United States of America
Practice Relating to Rule 25. Medical Personnel
The US Field Manual (1956) grants respect and protection to both permanent and temporary medical personnel as provided for in Articles 24–25 of the 1949 Geneva Convention I. The manual states:
The respect and protection accorded personnel by Articles 19, 24, and 25 [of the 1949 Geneva Convention I] mean that they must not knowingly be attacked, fired upon, or unnecessarily prevented from discharging their proper functions. The accidental killing or wounding of such personnel, due to their presence among or in proximity to combatant elements actually engaged, by fire directed at the latter, gives no just cause for complaint.
Protection is also granted to the personnel of aid societies by reference to Article 26 of the 1949 Geneva Convention I.
The US Air Force Pamphlet (1976) refers to the protection of medical personnel as set out in the 1949 Geneva Convention I.
The Pamphlet further 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 … medical … personnel”.
The US Air Force Commander’s Handbook (1980) provides that medical personnel, civilian or military, “should not be deliberately attacked, fired upon, or unnecessarily prevented from performing their medical duties. The same protection should also be given to any civilian or group of civilians trying to aid the sick and wounded after combat”.
The US Naval Handbook (1995) states:
Medical personnel, including medical and dental officers, technicians and corpsmen, nurses, and medical service personnel, have special protected status when engaged exclusively in medical duties and may not be attacked.
The manual qualifies “deliberate attack upon … medical personnel” as a war crime.
The Annotated Supplement to the US Naval Handbook (1997) notes: “The United States supports the principle in [Article 15 of the 1977 Additional Protocol I] that civilian medical … personnel be respected and protected and not be made the objects of attack”.
The US Naval Handbook (2007) states:
Medical personnel of the armed forces, including medical and dental officers, technicians and corpsmen, nurses, and medical service personnel, have special protected status when engaged exclusively in medical duties. In exchange for this protection, medical personnel must not commit acts harmful to the enemy. If they do, they risk losing their protection as noncombatants and could be attacked.
The Handbook also states:
Noncombatants [§ 5.4.2. – “Noncombatants are those members of the armed forces who do not take direct part in hostilities because of their status as medical personnel and chaplains”] may not be deliberately or indiscriminately attacked, unless they forgo their protection by taking a direct part in hostilities.
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 personnel.”
The Handbook also states:
Medical personnel … falling into enemy hands … unless their retention by the enemy is required to provide for the medical … needs of prisoners of war, … must be repatriated at the earliest opportunity.
The US Manual for Military Commissions (2010), Part IV, Crimes and Elements, states: “The term ‘protected person’ means any person entitled to protection under one or more of the  Geneva Conventions, including … military medical … personnel.”
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:
(2) PROTECTED PERSON. – The term “protected person” means any person entitled to protection under one or more of the Geneva Conventions, including –
(C) military medical or religious personnel.
The US Military Commissions Act (2009) amends Chapter 47A of Title 10 of the United States Code as follows:
“§ 950p. Definitions; construction of certain offenses; common circumstances
“(a) DEFINITIONS.—In this subchapter:
“(2) The term “protected person” means any person entitled to protection under one or more of the  Geneva Conventions, including … military medical … personnel.
David Hicks, an Australian citizen, was captured in Afghanistan in December 2001 and afterwards detained at Guantanamo Bay Naval Base, Cuba. In March 2007, in the Hicks case, the accused became the first person to be tried and convicted under the US Military Commissions Act of 2006. Following a pre-trial agreement struck with the Convening Authority, the accused pleaded guilty to the charge of “providing material support for terrorism”. In April 2007, Hicks returned to Australia to serve the remaining nine months of a suspended seven-year sentence. In the case’s record of trial for the 30 March 2007 hearing, the military judge defined various terms contained in the charge to which the accused had pleaded guilty:
“Protected person” means any person entitled to protection under one or more of the Geneva Conventions, including: (a) civilians not taking part in hostilities; (b) military personnel placed hors de combat by sickness, wounds, or detention; and (c) military medical or religious personnel.
At the CDDH, the United States stated that Committee II of the CDDH “was not competent to take a decision to apply to the 1949 Geneva Conventions the terms defined in Article 8”.
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 Additional Protocol II are 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.
In 1987, the Deputy Legal Adviser of the US Department of State affirmed that “we support the principle that medical and religious personnel must be respected and protected” as provided in Article 15 of the 1977 Additional Protocol I.
In 1991, in a diplomatic note to Iraq concerning operations in the Gulf War, the United States stated that medical personnel must be respected and protected at all times.
In 1996, the US Department of State qualified the killing of six ICRC medical aid workers in Chechnya as a “barbaric act” and condemned it “in the strongest possible terms”.
In 1998, the Office of General Counsel of the US Department of Defence issued a memorandum on the subject of whether radio operators assigned to an air force medical unit could be issued with identification cards bearing the red cross and documenting their status as personnel “exclusively engaged in supporting a medical unit or establishment in performance of its medical mission” under Article 24 of the 1949 Geneva Convention I. The memorandum concluded that “the administrative staff category would appear to be broad enough to cover radio operators, so long as they are exclusively engaged in supporting a medical unit or establishment in the performance of its medical mission”.
According to the Report on US Practice, it is the opinio juris
of the United States that medical personnel are not to be knowingly attacked or unnecessarily prevented from performing their duties in either international or non-international armed conflicts. It adds: “Customary practice has proceeded little beyond the specific rules of the Geneva Conventions, with a few exceptions.” The report notes that there is no practice of incorporating medical staff in combat units in the armed forces.
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.
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.”
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.
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
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.
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”.
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.