United States of America
Practice Relating to Rule 29. Medical Transports
The US Field Manual (1956) restates Article 35 of the 1949 Geneva Convention I and Article 21 of the 1949 Geneva Convention IV.
The US Air Force Commander’s Handbook (1980) provides that ambulances … “should not be deliberately attacked, fired upon, or unnecessarily prevented from performing their medical duties”.
The Handbook further stresses that medical transports lose their special immunity if they are used to commit “acts harmful to the enemy outside their humanitarian functions”. In this respect, the manual gives the example of “firing at the enemy from an ambulance”.
The US Naval Handbook (1995) states: “medical vehicles … may not be deliberately bombarded. Belligerents are required to ensure that such medical facilities are, as far as possible, situated in such manner that attacks against military targets in the vicinity do not imperil their safety.”
The manual qualifies “deliberate attack upon … medical vehicles” as a war crime.
The US Naval Handbook (2007) states that “medical vehicles … may not be deliberately bombarded. Belligerents are required to ensure that such medical facilities are, as far as possible, situated in such a manner that attacks against military targets in the vicinity do not imperil their safety.”
The Handbook also states that examples of war crimes that could be considered as grave breaches of the 1949 Geneva Conventions include: “Deliberate attacks upon … medical vehicles.”
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.
In 1987, in submitting the 1977 Additional Protocol II to the US Senate for advice and consent to ratification, the US President expressed the view that the obligations in the Protocol were “no more than a restatement of the rules of conduct with which US military forces would almost certainly comply as a matter of national policy, constitutional and legal protections, and common decency”.
The US Field Manual (1956) restates Article 36 of the 1949 Geneva Convention I and adds:
It is not necessary that the aircraft should have been specially built and equipped for medical purposes. There is no objection to converting ordinary aircraft into medical aircraft or to using former medical aircraft for other purposes, provided the distinctive markings are removed.
The US Air Force Pamphlet (1976) states:
Generally, a medical aircraft (identified as such) should not be attacked unless under the circumstances at the time it represents an immediate military threat and other methods of control are not available. For example, this might occur when it approaches enemy territory or a combat zone without permission and disregards instructions, or initiates an attack. Attacks might also occur when the aircraft is not identified as a medical aircraft because of lack of agreement as to the height, time and route.
The Pamphlet further 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 protected medical aircraft”.
The US Air Force Commander’s Handbook (1980) provides:
Medical aircraft, recognized as such, should not be deliberately attacked or fired on. Medical aircraft are not permitted to fly over territory controlled by the enemy, without the enemy’s prior agreement. Medical aircraft must comply with requests to land for inspection. Medical aircraft complying with such a request must be allowed to continue their flight, with all personnel on board, if inspection does not reveal that the aircraft has engaged in acts harmful to the enemy or otherwise violated the Geneva Conventions of 1949.
The US Naval Handbook (1995) qualifies “deliberate attack upon … medical aircraft” as a war crime.
The US Naval Handbook (2007) states that examples of war crimes that could be considered as grave breaches of the 1949 Geneva Conventions include: “Deliberate attacks upon … medical aircraft.”
It is reported that in the Vietnam War, US army medical evacuation helicopters marked with the red cross emblem suffered a high loss rate from enemy fire, with the result that some medical evacuation units armed their helicopters with machine guns.
In 1987, the Deputy Legal Adviser of the US Department of State affirmed: “We support the principle that known medical aircraft be respected and protected when performing their humanitarian functions.” He added: “That is a rather general statement of what is reflected in many, but not all, aspects of the detailed rules in Articles 24 through 31, which include some of the more useful innovations in the Protocol.”
The Report on US Practice notes that US practice suggests that if enemy forces do not respect the protected status of medical units, the right of self-defence may justify the use of force.
The US Air Force Pamphlet (1976) states: “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 … hospital ships”.
The US Air Force Commander’s Handbook (1980) provides that ambulances and hospital ships “should not be deliberately attacked, fired upon, or unnecessarily prevented from performing their medical duties”.
The US Naval Handbook (1995) qualifies “deliberate attack upon hospital ships” as a war crime.
The US Naval Handbook (2007) states that examples of war crimes that could be considered as grave breaches of the 1949 Geneva Conventions include: “Deliberate attacks upon … hospital ships.”
The US Manual on Detainee Operations (2008) states:
Legal Considerations
a. As a subset of military operations, detainee operations must comply with the law of war during all armed conflicts, however such conflicts are characterized, and in all other military operations …
…
c. The four Geneva Conventions of 1949 are fully applicable as a matter of international law to all military operations that qualify as international armed conflicts … The principles reflected in these treaties are considered customary international law, binding on all nations during international armed conflict. Although often referred to collectively as the “Geneva Conventions,” the specific treaties are:
…
(2)
[1949] Geneva Convention [II] … This convention … protects hospital ships.