Practice Relating to Rule 25. Medical Personnel

Geneva Convention (1906)
Article 8(1) of the 1906 Geneva Convention lists among the conditions not depriving mobile sanitary formations and fixed establishments of the protection guaranteed by Article 6 of the Convention the fact “that the personnel of a formation or establishment is armed and uses its arms in self defense or in defense of its sick and wounded”. 
Convention for the Amelioration of the Condition of the Wounded and Sick in Armies in the Field, Geneva, 6 July 1906, Article 8(1).
Geneva Convention (1929)
Article 8(1) of the 1929 Geneva Convention lists among the conditions not depriving mobile medical formations and fixed establishments of the protection guaranteed by Article 6 of the Convention the fact “that the personnel of the formation or establishment is armed, and that they use the arms in their own defence or in that of the sick and wounded in charge”. 
Convention for the Amelioration of the Condition of the Wounded and Sick in Armies in the Field, Geneva, 27 July 1929, Article 8(1)
Geneva Convention I
Article 22(1) of the 1949 Geneva Convention I lists among the conditions not depriving fixed establishments and mobile medical units of the protection guaranteed by Article 19 of the 1949 Geneva Convention I the fact “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”. 
Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field, Geneva, 12 August 1949, Article 22(1).
Additional Protocol I
Under Article 13(2)(a) of the 1977 Additional Protocol I, the fact 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” shall not be considered as an act harmful to the enemy, depriving a medical unit of its protected status. 
Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts (Protocol I), Geneva, 8 June 1977, Article 13(2)(a). Article 13 was adopted by consensus. CDDH, Official Records, Vol. VI, CDDH/SR. 37, 24 May 1977, p. 70.
Additional Protocol II (draft)
Article 17(2) and (3)(a) of the draft Additional Protocol II, adopted by consensus in Committee II of the CDDH, provided:
2.The protection to which medical units and transports are entitled shall not cease unless they are used to commit, outside their humanitarian function, acts harmful to the adverse Party.
3.The following shall not be considered as harmful acts:
(a) that the personnel of the unit or the transport are equipped with light individual weapons for their own defence or for that of the wounded and sick for whom they are responsible. 
CDDH, Official Records, Vol. XIII, CDDH/221/Rev.1, 3 February–18 April 1975, p. 130, § 170 and p. 197.
Eventually, however, subparagraph (3) was deleted from Article 17 of the draft Additional Protocol II, which was then adopted by consensus in the plenary meeting of the CDDH. 
CDDH, Official Records, Vol. VII, CDDH/SR.51, 3 June 1977, p. 113.
No data.
Argentina
Argentina’s Law of War Manual (1969) lists among the conditions not depriving fixed establishments and mobile medical units of their protection “the fact that the personnel of the unit or establishment are armed and use their arms in their own defence or in that of the wounded and sick in their charge”. 
Argentina, Leyes de Guerra, RC-46-1, Público, II Edición 1969, Ejército Argentino, Edición original aprobado por el Comandante en Jefe del Ejército, 9 May 1967, § 3.007.
Australia
Australia’s Commanders’ Guide (1994) provides that military medical personnel lose their protection “if they engage in acts harmful to the enemy … Protection will not be lost if medical members act in self-defence. Defensive weapons such as side-arms may be carried.” 
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 that medical personnel “are protected so long as they do not participate in hostilities. The carriage of light individual weapons for self-defence or for defence of wounded or sick in their care is not considered participation.” 
Australia, Manual on Law of Armed Conflict, Australian Defence Force Publication, Operations Series, ADFP 37 – Interim Edition, 1994, § 521; see also §§ 911 and 964.
Australia
Australia’s LOAC Manual (2006) states that medical personnel “are protected so long as they do not participate in hostilities. The carriage of light individual weapons for self-defence or for defence of wounded or sick in their care is not considered participation.” 
Australia, The Manual of the Law of Armed Conflict, Australian Defence Doctrine Publication 06.4, Australian Defence Headquarters, 11 May 2006, § 5.23; see also §§ 9.11 and 9.69.
The LOAC Manual (2006) replaces both the Defence Force Manual (1994) and the Commanders’ Guide (1994).
Belgium
Belgium’s Law of War Manual (1983) states: “Medical personnel may carry arms but only to defend themselves or the patients in their charge.” 
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 provides: “The prohibition to attack hospitals remains applicable even if … its personnel carry light individual weapons for their own defence or for the defence of the wounded in their charge, the establishment or material.” 
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) states: “The use of weapons by medical personnel and by sentries of military medical establishments and transports is subject to regulation (e.g. in case of self-defence).” 
Benin, Le Droit de la Guerre, III fascicules, Forces Armées du Bénin, Ministère de la Défense nationale, 1995, Fascicule II, p. 16.
Burundi
Burundi’s Regulations on International Humanitarian Law (2007) states: “Medical personnel … may carry light individual weapons for their own defence or for the defence of the wounded and sick.” 
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, 25 and 57.
The Regulations also states: “The prohibition of attack remains valid even if the hospital is guarded by sentries or if the nurses carry light individual weapons for their own protection and the protection of the wounded, installations and 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.
Cameroon
Cameroon’s Instructor’s Manual (1992) states: “The weapons carried by medical personnel must be of such a nature as to avoid any confusion with combatants.” 
Cameroon, Droit international humanitaire et droit de la guerre, Manuel de l’instructeur en vigueur dans les Forces Armées, Présidence de la République, Ministère de la Défense, Etat-major des Armées, Troisième Division, Edition 1992, p. 87, § 142.
Cameroon
Cameroon’s Instructor’s Manual (2006), under the heading “Command Responsibility”, states: “The weapons of the medical personnel must be of a nature and proportion so as to avoid any confusion with the status of a combatant.” 
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. 220, § 142.
Canada
Canada’s LOAC Manual (1999) lists among the conditions not depriving medical units of their protection the fact “that the personnel of the medical unit are armed for their own defence or that of the wounded and sick in their charge”. 
Canada, The Law of Armed Conflict at the Operational and Tactical Level, Office of the Judge Advocate General, 1999, p. 4-9, § 91(a).
Canada
Canada’s Code of Conduct (2001) provides: “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.” 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 4 June 2001, Rule 10, § 6.
Canada
Canada’s LOAC Manual (2001) states in its chapter on targeting:
447. Medical units and establishments
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 …
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;
448. Medical transports
2. Medical transports should not be armed (i.e., crew-served weapons) because of the danger that they may be mistaken as fighting vehicles. Medical personnel in the medical transports can, however, retain their personal weapons. 
Canada, The Law of Armed Conflict at the Operational and Tactical Levels, Office of the Judge Advocate General, 13 August 2001, §§ 447.3, 4.a and 448.2.
Canada
Canada’s Code of Conduct (2005) provides:
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. As a general rule medical transports should not have any weapons “mounted” on them to avoid being mistaken for fighting vehicles. 
Canada, Code of Conduct for CF Personnel, Office of the Judge Advocate General, 2005, Rule 10, § 6.
Central African Republic
The Central African Republic’s Instructor’s Manual (1999) states in Volume 2 (Instruction for group and patrol leaders): “The use of arms by medical personnel and sentries guarding military medical establishments and transports are subject to regulation (for example, legitimate defence).” 
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 IV, Section IV.
Chad
Chad’s Instructor’s Manual (2006) states:
Medical personnel may carry light weapons for their own personal protection. Medical establishments and means of transport may be guarded by a person on guard duty, sentries or an escort, who are not, however, entitled to oppose the capture of the medical establishment or means of transport. They must bear distinctive signs. 
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. 56.
Ecuador
Ecuador’s Naval Manual (1989) provides:
Possession of small arms for self-protection, for the protection of the wounded and sick, and for protection from marauders and others violating the law of armed conflict does not disqualify medical personnel from protected status. Medical personnel may not use such arms against enemy forces acting in conformity with the law of armed conflict. 
Ecuador, Aspectos Importantes del Derecho Internacional Marítimo que Deben Tener Presente los Comandantes de los Buques, Academia de Guerra Naval, 1989, § 11.5.
France
France’s LOAC Summary Note (1992) provides that personnel of military and civilian medical services “may not take a direct part in hostilities [and] they may only be equipped with individual arms for their own protection”. 
France, Fiche de Synthèse sur les Règles Applicables dans les Conflits Armés, Note No. 432/DEF/EMA/OL.2/NP, Général de Corps d’Armée Voinot (pour l’Amiral Lanxade, Chef d’Etat-major des Armées), 1992, § 2.3.
Germany
Germany’s Military Manual (1992) provides:
Medical personnel may be equipped with individual weapons for the protection of the wounded, sick and shipwrecked in their charge as well as for their own protection. Individual weapons are pistols, submachine guns and rifles. 
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, § 631; see also §§ 315 and 619.
Ireland
Ireland’s Basic LOAC Guide (2005) states: “Medical personnel may be armed with light individual weapons for their own protection and the protection of persons under their care.” 
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.
Kenya
Kenya’s LOAC Manual (1997) states: “Medical personnel may carry and use small arms for their self-defence and for the defence of the wounded and sick in their care.” 
Kenya, Law of Armed Conflict, Military Basic Course (ORS), 4 Précis, The School of Military Police, 1997, Précis No. 3, p. 9.
Netherlands
The Military Manual (1993) of the Netherlands provides:
Medical personnel may be armed with pistols, sub-machine guns and rifles, but not with machine guns or other weapons that have to be handled by more than one person, or with weapons that are meant for use against material objects, such as missile launchers and other anti-tank weapons, nor with fragmentation hand grenades and the like. 
Netherlands, Toepassing Humanitair Oorlogsrecht, Voorschift No. 27-412/1, Koninklijke Landmacht, Ministerie van Defensie, 1993, p. VI-5.
Netherlands
The Military Handbook (1995) of the Netherlands states:
Medical personnel may not in any way take part in hostilities, but they may be armed. They may, however, only use these weapons to defend themselves or the wounded and sick in their care and not, for example, to prevent being captured by the enemy. 
Netherlands, Handboek Militair, Ministerie van Defensie, 1995, pp. 7-40/7-41.
Netherlands
The Military Manual (2005) of the Netherlands states:
0618. Medical and religious personnel are non-combatants. They may not take part in hostilities. However, medical personnel may bear arms – see point 0621. If they fall into enemy hands, medical personnel are not considered as prisoners of war.
0621. In relation to medical personnel bearing arms, the rule is that they may carry a personal firearm such as a pistol, automatic pistol or rifle. Medical personnel may not be armed with machine guns or other support weapons. They must not bear weapons designed for use against materiel targets, such as rocket launchers and other anti-tank weapons, or fragmentation hand grenades, etc. They may fire their weapons in self-defence, for the defence of the wounded and sick in their care, and to preserve order and calm within the medical institution. 
Netherlands, Humanitair Oorlogsrecht: Handleiding, Voorschift No. 27-412, Koninklijke Landmacht, Militair Juridische Dienst, 2005, §§ 0618 and 0621.
Nigeria
Nigeria’s Manual on the Laws of War states that the protection of medical establishments is not forfeited “merely because medical personnel are armed for self-defence”. 
Nigeria, The Laws of War, by Lt. Col. L. Ode PSC, Nigerian Army, Lagos, undated, § 36.
Norway
Norway’s Medical Services Directive (2009) states:
(1) Medical personnel can be issued with and use personal weapons, which include pistol, machine gun, gun and rifle. These types of weapons should only be used in self-defence purposes.
(2) Medical personnel do not lose the protection they are entitled to if they are in a self-defence situation, using the weapon that are otherwise available to achieve a genuine self-defence, even if these weapons would be other weapons than personal weapons as defined in the first paragraph. 
Norway, Directive on Compliance with Certain International Law Obligations Concerning the Medical Services, Chief of Defence, Defence Staff Norway, 1 May 2009, § 5(1)–(2).
Peru
Peru’s IHL Manual (2004) states:
Medical personnel may only carry light individual weapons and are only permitted to use them to defend themselves and the wounded in their charge.
The weapons carried by medical personnel are limited to light, individual firearms, which can only be used for the purposes mentioned above. If they try to resist a military advance using weapons, they lose their “neutrality” in the conflict and, therefore, their right to protection, unless the enemy deliberately tries to kill the wounded and sick or the medical personnel themselves. 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 83.d.
The manual also states: “Regulations must be established governing the use of weapons by medical personnel, sentries guarding establishments and military medical transports to ensure that they are not confused with people taking a direct part in the hostilities.” 
Peru, Manual de Derecho Internacional Humanitario para las Fuerzas Armadas, Resolución Ministerial Nº 1394-2004-DE/CCFFAA/CDIH-FFAA, Lima, 1 December 2004, § 24.d.(2).(c).
Peru
Peru’s IHL and Human Rights Manual (2010) states:
Medical personnel may only carry light individual weapons and are only permitted to use them to defend themselves and the wounded in their charge.
The weapons carried by medical personnel are limited to light, individual firearms, which can only be used for the purposes mentioned above. If they try to resist a military advance using weapons, they lose their “neutrality” in the conflict and, therefore, their right to protection, unless the enemy deliberately tries to kill the wounded and sick or the medical personnel themselves. 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 74(d), p. 227; see also § 79(b)(1), p. 280.
The manual also states: “Regulations must be established governing the use of weapons by medical personnel, sentries guarding establishments and military medical transports to ensure that they are not confused with people taking a direct part in the hostilities.” 
Peru, Manual de Derecho Internacional Humanitario y Derechos Humanos para las Fuerzas Armadas, Resolución Ministerial No. 049-2010/DE/VPD, Lima, 21 May 2010, § 25(d)(2)(c), p. 229.
Russian Federation
The Russian Federation’s Regulations on the Application of IHL (2001) states: “Military medical personnel may have individual small arms for their own defence and protection of the wounded and sick in their charge.” 
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.
The Regulations further states:
Medical transports are allowed to carry individual small arms and ammunition taken from the transported wounded (sick) and shipwrecked as well as individual small arms of the transported military medical personnel. 
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, § 152.
Sierra Leone
Sierra Leone’s Instructor Manual (2007) states:
[M]edical personnel may carry a Light Individual Weapon (LIW) for self-defence and for the protection of patients under their care from unlawful attack.
Authorized Use of Arms
… medical personnel may use their arms:
- When they or a patient under their care are attacked by marauders, bandits or other persons violating the law of war.
- Medical personnel would be allowed to use his weapon without losing their special protection, if, for example, an enemy soldier enters a medical facility and start killing medical staff or patients.
- Medical personnel may also use his light individual weapon when serving on special duties. For example, when serving on sentry, or guard duty. Such use should however be limited to protecting medical installations, personnel, wounded and sick.
- The Light Individual Weapon may also be used by medical personnel in self-defence; if, for example, the enemy has fired upon him, his medical unit or those under its care.
Unauthorized Use of Arms
Medical personnel should not use their weapon against enemy forces acting in accordance with the law of war … Medical personnel will forfeit their protected status and may be attacked if they unlawfully use their weapon. 
Sierra Leone, The Law of Armed Conflict. Instructor Manual for the Republic of Sierra Leone Armed Forces (RSLAF), Armed Forces Education Centre, September 2007, pp. 57–58.
[emphasis in original]
South Africa
South Africa’s LOAC Manual (1996) provides:
Medical personnel must abstain from all acts of hostility or they lose their protection. They are authorised to carry only light arms and have the right to use them only for their own defence or for that of the wounded or sick for whom they are responsible. 
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, § 48. This manual is also included in Chapter 4 of the Draft Civic Education Manual of 1997.
South Africa
South Africa’s Revised Civic Education Manual (2004) states:
Medical … personnel must abstain from all acts of hostility or they lose their protection. They are authorised to carry only light arms and have the right to use them only for their own defence or for that of the wounded and sick for whom they are responsible. 
South Africa, Revised Civic Education Manual, South African National Defence Force, 2004, Chapter 4, § 64.
South Africa
South Africa’s LOAC Teaching Manual (2008) states:
Military medical personnel and military religious personnel are entitled to be armed with light individual weapons for their own protection or for that of the wounded and sick in their care. ([1949] Geneva Convention I article 22, [1949] Geneva Convention II article 35 and [1977] Additional Protocol I article 28.)
Geneva Convention I article 22, provides for specific aspects which do NOT cause medical institutions or units to lose their protection:
- The Carrying or Presence of Weapons
- Medical personnel have the right to carry light weapons and may use such weapons, if necessary, in their own defence or in that of the wounded and sick in their charge.
- They must nevertheless refrain from any aggressive action and may not use force to prevent the capture of the Unit.
Conclusion
… Military medical and religious institutions, units and transportation can lose their right to protection if used to commit acts which are harmful to the enemy and which are outside their humanitarian duties. However, they do not forfeit their protection in the following instances:
- If they carry light weapons for personal protection. 
South Africa, Advanced Law of Armed Conflict Teaching Manual, School of Military Justice, 1 April 2008, as amended to 25 October 2013, Learning Unit 2, pp. 62, 66–67 and 69.
[emphasis in original]
Spain
Spain’s LOAC Manual (1996) states that military medical personnel
may carry arms for self-defence and for the defence of the wounded, sick and shipwrecked. They may not use them to avoid being taken prisoner. Using these arms in combat will terminate the protection to which they are entitled. 
Spain, Orientaciones. El Derecho de los Conflictos Armados, Publicación OR7-004, 2 Tomos, aprobado por el Estado Mayor del Ejército, División de Operaciones, 18 March 1996, Vol. I, § 4.5.b.(1)(b); see also § 9.6.b.(2).
Spain
Spain’s LOAC Manual (2007) states with regard to medical personnel of the armed forces:
Medical personnel can carry weapons to defend themselves and the wounded, sick and shipwrecked in their charge. They must not use these weapons to avoid being captured or taken prisoner. If they use these weapons in acts of war, they will lose their entitlement to 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.(1).(b); see also §§ 3.2.a and 9.6.b.(2).
The manual also states:
The following are not considered harmful to the adverse party: medical personnel equipped with light individual weapons for their own defence or for that of the wounded and sick in their charge; medical units guarded by pickets, sentries or escorts … 
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, § 7.3.a.(10).
Switzerland
Switzerland’s Basic Military Manual (1987) states: “Medical personnel may be armed with light weapons for its own defence.” 
Switzerland, Lois et coutumes de la guerre (Extrait et commentaire), Règlement 51.7/II f, Armée Suisse, 1987, Article 78(2); see also Article 83, commentary.
Switzerland
Switzerland’s Regulation on Legal Bases for Conduct during an Engagement (2005) states:
178 For their own protection, medical personnel may be armed with a personal weapon (e.g. assault rifle, submachine gun, pistol). Explosive weapons and collective weapons are prohibited. Medical personnel do not participate in hostilities, except for their own protection or for the protection of the patients in their care. Nor must they be engaged in other harmful acts (e.g. intelligence services). 
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, § 179.
Togo
Togo’s Military Manual (1996) states: “The use of weapons by medical personnel and by sentries of military medical establishments and transports is subject to regulation (e.g. in case of self-defence).” 
Togo, Le Droit de la Guerre, III fascicules, Etat-major Général des Forces Armées Togolaises, Ministère de la Défense nationale, 1996, Fascicule II, p. 16.
Ukraine
Ukraine’s IHL Manual (2004) states: “Medical personnel of the armed forces may carry light individual weapons for self-defence and to defend wounded and sick”. 
Ukraine, Manual on the Application of IHL Rules, Ministry of Defence, 11 September 2004, § 1.2.34.
United Kingdom of Great Britain and Northern Ireland
The UK Military Manual (1958) lists among the conditions not depriving hospitals and mobile medical units of their protection the fact that “the personnel are armed, and use their arms for their own defence or for the defence of the wounded and sick”. 
United Kingdom, The Law of War on Land being Part III of the Manual of Military Law, The War Office, HMSO, 1958, § 352.
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Pamphlet (1981) provides: “Medical personnel may carry and use small arms for their self-defence and for the defence of the wounded and sick in their care.” 
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, § 9(b).
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Manual (2004) states:
7.15. Medical personnel may be equipped with “light individual weapons for their own defence or for that of the wounded and sick in their charge.”
7.15.1. Light individual weapons are those that can be handled and fired by one person and primarily intended for personnel targets. It follows that medical personnel may be armed with sub-machine guns, self-loading rifles and handguns. It should be stressed that the provision and use of these arms must be merely for defensive purposes as outlined above. Medical personnel (and chaplains) are non-combatants so they are not otherwise entitled to take part in hostilities. Medical personnel may use their weapons only if they, or those in their care, are attacked. 
United Kingdom, The Manual of the Law of Armed Conflict, Ministry of Defence, 1 July 2004, §§ 7.15–7.15.1.
United Kingdom of Great Britain and Northern Ireland
The UK LOAC Manual (2004), as amended in 2010, states: “Medical personnel do not forfeit their protection under Geneva Convention I 1949 by being armed with light individual weapons and by using those arms in their own defence or in the defence of the wounded and sick in their charge.” 
United Kingdom, The Manual of the Law of Armed Conflict, Ministry of Defence, 1 July 2004, as amended by Amendment 3, Ministry of Defence, September 2010, § 4.2.3.
United States of America
The US Field Manual (1956) states:
Although medical personnel may carry arms for self-defense, they may not employ such arms against enemy forces acting in conformity with the law of war. These arms are for their personal defense and for the protection of the wounded and sick under their charge against marauders and other persons violating the law of war. 
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, § 223(b).
United States of America
The US Air Force Commander’s Handbook (1980) states: “Medical personnel are permitted to carry arms solely to protect themselves and their patients against unlawful attack.” 
United States, Air Force Pamphlet 110-34, Commander’s Handbook on the Law of Armed Conflict, Judge Advocate General, US Department of the Air Force, 25 July 1980, § 3-2(d).
United States of America
The US Naval Handbook (1995) states:
Possession of small arms for self-protection, for the protection of the wounded and sick, and for protection from marauders and others violating the law of armed conflict does not disqualify medical personnel from protected status. Medical personnel may not use such arms against enemy forces acting in conformity with the law of armed conflict. 
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), § 11.5.
United States of America
The Annotated Supplement to the US Naval Handbook (1997) notes that “there was no agreement at the [CDDH] as to what “light individual weapons” for self-defence and for the defence of patients meant, although a number of military experts agreed with the British proposal (see infra). 
United States, Annotated Supplement to the Commander’s Handbook on the Law of Naval Operations, prepared by the Oceans Law and Policy Department, Center for Naval Warfare Studies, Naval War College, Newport, Rhode Island, November 1997, § 11.5, footnote 32.
United States of America
The US Naval Handbook (2007) states:
Medical personnel may possess small arms for self-protection or for the protection of the wounded and sick in their care against marauders and others violating the law of armed conflict. Medical personnel may not use such arms against enemy forces acting in conformity with the law of armed conflict. 
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, § 8.2.4.1.
Yugoslavia, Socialist Federal Republic of
The Socialist Federal Republic of Yugoslavia’s Military Manual (1988) provides that military medical personnel may carry light weapons for their self-defence. Such personnel is authorized to engage in armed resistance against enemy armed forces directly and deliberately attacking, in spite of warning, and against marauders. 
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, §§ 171–172.
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).
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).
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 of the Geneva Convention I and Article 22 of the Geneva Convention II, and of the 1977 Additional Protocol I, including violations of Article 13(2)(a), are punishable offences. 
Ireland, Geneva Conventions Act, 1962, as amended in 1998, Section 4(1) and (4).
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.
Sweden
Sweden’s Total Defence Ordinance relating to IHL (1990) provides: “Those assigned in war time to the armed forces health and medical services may only carry light personal arms.” 
Sweden, Total Defence Ordinance relating to IHL, 1990, Section 10, p. 181.
Switzerland
Switzerland’s Ordinance on the Red Cross Service (2006) states:
Article 1 Object and scope of application
1 The present ordinance regulates:
a. the attribution of the members of the Red Cross Service (RCS) to the army;
Article 9 Arming
1 In principle, members of the RCS carry out their tasks unarmed.
2 On request, the army can equip them with a pistol as an individual weapon and instruct them about their use. 
Switzerland, Ordinance on the Red Cross Service, 2006, Articles 1(1)(a) and 9(1)–(2).
South Africa
In 1987, in the Petane case, the Cape Provincial Division of South Africa’s Supreme Court dismissed the accused’s claim that the 1977 Additional Protocol I reflected customary international law. The Court stated:
The accused has been indicted before this Court on three counts of terrorism, that is to say, contraventions of s 54(1) of the Internal Security Act 74 of 1982. He has also been indicted on three counts of attempted murder.
The accused’s position is stated to be that this Court has no jurisdiction to try him.
… The point in its early formulation was this. By the terms of [the 1977 Additional] Protocol I to the [1949] Geneva Conventions the accused was entitled to be treated as a prisoner-of-war. A prisoner-of-war is entitled to have notice of an impending prosecution for an alleged offence given to the so-called “protecting power” appointed to watch over prisoners-of-war. Since, if such a notice were necessary, the trial could not proceed without it, Mr Donen suggested that the necessity or otherwise for giving such a notice should be determined before evidence was led. …
On 12 August 1949 there were concluded at Geneva in Switzerland four treaties known as the Geneva Conventions. …
South Africa was among the nations which concluded the treaties. … Except for the common art 3, which binds parties to observe a limited number of fundamental humanitarian principles in armed conflicts not of an international character, they apply to wars between States.
After the Second World War many conflicts arose which could not be characterised as international. It was therefore considered desirable by some States to extend and augment the provisions of the Geneva Conventions, so as to afford protection to victims of and combatants in conflicts which fell outside the ambit of these Conventions. The result of these endeavours was Protocol I and Protocol II to the Geneva Conventions, both of which came into force on 7 December 1978.
Protocol II relates to the protection of victims of non-international armed conflicts. Since the State of affairs which exists in South Africa has by Protocol I been characterised as an international armed conflict, Protocol II does not concern me at all.
The extension of the scope of art 2 of the Geneva Conventions was, at the time of its adoption, controversial. …
The article has remained controversial. More debate has raged about its field of operation than about any other articles in Protocol I. …
South Africa is one of the countries which has not acceded to Protocol I. Nevertheless, I am asked to decide, as I indicated earlier, as a preliminary point, whether Protocol I has become part of customary international law. If so, it is argued that it would have been incorporated into South African law. If it has been so incorporated it would have to be proved by one or other of the parties that the turmoil which existed at the time when the accused is alleged to have committed his offences was such that it could properly be described as an “armed conflict” conducted by “peoples” against a “ra[c]ist regime” in the exercise of their “right of self-determination”. Once all this has been shown it would have to be demonstrated to the Court that the accused conducted himself in such a manner as to become entitled to the benefits conferred by Protocol I on combatants, for example that, broadly speaking, he had, while he was launching an attack, distinguished himself from civilians and had not attacked civilian targets. …
… I am prepared to accept that where a rule of customary international law is recognised as such by international law it will be so recognised by our law.
To my way of thinking, the trouble with the first Protocol giving rise to State practice is that its terms have not been capable of being observed by all that many States. At the end of 1977 when the treaty first lay open for ratification there were few States which were involved in colonial domination or the occupation of other States and there were only two, South Africa and Israel, which were considered to fall within the third category of ra[c]ist regimes. Accordingly, the situation sought to be regulated by the first Protocol was one faced by few countries; too few countries in my view, to permit any general usage in dealing with armed conflicts of the kind envisaged by the Protocol to develop.
Mr Donen contended that the provisions of multilateral treaties can become customary international law under certain circumstances. I accept that this is so. There seems in principle to be no reason why treaty rules cannot acquire wider application than among the parties to the treaty.
Brownlie Principles of International Law 3rd ed at 13 agrees that non-parties to a treaty may by their conduct accept the provisions of a multilateral convention as representing general international law. …
I incline to the view that non-ratification of a treaty is strong evidence of non-acceptance.
It is interesting to note that the first Protocol makes extensive provision for the protection of civilians in armed conflict. …
In this sense, Protocol I may be described as an enlightened humanitarian document. If the strife in South Africa should deteriorate into an armed conflict we may all one day find it a cause for regret that the ideologically provocative tone of s 1(4) has made it impossible for the Government to accept its terms.
To my mind it can hardly be said that Protocol I has been greeted with acclaim by the States of the world. Their lack of enthusiasm must be due to the bizarre mixture of political and humanitarian objects sought to be realised by the Protocol. …
According to the International Review of the Red Cross (January/February 1987) No 256, as at December 1986, 66 States were parties to Protocol I and 60 to Protocol II, which, it will be remembered, deals with internal non-international armed conflicts. With the exception of France, which acceded only to Protocol II, not one of the world’s major powers has acceded to or ratified either of the Protocols. This position should be compared to the 165 States which are parties to the Geneva Conventions.
This approach of the world community to Protocol I is, on principle, far too half-hearted to justify an inference that its principles have been so widely accepted as to qualify them as rules of customary international law. The reasons for this are, I imagine, not far to seek. For those States which are contending with “peoples[’]” struggles for self-determination, adoption of the Protocol may prove awkward. For liberation movements who rely on strategies of urban terror for achieving their aims the terms of the Protocol, with its emphasis on the protection of civilians, may prove disastrously restrictive. I therefore do not find it altogether surprising that Mr Donen was unable to refer me to any statement in the published literature that Protocol I has attained the status o[f] customary international [law].
I have not been persuaded by the arguments which I have heard on behalf of the accused that the assessment of Professor Dugard, writing in the Annual Survey of South African Law (1983) at 66, that “it is argued with growing conviction that under contemporary international law members of SWAPO [South-West Africa People’s Organisation] and the ANC [African National Congress] are members of liberation movements entitled to prisoner-of-war status, in terms of a new customary rule spawned by the 1977 Protocols”, is correct. On what I have heard in argument I disagree with his assessment that there is growing support for the view that the Protocols reflect a new rule of customary international law. No writer has been cited who supports this proposition. Here and there someone says that it may one day come about. I am not sure that the provisions relating to the field of application of Protocol I are capable of ever becoming a rule of customary international law, but I need not decide that point today.
For the reasons which I have given I have concluded that the provisions of Protocol I have not been accepted in customary international law. They accordingly form no part of South African law.
This conclusion has made it unnecessary for me to give a decision on the question of whether rules of customary international law which conflict with the statutory or common law of this country will be enforced by its courts.
In the result, the preliminary point is dismissed. The trial must proceed. 
South Africa, Supreme Court, Petane case, Judgment, 3 November 1987, pp. 2–8.
South Africa
In 2010, in the Boeremag case, South Africa’s North Gauteng High Court stated:
In Petane, … Conradie J found that the provisions of [the 1977 Additional] Protocol I are not part of customary international law, and therefore are also not part of South African law.
Referring to the fact that in December 1986 only 66 of the 165 States party to the Geneva Conventions had ratified Protocol I, the Court [in Petane] stated:
This approach of the world community to Protocol I is, on principle, far too half-hearted to justify an inference that its principles have been so widely accepted as to qualify them as rules of customary international law. The reasons for this are, I imagine, not far to seek. For those States which are contending with “peoples[’]” struggles for self-determination, adoption of the Protocol may prove awkward. For liberation movements who rely on strategies of urban terror for achieving their aims the terms of the Protocol, with its emphasis on the protection of civilians, may prove disastrously restrictive. I therefore do not find it altogether surprising that Mr Donen was unable to refer me to any statement in the published literature that Protocol I has attained the status of customary international law.
Important changes with respect to certain aspects applicable at the time of Petane have taken place. The ANC [African National Congress] has become South Africa’s ruling party and in 1995 ratified Protocol I. The total number of States that have ratified it, is now … 162.
This last aspect forms the basis on which the First Respondent [the State] and the applicants agree that Protocol I forms part of customary international law as well as of South African law. As requested, this position is accepted for the purposes of the decision, without deciding on the matter.
Despite these changes, it remains debatable whether the provisions of Protocol I have become a part of South African law in this way.
The consensus of both parties to the conflict is required. See Petane … and Article 96 of Protocol I. …
Parliament’s failure to incorporate Protocol I into legislation in accordance with Article 231(4) of the Constitution in fact points to the contrary, and is indicative that the requirements of usus and/or opinio juris have not been met. See Petane. 
South Africa, North Gauteng High Court, Boeremag case, Judgment, 26 August 2010, pp. 21–22.
[footnotes in original omitted]
The Court also held:
If the [1977 Additional Protocol I] applies in South Africa as customary international law, the two requirements that form the basis of customary law must be met. It is arguable that the requirement of usus has been met by the vast number of States that have acceded or ratified it. By ratifying Protocol I the Republic of South Africa has indicated its intention to apply the Protocol, thereby fulfilling the requirement of opinio juris. 
South Africa, North Gauteng High Court, Boeremag case, Judgment, 26 August 2010, p. 66.
Germany
In 2005, in reply to a written question by a Member of the Bundestag (Lower House of Parliament), Germany’s Parliamentary State Secretary, Ministry of Defence, wrote:
Male and female members of the medical service currently do service involving the use of arms only in the context of the ISAF [International Security Assistance Force] mission, namely in the form of guard duty. Currently, about 300 male and female members of the medical service are employed in Kabul. Overall, they do 20 guard duty shifts per week.
The use of male and female members of the medical service for guard duty in this context does not give cause to legal concerns. Federal law contains no provision according to which members of the medical service of the Federal Armed Forces would not be allowed to do guard duty.
The peace missions of the Federal Armed Forces and the right of the contingents to defend themselves by means of the guard duty are to be judged under international law mainly against the UN mandates which are at the basis of the deployments as well as against status of forces agreements, which do not exclude guard duty by male and female members of the medical service.
Special features of international law apply to members of the medical service not in peace time, but in times of armed conflicts. According to Article 24 of Geneva Convention I for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field of 12 August 1949, medical personnel exclusively engaged in the search for, or the collection, transport or treatment of the wounded or sick, or in the prevention of disease, as well as staff exclusively engaged in the administration of medical units and establishments shall be respected and protected in all circumstances. Article 22 further shows that in international armed conflicts the male and female members of the medical service may protect themselves and the wounded and sick also with arms, without losing their special protection under international law. The ISAF mission, however, does not take place in the context of an international armed conflict.
As regards the ISAF mission, international law provisions do not limit the use of members of the medical service for guard duty, during which they need to abstain from wearing the armlet with the protective emblem. The right of male and female members of the medical service to wear an armlet with the protective emblem (red cross on a white ground) is regulated by international law. On the basis of a special provision also applicable in times of peace (Article 44 of Geneva Convention I for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field of 12 August 1949) the distinctive emblem must not be worn when fulfilling duties other than medical service duties. 
Germany, Bundestag, Written questions with the replies by the Federal Government received from 18 October to 5 November 2005, Reply by Parliamentary State Secretary, Ministry of Defence, 26 October 2005, BT-Drs. 16/48, 4 November 2005, pp. 16–17.
Hungary
At the CDDH, Hungary stated: “The proposal that civilian medical units should be armed was a new one which his delegation was not prepared to endorse fully at that stage, although it did not wish to exclude it completely.” 
Hungary, Statement at the CDDH, Official Records, Vol. XI, CDDH/SR.14, 7 March 1974, p. 128, § 67.
India
The Report on the Practice of India states: “Medical and religious personnel are also authorised to wear their personal arms for their individual safety.” 
Report on the Practice of India, 1997, Answers to additional questions on Chapter 2.7.
Kuwait
The Report on the Practice of Kuwait states that medical personnel are authorized to defend themselves. 
Report on the Practice of Kuwait, 1997, Chapter 2.7.
Philippines
On the basis of an interview with an officer of the armed forces, the Report on the Practice of the Philippines states that members of the medical corps are not allowed to carry arms, except when in garrison, “because they become the target of the enemy”. 
Report on the Practice of the Philippines, 1997, Interview with an officer of the armed forces, Chapter 2.7.
Union of Soviet Socialist Republics
In a plenary meeting of the CDDH, the representative of the USSR stated that he:
thought the deletion of paragraph 3 [of Article 17 of the draft Additional Protocol II] would enormously complicate matters for medical personnel in actual combat conditions. If, for instance, an army doctor disarmed a wounded soldier and failed to throw away the weapon, would he thereby forfeit his right to protection? He appealed to the representative of Pakistan to restore paragraph 3. 
USSR, Statement at the CDDH, Official Records, Vol. VII, CDDH/SR.51, 3 June 1977, p. 113, § 45.
United Kingdom of Great Britain and Northern Ireland
The Report on UK Practice refers to a letter from an army lawyer who, after consultation with the medical-legal department, confirmed that medical personnel may carry a weapon for the purposes of self-defence and defence of their patients only. He also noted that, during the Gulf War, a certain commander of a field hospital would not allow any weapons at all within the hospital confines, even for self-defence. 
Report on UK Practice, 1997, Letter from an army lawyer, 3 March 1998, Chapter 2.7.
United States of America
At the CDDH, the United States “agreed that the carrying of arms by civilian medical personnel … should not be considered as harmful, but in occupied territories or in areas in which fighting was taking place, the right of the party in control of the area to disarm such personnel should be reserved”. 
United States, Statement at the CDDH, Official Records, Vol. XI, CDDH/SR.14, 7 March 1974, p. 128, § 66.
United States of America
According to the Report on US Practice, it is the opinio juris of the United States that
[medical] personnel and medical vehicles may be armed, but in international armed conflicts, they may use their weapons only in self-defence and in defence of their patients against marauders and against those enemy forces that do not respect their protected status. 
Report on US Practice, 1997, Chapter 2.7.
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ICRC
The ICRC’s Commentary on the Additional Protocols, on the interpretation of the expression “light individual weapons”, states:
This expression was not defined, but it appears from the discussions in Committee II … that it refers to weapons which are generally carried and used by a single individual. Thus not only hand weapons such as pistols are permitted, but also rifles or even sub-machine guns. On the other hand, machine guns and any other heavy arms which cannot easily be transported by an individual and which have to be operated by a number of people are prohibited. Thus it is evident that the level of acceptance is quite high. However, this is the case above all to prevent the unit’s right to protection from being suppressed too easily. 
Yves Sandoz et al. (eds.), Commentary on the Additional Protocols, ICRC, Geneva, 1987, § 563.
ICRC
To fulfil its task of disseminating IHL, the ICRC has delegates around the world teaching armed and security forces that: “Medical personnel may be armed with light individual weapons for their own protection or for that of the wounded and sick in their charge.” 
Frédéric de Mulinen, Handbook on the Law of War for Armed Forces, ICRC, Geneva, 1987, § 76.
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