds of resistance to the adversary, which, in spite of the warnings, attacks them deliberately or directly. 
Bosnia and Herzegovina, Instructions on the Implementation of the International Law of War in the Armed Forces of the Republic of Bosnia and Herzegovina , Official Gazette of ABiH, No. 2/92, 5 December 1992, Item 15, § 2.
Burkina Faso
Burkina Faso’s Disciplinary Regulations (1994) provides that, under the laws and customs of war, soldiers in combat must respect hospitals and places where the wounded and sick, civilian or military, are collected, as well as medical units, buildings and material. 
Burkina Faso, Règlement de Discipline Générale dans les Forces Armées, Décret No. 94-159/IPRES/DEF, Ministère de la Défense, 1994, Article 35(1).
Burundi
Burundi’s Regulations on International Humanitarian Law (2007) states: “Mobile and fixed medical units … may not be attacked. Conversely, they may not engage in hostilities, otherwise their protection is cancelled.” 
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, p. 15; see also Part I bis, pp. 11, 19 and 25.
The Regulations also 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. 25, 31, 80 and 84.
The Regulations further states: “This prohibition of attack remains even if the hospital is guarded by sentries or if the nurses carry light individual weapons for their own protection or for the protection of the wounded, installations or material.” 
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. 84.
The Regulations also states: “In order to ensure that the armed medical units benefit from the same protection [as unarmed medical units], it must be avoided to utilize them in support of combat ([i.e.,] nurses taking part in combat, ambulances transporting weapons or combatants, troops with weapons based in the hospital, etc.).” 
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. 84.
Cameroon
Cameroon’s Disciplinary Regulations (1975) provides that, under the laws and customs of war, each soldier must respect medical units and establishments, as well as places where the wounded and sick, civilian or military, are collected. 
Cameroon, Règlement de discipline dans les Forces Armées, Décret No. 75/700, 6 November 1975, Article 31.
The regulations further provide that the protection of medical units and establishments, as well as places where the wounded and sick, civilian or military, are collected, is contingent on their not being used for military purposes. 
Cameroon, Règlement de discipline dans les Forces Armées, Décret No. 75/700, 6 November 1975, Article 31.
Cameroon
Cameroon’s Instructor’s Manual (2006) states under the heading “Enemy Military Objects”:
Medical military units and their material must not be used for any other purposes while they are still needed for the care of the wounded and sick.
Captured mobile medical units remain reserved for the wounded, sick and shipwrecked. 
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. 123, § 403; see also p. 165, § 463.
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 airplanes 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) 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
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
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
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.
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 … establishments … and materials.” 
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.
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 hospitals and areas where sick or wounded civilians or servicemen gather, … medical units, buildings, [and] … materials. 
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 infrastructure”. 
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: “A medical building (permanent hospital or field hospital, treatment post, etc.) may not be used for military purposes if it contains 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.
The manual further states that attacking “medical … establishments and units” is a war crime. 
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. 78.
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 establishments”. 
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 units 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; see also p. 29, § 2(a).
Congo
Congo’s Disciplinary Regulations (1986) provides that hospitals, places where the wounded and sick, whether civilian or military, are collected and medical units, buildings and material 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 1. Basic notions of IHL
The principle of distinction specifies who and what can be attacked and who and what cannot be attacked.
- Who and what must be protected?
- medical personnel, material and establishments,
Lesson 2. Identification
II.2 Persons and objects under special protection
- medical personnel, material and establishments,
Lesson 3. Rules of behaviour in combat
15. Respect medical personnel, material and establishments. 
Côte d’Ivoire, Droit de la guerre, Manuel d’instruction, Livre I: Instruction de base, Ministère de la Défense, Forces Armées Nationales, November 2007, pp. 14–15, 17, 19, 21 and 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. …
Medical material means any medical equipment or any medical supply as well as all resources exclusively intended to provide adequate services and to care for the wounded and sick. 
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.2.5. Medical units and establishments
Medical units and establishments must be respected and protected and must not be made the object of attacks. …
Medical units means establishments and other units, whether military or civilian, organized for medical purposes. The term “medical units” must be understood in a wide sense and includes:
- hospitals and similar units;
- blood transfusion centres;
- preventive medicine centres and institutes;
- medical depots;
- medical and pharmaceutical stores of such units.
The protection to which civilian medical units are entitled shall not cease unless they are used to commit acts harmful to the enemy. Protection may, however, be interrupted after a warning has been given and after such warning has remained unheeded. …
The following actions are not considered as harmful to the enemy and do not deprive medical units of protection:
- that the personnel of the medical unit are armed for their own defence or for that of the wounded and sick in their charge;
- that the medical unit is guarded by a picket or by sentries or by an escort;
- that small arms and ammunition taken from the wounded and sick, and not yet handed to the proper service, are found in the units;
- that the humanitarian activity of the medical units and establishments or their personnel extends to civilian and military wounded and sick. 
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, pp. 38–39.
Croatia
Croatia’s Commanders’ Manual (1992) states that “specifically protected objects may not become military objectives and may not be attacked”, including units of the military and civilian medical service. 
Croatia, Basic Rules of the Law of Armed Conflicts – Commanders’ Manual, Republic of Croatia, Ministry of Defence, 1992, §§ 7 and 13; see also § 31 (search for information).
Croatia
Croatia’s Soldiers’ Manual (1992) instructs soldiers to respect medical objects. 
Croatia, Rules of Conduct for Soldiers, Republic of Croatia, Ministry of Defence, 1992, pp. 2–3.
Djibouti
Djibouti’s Disciplinary Regulations (1982) stated: “Combatants must … respect medical units, establishments and … buildings and places where wounded and sick civilians and combatants are gathered”. 
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 establishments and field hospitals, but to protect them. 
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 establishments and units (both mobile and fixed), … and medical equipment and stores 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 further states:
If medical facilities are used for military purposes inconsistent with their humanitarian mission, and if appropriate warnings that continuation of such use will result in loss of protected status are unheeded, the facilities become subject to attack. 
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 establishments” 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.
France
France’s Disciplinary Regulations (1978), as amended, provides that soldiers in combat must respect and protect hospitals and places where the wounded and sick, civilian or military, are collected, as well as medical units, buildings and materials. 
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) provides: “The specific immunity granted to certain persons and objects by the law of war [including the material of military and civilian medical services] must be strictly observed … They may not be attacked.” 
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, §§ 2.2 and 2.3.
The Summary Note further states:
The immunity of specifically protected objects may only be lifted under certain conditions and under the personal responsibility of the commander. Military necessity justifies only those measures which are indispensable for the accomplishment of the mission. 
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, § 2.4.
France
France’s LOAC Manual (2001), with reference to Article 12 of the 1977 Additional Protocol I, includes medical units 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.
Ethiopia
According to Ethiopia’s Standing Rules of Engagement (2007), hospitals do not constitute military objectives. 
Ethiopia, Standing Rules of Engagement, National Defense Force, Addis Ababa, 2007, § 8.4.5.
Germany
Germany’s Military Manual (1992) provides:
612. Fixed medical establishments … and mobile medical units of the medical service shall under no circumstances be attacked. Their unhampered employment shall be ensured at all times. As far as possible, medical establishments and units shall be sited or employed at an adequate distance to military objectives
613. [Fixed medical establishments, vehicles and mobile medical units of the medical service] shall not be used to commit acts harmful to the enemy.
618. Medical establishments which contrary to their intended purpose are used to carry out acts harmful to the enemy may lose their protection after prior warning has been given.
619. To this effect, the following acts shall not be considered as hostile acts:
–that medical personnel use arms for their own protection, and that of the wounded and sick;
–that medical personnel and medical establishments are protected by sentries or an escort;
–that medical personnel are employed as sentries for the protection of their own medical establishments; and
–that war material taken from the wounded and sick is retained. 
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, §§ 612-613 and 618-619; see also § 616 (property of aid societies).
Germany
Germany’s IHL Manual (1996) states:
Fixed medical establishments … and mobile medical units of the medical service shall under no circumstance be attacked. Their unhampered employment shall be ensured at all times. As far as possible, medical establishments and units shall be sited or employed at an adequate distance to military objectives. 
Germany, ZDv 15/1, Humanitäres Völkerrecht in bewaffneten Konflikten – Grundsätze, DSK VV230120023, Bundesministerium der Verteidigung, June 1996, § 503.
The manual further states that fixed medical establishments, vehicles and mobile medical units of the medical service “shall not be used to commit, outside their humanitarian function, acts harmful to the enemy”. 
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. Their unhampered employment shall be ensured at all times.” 
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 hospitals and places of gathering of wounded and sick.” 
Greece, Hellenic Territorial Army Regulation of Internal Service Code, Presidential Decree 130/1984 (Military Regulation 20-1), as amended, Article 14(d).
Greece
The Hellenic Navy’s International Law Manual (1995) provides:
1. … [T]he provisions of the otherwise obsolete IX Hague Convention concerning the respect and protection of the victims of armed conflict should be considered as bearing a perpetual binding effect.
2. To the above effect, the significance of the codified text of IX Hague Convention is great and the following provisions should be applied by the belligerents:
b. In bombardments by naval forces, all the necessary measures must be taken by the commander to spare, as far as possible, … hospitals and places where sick and wounded are collected (art. 5). 
Greece, International Law Manual, Hellenic Navy General Staff, Directorate A2, Division IV, 1995, Chapter 7, Part II, §§ 1–2.
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 establishments and equipment. 
Hungary, A Hadijog, Jegyzet a Katonai, Föiskolák Hallgatói Részére, Magyar Honvédség Szolnoki Repülötiszti Föiskola, 1992, p. 19.
Ireland
Ireland’s Basic LOAC Guide (2005) states: “Prohibited targets include … medical facilities.” 
Ireland, Basic Guide to the Law of Armed Conflict, TP/TRG/01-2005, Director of Defence Forces Training, Department of Defence, July 2005, p. 4.
Israel
According to the Report on the Practice of Israel, Israel’s Law of War Booklet (1986) grants protection to medical facilities as long as they are clearly recognizable as such and are not used for hostile activities. 
Report on the Practice of Israel, 1997, Chapter 2.7, referring to Conduct in the Battlefield in Accordance with the Law of War, Israel Defense Forces, 1986, p. 7.
Israel
Israel’s Manual on the Laws of War (1998) states:
The wounded are regarded as persons who have stopped taking part in the fighting and they shall not be harmed. Hence, it is prohibited to interfere with the administration of medical aid. This prohibition includes the ban on striking hospitals and medical facilities, whether civilian or military, as well as wounded-collection sites, medical warehouses, ambulances and so forth … In any event, it is absolutely forbidden to attack the enemy’s medical facilities, military included, or the enemy’s wounded. 
Israel, Laws of War in the Battlefield, Manual, Military Advocate General Headquarters, Military School, 1998, p. 32.
Israel
Israel’s Manual on the Rules of Warfare (2006) states: “Hospitals and medical installations, whether civilian or military, must not be used as military targets as well as the sites used for collecting casualties, medical depots, ambulances and similar facilities.” 
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 further states: “It is absolutely forbidden to attack the medical facilities of the enemy including military medical facilities.” 
Israel, Rules of Warfare on the Battlefield, Military Advocate-General’s Corps Command, IDF School of Military Law, Second Edition, 2006, p. 24.
In the case of a large military base converted into a clearing station for the wounded, the manual states: “it must not be attacked as it is a medical facility (on the assumption that no military activities are conducted therein, being disguised as treatment for the wounded)”. 
Israel, Rules of Warfare on the Battlefield, Military Advocate-General’s Corps Command, IDF School of Military Law, Second Edition, 2006, p. 27.
In addition, the manual states: “Protected places (hospitals, places of worship, etc.) must remain protected as long as military action is not being deployed therefrom.” 
Israel, Rules of Warfare on the Battlefield, Military Advocate-General’s Corps Command, IDF School of Military Law, Second Edition, 2006, p. 49.
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) states that “specifically protected objects may not become military objectives and may not be attacked”, including units of the military and civilian medical services. 
Italy, Regole elementari di diritto di guerra, SMD-G-012, Stato Maggiore della Difesa, I Reparto, Ufficio Addestramento e Regolamenti, Rome, 1991, §§ 7 and 13; see also § 31 (search for information).
Italy
Italy’s IHL Manual (1991) states: “mobile medical units [and] fixed establishments of the medical service … must be respected and protected”. 
Italy, Manuale di diritto umanitario, Introduzione e Volume I, Usi e convenzioni di Guerra, SMD-G-014, Stato Maggiore della Difesa, I Reparto, Ufficio Addestramento e Regolamenti, Rome, 1991, Vol. I, § 14.
The manual qualifies “attacks on medical units … which must be respected and protected at all times” as war crimes. 
Italy, Manuale di diritto umanitario, Introduzione e Volume I, Usi e convenzioni di Guerra, SMD-G-014, Stato Maggiore della Difesa, I Reparto, Ufficio Addestramento e Regolamenti, Rome, 1991, Vol. I, § 85.
Kenya
Kenya’s LOAC Manual (1997) states: “Protection from attack is given to fixed and mobile medical units … Medical units can be military or civilian and includes medical depots and pharmaceutical stores, as well as hospitals and treatment centres.” 
Kenya, Law of Armed Conflict, Military Basic Course (ORS), 4 Précis, The School of Military Police, 1997, Précis No. 3, p. 9.
The manual also states that medical units and medical transports may not be attacked but specifies that “they must not take part in hostilities. If they do, their protection might be forfeited.” 
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 Army Regulations (1971) instructs combatants “to refrain from causing damage to hospitals and places where the sick and the wounded, civilian and military, are collected”. 
Lebanon, Règlement Général de l’Armée, No. 1/400, Ministère de la Défense, Commandement de l’Armée, 14 January 1971, p. 7.
Lebanon
Lebanon’s Teaching Manual (1997) provides for respect for medical units. 
Lebanon, Manuel de l’Instruction Nationale dans l’Armée Libanaise, 1997, p. 77.
Madagascar
Madagascar’s Military Manual (1994) states that “specifically protected objects may not become military objectives and may not be attacked”, including units of the military and civilian medical services. 
Madagascar, Le Droit des Conflits Armés, Ministère des Forces Armées, August 1994, Fiche No. 2-O, § 7 and Fiche No. 3-O, § 13; see also Fiche No. 3-SO, § h and Fiche No. 2-T, § 27.
Mali
Mali’s Army Regulations (1979) provides that, under the laws and customs of war, soldiers in combat must respect hospitals and places where the wounded and sick, civilian or military, are collected, as well as medical units, buildings and material. 
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. 
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 further states:
94. Fixed establishments and 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.
95. The protection to which these medical units are entitled may cease if they are used to commit acts harmful to the enemy (for example, sheltering unwounded soldiers or installing a military observation post). Protection may only cease, however, after a warning has been given, setting a reasonable time limit, and after the warning has remained unheeded. 
Mexico, Manual de Derecho Internacional Humanitario para el Ejército y la Fuerza Área Mexicanos, Ministry of National Defence, June 2009, §§ 94–95.
The manual also states: “Establishments ashore entitled to the protection of the [1949] Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field must be protected from bombardment or attack from the sea.” 
Mexico, Manual de Derecho Internacional Humanitaria para el Ejército y la Fuerzas Área Mexicanos, Ministry of National Defence, June 2009, § 123.
The manual further states:
[The 1977 Additional Protocol I] … applies in international armed conflicts, including national wars of liberation, providing the following guarantees:
B. … [H]ospitals enjoy the same protection as military medical personnel and units. 
Mexico, Manual de Derecho Internacional Humanitario para el Ejército y la Fuerza Área Mexicanos, Ministry of National Defence, June 2009, § 256(B); see also § 255.
Mexico
Mexico’s IHL Guidelines (2009), in a section entitled “Basic rules of conduct in armed conflict”, states: “Do not attack medical … facilities … Ensure their protection.” 
Mexico, Cartilla de Derecho Internacional Humanitario, Ministry of National Defence, 2009, § 14(i).
Morocco
Morocco’s Disciplinary Regulations (1974) provides that, under the laws and customs of war, soldiers in combat must respect hospitals and places where the wounded and sick, civilian or military, are collected, as well as medical units, buildings and material.  
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 units must be respected and protected. They may not be attacked. Medical units may not be used under any circumstances to shield military objectives against attacks. The parties to the conflict must ensure, as far as possible, that medical units are located in such a way that attacks on military objectives do not endanger their safety. 
Netherlands, Toepassing Humanitair Oorlogsrecht, Voorschift No. 27-412/1, Koninklijke Landmacht, Ministerie van Defensie, 1993, p. VI-5.
The manual restates the rules on loss of protection of medical units found in Article 13 of the 1977 Additional Protocol I. 
Netherlands, Toepassing Humanitair Oorlogsrecht, Voorschift No. 27-412/1, Koninklijke Landmacht, Ministerie van Defensie, 1993, p. VI-5.
With respect to non-international armed conflicts in particular, the manual states: “medical units … must be respected and protected. They may not be attacked. … [Such protection] ceases when they are used, outside their humanitarian function, to commit hostile acts. But even then a warning must be given.” 
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 units (medical establishments, hospitals and first-aid posts) may not be attacked.” 
Netherlands, Handboek Militair, Ministerie van Defensie, 1995, p. 7-40.
The Handbook further provides: “Medical units may not be used to commit acts, outside their humanitarian function, which can be detrimental for the enemy (for example housing healthy soldiers or regular units).” 
Netherlands, Handboek Militair, Ministerie van Defensie, 1995, p. 7-40.
Netherlands
The Military Manual (2005) of the Netherlands states:
0620. Medical units must be respected and protected. They may not be attacked. Medical units may in no circumstances be used to attempt to shield military objectives from attack. The parties to a conflict must ensure that the medical units are located, as far as possible, in places where attacks on military objectives do not imperil their safety …
0622. The protection of medical units ends if they are used to commit acts harmful to the enemy, outside their humanitarian function. Their protection may, however, cease only after a warning has been given, setting a reasonable time limit, and after such warning has gone unheeded. The following do not constitute grounds for the ending of protection:
- if the personnel of the medical unit are equipped with personal small arms for their own defence or for that of the wounded and sick in their charge, and for the preservation of order and calm within the unit;
- if the unit is guarded by sentries or similar guards;
- if small arms and ammunition, taken from the wounded and sick and not yet handed in, are found in the units.
0623. The equipment of medical units which fall into enemy hands must remain in service for the treatment of the wounded and sick. Buildings, equipment and stocks of medical units may be used for other purposes only in exceptional situations. In a case of compelling military necessity, commanding officers may use such medical equipment and stocks if they have first taken the necessary steps to supply the wounded and sick in care. Buildings, equipment and stocks of medical units may not be deliberately destroyed. 
Netherlands, Humanitair Oorlogsrecht: Handleiding, Voorschift No. 27-412, Koninklijke Landmacht, Militair Juridische Dienst, 2005, §§ 0620 and 0622–0623.
In its chapter on neutrality, the manual states:
0939. Medical units and medical aircraft
A neutral State may offer its medical units to a party in the conflict. This is not viewed as involvement in the conflict. The personnel of such units cannot be held if captured: they must be allowed to return to their country or to the territory of the party to the conflict with which they were serving. 
Netherlands, Humanitair Oorlogsrecht: Handleiding, Voorschift No. 27-412, Koninklijke Landmacht, Militair Juridische Dienst, 2005, § 0939.
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 establishments on land … must be respected and protected at all times and must not be attacked …
Medical units are establishments, whether military or civilian, organised for medical purposes, and may be fixed or mobile, permanent or temporary.
It is forbidden to attack 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 1109(1).
The manual also states that the immunity granted to medical units and transports “ceases once they are used for purposes hostile to the adverse Party and outside their humanitarian purpose”. 
New Zealand, Interim Law of Armed Conflict Manual, DM 112, New Zealand Defence Force, Headquarters, Directorate of Legal Services, Wellington, November 1992, § 1007(1).
The manual further states:
Civilian hospitals continue to enjoy protection so long as they are not made use of to commit acts harmful to the enemy. In the event of such misuse, however, the hospitals remain protected until due warning, with a reasonable time limit, has been given and remained unheeded. 
New Zealand, Interim Law of Armed Conflict Manual, DM 112, New Zealand Defence Force, Headquarters, Directorate of Legal Services, Wellington, November 1992, § 1109(2).
The manual further states that “attacking a privileged or protected building” [or the] “use of a privileged building for improper purposes” is a war crime recognized by the customary law of armed conflict. 
New Zealand, Interim Law of Armed Conflict Manual, DM 112, New Zealand Defence Force, Headquarters, Directorate of Legal Services, Wellington, November 1992, 1703(5) and 1704(5).
With respect to non-international armed conflicts in particular, the manual states:
[M]edical units … are to be respected at all times and not made the object of attack … [Such protection] shall cease only if they commit hostile acts outside their humanitarian function. In such circumstances, a warning must be given with, whenever appropriate, a time limit, and protection only ceases if the time limit is unheeded. 
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 medical establishments and units” and “protection of civilian hospitals”. 
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(2) and (36).
Nigeria
Nigeria’s Operational Code of Conduct (1967) provides: “hospitals … should not be tampered with or molested.” 
Nigeria, Operational Code of Conduct for Nigerian Armed Forces, Federal Military Government of Nigeria, July 1967, § 4(d).
Nigeria
Nigeria’s Military Manual (1994) provides:
Specifically protected … establishments … recognised as such must be respected … Specifically protected establishments 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).
Nigeria
Nigeria’s Manual on the Laws of War provides:
Medical units and establishments are not to be attacked by the belligerents and must at all times be respected and protected … Medical units and establishments must be located, if possible, in such places that attacks on military targets would not endanger their safety. 
Nigeria, The Laws of War, by Lt. Col. L. Ode PSC, Nigerian Army, Lagos, undated, § 36.
The manual also provides:
Medical establishments are not entitled to protection when not used for humanitarian purposes; however, protection may be withdrawn only after the warning. Protection is not forfeited merely because medical personnel are armed for self-defence or when there are sentries who guard the medical establishments or when the activities of the unit include treatment of civilian wounded and sick. 
Nigeria, The Laws of War, by Lt. Col. L. Ode PSC, Nigerian Army, Lagos, undated, § 36.
The manual qualifies “the bombardment of hospitals and other privileged buildings” and “improper use of a privileged building for military purposes” as war crimes. 
Nigeria, The Laws of War, by Lt. Col. L. Ode PSC, Nigerian Army, Lagos, undated, § 6.
Peru
Peru’s IHL Manual (2004) states:
a. Definitions
Medical units are establishments and other units, whether military or civilian, organized for medical purposes, namely the search for, collection, transportation, diagnosis and treatment (including first-aid treatment) of the wounded, sick and shipwrecked and the prevention of disease. The term includes, for example, hospitals and other similar units, blood transfusion centres, preventive medicine centres and institutes, medical depots and the medical and pharmaceutical stores of such units. Medical units may be fixed or mobile and permanent or temporary.
b. Respect and protection
Medical units must be respected and protected at all times. This means not only that it is prohibited to attack or damage them, but also that they must be allowed to carry out the functions assigned to them. In particular, measures must be taken to enable them to obtain the medical supplies they require and to defend them from offences committed against them. 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 88.a and b; see also §§ 100, 100.a and 172.h.
The manual also states:
In order to enjoy the right to respect and protection, medical units must comply with [the following] requirements:
They must not be used to commit acts harmful to the enemy … If a medical unit does commit an act harmful to the enemy, a warning should be given, if possible (it would not be possible if the enemy was under fire from the unit in question), before the unit is attacked. In any event, an attempt must be made to protect the wounded and sick. 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 88.b.(2).
The manual also provides: “It is prohibited to move medical units … 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).
The manual further states: “Medical units must be located as far away as possible from military objectives.” 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 30.m.
Peru
Peru’s IHL and Human Rights Manual (2010) states:
79. Medical Units
a. Definitions
Medical units are establishments and other units, whether military or civilian, organized for medical purposes, namely the search for, collection, transportation, diagnosis and treatment (including first-aid treatment) of the wounded, sick and shipwrecked and the prevention of disease. The term includes, for example, hospitals and other similar units, blood transfusion centres, preventive medicine centres and institutes, medical depots and the medical and pharmaceutical stores of such units. Medical units may be fixed or mobile and permanent or temporary.
b. Respect and protection
Medical units must be respected and protected at all times. This means not only that it is prohibited to attack or damage them, but also that they must be allowed to carry out the functions assigned to them. In particular, measures must be taken to enable them to obtain the medical supplies they require and to defend them from offences committed against them.
Conversely, a medical unit may not be defended against the enemy if the enemy advances through the territory were the unit is located. Such defence would be considered to constitute a hostile act which could mean the unit would no longer be entitled to protection. In such a situation, the enemy’s obligation to respect the unit would not mean that the unit may not be occupied, but that the wounded and sick as well as the medical personnel and equipment must be treated with consideration.
In order to enjoy the right to respect and protection, the medical units must comply with the following requirements:
(1) The units must be assigned to the medical services of the armed forces or, if they are civilian units, they must be recognized and authorized by the competent authority of the party to the conflict for whom they are acting or of the State under whose responsibility they are operating (if the units were supplied by a State who is not a party to the conflict or by a voluntary society within this State). In all cases, the authorities of a party to the conflict with jurisdiction over the medical unit that is entitled to protection and, thus, to use the distinctive emblem, are therefore responsible for such unit and must make sure that the unit is duly used in accordance with its objectives, which means that it must comply with the … [following] requirement.
(2) Medical units may not be used to commit acts harmful to the enemy. … If a medical unit does commit an act harmful to the enemy, a warning should be given, if possible (it would not be possible if the enemy was under fire from the unit in question), before the unit is attacked. In any event, an attempt must be made to protect the wounded and sick. 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 79, pp. 279–280.
The manual also states: “It is prohibited to move medical units … 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.
The manual further states: “Medical units must be located as far away as possible from military objectives”. 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 31(n), p. 246; see also § 25(c)(9), p. 228.
The manual also states: “During air bombardment, commanders must take all necessary measures to protect to the extent possible … hospitals and other places where the wounded and sick are collected, provided that such buildings, objects or places are not at the same time used for military purposes.” 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 163, pp. 343–344.
Republic of Korea
The Republic of Korea’s Operational Law Manual (1996) states that military medical facilities shall be protected. 
Republic of Korea, Operational Law Manual, 1996, p. 133.
Romania
Romania’s Soldiers’ Manual requires respect for medical units. 
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 facilities” 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).
The manual further lists among the responsibilities of commanders in peacetime “to ensure that medical units, establishments and facilities are located in such a way that their security will not be jeopardized during attacks against military objectives”. 
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, § 14.
Russian Federation
The Russian Federation’s Regulations on the Application of IHL (2001) states: “objects protected by international humanitarian law include … medical units … 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 conflicts, the Regulations states:
Medical units … shall be respected and protected at all times and shall not be the object of attack except for cases when they are used to commit hostile acts. Protection may, however, cease only after a warning has been given and after such warning has remained unheeded. 
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 hospitals and places where the wounded and sick, civilian or military, are collected, as well as medical units, buildings and material. 
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 establishments (hospitals) must be protected and armed persons may not enter them. Their content and actual use may be checked through an inspection ordered by the person responsible for the maintenance of order.” 
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:
[M]edical units are protected from attack … [but] medical personnel may lose their protection if they take part in hostilities.
However, their protection will not be lost if:
a. They are armed only with light individual weapons.
b. The medical unit is guarded by picket, sentries or an escort.
c. Small arms and equipment taken from patient are stored temporarily in the medical unit pending their return to combat unit.
d. The delivery to medical unit of wounded and sick personnel is in non-medical transport, such as ordinary, unmarked military vehicle or helicopters. 
Sierra Leone, The Law of Armed Conflict. Instructor Manual for the Republic of Sierra Leone Armed Forces (RSLAF), Armed Forces Education Centre, September 2007, p. 59.
South Africa
South Africa’s LOAC Manual (1996) defines medical units in accordance with Article 8 of the 1977 Additional Protocol I and states: “Medical units shall at all times be respected and protected.” 
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, §§ 57–59.
The manual further provides:
55. The obligation to respect the means of medical transport does not cease unless they are used to commit acts injurious to the enemy (e.g. transporting able-bodied soldiers or weapons).
59. A medical unit must not be defended against the enemy in the event of penetration by the enemy into the territory where it is located. Such defence would constitute a hostile act, causing the unit to forfeit its right to protection. Weapons emplacements alongside or near medical units may also cause a loss of the right to protection. Other examples are locating an observation post in the unit and storing ammunition in the unit. Emphasis is placed on medical personnel being neutral. Medical personnel should ensure that nothing and no one within the unit may be considered as harmful to the enemy and thus endanger the protection of the unit. 
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, §§ 55 and 59.
South Africa
South Africa’s Revised Civic Education Manual (2004) states:
71. Medical Units. “Medical units” are defined as establishments and other units, whether military or civilian, which are organised for medical purposes (i.e. the search for collection, diagnosis or treatment – including first aid treatment – of the wounded, sick and shipwrecked, or the prevention of disease). The term includes hospitals and similar units, blood transfusion centres, preventive medicine centres, medical depots and the medical and pharmaceutical stores of such units.
72. Medical units may be fixed or mobile, permanent or temporary.
73. Medical units shall at all times be respected and protected. … [A] medical unit must not be defended against the enemy in the event of penetration by the enemy into the territory where the unit is located. Such defence would constitute a hostile act, causing the unit to forfeit its right to protection. Weapons emplacements alongside or near medical units may also cause a loss of the right to protection. Other examples are locating an observation post in the unit and storing ammunition in the unit. Emphasis is placed on medical personnel being neutral. Medical personnel should ensure that nothing and no-one within the unit may be considered as harmful to the enemy and thus endanger the protection of the unit. 
South Africa, Revised Civic Education Manual, South African National Defence Force, 2004, Chapter 4, §§ 71–73.
Spain
Spain’s LOAC Manual (1996) defines medical units 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, § 4.5.b.(2)(b).
The manual states: “Medical units must be respected and protected in all circumstances.” 
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.b.(2).
The manual further provides: “The protection of medical units ceases only when they are used to commit acts hostile to the enemy and after a warning setting a reasonable time-limit to stop the hostile activity has remained unheeded.” It refers to the acts enumerated in Article 22 of the 1949 Geneva Convention I as those not considered hostile to the enemy. 
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.b.(4).
Spain
Spain’s LOAC Manual (2007) defines medical units in accordance with Article 8 of the 1977 Additional Protocol I. 
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.b.(1); see also § 4.5.b.(2).(b).
The manual states:
Medical units must be respected and protected at all times. This means that:
- they must not be attacked;
- their continued operation must be guaranteed if they fall into the power of the enemy;
- they must be given assistance and supplies;
- there are limitations on the right to requisition them.
The prohibition on attacking medical units does not mean that they cannot be occupied or requisitioned under the conditions specified below. Medical units must not be defended, if penetrated by the enemy, because this would constitute an act of hostility and result in the discontinuance of 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, § 9.2.b.(2).
The manual adds that civilian medical units “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).
The manual further states that “medical facilities when they are used in military action for a purpose other than their intended one” become military objectives and may be attacked. 
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 § 9.2.b.(4).
The manual further provides:
Advance warning must be given of attacks on civilian or military fixed medical establishments and mobile medical units which have lost the right to protection after committing acts harmful to the troops of the adverse party. A reasonable time limit must have been given and remained unheeded before the attack takes place. 
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, § 2.3.b.(2); see also § 9.2.b.(4).
Sweden
Sweden’s IHL Manual (1991) considers that Article 12 of the 1977 Additional Protocol I on the protection of medical units 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 that “military and civilian hospitals marked with the red cross emblem” must be respected and protected. 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 30(a).
The manual also provides that medical establishments and units of the medical service “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.
The manual further provides:
The protection afforded to medical establishments, vehicles, aircraft and units may only be terminated if they are used to commit acts harmful to the enemy. The protection may only be terminated after a warning and a reasonable delay. Examples of violations: installation of an observation post on a hospital roof or a firing position in a medical post, collecting able-bodied troops in a field hospital, using an ambulance to transport munitions. Examples of acts which do not terminate protection: the presence of armed guards in front of a hospital, of weapons and munitions taken from the wounded inside an ambulance, the fact that the personnel of the unit or establishment are armed and that they use their arms for their own defence or the defence of the wounded and the sick, the presence of civilian wounded and sick. 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 83.
The manual also states: “To the maximum extent possible, medical establishments shall be located at a safe distance from military objectives.” 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 84.
The manual qualifies the “intentional destruction of hospitals” as a war crime. 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 192, commentary.
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, “[s]urveillance posts on a hospital roof” can be shot at, explaining: “After a prior warning has remained in vain: perfidy, misuse of the distinctive emblem”. 
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.
205 Access to medical establishments may be guarded by armed posts that carry out access control. This does not deprive the establishment of its protection.
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, 203–206, 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 services 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 further states: “Specially protected establishments shall remain untouched and no [armed] person may enter them. Their 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. 8.
Ukraine
Ukraine’s IHL Manual (2004) states: “Objects protected by international humanitarian law [include] medical units … Attacks against such objects shall be prohibited.” 
Ukraine, Manual on the Application of IHL Rules, Ministry of Defence, 11 September 2004, § 1.2.51.
“Medical units” are defined as “medical military establishments, units and institutions organized for medical maintenance of forces … Medical units … may be escorted by guard or convoy.” 
Ukraine, Manual on the Application of IHL Rules, Ministry of Defence, 11 September 2004, § 1.2.35.
United Kingdom of Great Britain and Northern Ireland
The UK Military Manual (1958) restates Article 27 of the 1907 Hague Regulations. 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, §§ 290 and 300.
The manual notes, however:
Accusations have frequently been made that the rule concerning immunity of hospitals has been deliberately disregarded during a siege. The complaints were often due to the fact that buildings used for medical purposes were scattered over the town and that they were thus liable to be struck by chance of erratic shots. It is therefore desirable that the sick and wounded should, if possible, be concentrated in one quarter, remote from the defences and the defending troops, or by arrangement with the besieger, in neutralised grounds. 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 304.
The manual further states: “It is forbidden to attack civilian hospitals.” 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 30.
The manual also states: “Fixed medical establishments (hospitals) and mobile units of the medical service may in no circumstances be attacked. They must at all times be respected and protected.” 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 351.
The manual states: “In addition to the ‘grave breaches’ of the 1949 [Geneva] Conventions … the following are examples of punishable violations of the laws of war, or war crimes: … (o) bombardment of hospitals and other privileged buildings”. 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 626(o).
The manual restates the rules on loss of protection of medical units and civilian hospitals set out in Articles 21–22 of the 1949 Geneva Convention I and Article 19 of the 1949 Geneva Convention IV respectively. 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, §§ 31 and 352.
The manual further states: “In addition to the ‘grave breaches’ of the 1949 [Geneva] Conventions … the following are examples of punishable violations of the laws of war, or war crimes: … (h) improper use of a privileged building for military purposes”. 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 626(h).
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Pamphlet (1981) provides: “Protection from attack is given to fixed and mobile medical units … Medical units can be military or civilian and include medical depots and pharmaceutical stores as well as hospitals and treatment centres.” 
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.
The pamphlet further states that medical units and transports “must not take part in hostilities and if they do it may result in protection being forfeited”. 
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.
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Manual (2004) states:
7.10. Medical units are “establishments and other units, whether military or civilian, organized for medical purposes, namely the search for, collection, transportation, diagnosis or treatment – including first-aid treatment – of the wounded, sick and shipwrecked, or for the prevention of disease. The term includes, for example, hospitals and other similar units, blood transfusion centres, preventive medicine centres and institutes, medical depots and the medical and pharmaceutical stores of such units. Medical units may be fixed or mobile, permanent or temporary.”
7.10.1. It follows that the definition of medical units is sufficiently comprehensive to include those on land, sea and in the air. It includes civilian medical units provided that they (a) belong to one of the parties to the conflict; (b) are recognized and authorized by the competent authority of one of the parties to the conflict; or (c) while belonging to a neutral or other state not a party to the conflict, or a recognized and authorized aid society of such a state or an impartial international humanitarian organization, have been made available to a party to the conflict for humanitarian purposes.
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, §§ 7.10–7.10.1 and 7.13–7.13.1.
With regard to internal armed conflicts, the manual states:
It is prohibited to attack … medical buildings, including hospitals and places where the wounded and sick are cared for, medical material, medical units, and transport … 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.
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.
Lastly, in its chapter on enforcement of the law of armed conflict, the manual refers to the “use of a privileged building for improper purposes” and “attacking a privileged or protected building” as war crimes “traditionally recognized by the customary law of armed conflict”. 
United Kingdom, The Manual of the Law of Armed Conflict, Ministry of Defence, 1 July 2004, § 16.29.
United States of America
The US Field Manual (1956) restates Article 19 of the 1949 Geneva Convention I. 
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, § 220(a).
United States of America
The US Field Manual (1976) restates Articles 21–22 of the 1949 Geneva Convention I and notes:
The presence of such arms and ammunition in a medical unit or establishment is not of itself cause for denying the protection to be accorded to such organisations under [the 1949 Geneva Convention I]. However, such arms and ammunition should be turned in as soon as practicable and, in any event, are subject to confiscation. 
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, §§ 222–223.
The manual further states: “In addition to the ‘grave breaches’ of the Geneva Conventions of 1949, the following acts are representative of violations of the law of war (“war crimes”): … h. Improper use of privileged buildings for military purposes”. 
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, § 504(h).
United States of America
The US Air Force Pamphlet (1976) refers to the protection of medical units as set out in the 1949 Geneva Convention I. 
United States, Air Force Pamphlet 110-31, International Law – The Conduct of Armed Conflict and Air Operations, US Department of the Air Force, 1976, § 12-2(b).
The pamphlet also provides:
In addition to grave breaches of the Geneva Conventions of 1949, the following acts are representative of situations involving individual criminal responsibility:
(1) deliberate attack on … medical establishments [and] units,
(7) wilful and improper use of privileged buildings or localities for military purposes. 
United States, Air Force Pamphlet 110-31, International Law – The Conduct of Armed Conflict and Air Operations, US Department of the Air Force, 1976, § 15-3(c)(1) and (7).
United States of America
The US Air Force Commander’s Handbook (1980) provides that hospitals and aid stations “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 states:
Hospitals … lose their special status under the Geneva Conventions if they commit, or are used to commit, acts harmful to the enemy outside their humanitarian functions.
For example, using a hospital as an observation post, or to store nonmedical military supplies, or firing at the enemy from an ambulance, would deprive the hospital and the ambulance of protected status … Both the Geneva Conventions and the rules of engagement may impose additional restrictions on actually attacking medical activities that are improperly used. Thus, hospitals and mobile medical units may not be attacked until after a warning has been given setting, in proper cases, a reasonable time limit to correct past abuses. 
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 Instructor’s Guide (1985) states: “In addition to the grave breaches of the Geneva Conventions, the following acts are further examples of war crimes: … firing on facilities which are undefended and without military significance such as … hospitals … [and] improperly using privileged buildings for military purposes.” 
United States, Instructor’s Guide – The Law of War, Headquarters Department of the Army, Washington, April 1985, p. 13.
United States of America
The US Rules of Engagement for Operation Desert Storm (1991) states:
Hospitals will be given special protection.
Do not engage hospitals unless the enemy uses the hospital to commits acts harmful to US forces, and then only after giving a warning and allowing a reasonable time to expire before engaging, if the tactical situation permits. 
United States, Desert Storm – Rules of Engagement, Pocket Card, US Central Command, January 1991, reprinted in Operational Law Handbook, International and Operational Law Department, The Judge Advocate General’s School, United States Army, Charlottesville, Virginia, 1995, pp. 8-7 and 8-8, § D.
United States of America
The US Naval Handbook (1995) states:
Medical establishments and units (both mobile and fixed), … and medical equipment and stores 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 further states:
If medical facilities are used for military purposes inconsistent with their humanitarian mission, and if appropriate warnings that continuation of such use will result in loss of protected status are unheeded, the facilities become subject to attack. 
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 facilities” 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 Manual for Military Commissions (2007), Part IV, Crimes and Elements, defines protected property as follows:
The term “protected property” means property specifically protected by the law of war (such as buildings dedicated to religion, education, art, science or charitable purposes, historic monuments, hospitals, or places where the sick and wounded are collected), if such property is not being used for military purposes or is not otherwise a military objective. Such term includes objects properly identified by one of the distinctive emblems of the Geneva Conventions, but does not include civilian property that is a military objective. 
United States, Manual for Military Commissions, published in implementation of the Military Commissions Act of 2006, 10 U.S.C. §§ 948a, et seq., 18 January 2007, Part IV, § 6(a)(3), p. IV-3.
The manual includes in the list of crimes triable by military commissions:
ATTACKING PROTECTED PROPERTY.
a. Text. “Any person subject to this chapter who intentionally engages in an attack upon protected property shall be punished as a military commission under this chapter may direct.”
b. Elements.
(1) The accused engaged in an attack;
(2) The object of the attack was protected property;
(3) The accused intended such protected property to be an object of the attack;
(4) The accused knew or should have known of the factual circumstances that established the property’s protected status; and
(5) The attack took place in the context of and was associated with armed conflict.
c. Comment. The intent required for this offense precludes its applicability with regard to collateral damage or death, damage, or injury incident to a lawful attack.
d. Maximum punishment. Confinement for 20 years.  
United States, Manual for Military Commissions, published in implementation of the Military Commissions Act of 2006, 10 U.S.C. §§ 948a, et seq., 18 January 2007, Part IV, § 6(4), p. IV-5.
Also included in the list of crimes is:
USING PROTECTED PROPERTY AS A SHIELD.
a. Text. “Any person subject to this chapter who positions, or otherwise takes advantage of the location of, protected property with the intent to shield a military objective from attack, or to shield, favor, or impede military operations, shall be punished as a military commission under this chapter may direct.”
b. Elements.
(1) The accused positioned or otherwise took advantage of the location of protected property;
(2) The accused did so with the intent to shield a military objective from attack, or to shield, favor, or impede military operations; and
(3) The act took place in the context of and was associated with armed conflict.
c. Maximum punishment. Confinement for life. 
United States, Manual for Military Commissions, published in implementation of the Military Commissions Act of 2006, 10 U.S.C. §§ 948a, et seq., 18 January 2007, Part IV, § 6(10), p. IV-8.
United States of America
The US Naval Handbook (2007) states:
Medical establishments and units (both mobile and fixed), … and medical equipment and stores 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. If medical facilities are used for military purposes inconsistent with their humanitarian mission, and if appropriate warnings that continuation of such use will result in loss of protected status are unheeded, the facilities become subject to attack. 
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 further states that examples of war crimes that could be considered as grave breaches of the 1949 Geneva Conventions include: “Deliberate attacks upon … medical facilities.” 
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).
United States of America
The US Manual for Military Commissions (2010), Part IV, Crimes and Elements, defines protected property as follows:
The term “protected property” means any property specifically protected by the law of war (including … hospitals, and places where the sick and wounded are collected), if such property is not being used for military purposes or is not otherwise a military objective. Such term includes objects properly identified by one of the distinctive emblems of the Geneva Conventions, but does not include civilian property that is a military objective. 
United States, Manual for Military Commissions, published in implementation of Chapter 47A of Title 10, United States Code, as amended by the Military Commissions Act of 2009, 10 U.S.C, §§ 948a, et seq., 27 April 2010, § 1(a)(3), p. IV-1.
The manual includes in the list of crimes triable by military commissions:
ATTACKING PROTECTED PROPERTY.
a. Text. “Any person subject to this chapter who intentionally engages in an attack upon protected property shall be punished as a military commission under this chapter may direct.”
b. Elements.
(1) The accused engaged in an attack;
(2) The object of the attack was protected property;
(3) The accused intended such protected property to be an object of the attack;
(4) The accused knew or should have known of the factual circumstances that established the property’s protected status; and
(5) The attack took place in the context of and was associated with hostilities.
c. Comment. The intent required for this offense precludes its applicability with regard to collateral damage or death, damage, or injury incident to a lawful attack.
d. Maximum punishment. Confinement for 20 years. 
United States, Manual for Military Commissions, published in implementation of Chapter 47A of Title 10, United States Code, as amended by the Military Commissions Act of 2009, 10 U.S.C, §§ 948a, et seq., 27 April 2010, § 5(4), p. IV-5.
Also included in the list of crimes is:
USING PROTECTED PROPERTY AS A SHIELD.
a. Text. “Any person subject to this chapter who positions, or otherwise takes advantage of the location of, protected property with the intent to shield a military objective from attack, or to shield, favor, or impede military operations, shall be punished as a military commission under this chapter may direct.”
b. Elements.
(1) The accused positioned or otherwise took advantage of the location of protected property;
(2) The accused did so with the intent to shield a military objective from attack, or to shield, favor, or impede military operations; and
(3) The act took place in the context of and was associated with hostilities.
c. Maximum punishment. Confinement for life. 
United States, Manual for Military Commissions, published in implementation of Chapter 47A of Title 10, United States Code, as amended by the Military Commissions Act of 2009, 10 U.S.C, §§ 948a, et seq., 27 April 2010, § 5(10), p. IV-8.
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 units to civilian medical establishments. 
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, §§ 169 and 195; see also § 82 (conduct of hostilities).
The manual also restates Articles 21–22 of the 1949 Geneva Convention I. 
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, §§ 170–171.
Zimbabwe
Zimbabwe’s Code of Conduct for Combatants (1993) states: “Special protection is to be given to … hospital[s]”. 
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.
Under the heading “Distinctive signs”, the Code of Conduct also shows an image of a building with a red cross on a white ground and states: “Leave these buildings [and] establishments … untouched”. 
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. 13.
Argentina
Argentina’s Code of Military Justice (1951), as amended in 1984, punishes “whoever attacks, without any necessity, hospitals … which are marked by the appropriate distinctive signs”. 
Argentina, Code of Military Justice, 1951, as amended in 1984, Article 746(2).
Australia
Australia’s War Crimes Act (1945) considers “any war crime within the meaning of the instrument of appointment of the Board of Inquiry [set up to investigate war crimes committed by enemy subjects]” as a war crime, including the deliberate bombardment of hospitals. 
Australia, War Crimes Act, 1945, Section 3.
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:
268.46 War crime – attacking protected objects
A person (the perpetrator) commits an offence if:
(a) the perpetrator directs an attack; and
(b) the object of the attack is any one or more of the following that are not military objectives:
(iii) hospitals or places where the sick and wounded are collected; and
(c) the perpetrator’s conduct takes place in the context of, and is associated with, an international armed conflict.
Penalty: Imprisonment for 20 years.
268.66 War crime – attacking 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, § 268.46, p. 331 and § 268.66, p. 345.
The Criminal Code Act further states with respect to war crimes that are other serious violations of the laws and customs applicable in an armed conflict that is not an international armed conflict:
268.78 War crime – attacking 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).
268.80 War crime – attacking protected objects
A person (the perpetrator) commits an offence if:
(a) the perpetrator directs an attack; and
(b) the object of the attack is any one or more of the following
that are not military objectives:
(i) buildings dedicated to religion, education, art, science or charitable purposes;
(ii) historic monuments;
(iii) hospitals or places where the sick and wounded are collected; and
(c) 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. 
Australia, Criminal Code Act, 1995, as amended to 2007, Chapter 8, § 268.78, p. 355 and § 268.80, pp. 356–357.
Australia
Australia’s ICC (Consequential Amendments) Act (2002) incorporates in the Criminal Code the war crimes defined in the 1998 ICC Statute, including “attacking protected objects … [which] are not military objectives, [including] … hospitals or places where the sick and wounded are collected” in both international and non-international armed conflicts. 
Australia, ICC (Consequential Amendments) Act, 2002, Schedule 1, §§ 268.46 and 268.80.
Azerbaijan
Azerbaijan’s Criminal Code (1999) provides that “directing attacks … against hospitals, which are easily seen and distinguishable, and against places where the sick and wounded are collected, without any military necessity” constitutes a war crime in international and non-international armed conflicts. 
Azerbaijan, Criminal Code, 1999, Article 116(8).
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 Penal Code (1867), 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 … :
35. intentionally directing attacks against … medical units [and]… hospitals, provided they are not military objectives. 
Belgium, Penal Code, 1867, as amended on 5 August 2003, Chapter III, Title I bis, Article 136 quater, § 1(15)(35); see also Chapter III, Title I bis, Article 136 quater, § 1(21).
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 … :
21. intentionally directing attacks against … medical units … [and] hospitals, provided they are not military objectives. 
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)(21); see also Article 1 ter, § 1(11 bis).
Bosnia and Herzegovina
Under the Federation of Bosnia and Herzegovina’s Criminal Code (1998), it is a war crime to order that “an attack be launched against objects specifically protected by international law” or to carry out such an attack. 
Bosnia and Herzegovina, Federation, Criminal Code, 1998, Article 154(2).
The Republika Srpska’s Criminal Code (2000) contains the same provision. 
Bosnia and Herzegovina, Republika Srpska, Criminal Code, 2000, Article 433(2).
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 material … and stocks of medical facilities or units 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); see also Article 173(2)(a) and (b).
Burundi
Burundi’s Law on Genocide, Crimes against Humanity and War Crimes (2003) states:
[The following are] considered as war crimes:
B. Other serious violations of the laws and customs applicable in international armed conflicts, within the established framework of international law, namely, any of the following acts:
i) launching deliberate attacks against … hospitals or places where the sick or wounded are collected, provided these buildings are not military objectives;
D. Other serious violations of the laws and customs applicable in armed conflicts not of an international character, within the established framework of international law, namely, any of the following acts:
c) launching deliberate attacks against … hospitals or places where the sick or wounded are collected, provided these buildings are not military objectives. 
Burundi, Law on Genocide, Crimes against Humanity and War Crimes, 2003, Article 4(B)(i) and (D)(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:
9°. Intentionally directing attacks against … hospitals and places where the sick and wounded are collected, provided they are not military objectives;
24°. Intentionally directing attacks against buildings, material [and] medical units …
5. … [S]erious violations of the laws and customs applicable in armed conflicts not of an international character, within the established framework of international law, namely, any of the following acts:
4°. Intentionally directing attacks against … hospitals and places where the sick and wounded are collected, provided they are not military objectives. 
Burundi, Penal Code, 2009, Article 198(2)(9°) and (24°), and (5)(4°).
Canada
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).
Chile
Chile’s Code of Military Justice (1925) provides for a prison sentence for “anyone who, contrary to instructions received, unnecessarily and maliciously attacks hospitals or poorhouses which are marked with signs employed for that purpose”. 
Chile, Code of Military Justice, 1925, Article 261.
China
China’s Law Governing the Trial of War Criminals (1946) provides that “deliberate bombing of hospitals” constitutes a war crime. 
China, Law Governing the Trial of War Criminals, 1946, Article 3(10).
Colombia
Colombia’s Military Penal Code (1999) provides a prison sentence for “anyone who during military service and without proper cause … attacks hospitals or poorhouses which are properly marked”. 
Colombia, Military Penal Code, 1999, Article 174.
Congo
Congo’s Genocide, War Crimes and Crimes against Humanity Act (1998) defines war crimes with reference to the categories of crimes set out in Article 8 of the 1998 ICC Statute. 
Congo, Genocide, War Crimes and Crimes against Humanity Act, 1998, Article 4.
Croatia
Under Croatia’s Criminal Code (1997), “the launching of an attack against objects under special protection of international law” is a war crime. 
Croatia, Criminal Code, 1997, Article 158(2).
Croatia
Croatia’s Criminal Code (1997), as amended to 2006, states that a war crime is committed by “whoever violates the rules of international law in time of war, armed conflict or occupation by ordering [or committing] an attack against objects protected by international law”. 
Croatia, Criminal Code, 1997, as amended in June 2006, Article 158(2).
The Criminal Code further 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 institutions or units when there is no justification by military necessity. 
Croatia, Criminal Code, 1997, as amended in June 2006, Article 159.
Cuba
Under Cuba’s Penal Code (1987), failure to respect the protected status under international law of establishments and other facilities organized for the wounded and the sick is an offence. 
Cuba, Penal Code, 1987, Article 123.
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).
Dominican Republic
The Dominican Republic’s Code of Military Justice (1953) provides for the punishment of any soldier who, “without necessity, attacks hospitals … which are recognizable by the signs established for such cases”. 
Dominican Republic, Code of Military Justice, 1953, Article 201(2).
El Salvador
El Salvador’s Code of Military Justice (1934) provides for the protection of medical establishments and units. 
El Salvador, Code of Military Justice, 1934, Article 69.
Estonia
Under Estonia’s Penal Code (2001), “an attack against … a medical institution or unit” is a war crime. 
Estonia, Penal Code, 2001, § 106.
Ethiopia
Ethiopia’s Penal Code (1957) punishes anyone for “crimes against the wounded, sick or shipwrecked” who organizes, orders or engages in “the destruction, rendering unserviceable or appropriation of supplies, installations or stores belonging to the medical or first-aid services, in a manner which is unlawful, arbitrary or disproportionate to the requirements of strict military necessity”. 
Ethiopia, Penal Code, 1957, Article 283(b).
Ethiopia
Ethiopia’s Criminal Code (2004) states:
Article 271.- War Crimes against Wounded, Sick or Shipwrecked Persons or Medical Services.
(1) Whoever, in the circumstances defined above [i.e., in time of war, armed conflict or occupation … and in violation of the rules of public international law and of international humanitarian conventions] organizes, orders or engages in:
(b) the destruction, rendering unserviceable or appropriation of supplies, installations, transport materials or stores belonging to the medical or first aid services, in a manner which is unlawful, arbitrary or disproportionate to the requirements of strict military necessity …
is punishable in accordance with Article 270 [i.e., with rigorous imprisonment from five years to twenty-five years, or, in more serious cases, with life imprisonment or death]. 
Ethiopia, Criminal Code, 2004, Article 271(1).
The Criminal Code of 2004 repealed Ethiopia’s Penal Code of 1957.
France
France’s Code of Defence (2004), as amended in 2008, states:
[Combatants] shall respect and protect hospitals and other movable or immovable property dedicated to [health] care unless these properties are used to commit, outside their humanitarian function, acts harmful [to the combatant]. 
France, Code of Defence, 2004, as amended in 2008, Article D4122-10.
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 units … displaying, in accordance 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 units”. 
Georgia, Criminal Code, 1999, Article 411(2).
Germany
Germany’s Law Introducing the International Crimes Code (2002) punishes 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”. 
Germany, Law Introducing the International Crimes Code, 2002, Article 1, § 11(1)(2).
Guatemala
Guatemala’s Penal Code (1973) criminalizes violations of the duties under international law in respect of hospitals or other places sheltering the wounded and sick. 
Guatemala, Penal Code, 1973, Article 378.
Iraq
Under Iraq’s Military Penal Code (1940), attacks on medical units are an offence. 
Iraq, Military Penal Code, 1940, Article 115(b).
Iraq
Iraq’s Law of the Supreme Iraqi Criminal Tribunal (2005) identifies the following as a serious violation of the laws and customs of war applicable in both international and non-international armed conflicts: “Intentionally directing attacks against buildings which do not constitute military objectives, and are … hospitals and places where the sick and wounded are collected.” 
Iraq, Law of the Supreme Iraqi Criminal Tribunal, 2005, Article 13(2)(J) and (4)(D).
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 19 and Articles 21–22 of the Geneva Convention I and Articles 18 and 19 of the Geneva Convention IV, and of the 1977 Additional Protocol I, including violations of Articles 12 and 13, as well as any “contravention” of the 1977 Additional Protocol II, including violations of Article 11(1)–(2), 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 1992, states that the establishments and material of the military medical service must be “respected and protected”. 
Italy, Law of War Decree, 1938, as amended in 1992, Article 95.
The Decree further provides that the protection of military medical services is contingent on the condition that “under no circumstances may they be used for purposes other than those intended”. 
Italy, Law of war Decree, 1938, as amended in 1992, Article 45.
Lithuania
Lithuania’s Criminal Code (1961), as amended in 1998, prohibits attacks against military or civilian hospitals and health centres. 
Lithuania, Criminal Code, 1961, as amended in 1998, Article 337.
Mexico
Mexico’s Code of Military Justice (1933), as amended in 1996, punishes anyone who attacks hospitals without any military necessity. 
Mexico, Code of Military Justice, 1933, as amended in 1996, Article 209.
Netherlands
The Definition of War Crimes Decree (1946) of the Netherlands qualifies the “deliberate bombardment of hospitals” as a war crime. 
Netherlands, Definition of War Crimes Decree, 1946, Article 1.
Netherlands
Under the International Crimes Act (2003) of the Netherlands, “intentionally directing attacks against … hospitals and places where the sick and wounded are collected, provided they are not military objectives” is a crime, whether committed in an international or a non-international armed conflict. 
Netherlands, International Crimes Act, 2003, Articles 5(5)(p) and 6(3)(d).
New Zealand
Under New Zealand’s International Crimes and ICC Act (2000), war crimes include the crimes defined in Article 8(2)(b)(ix) and (e)(iv) of the 1998 ICC Statute. 
New Zealand, International Crimes and ICC Act, 2000, Section 11(2).
Nicaragua
Nicaragua’s Military Penal Code (1996) provides for the punishment of any soldier who “knowingly violates the protection due to medical establishments, medical mobile units, … and medical material … 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.
Norway
Norway’s Penal Code (1902), as amended in 2008, states: “Any person is liable to punishment for a war crime who in connection with an armed conflict … directs an attack against … hospitals and places where the sick and wounded are collected”. 
Norway, Penal Code, 1902, as amended in 2008, § 106(f).
Peru
Peru’s Code of Military Justice (1980) provides for the punishment of soldiers who, in times of armed conflict, “without any necessity attack hospitals recognizable by the emblems established to that end”. 
Peru, Code of Military Justice, 1980, Article 95(2).
Peru
Peru’s Code of Military and Police Justice (2006) states:
A member of the military or police shall be imprisoned for a period of no less than eight and no more than 15 years if he or she in the context of an international or non-international armed conflict:
2. Directs an attack by any means against civilian objects if they are protected by international humanitarian law, in particular … hospitals and places where the sick and wounded are collected. 
Peru, Code of Military and Police Justice, 2006, Article 95(2).
This article is no longer in force. Along with certain other articles in this legislation, it was declared unconstitutional by the Constitutional Court (in banc decision for case file No. 0012-2006-PI-TC, 8 January 2007) because it does not stipulate a crime committed in the line of duty that would fall under the jurisdiction of a military court pursuant to Article 173 of Peru’s Constitution.
Peru
Peru’s Military and Police Criminal Code (2010) states:
A member of the military or the police shall be punished with deprivation of liberty of not less than five and not more than twelve years if, in a state of emergency and when the Armed Forces assume control of the internal order, … he or she attacks hospitals or charitable homes that bear the conventional signs. 
Peru, Military and Police Criminal Code, 2010, Article 81.
In a chapter entitled “Crimes involving the use of prohibited methods in the conduct of hostilities”, the Code also 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 civilian objects by any means, provided that these objects are protected by International Humanitarian Law, in particular … hospitals and places where the sick and wounded are collected. 
Peru, Military and Police Criminal Code, 2010, Article 91(2).
In a chapter entitled “Crimes against humanitarian operations and emblems”, the Code further states:
A member of the military or the police shall be punished with deprivation of liberty of not less than five years and not more than ten years if, in a state of emergency and when the Armed Forces assume control of the internal order, he or she:
2. Attacks medical … buildings [or] units … 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).
Philippines
The Articles of War (1938) of the Philippines prohibits and punishes attacks on medical buildings. 
Philippines, Articles of War, 1938, Article 79.
Poland
Poland’s Penal Code (1997) provides for the punishment of “any person who, during hostilities, attacks … a hospital”. 
Poland, Penal Code, 1997, Article 122(1).
Portugal
Portugal’s Penal Code (1996) provides:
A person who, in violation of rules or principles of general or common international law, in time of war, armed conflict or occupation, destroys or damages, without military necessity, … institutions dedicated to … humanitarian purposes, shall be punished by a prison sentence of between three and ten years. 
Portugal, Penal Code, 1996, Article 242.
Republic of Korea
The Republic of Korea’s ICC Act (2007) provides for the punishment of anyone who commits the war crime of “[d]irecting attacks against civilian objects, namely … hospitals and places where the sick and wounded are collected” in both international and non-international armed conflicts. 
Republic of Korea, ICC Act, 2007, Article 13(1)(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:
a) buildings [and/or] any construction … that serves as hospitals,
c) medical equipment warehouses. 
Romania, Penal Code, 1968, Article 359.
Senegal
Senegal’s Penal Code (1965), as amended in 2007, states that the following constitute war crimes:
b) [O]ther serious violations of the laws and customs applicable in international armed conflict, within the established framework of international law, namely, any of the following acts:
8. launching deliberate attacks against … hospitals or places where the sick or wounded are collected, as long as these buildings are not military objectives;
d) …
Other serious violations of the laws and customs applicable in armed conflicts not of an international character, within the established framework of international law, namely, any of the following acts:
4. launching deliberate attacks against … hospitals or places where the sick or wounded are collected, provided these buildings are not military objectives. 
Senegal, Penal Code, 1965, as amended in 2007, Article 431-3(b)(8) and (d)(4).
Serbia
Serbia’s Criminal Code (2005) states that, in time of war, armed conflict or occupation, ordering or committing an “attack on facilities particularly protected under international law” constitutes a war crime. 
Serbia, Criminal Code, 2005, Article 372(2).
The Criminal Code also states that ordering or committing the “[destruction] or appropriation of … stocks of medical institutions or units, not justified by military necessity” constitutes a war crime. 
Serbia, Criminal Code, 2005, Article 373.
Slovenia
Under Slovenia’s Penal Code (1994), “an attack on buildings specially protected under international law” is a war crime. 
Slovenia, Penal Code, 1994, Article 374(2).
Somalia
Somalia’s Military Criminal Code (1963) states:
363. Where a commander fails to adopt measures to protect buildings, places or objects that must be respected. – 1. A penalty of military confinement for up to three years shall be imposed on a commander of attacking forces who fails to adopt the measures prescribed by law and by international agreements to ensure respect for:
(a) hospitals or any other building or place of recovery or treatment for the sick and wounded, mobile medical units or fixed medical establishments … where they are not at the same time being used for military purposes and have been designated by the distinctive signs specified in the international conventions, or have in some way been indicated in advance to the enemy, and are easily visible even from a great distance and at a high altitude.
...
375. Use of weapons against … hospitals … – Anyone who uses weapons against … hospitals, mobile medical units, fixed medical establishments … or any other place for the recovery or treatment of the sick or wounded … when, in accordance with the law and international agreements, they must be regarded as respected and protected, shall, unless the act constitutes a more serious offence, be punished by military confinement for not less than 10 years. 
Somalia, Military Criminal Code, 1963, Articles 363(1)(a) and 375.
South Africa
South Africa’s ICC Act (2002) reproduces the war crimes listed in the 1998 ICC Statute, including in both international and non-international armed conflicts: “intentionally directing attacks against … hospitals and places where the sick and wounded are collected, provided they are not military objectives”. 
South Africa, ICC Act, 2002, Schedule 1, Part 3, §§ (b)(ix) and (e)(iv).
Spain
Spain’s Military Criminal Code (1985) provides for the punishment of any soldier who “knowingly violates the protection due to medical establishments, mobile medical units, … and medical material … 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).
Sudan
Sudan’s Armed Forces Act (2007) provides:
Subject to the provisions of the Criminal Act of 1991, shall be punished with imprisonment for a term not exceeding five years, whoever directs attacks against … hospitals [or] places of gathering of the sick. 
Sudan, Armed Forces Act, 2007, Article 156.
Sweden
Sweden’s Penal Code (1962), as amended in 1998, provides:
A person guilty of a serious violation of a treaty or agreement with a foreign power or an infraction of a generally recognised principle or tenet relating to international humanitarian law concerning armed conflicts shall be sentenced for a crime against international law to imprisonment for at most four years. Serious violations shall be understood to include:
(5) initiating an attack against establishments or installations which enjoy special protection under international law. 
Sweden, Penal Code, 1962, as amended in 1998, Chapter 22, § 6.
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 units”. 
Tajikistan, Criminal Code, 1998, Article 403(2).
Ukraine
Ukraine’s Criminal Code (2001) provides for the protection of medical establishments and units. 
Ukraine, Criminal Code, 2001, Article 414.
United Kingdom of Great Britain and Northern Ireland
Under the UK ICC Act (2001), it is a punishable offence to commit a war crime as defined in Article 8(2)(b)(ix) and (e)(iv) of the 1998 ICC Statute. 
United Kingdom, ICC Act, 2001, Sections 50(1) and 51(1) (England and Wales) and Section 58(1) (Northern Ireland).
United States of America
Under the US War Crimes Act (1996), violations of Article 27 of the 1907 Hague Regulations are war crimes. 
United States, War Crimes Act, 1996, Section 2441(c)(2).
United States of America
The US Military Commissions Act (2006), passed by Congress following the Supreme Court’s decision in Hamdan v. Rumsfeld in 2006, amends Title 10 of the United States Code as follows:
§ 950v. Crimes triable by military commissions
“(a) DEFINITIONS AND CONSTRUCTION.—In this section:
“ …
“(3) PROTECTED PROPERTY.—The term “protected property” means property specifically protected by the law of war (such as buildings dedicated to religion, education, art, science or charitable purposes, historic monuments, hospitals, or places where the sick and wounded are collected), if such property is not being used for military purposes or is not otherwise a military objective. Such term includes objects properly identified by one of the distinctive emblems of the Geneva Conventions, but does not include civilian property that is a military objective.
“ …
“(b) OFFENSES.—The following offenses shall be triable by military commission under this chapter at any time without limitation:
“(4) ATTACKING PROTECTED PROPERTY.—Any person subject to this chapter who intentionally engages in an attack upon protected property shall be punished as a military commission under this chapter may direct.
“…
“(10) USING PROTECTED PROPERTY AS A SHIELD.—Any person subject to this chapter who positions, or otherwise takes advantage of the location of, protected property with the intent to shield a military objective from attack, or to shield, favor, or impede military operations, shall be punished as a military commission under this chapter may direct.  
United States, Military Commissions Act, 2006, Public Law 109-366, Chapter 47A of Title 10 of the United States Code, 17 October 2006, p. 120 Stat. 2626, § 950v(a)(3) and (b)(4) and (10).
United States of America
The US Military Commissions Act (2009) amends Chapter 47A of Title 10 of the United States Code as follows:
§ 950t. Crimes triable by military commission
“The following offenses shall be triable by military commission under this chapter at any time without limitation:
“ …
“(4) ATTACKING PROTECTED PROPERTY.—Any person subject to this chapter who intentionally engages in an attack upon protected property shall be punished as a military commission under this chapter may direct.
“ …
“(10) USING PROTECTED PROPERTY AS A SHIELD.—Any person subject to this chapter who positions, or otherwise takes advantage of the location of, protected property with the intent to shield a military objective from attack, or to shield, favor, or impede military operations, shall be punished as a military commission under this chapter may direct. 
United States, Military Commissions Act, 2009, § 950t(4) and (10).
The Act also states:
§ 950p. Definitions; construction of certain offenses; common circumstances
“(a) DEFINITIONS.—In this subchapter:
“…
“(3) The term ‘protected property’ means any property specifically protected by the law of war, including … hospitals, and places where the sick and wounded are collected, but only if and to the extent such property is not being used for military purposes or is not otherwise a military objective. The term includes objects properly identified by one of the distinctive emblems of the Geneva Conventions, but does not include civilian property that is a military objective. 
United States, Military Commissions Act, 2009, § 950p(a)(3).
Uruguay
Uruguay’s Military Penal Code (1943), as amended, punishes military personnel, equiparados and even persons unconnected with the armed forces “for unjustified attacks on hospitals and asylums”. 
Uruguay, Military Penal Code, 1943, as amended, Article 58(12).
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:
17. Intentionally directing attacks against … hospitals and places where the sick and wounded are collected, provided they are not military objectives.
32. Intentionally directing attacks against medical buildings, material [and] units. 
Uruguay, Law on Cooperation with the ICC, 2006, Article 26.2, 26.3.17 and 26.3.32.
Venezuela
Venezuela’s Code of Military Justice (1998), as amended, provides for the punishment of “burning, destroying or attacking hospitals on land and on sea”. 
Venezuela, Code of Military Justice, 1998, as amended, Article 474(1).
Yugoslavia, Socialist Federal Republic of
Under the Socialist Federal Republic of Yugoslavia’s Penal Code (1976), as amended in 2001, “the launching of an attack on facilities that are specifically protected under international law” is a war crime. 
Yugoslavia, Socialist Federal Republic of, Penal Code, 1976, as amended in 2001, Article 143.
Canada
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.
Canada
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.
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 units “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.
Democratic Republic of the Congo
In 2010, in the Barnaba Yonga Tshopena case, the Military Garrison Court of Ituri-Bunia convicted a leader of the Front for Patriotic Resistance in Ituri (FRPI) of several war crimes, including attacking and pillaging hospitals. Regarding the attack of hospitals, the Court stated:
90 … [T]he defendant … is accused of [committing a] war crime by [carrying out] attacks against buildings that do not constitute military objectives, which is a punishable act according to article 8(2)(e)(iv) [of the 1998 ICC Statute] …
91 … [T]he war crime addressed by this article is defined as the act of attacking and destroying buildings of common and/or public use, unless such attacks and destructions are imperatively demanded by military necessities.
92. In view of the [2000 ICC] Elements of Crimes, [this] war crime requires, in addition to a link between the crime and the existence of an armed conflict not of an international character, and the awareness by the perpetrator of the factual circumstances that established the existence of this conflict, that the following five elements be present:
i) an action by the perpetrator consisting of launching or directing an attack; ii) the object of the attack must be one or more buildings which do not constitute military objectives; iii) the perpetrator must intend these buildings to be the object of his attack knowing that they are not military objectives; iv) the conduct of the perpetrator must take place in the context of an armed conflict not of an international character; v) the perpetrator must be aware of the factual circumstances that established the existence of an armed conflict.
Attack shall be understood here in the sense of article 49(1) of the [1977] Additional Protocol I … , which defines attacks as “acts of violence against the adversary, whether in offence or in defence”.
93 … [I]n the present case, during the attacks launched against Nyankunde and Groupement Musedzo respectively on 5 and 12 September by FRPI Ngiti militiamen, the destructive attacks were deliberately directed against buildings which did not constitute military objectives, in particular hospital buildings …
96 … [T]hose buildings were damaged or destroyed because they were targeted by the Ngiti combatants …
97 … [S]uch attacks were launched against buildings in both places during a period where there was an armed conflict not of an international character in the territory of Irumu, in Ituri, situated in the Eastern Province of the Democratic Republic of the Congo.
98 … [T]he FRPI leaders who planned and ordered the above-mentioned attacks, as well as all Ngiti militiamen and combatants of the political-military movement who materially committed the attacks, were aware of the existence of an armed conflict of this nature in Ituri and had the intention to direct such attacks against those buildings knowing that they did not constitute military objectives. This proves the existence of the intentional or mental element which constitutes the direct and special dolus according to article 30 of the [1998 ICC] … Statute.
99 … [T]herefore, this Court finds that there is sufficient evidence to establish substantial grounds to believe that these attacks which constitute war crimes were intentionally launched against buildings that were not military objectives in Nyankunde and Groupement Musedzo by the FRPI Ngiti combatants with the support, authorization, blessing and/or lack of control by the leaders of this political-military movement called FRPI, including the defendant. 
Democratic Republic of the Congo, Military Garrison Court of Ituri-Bunia, Barnaba Yonga Tshopena case, Judgment, 9 July 2010, §§ 90–93 and 96–99.
Regarding the crime of pillaging, the Court stated:
100 … [T]he defendant … is accused of committing the war crime of pillaging in Nyankunde and Groupement Musedzo in the territory of Irumu, in Ituri, respectively on 5 and 12 September 2002 or around these dates, in violation of article 8(2)(e)(v) of the … [1998 ICC] Statute …
101 … [I]n view of the [2000 ICC] Elements of Crimes, the following elements must be fulfilled so this offence is committed:
i) the perpetrator must appropriate certain property; ii) the perpetrator must have the intention to deprive the owner of the property and to appropriate it for private or personal use; iii) the appropriation must be carried out without the consent of the owner; iv) the conduct must take place in the context of and be associated with an armed conflict not of an international character; and finally v) the perpetrator must be aware of the factual circumstances that established the existence of an armed conflict.
102 … [I]n the present case, during the assaults launched against Nyankunde and Groupement Musedzo respectively on 5 and 12 September by FRPI Ngiti combatants, certain property was indeed transferred from the population of those places under the control of the attackers, who appropriated [such property] without the consent of the owners, who were silent because they had either died or fled.
103 … [T]he evidence produced before the Court … establishes that FRPI Ngiti combatants intentionally pillaged property in the Collectivité Chefferie de Nyankunde and Groupement Musedzo after having taken control over these places. Several pillaged objects … were taken to the residence of the accused … where they were shared …
107 … [T]he pillaging continued for several days. It was common to see the attackers, assisted by women and children, removing part of the roofs of the houses, breaking down [entrance] doors and appropriating various pieces of furniture … Incidentally, even … hospitals were not spared from the pillaging.
108 … [T]his pillaging took place on the occasion of the attacks launched … on 5 September 2002 against Nyankunde and on 12 September 2002 against Groupement Musedzo within the context of an armed conflict not of an international character.
109 … [T]hroughout the period when the pillaging took place, the FRPI leaders who ordered the above-mentioned attacks, as well as the combatants of this political-military movement who materially committed the attacks, were aware of the existence of an armed conflict of this nature in Ituri. This proves the existence, in the present case, of the intentional or mental element which constitutes the special dolus in conformity with the requirements of intention and knowledge established by article 30 of the [1998 ICC] … Statute.
110 … After examining … the evidence … , the Court … is convinced that, on the occasion of the attacks launched respectively on 5 and 12 September 2002 against Collectivité Chefferie de Nyankunde and Groupement Musedzo, followed by their prolonged occupation by the FRPI Ngiti combatants, the latter indeed appropriated, for their private or personal use, objects belonging to the civilian populations … This includes livestock, electronic household appliances, motorcycles and bicycles, furniture, clothing, money, and even roof parts, doors and windows snatched from public buildings and private dwellings, without the consent of the legitimate owners and without the justification of any military necessity.
111 … [T]herefore, this Court finds that there is sufficient evidence to establish substantial grounds to believe that the war crime of pillaging was intentionally committed in the Collectivité Cheffereie de Nyankunde and Groupement Musedzo by the Ngiti combatants of the armed militia FRPI with the support, authorization and/or blessing of the leaders of this political-military movement, including the defendant. 
Democratic Republic of the Congo, Military Garrison Court of Ituri-Bunia, Barnaba Yonga Tshopena case, Judgment, 9 July 2010, §§ 100–103 and 107–111.
Regarding the applicable law, the Court stated:
[T]he constitutional provisions of the Democratic Republic of the Congo, namely articles 153(4) and 215 of 18 February 2006 [Constitution (2006)], authorize both civil and military courts and tribunals to apply duly ratified international agreements and treaties, and give them higher authority than domestic legislation. This constitutional authorization combined with the self-executing nature of the … [1998 ICC] Statute justify the direct application of this treaty by Congolese courts and tribunals. 
Democratic Republic of the Congo, Military Garrison Court of Ituri-Bunia, Barnaba Yonga Tshopena case, Judgment, 9 July 2010, § 63.
Israel
In its judgment in Physicians for Human Rights v. IDF Commander in the West Bank in 2002, Israel’s High Court of Justice stated:
[I]nternational law provides protection for medical stations and personnel against attack by combat forces. Article 19 of the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field, of Aug. 12, 1949 [hereinafter The First Geneva Convention] forbids, under all circumstances, attack of 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. See Y. Dinstein, The Law of War 144–45 (1983).
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. Note the provisions of Articles 24 of the First Geneva Convention as well as the provisions of article 26, which expands this protection to include the Red Cross and similar voluntary aid societies. [emphasis in original]
Moreover, Article 21 of the First Geneva Convention provides that the protection 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.”
Against this legal background, we recall our words from our decision in HCJ 2936/02:
[W]e see fit to emphasize that our combat forces are required to abide by the rules of humanitarian law regarding the care of the wounded, the ill, and bodies of the deceased. The fact that medical personnel have abused their position in hospitals and in ambulances has made it necessary for the IDF to act in order to prevent such activities but does not, in and of itself, justify sweeping breaches of humanitarian rules. Indeed, this is also the position of the State. This stance is required, not only under the rules of international law on which the petitioners have based their arguments here, but also in light of the values of the State of Israel as a Jewish and democratic state.
The IDF shall once again instruct the combat forces, down to the level of the lone soldier in the field, of this commitment by our forces based on law and morality – and, according to the State, even on utilitarian considerations – through concrete instructions which will prevent, to the extent possible, and even in severe situations, incidents which are inconsistent with the rules of humanitarian law.
The instructions which are to be given to soldiers should deal with, among other things, the reasonable and fair warnings which should be given to medical teams. These guidelines should be subject to the circumstances, and should be carried out by the IDF in a way that balances the threat of Palestinian fighters camouflaged as medical teams against the legal and moral obligation to uphold humanitarian rules regarding the treatment of the sick and wounded. Such a balance should take into consideration, among other things, the imminence and severity of any threat. 
Israel, High Court of Justice, Physicians for Human Rights v. IDF Commander in the West Bank, 28 April 2002, § 1.
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:
17. … Everyone agrees that the rules of customary international law – which grant protection to medical … institutions … – apply to the combat operations that are being carried out in the “Cast Lead” operation and bind the actions of the IDF [Israel Defense Forces].
18. The provisions of international humanitarian law grant protection to medical facilities … from being attacked. Thus art. 18 of the [1949] Fourth Geneva Convention provides protection for hospitals … .
19. It is clear from these provisions that international humanitarian law attaches great importance to medical … facilities. Notwithstanding, this protection is not absolute, and it will be lost if use is made of medical facilities for non-humanitarian purposes, or if they are exploited for military purposes. … [T]he protection of medical facilities will cease if they are used “to commit, outside their humanitarian duties, acts harmful to the enemy” (art. 21 of the First Geneva Convention; art. 19 of the Fourth Geneva Convention). In this regard, the 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 medical personnel, hospitals and ambulances requires the IDF 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, §§ 17–19.
Afghanistan
In 2012, the Office of the President of Afghanistan issued a press release entitled “President Karzai calls on Taliban to stop pursuing objectives of outsiders, but rather begin a life of dignity and honor under Afghanistan[’s] Constitution”, which stated: “In his Eid remarks, the President urged the Taliban and other armed opposition to renounce violence and killings in Afghanistan and to stop destroying … hospitals …”. 
Afghanistan, Office of the President, “President Karzai calls on Taliban to stop pursuing objectives of outsiders, but rather begin a life of dignity and honor under Afghanistan[’s] Constitution”, Press Release, 26 October 2012.
Angola
According to the Report on the Practice of Angola, few violations of the rules found in the 1977 Additional Protocols I and II affording protection to the wounded and the sick were recorded in the conflict in Angola between 1975 and 1992. However, after the 1992 election and the resumption of hostilities, attacks on medical installations were more frequent. On the basis of eye-witness accounts, the report provides the following examples: the UNITA (União Nacional para Independência Total de Angola) hospital in Luanda was attacked by government forces and the hospitals of Capanda and Laluquemse were attacked by UNITA in 1992. 
Report on the Practice of Angola, 1998, Chapter 2.1.
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 … hospitals” could not go on with impunity. 
Argentina, Statement before the UN Security Council, UN Doc. S/PV.3203, 20 April 1993, p. 57.
Bosnia and Herzegovina
The Report on the Practice of the Republika Srpska notes that attacks on medical objects during the conflict in Bosnia and Herzegovina were often abusively justified on the grounds that these objects were allegedly used for military purposes.  
Report on the Practice of Republika Srpska, 1997, Chapter 2.7.
Canada
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.
Canada
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.
Canada
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.
Canada
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.
Canada
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.
China
At the International Conference of the Red Cross in 1952, China denounced the bombardment of hospitals during the Korean War. 
China, Statement of 30 July 1952 at the 18th International Conference of the Red Cross, Toronto, 26 July,7 August 1952, reprinted in Documents on Foreign Affairs of the People’s Republic of China, World Knowledge Press, Beijing, Vol. 2, pp. 82–83.
China
In 1972, in a statement before the General Conference of UNESCO concerning US attacks in Viet Nam, China criticized the United States because it allegedly had “wantonly bombarded Vietnamese cities and villages, seriously destroyed many schools and cultural and sanitary facilities, [and] killed a large number of teachers, students, patients and medical personnel”. 
China, Statement before the General Conference of UNESCO, 25 October 1972, Selected Documents of the Chinese Delegation to the United Nations, The People’s Press, Beijing, 1972, p. 239.
China
The Report on the Practice of China states: “China is of the opinion that … medical objects shall be respected and protected from attacks.” 
Report on the Practice of China, 1997, Chapter 2.7.
For more than 150 years, the international community has been in agreement that warfare should be made less inhumane, through the rules and principles of international humanitarian law. Civilians should be protected in armed conflict. … However, these rules and principles are challenged and sometimes even ignored. … This is for instance the case in Syria (and Iraq) where hospitals … are being made the actual targets of warfare. This must stop. 
Denmark, Statement by the Minister for Foreign Affairs of Sweden before the UN Security Council during a debate on the protection of civilians in armed conflict made on behalf of Denmark, Finland, Iceland, Norway and Sweden, 30 January 2015.
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 IHL”, stated:
Distinction
2. It is prohibited to attack … hospitals.
Specific protection
2. … [M]edical … establishments [and] medical equipment (hospitals, clinics … etc.) … shall be respected and protected. 
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 on 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 statement submitted to the ICJ in the Nuclear Weapons case in 1995, Egypt declared: “According to the First and Second Geneva Conventions of 1949, it is prohibited to attack military establishments and mobile medical units of the Medical Service … in any circumstances.” 
Egypt, Written statement submitted to the ICJ, Nuclear Weapons case, June 1995, p. 13, § 21.
In a further statement, Egypt stated that it was prohibited to attack civilian hospitals. 
Egypt, Written comments on other written statements submitted to the ICJ, Nuclear Weapons case, September 1995, p. 21, § 50.
Finland
In 1994, during a debate in the UN Security Council on the situation in the former Yugoslavia, Finland stated:
Even though there might have been provocations by the Bosnian Government forces, the merciless onslaught by the Serb forces against the safe area [of Goražde] – with the deliberate targeting of hospitals … – cannot be justified. On the contrary, it must be strongly condemned. The Serbs must realize that what they are doing is a blatant violation of basic humanitarian law, and those responsible for these atrocities will be held personally accountable. 
Finland, Statement before the UN Security Council, UN Doc. S/PV.3367, 21 April 1994, p. 34.
For more than 150 years, the international community has been in agreement that warfare should be made less inhumane, through the rules and principles of international humanitarian law. Civilians should be protected in armed conflict. … However, these rules and principles are challenged and sometimes even ignored. … This is for instance the case in Syria (and Iraq) where hospitals … are being made the actual targets of warfare. This must stop. 
Finland, Statement by the Minister for Foreign Affairs of Sweden during a UN Security Council debate on the protection of civilians in armed conflict made on behalf of Denmark, Finland, Iceland, Norway and Sweden, 30 January 2015.
France
In 1994, during a debate in the UN Security Council concerning the situation in Rwanda, France stated that the international community was faced with a “humanitarian catastrophe” to which it “could not fail to react”, and referred in particular to the fact that hospitals had not been spared by attacks. 
France, Statement before the UN Security Council, UN Doc. S/PV.3377, 16 May 1994, p. 11.
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 units 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 … hospitals … 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.
Iraq
In 1987, in a letter to the UN Secretary-General, Iraq complained of the bombardment by the Islamic Republic of Iran of the hospital of the town of Dohuk which it deemed “in complete contradiction to the fundamental principles of humanitarian international law”. Iraq stated: “The international community long ago decided that hospitals and other medical centres were objectives against which any military activity whatsoever was prohibited.” 
Iraq, Letter dated 19 November 1987 to the UN Secretary-General, UN Doc. S/19282, 19 November 1987.
Islamic Republic of Iran
According to the Report on the Practice of the Islamic Republic of Iran, the Iranian authorities condemned attacks by Iraqi troops on civilian objects such as hospitals during the Iran–Iraq War. 
Report on the Practice of the Islamic Republic of Iran, 1997, Chapter 1.3.
The report notes in particular that, during the “war of the cities”, hospitals were targeted on many occasions, and that the Islamic Republic of Iran condemned such attacks, regarding them as being contrary to international conventions. 
Report on the Practice of the Islamic Republic of Iran, 1997, Chapter 4.2.
Israel
According to the Report on the Practice of Israel, the Israel Defense Forces (IDF) do not have a policy of targeting the medical facilities of their adversaries. The report adds that the implementation of this policy is subject to such facilities being clearly recognizable and not used for hostile activities. 
Report on the Practice of Israel, 1997, Chapter 2.7, referring to Conduct in the Battlefield in Accordance with the Law of War, Israel Defense Forces, 1986, p. 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 facilities … 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’s operational plans and rules of engagement order special precautions with regard to military activity in proximity to … Red Cross facilities [and] hospitals”. 
Israel, Ministry of Foreign Affairs, The Operation in Gaza 27 December 2008–18 January 2009: Factual and Legal Aspects, 29 July 2009, § 259.
Jordan
During the conflict in Jordan in 1970, Jordanian armed forces reportedly attacked hospitals harbouring rebels. The allegation was denied. According to the Report on the Practice of Jordan, Jordan’s position was that the conflict was governed by national law rather than by international law. 
Report on the Practice of Jordan, 1997, Chapter 1.4.
The manual further states that according to Jordanian practice, medical units are generally not placed near military objectives. 
Report on the Practice of Jordan, 1997, Chapter 2.7.
Nigeria
According to the Report on the Practice of Nigeria, Nigerian practice recognizes the protection of medical objects from attack. The report states: “Nigerian opinio juris is … that the protection from attack of medical objects is a part of customary international law.” 
Report on the Practice of Nigeria, 1997, Chapter 2.7.
Norway
In 1980, during a debate in the UN Security Council concerning an attack on UNIFIL headquarters in southern Lebanon, Norway strongly condemned “the deliberate shelling on the United Nations field hospital, which under international law enjoys special protection. The fact that that hospital serves the civilian population as well makes the matter even more serious.” 
Norway, Statement before the UN Security Council, UN Doc. S/PV.2215, 15 April 1980, § 7.
Norway
In 2009, in a statement on Gaza before the UN General Assembly, the permanent representative of Norway stated: “Norway also strongly condemns Israel’s shelling of the al-Quds Hospital of the Palestinian Red Crescent. Such attacks are completely unacceptable and contrary to international law.” 
Norway, Statement by the permanent representative of Norway before the UN General Assembly during a debate on Gaza, 16 January 2009.
For more than 150 years, the international community has been in agreement that warfare should be made less inhumane, through the rules and principles of international humanitarian law. Civilians should be protected in armed conflict. … However, these rules and principles are challenged and sometimes even ignored. … This is for instance the case in Syria (and Iraq) where hospitals … are being made the actual targets of warfare. This must stop. 
Norway, Statement by the Minister for Foreign Affairs of Sweden before the UN Security Council during a debate on the protection of civilians in armed conflict made on behalf of Denmark, Finland, Iceland, Norway and Sweden, 30 January 2015.
Rwanda
In response to the Report of the International Commission of Inquiry on Human Rights Violations in Rwanda, the Rwandan Government demanded that the forces opposing the Rwandese Patriotic Front (RPF) put an end to attacks on civilian objects, including hospitals. 
Rwanda, President of the Republic, Statement by The Government of Rwanda concerning the Final Report of the International Commission of Inquiry on Human Rights Violations in Rwanda since 1 October 1990, Kigali, 7 April 1993.
Saudi Arabia
In 1980, during a debate in the UN Security Council concerning an attack on UNIFIL headquarters in southern Lebanon, Saudi Arabia stated that it considered the shelling of the UNIFIL hospital “most abhorrent”. 
Saudi Arabia, Statement before the UN Security Council, UN Doc. S/PV.2218, 24 April 1980, § 46.
Sri Lanka
In 2008, in its initial report to the Committee on the Rights of the Child under the 2000 Optional Protocol on the Involvement of Children in Armed Conflict, Sri Lanka stated:
83. In accordance with resolution 1612 and Section VI, paragraph 2 of the Terms of Reference of the Working Group of the Security Council on children and armed conflict, the TFMR [Task Force for Monitoring and Reporting] will focus on violations against children affected by armed conflict …
84. … [V]iolations and abuses committed against children affected by armed conflict including … attacks against … hospitals … will … be addressed. 
Sri Lanka, Initial report to the Committee on the Rights of the Child under the Optional Protocol on the Involvement of Children in Armed Conflict, 15 February 2010, UN Doc. CRC/C/OPAC/LKA/1, submitted 16 June 2008, §§ 83–84.
For more than 150 years, the international community has been in agreement that warfare should be made less inhumane, through the rules and principles of international humanitarian law. Civilians should be protected in armed conflict. … However, these rules and principles are challenged and sometimes even ignored. … This is for instance the case in Syria (and Iraq) where hospitals … are being made the actual targets of warfare. This must stop. 
Sweden, Statement by the Minister for Foreign Affairs of Sweden before the UN Security Council during a debate on the protection of civilians in armed conflict made on behalf of Denmark, Finland, Iceland, Norway and Sweden, 30 January 2015.
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.
Emblems (distinctive sign)
In Armed conflicts recognisable emblems serve above all to protect military and civilian medical installations as well as the buildings of national relief organisations and their personnel from attack (protective function). This protection is guaranteed not by the emblems themselves but is based directly in international law. 
Switzerland, Federal Department of Foreign Affairs, ABC of International Humanitarian Law, 2009, pp. 12 and 18.
Switzerland
In 2009, in a statement before the UN Security Council during an open debate on the protection of civilians in armed conflict, the permanent representative of Switzerland stated:
The current situation in Gaza cries out to us the importance of the issue we are discussing today. The main victims of the Israeli-Palestinian conflict are civilians. …
… Switzerland also wishes to recall that all the parties to the conflict are under the obligation to protect medical personnel, hospitals and other sanitary facilities. 
Switzerland, Statement by the permanent representative of Switzerland before the UN Security Council on the protection of civilians in armed conflict, 14 January 2009, pp. 5–6.
Switzerland
In 2009, in its Report on Foreign Policy, Switzerland’s Federal Council stated:
One of the primary concerns of humanitarian law and policy is to guarantee access to victims and to provide assistance to them. However, it frequently occurs … that it is impossible to ensure the security of humanitarian actors. This was once more clearly evident in the Gaza Strip at the end of 2008 and at the beginning of 2009. Switzerland called upon all the parties to the conflict … to protect medical personnel, hospitals and other medical units. 
Switzerland, Federal Council, Report on Foreign Policy 2009, 2 September 2009, Section 3.3.7.3, p. 5811.
Switzerland
In 2010, in its Report on IHL and Current Armed Conflicts, Switzerland’s Federal Council states:
3.3 Increasing use of guerrilla tactics …
International humanitarian law in force treats these cases in a relatively complete manner, binding non-State and State actors alike. … The use of human shields constitutes equally a serious violation of international humanitarian law, as does the abusive and deliberate use of protected objects (religious buildings, hospitals, cultural property) to protect military objectives or to serve as a base for combat operations. 
Switzerland, Federal Council, Report on IHL and Current Armed Conflicts, 17 September 2010, Section 3.3, p. 12.
[footnotes in original omitted]
Switzerland
In 2011, in a statement before the UN Security Council during an open debate on children and armed conflict, made on behalf of the Group of Friends of Children and Armed Conflict, including Switzerland, the deputy permanent representative of Canada stated:
Members of the Friends Group have reliably called on the [UN] 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.
Switzerland
In 2012, Switzerland’s Federal Department of Foreign Affairs issued a press release entitled “Appeal by the Swiss authorities for compliance with international humanitarian law in Syria”, which stated: “Moverover, the parties [to the conflict] are subject to the obligation to respect and protect at all times fixed establishments and mobile medical units as well as all humanitarian actors”. 
Switzerland, Federal Department of Foreign Affairs, “Appeal by the Swiss authorities for compliance with international humanitarian law in Syria”, Press Release, 15 November 2012, § 9.
Switzerland
In 2013, in a statement before the UN Human Rights Council during an interactive dialogue with the Commission of Inquiry on Syria and the UN Special Rapporteur on the human rights of internally displaced persons, the representative of Switzerland stated: “Switzerland condemns in the strongest terms deliberate attacks against medical and humanitarian personnel as well as medical installations, which, let us recall, are protected under international humanitarian law.” 
Switzerland, Statement by the representative of Switzerland before the UN Human Rights Council during an interactive dialogue with the UN Commission of Inquiry on Syria and the UN Special Rapporteur on the human rights of internally displaced persons, 16 September 2013.
Switzerland
In 2013, in a statement at the 64th Session of the Executive Committee of the Programme of the UN High Commissioner for Refugees, the ambassador of Switzerland stated: “Switzerland condemns in the strongest terms deliberate attacks against medical and humanitarian personnel as well as medical infrastructure and material. Such attacks constitute a war crime, a flagrant violation of international humanitarian law and an attack on human dignity.” 
Switzerland, Statement by the ambassador of Switzerland at the 64th Session of the Executive Committee of the Programme of the UN High Commissioner for Refugees, 1 October 2013.
Switzerland
In 2013, in a statement before the UN General Assembly during an interactive dialogue with the UN Special Rapporteur on the human rights of internally displaced persons, the representative of Switzerland stated: “Switzerland condemns in the strongest terms deliberate attacks against the civilian population, including medical and humanitarian personnel, as well as against civilian, and especially medical, infrastructure. Such attacks constitute serious violations of international humanitarian law.” 
Switzerland, Statement by the representative of Switzerland before the UN General Assembly during an interactive dialogue with the UN Special Rapporteur on the human rights of internally displaced persons, 24 October 2013.
United Kingdom of Great Britain and Northern Ireland
At the CDDH, the United Kingdom welcomed “the humanitarian advances made in such fields as … the extension of protection to a wider group of medical units”. 
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 1980, during a debate in the UN Security Council concerning an attack on UNIFIL headquarters in southern Lebanon, the United States stated: “On 12 April UNIFIL headquarters and the hospital at Naqoura were heavily shelled by militia artillery … These attacks must be brought to an end, once and for all.” 
United States, Statement before the UN Security Council, UN Doc. S/PV.2218, 24 April 1980, § 77.
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 contained 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.
United States of America
In 1987, the Deputy Legal Adviser of the US Department of State affirmed: “We also support the principle that medical units, including properly authorized civilian medical units, be respected and protected at all times and not be the object of attacks.” 
United States, Remarks of Michael J. Matheson, Deputy Legal Adviser, US Department of State, The Sixth Annual American Red Cross-Washington College of Law Conference on International Humanitarian Law: A Workshop on Customary International Law and the 1977 Protocols Additional to the 1949 Geneva Conventions, American University Journal of International Law and Policy, Vol. 2, 1987, p. 423.
United States of America
In 1992, in its final report to Congress on the conduct of the Gulf War, the US Department of Defense stated:
Contrary to the admonishment against such conduct contained in [the 1949 Geneva Conventions I and IV] and certain principles of customary law codified in [the 1977 Additional Protocol I], the Government of Iraq placed military assets (personnel, weapons, and equipment) … next to protected objects (mosques, medical facilities, …) in an effort to protect them from attack. For this purpose, military supplies were stored in mosques … and hospitals in Iraq and Kuwait. 
United States, Department of Defense, Final Report to Congress on the Conduct of the Persian Gulf War, 10 April 1992, Appendix O, The Role of the Law of War, ILM, Vol. 31, 1992, p. 624.
United States of America
In 1991, in a diplomatic note to Iraq concerning operations in the Gulf War, the United States stated that medical facilities and hospital ships must be respected and protected at all times. 
United States, Department of State, Diplomatic note to Iraq, Washington, 19 January 1991, annexed to Letter dated 21 January 1991 to the President of the UN Security Council, UN Doc. S/22122, 21 January 1991, Annex I, p. 2.
Venezuela
In 1993, during a debate in the UN Security Council on the situation in the former Yugoslavia, Venezuela stated that those who had committed war crimes and crimes against humanity, including “attacks upon hospitals”, had to be brought to justice. 
Venezuela, Statement before the UN Security Council, UN Doc. S/PV.3269, 24 August 1993, p. 44.
Yugoslavia, Socialist Federal Republic of
Order No. 579 issued in 1991 by the Chief of General Staff of the Yugoslav People’s Army (YPA) provides:
Any attack on … protected objects (… medical facilities, etc.) is strictly prohibited, except when these objects are used to launch attacks on YPA units. In such cases, the commanding officer in charge shall, before opening fire, warn the opposing side in an appropriate manner to stop fire and vacate the objects in question. 
Yugoslavia, Socialist Federal Republic of, Chief of General Staff of the Yugoslav People’s Army, Political Department, Order No. 579, 14 October 1991, § 3.
Zimbabwe
The Report on the Practice of Zimbabwe regards the rule on the protection of medical objects as being part of customary international law. 
Report on the Practice of Zimbabwe, 1998, Chapter 2.7.
UN Security Council
In a resolution adopted in 1980, the UN Security Council condemned “the deliberate shelling of the headquarters of [UNIFIL] and more particularly the field hospital, which enjoys special protection under international law”. 
UN Security Council, Res. 467, 21 April 1980, § 3, voting record: 12-0-3.
UN Security Council
In a resolution adopted in 1992 on the former Yugoslavia, the UN Security Council:
Expressing 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 … hospitals, …
2. Strongly condemns any violations of international humanitarian law, …
3. Demands 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 Security Council
In a resolution adopted in 1992 on the situation in Somalia, the UN Security Council expressed its “grave alarm at the continuing reports of widespread violations of international humanitarian law, including deliberate attacks on medical and relief facilities” and condemned all these violations. 
UN Security Council, Res. 794, 3 December 1992, preamble and § 5, voting record: 15-0-0.
UN Security Council
In a resolution adopted in 1999, the UN Security Council strongly condemned “attacks on objects protected under international law” and called on all parties “to put an end to such practices”. 
UN Security Council, Res. 1265, 17 September 1999, § 2, voting record: 15-0-0.
UN Security Council
In a resolution adopted in 2004 on the protection of children in armed conflict, the UN Security Council strongly condemned certain crimes involving children in armed conflict, including “attacks against schools and hospitals”. 
UN Security Council, Res. 1539, 22 April 2004, § 1, voting record: 15-0-0.
UN Security Council
In 2006, in a statement by its President on the protection of children in armed conflict, the UN Security Council strongly condemned “attacks against schools and hospitals by parties to armed conflict”. 
UN Security Council, Statement by the President, UN Doc. S/PRST/2006/48, 28 November 2006, p. 2.
UN General Assembly
In a resolution adopted in 1984 on the situation of human rights in El Salvador, the UN General Assembly urged the government and the insurgent forces “to agree as early as possible to respect … all military hospitals, as required by the Geneva Conventions”. 
UN General Assembly, Res. 39/119, 14 December 1984, § 9, voting record: 93-11-40-15.
UN General Assembly
In a resolution adopted in 1985 on the situation of human rights and fundamental freedoms in El Salvador, the UN General Assembly:
Expresses … its deep concern at the fact that serious and numerous violations of human rights continue to take place in El Salvador owing above all to non-fulfilment of the humanitarian rules of war, and therefore … recommends that the Special Representative [for El Salvador] should, for the duration of the armed conflict, continue to observe and to inform the General Assembly and the Commission on Human Rights of the extent to which the contending parties are respecting those rules, particularly as regards humanitarian treatment and respect for … military hospitals of either party. 
UN General Assembly, Res. 40/139, 13 December 1985, § 3, voting record: 100-2-42-15.
This recommendation was reiterated in a subsequent resolution in 1986. 
UN General Assembly, Res. 41/157, 4 December 1986, § 4, voting record: 110-0-40-9.
UN Commission on Human Rights
In a resolution adopted in 1983, the UN Commission on Human Rights deplored an attack by occupying troops in Kampuchea against border encampments, including a hospital, as a violation of fundamental principles of humanitarianism and of the UN Charter.  
UN Commission on Human Rights, Res. 1983/5, 15 February 1983, § 2, voting record: 28-9-4.
UN Commission on Human Rights
In a resolution adopted in 1987 on the situation of human rights in El Salvador, the UN Commission on Human Rights requested that the Special Representative for El Salvador “continue to observe and inform the General Assembly and the Commission of the extent to which the contending parties are respecting the humanitarian rules of war, particularly as regards respect for … military hospitals of either side”. 
UN Commission on Human Rights, Res. 1987/51, 11 March 1987, § 5, voting record: 36-0-7.
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 strongly condemned “the offensives of the Israeli army of occupation against hospitals and sick persons”. 
UN Commission on Human Rights, Res. 2004/10, 15 April 2004, § 9, voting record: 31-7-15.
UN Commission on Human Rights
In a resolution adopted in 2005 on the rights of the child, the UN Commission on Human Rights urged “all parties to armed conflict to end … violations against children, including … attacks against … hospitals”. 
UN Commission on Human Rights, Res. 2005/44, 19 April 2005, § 36, voting record: 52-1-0.
UN Human Rights Council
In a resolution adopted in 2006 on the situation of human rights in Lebanon caused by Israeli military operations, the UN Human Rights Council stated that it was guided by:
the Charter of the United Nations, relevant human rights instruments and international humanitarian law, in particular the Hague Conventions of 1899 and 1907 on the Laws and Customs of War on Land which prohibit attacks and bombardment of civilian populations and objects and lay down obligations for general protection against dangers arising from military operations against civilian objects, hospitals, relief materials and means of transportation. 
UN Human Rights Council, Res. S-2/1, 11 August 2006, preamble, voting record: 27-11-8.
UN Sub-Commission on Human Rights
In a resolution adopted in 1985 on the situation in El Salvador, the UN Sub-Commission on Human Rights recommended that the Special Representative for El Salvador “inform the Commission on whether both parties accept their obligation to respect the Geneva Conventions and to what extent they are truly observing them, especially in those aspects which refer to the protection of … military hospitals”. 
UN Sub-Commission on Human Rights, Res. 1985/18, 29 August 1985, § 4.
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 hospitals. 
UN Commission on Human Rights, Res. 1992/S-1/1, 14 August 1992, preamble, adopted without a vote.
UN Sub-Commission on Human Rights
In a resolution adopted in 1989, the UN Sub-Commission on Human Rights expressed regret that “the Government of El Salvador … has attacked military hospitals”. 
UN Sub-Commission on Human Rights, Res. 1989/9, 31 August 1989, preamble, adopted without a vote.
UN Commission on Human Rights (Special Rapporteur)
In 1992, 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 concluded that hospitals had been deliberately attacked, even though the red cross emblem was clearly visible or the building was itself clearly visible from the positions held by the Bosnian Serbs. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Former Yugoslavia, Report, UN Doc. E/CN.4/1992/S-1/9, 28 August 1992, § 17.
In another report in 1993, he stated that such attacks constituted a fundamental violation of the laws of war. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Former Yugoslavia, Third periodic report, UN Doc. E/CN.4/1994/6, 26 August 1993, § 25; see also Fifth periodic report, UN Doc. E/CN.4/1994/47, 17 November 1993, §§ 162–164.
In a further report in 1994, the Special Rapporteur noted that attacks on Goražde included numerous and clear violations of human rights and IHL, including the deliberate targeting of highly vulnerable targets such as hospitals. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Former Yugoslavia, Seventh periodic report, UN Doc. E/CN.4/1995/4, 10 June 1994, §§ 8–11.
UN Commission on Human Rights (Special Rapporteur)
In 1994, 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 the deliberate targeting of the Goražde hospital. He noted allegations that the hospital was in fact a “military command centre” and that there were machine-gun emplacements on the roof and mortar launching equipment on the ground. According to international observers, these allegations were entirely unfounded and the hospital served no military function during the offensive. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in the Former Yugoslavia, Seventh periodic report, UN Doc. E/CN.4/1995/4, 10 June 1994, § 9.
UN Commission on Human Rights (Special Rapporteur)
In 1994, in a report on the situation of human rights in Rwanda, the Special Rapporteur of the UN Commission on Human Rights noted that a shell had hit an ICRC hospital. Commenting on the justification by the Front Patriotique Rwandais (FPR) of its action on the grounds that members of the Rwandan Armed Forces were sheltering behind the hospital in order to attack, the Special Rapporteur said that such an attitude could not but demoralize the survivors. 
UN Commission on Human Rights, Special Rapporteur on the Situation of Human Rights in Rwanda, Report, UN Doc. E/CN.4/1995/7, 24 June 1994, § 31.
UN Commission on the Truth for El Salvador
In its report in 1993, the UN Commission on the Truth for El Salvador regarded an attack on an Farabundo Martí para la Liberación Nacional (FMLN) mobile hospital by a unit of the Salvadoran Air Force as a violation of IHL. 
UN Commission on the Truth for El Salvador, Report, UN Doc. S/25500, 1 April 1993, Annex, pp. 87–89.
UN Commission of Experts Established pursuant to Security Council Resolution 780 (1992)
In 1994, in its final report on grave breaches of the Geneva Conventions and other violations of IHL committed in the former Yugoslavia, the UN Commission of Experts Established pursuant to Security Council Resolution 780 (1992) stated that one of the most frequently targeted sites was the Kosovo hospital in Sarajevo. The Commission regarded the attacks against and destruction of protected targets, such as hospitals, as evidence of a consistent and repeated pattern of grave breaches of the 1949 Geneva Conventions and other violations of IHL. 
UN Commission of Experts Established pursuant to Security Council Resolution Res. 780 (1992), Final report, UN Doc. S/1994/674, 27 May 1994, §§ 189–194.
The Commission noted that attacks against hospitals and locations marked with the red cross or red crescent emblem were used as a coercive means to remove the population from strategic areas and were linked to practices of ethnic cleansing. 
UN Commission of Experts Established pursuant to Security Council Resolution Res. 780 (1992), Final report, UN Doc. S/1994/674, 27 May 1994, §§ 133–34.
UN Special Committee to investigate Israeli practices affecting the human rights of the Palestinian people and other Arabs in the occupied territories
In 1994, the Special Committee to investigate Israeli practices affecting the human rights of the Palestinian people and other Arabs in the occupied territories, referring to eye-witnesses, reported the incursion by the Israeli army into a Red Crescent hospital. According to the information, rocket launchers were put on the roof of the building and windows were used to fire from. The Special Committee also reported raids on hospitals. 
Special Committee to investigate Israeli practices affecting the human rights of the Palestinian people and other Arabs of the occupied territories established pursuant to UN General Assembly Res. 2443 (XXIII), 26th report covering the period from 27 August 1993 to 26 August 1994, UN Doc. A/49/511, 18 October 1994, §§ 316–317 and 728.
Council of Europe Parliamentary Assembly
In 1985, a report on a draft resolution of the Council of Europe Parliamentary Assembly on the situation in Afghanistan stated that it had been noted in a report of the Special Rapporteur of the UN Commission on Human Rights that Soviet forces systematically bombed civilian hospitals. The report regarded these incidents as “violations of human rights”.  
Council of Europe, Parliamentary Assembly, Report on the deteriorating situation in Afghanistan, Doc. 5495, 15 November 1985, §§ 16–17 and Appendix 1.
Council of Europe Parliamentary Assembly
In 1996, in its opinion on the Russian Federation’s application for membership, the Committee on Legal Affairs and Human Rights of the Council of Europe Parliamentary Assembly stated: “The recent attack on the Kislyar Hospital in Dagestan, even though it ended relatively peacefully, was an act of terrorism on the Chechen side, which has to be condemned most strongly.” 
Council of Europe, Parliamentary Assembly, Committee on Legal Affairs and Human Rights, Opinion on the Russian Federation’s application for membership of the Council of Europe, Doc. 7463, 18 January 1996, § 50.
European Community
In a statement issued in 1990 on Liberia, the 12 EC member States called on the parties, “in conformity with international law and the most basic humanitarian principles, to safeguard from violence … places of refuge such as … hospitals, where defenceless civilians sought shelter”. 
EC, Statement 90/294 concerning Liberia, European Political Cooperation Documentation Bulletin, Vol. 6, 1990, p. 295.
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 objects and installations. 
International Conference for the Protection of War Victims, Geneva, 30 August–1 September 1993, Final Declaration, § II (9), ILM, Vol. 33, 1994, p. 301.
International Criminal Tribunal for the former Yugoslavia
In its judgment in the Galić case in 2006, the ICTY Appeals Chamber stated:
340. Given the evidence, the Trial Chamber was clearly correct to find both that the Koševo hospital “was regularly targeted during the Indictment Period by the SRK [Sarajevo Romanija Corps]” and that “ABiH [Army of Bosnia and Herzegovina] mortar fire originated from the hospital grounds or from its vicinity and that these actions may have provoked SRK counter-fire”. But its conclusion that the firing on the Koševo hospital buildings “was certainly not aimed at any possible military target” is partially incorrect. If the hospital, whether the building or the grounds, was used as a base to fire at SRK forces, then the hospital was, at least temporarily, a military target. As the ICRC Commentary to Additional Protocol I to the Geneva Conventions states: “If the medical unit is used to commit acts which are harmful to the enemy, it actually becomes a military objective which can legitimately be attacked, and even destroyed”.
341. It is important to establish exactly what restrictions international humanitarian law establishes, as set out in the Fourth Geneva Convention and Additional Protocols thereto, regarding attacks on hospitals. All three instruments state that hospitals shall not be the object of attack. However, all three also state – with slightly different wording – that hospitals lose their protection if they are used for military purposes. The Fourth Geneva Convention states that the protection ceases if “they are used to commit, outside their humanitarian duties, acts harmful to the enemy”; Additional Protocol I, if “they are used to commit, outside their humanitarian function, acts harmful to the enemy”; and Additional Protocol II, if “they are used to commit hostile acts, outside their humanitarian function”.
342. The Fourth Geneva Convention and the two Additional Protocols, along with the ICRC Commentary, give examples of actions that result in loss of protection under international humanitarian law for hospitals. According to the ICRC Commentary, these include:
• “[T]he use of a hospital as a shelter for able-bodied combatants or fugitives”;
• The use of a hospital “as an arms or ammunition dump”;
• The use of a hospital “as a military observation post”;
• “[T]he deliberate siting of a medical unit in a position where it would impede an enemy attack”; and
• Heavy fire from every window of a hospital meeting an approaching body of troops.
343. According to Geneva Convention IV, Additional Protocol I and the ICRC Commentary, these actions do not lose protection:
• Nursing sick or wounded members of the armed forces;
• “The presence of small arms and ammunition taken from such combatants which have not yet been handed to the proper service”;
• “[T]he personnel of the unit are equipped with light individual weapons for their own defence or for that of the wounded and sick in their charge”;
• “[T]he unit is guarded by a picket or by sentries or by an escort”;
• “[M]embers of the armed forces or other combatants are in the unit for medical reasons”;
• “[A] mobile medical unit accidentally breaks down while it is being moved in accordance with its humanitarian function, and thereby obstructs a crossroads of military importance”; and
• “[R]adiation emitted by X-ray apparatus […] interfere[s] with the transmission or reception of wireless messages at a military location, or with the working of a radar unit”.
344. Therefore, where a hospital is used for one of the hostile purposes articulated above, or for an analogous purpose, or for a purpose even more hostile, the hospital loses protection and becomes a legitimate military objective while used for that purpose. However, that loss of protection is not instantaneous: a warning period is required. Additional Protocols I and II have the same wording: “Protection may, however, cease only after a warning has been given, setting, whenever appropriate, a reasonable time-limit, and after such warning has remained unheeded.”
346. The law is thus clear: a hospital becomes a legitimate target when used for hostile or harmful acts unrelated to its humanitarian function, but the opposing party must give warning before it attacks. In this case, the hospital was used as a base to fire mortars at the SRK forces. Therefore, the Trial Chamber erred in law in determining that fire on the hospital was “not aimed at any possible military target”, because fire from the hospital turned it into a target. At the same time, however, military activity does not permanently turn a protected facility into a legitimate military target. It remains a legitimate military target only as long as it is reasonably necessary for the opposing side to respond to the military activity. Additionally, an attack must be aimed at the military objects in or around the facility, so only weaponry reasonably necessary for that purpose can be used. 
ICTY, Galić case, Judgment on Appeal, 30 November 2006, §§ 340–344 and 346.
Eritrea-Ethiopia Claims Commission
In its Eritrea’s Damages Claims final award in 2009, the Eritrea-Ethiopia Claims Commission, in considering the importance of the protection of medical units, stated:
211. Numerous provisions of humanitarian law highlight the importance of protecting medical facilities and services, and of assuring their ability to operate. Article 18 of the [1949] Fourth Geneva Convention provides that “[c]ivilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected …” Article 20 requires respect and protection for persons solely engaged in operating and administering civilian hospitals. Article 23 requires parties to allow free passage of medical and hospital stores intended for civilians. Article 55 requires an Occupying Power to ensure the availability of medical supplies to the civilian population “to the fullest extent of the means available to it,” and bars requisitioning of such supplies except under limited conditions. Article 12 of [the 1977 Additional] Protocol I directs that medical units “be respected and protected at all times and shall not be the object of attack.” (“Medical units” are broadly defined to include civilian hospitals, preventive medicine centers, and other types of civilian facilities.) Article 15 of Protocol I likewise requires that civilian medical personnel be “respected and protected.”
212. These treaty provisions protecting medical facilities, and others like them, appear in instruments concluded between States. However, they do not exist primarily to protect States’ interests or property. Instead, their fundamental purpose is to provide protection to individuals caught up in armed conflict or its aftermath. They cumulatively aim to assure that the wounded and sick “receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition.” 
Eritrea-Ethiopia Claims Commission, Eritrea’s Damages Claims, Final Award, 17 August 2009, §§ 211–212.
[footnotes in original omitted]
ICRC
In its Commentary on the First Geneva Convention, the ICRC prepared a more precise definition of “acts harmful to the enemy”, they being “acts the purpose or effect of which is to harm the adverse Party, by facilitating or impeding military operations”. 
Jean S. Pictet (ed.), Commentary on the First Geneva Convention, ICRC, Geneva, 1952, p. 200.
The Commentary on Article 21 of the 1949 Geneva Convention I gives as examples:
The use of a hospital as a shelter for able-bodied combatants or fugitives, as an arms or ammunition dump, or as a military observation post; another would be the deliberate siting of a medical unit in a position where it would impede an enemy attack. 
Jean S. Pictet (ed.), Commentary on the First Geneva Convention, ICRC, Geneva, 1952, pp. 200–201.
ICRC
To fulfil its task of disseminating IHL, the ICRC has delegates around the world teaching armed and security forces that:
65. “Medical establishment” means any establishment assigned exclusively to medical purposes. The term comprises in particular “hospitals, similar units of any size, blood transfusion centres, preventive medicine centres and institutes, medical transportation locations, medical depots and the medical and pharmaceutical stores of such establishments.
78. The law of war grants the same status to civilian and military medical services … [T]he provisions governing military medical … establishments … 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, §§ 65 and 78.
Delegates also teach that:
The protection to which specifically protected persons and objects are entitled shall not cease unless they are used to commit acts harmful to the enemy. Protection may cease only after due warning has been given, and after such warning has remained unheeded. A reasonable time-limit shall be set. 
Frédéric de Mulinen, Handbook on the Law of War for Armed Forces, ICRC, Geneva, 1987, § 224.
Delegates further teach that:
474. Specifically protected … establishments … recognized as such must be respected.
476. Specifically protected establishments shall remain untouched and shall not be entered. Their contents and effective use may be verified by inspection. 
Frédéric de Mulinen, Handbook on the Law of War for Armed Forces, ICRC, Geneva, 1987, §§ 474 and 476.
ICRC
In a press release in 1978, the ICRC urgently appealed to the belligerents in Lebanon “to take measures immediately to ensure that hospitals and medical personnel may continue their work unimpeded and in safety”. 
ICRC, Press Release No. 1341, Lebanon: ICRC appeals for truce, 2 October 1978.
ICRC
In a press release issued in 1991 in the context of the Gulf War, the ICRC reminded the parties to the conflict to respect and protect medical establishments at all times. 
ICRC, Press Release No. 1658, Gulf War: ICRC reminds States of their obligations, 17 January 1991.
National Societies (Hungary and Yugoslavia)
In a joint statement adopted in 1991, the Yugoslav Red Cross and the Hungarian Red Cross expressed their deep concern about “the protracting internal conflict in Yugoslavia” and urged the parties to the conflict “to refrain from armed actions against … sanitary establishments”. 
Yugoslav Red Cross and Hungarian Red Cross, Joint Statement, Subotica, 25 October 1991.
National Society (Croatia)
On several occasions in 1991, the Croatian Red Cross denounced attacks on medical objects by the Yugoslav army. 
Croatian Red Cross, Protest against violation of IHL rules, 24 September 1991; Appeal to stop attacks on hospitals and medical personnel by the Yugoslav forces, 22 November 1991.
ICRC
In a press release in 1992, the ICRC reminded the parties to the conflict in Nagorno-Karabakh of their obligation to respect and protect medical establishments. 
ICRC, Press Release No. 1670, Nagorno-Karabakh: ICRC calls for respect for humanitarian law, 12 March 1992.
ICRC
In a press release in 1992, the ICRC enjoined the parties to the conflict in Afghanistan “to respect medical personnel and establishments”. 
ICRC, Press Release No. 1712, Afghanistan: ICRC appeals for compliance with humanitarian rules, 5 May 1992; see also Press Release No. 1724, Kabul: ICRC urges respect for civilians as medical facilities struggle to cope, 20 July 1992 and Press Release No. 1726, Afghanistan: New ICRC appeal for compliance with humanitarian rules, 14 August 1992.
ICRC
In a press release in 1992, the ICRC appealed to all parties to the conflict in Bosnia and Herzegovina to instruct all combatants in the field to respect medical establishments. 
ICRC, Press Release No. 1725, Bosnia and Herzegovina: ICRC issues solemn appeal to all parties to conflict, 13 August 1992.
ICRC
In a press release in 1992, the ICRC urged the parties to the conflict in Tajikistan “to make certain that medical … establishments are respected and protected”. 
ICRC, Press Release, Tajikistan: ICRC urges respect for humanitarian rules, ICRC Dushanbe, 23 November 1992.
ICRC
In a press release in 1993 issued in the context of the conflict in Afghanistan, the ICRC stated:
Four rockets were fired at the Karte Seh surgical hospital in Kabul of 16 April. The International Committee of the Red Cross (ICRC) strongly condemns this and any other attack on the civilian population or medical facilities. Last Friday’s attack, which was launched during visiting hours, killed three people and injured 44. The injured, most of whom were relatives of patients, were treated on the spot. Following the attack, the ICRC immediately contacted the parties concerned and reminded them of their obligation under international humanitarian law to spare civilians and civilian property, in particular all medical facilities. 
ICRC, Press Release No. 1745, ICRC protests attack on Kabul hospital, 19 April 1993.
ICRC
In a communication to the press in 1993, the ICRC stated that it had appealed to all parties to the conflict in Georgia “to respect hospitals and medical personnel in all circumstances”. 
ICRC, Communication to the Press No. 93/32, Conflict in Georgia: ICRC action, 22 September 1993.
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 equipment [and] installations.” 
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 a communication to the press in 1994, the ICRC requested that the parties to the internal conflict in Mexico remove all military units from the vicinity of first-aid posts. 
ICRC, Communication to the Press No. 94/5, Mexico: ICRC ready to restore medical services in conflictual areas of Chiapas state, 5 February 1994.
ICRC
In 1994, in a Memorandum on Respect for International Humanitarian Law in Angola, the ICRC stated:
Hospitals, ambulances and other medical units … shall be protected and respected … Hospitals and medical units and means of transport shall not be the object of attack; they shall be used exclusively to give or to facilitate care and shall not be used to prepare or commit hostile acts. 
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 in 1994, the ICRC reminded the parties to the conflict in Afghanistan that medical establishments “are entitled to special protection and must be respected in all circumstances”. 
ICRC, Press Release No. 1764, Afghanistan: ICRC calls for respect for the civilian population, 8 February 1994; see also Press Release No. 1783, Afghanistan: ICRC urges respect for the civilian population, 16 August 1994.
ICRC
In a press release issued in 1994 in the context of the conflict in Bosnia and Herzegovina, the ICRC stated:
Special protection must be given to Bihac hospital, where more than a thousand casualties are being cared for at present. This means that … no attacks must be directed against the hospital itself or the hospital compound. … [The buildings and compound] must serve exclusively to provide medical care and must not be used to prepare for or engage in military acts [and] no arms must be deployed either inside the hospital, the hospital compound or in the immediate surroundings 
ICRC, Press Release No. 1792, Bihac: Urgent ICRC Appeal, 26 November 1994.
ICRC
In a press release in 1994, the ICRC enjoined the parties to the conflict in Chechnya “to ensure that medical … establishments … 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.
ICRC
In a press release in 1995, the ICRC expressed concern about an attack on a hospital in Burundi, which it regarded as a grave breach of IHL, and reminded the belligerents that all medical units must be respected. 
ICRC, Press Release No. 50, Burundi: Grenade lands in hospital room, 13 December 1995.
ICRC
In a communication to the press in 1996, the ICRC called on the parties to the conflict in Afghanistan “to avoid damage to any structure sheltering wounded or displaced people”.  
ICRC, Communication to the Press No. 96/29, Afghanistan: civilian population trapped in fighting, 26 September 1996.
ICRC
In a press release in 2000, following allegations that the Palestine Red Crescent Society had been targeted in shooting incidents, the ICRC stated: “Any attacks … on medical installations … 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 called on “all those involved in the violence to respect … hospitals and other medical establishments”. 
ICRC, Communication to the Press No. 00/42, ICRC appeal to all involved in violence in the Near East, 21 November 2000.
Americas Watch
Witness for Peace, an NGO that attempted to document abuses by the contras during the conflict in Nicaragua, reported several attacks on health facilities between 1987 and 1988. In 1988, in a report on human rights in Nicaragua, Americas Watch denounced these incidents, “because health workers, including those assisting the forces in the conflict, are the object of special protection under international humanitarian law”. 
Americas Watch, Human Rights in Nicaragua: August 1987–August 1988, New York, August 1988, pp. 124–125.
In a previous report in 1986, Americas Watch had already denounced the destruction of a health centre and the theft of medicine by contras, commenting that it was unclear whether the building was destroyed intentionally or not, as it was next to other defended buildings that the rebels were trying to take. The report concluded, however, that: “Even if the destruction of the health center was involuntary, the theft of medicine and the mistreatment of the health workers constitute violations of medical neutrality.” 
Americas Watch, Human Rights in Nicaragua: 1985–1986, New York, March 1986, pp. 108–109.
Africa Watch
In 1989, in a report on violations of the laws of war in Angola, Africa Watch stated that the targeting of medical objects was unlawful. 
Africa Watch, Angola: Violations of the Laws of War by Both Sides, New York, April 1989, pp. 147–148.
Instituto de Derechos Humanos de la Universidad Centroamericano
In a report on the offensive by the Farabundo Martí Front for National Liberation (FMLN) in El Salvador in November 1989, the Instituto de Derechos Humanos de la Universidad Centroamericano stated:
Available reports, on the other hand, indicate that the FMLN is responsible for the partial destruction of the regional hospital of Zacatecoluca. According to reports from the FMLN, the army had put an observation post on the roof of the building, thus converting it into a military objective. 
Instituto de Derechos Humanos de la Universidad Centroamericana, “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. 65.
International Institute of 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 International Institute of Humanitarian Law, provides: “The obligation to respect and protect … medical units … in the conduct of military operations is a general rule applicable in non-international armed conflicts.” 
International Institute of 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.
Médecins Sans Frontières (MSF)
In 1993, during the conflict in Somalia, MSF denounced an attack on its compound by UNOSOM II as a violation of the principle of immunity of medical installations and personnel. MSF stated:
The armed forces were aware of the nature and identity of the building. According to the latest reports available to MSF, this attack was generated by the suspect presence of a microphone boom at the back of a vehicle parked in front of the building. This microphone boom was apparently mistaken for a weapon. The nature of the retaliation appears out of all proportion to the nature of the threat. 
MSF, Communication on the violations of humanitarian law in Somalia during UNOSOM operations, 21 July 1993, § 1(a).
Médecins Sans Frontières (MSF)
In a communication to the press in 1994, MSF stated that the Government of Afghanistan had insisted that the attack that damaged the ICRC hospital had in no way been directed at it and that no party to the conflict would deliberately target a facility displaying the red cross emblem. MSF denounced, however, the indiscriminate shelling of hospitals in Kabul. It considered the incidents to be grave violations of the law of war and the right of the victims to safe health care. 
MSF-Switzerland, Communication to the Press concerning attacks on hospital facilities in Afghanistan, 6 January 1994.