Practice Relating to Rule 110. Treatment and Care of the Wounded, Sick and Shipwrecked

In all circumstances, the wounded, sick and shipwrecked, to whichever party they belong, must be respected and protected … There shall be no distinction based on any grounds other than medical ones.  (emphasis added)

1. The wounded, sick and shipwrecked are to be protected, respected, treated humanely and cared for by the Detaining Power without any adverse discrimination.

2. … The term “wounded, sick and shipwrecked”, includes civilians.

1. Only urgent medical requirements will justify any priority in treatment among those who are sick and wounded.

2. Regardless of the party to which they belong, or whether they are combatants or non-combatants, the wounded, sick and shipwrecked are to be respected and protected without any adverse discrimination. 

As a matter of law, wounded PW [prisoners of war] are to receive the same medical treatment as Canadian casualties with priorities for treatment and evacuation being allocated solely according to medical criteria. 

Persons who do not directly participate in hostilities and those rendered hors de combat because they are sick, wounded, shipwrecked, captured or for other reasons, must be respected and protected against the consequences of the war. All victims must be assisted without discrimination. 

Prisoners of war can be sick, traumatized or wounded. In such cases, they must be evacuated and cared for by the friendly or enemy medical service at the front. Medical urgency must be the only factor which determines the priority of care. There must be no discrimination in favour of friendly troops. 

The wounded, sick and shipwrecked shall be respected and protected in all circumstances … They shall be treated humanely and cared for …

…

There shall be no distinction among them other than on medical grounds. 

There is no absolute obligation to accept civilian wounded and sick only so far as it is practicable to do so. For example, if military medical facilities are not being used but might be used in the immediate future because of an impending battle, there is no obligation to treat civilians. Once a civilian patient has been accepted, however, discrimination against him/her on other than medical grounds is not permissible. 

[a.] Medical ethics in armed conflict are the same as in peacetime, taking into account that:

…

c. Assistance must be provided without making any distinction based on criteria other than medical grounds.

…

Priority of treatment must always be dictated by the degree of medical urgency. 

[a.] Medical ethics in armed conflict are the same as in peacetime, taking into account that:

…

c. Assistance must be provided without making any distinction based on criteria other than medical grounds.

…

Priority of treatment must always be dictated by the degree of medical urgency. 

Military commanders may appeal to the charity of the local population to voluntarily collect and care for the wounded and sick. The military authorities must permit the inhabitants and relief societies, even in invaded or occupied areas, spontaneously to collect and care for wounded or sick of whatever nationality.  [emphasis added]

…

…

Civilian medical personnel shall be respected and protected. … Occupying Powers must assist them with the performance of their functions and may not require from them to give priority to the treatment of any person, except on medical grounds.

…

…

…

- Wounded and sick may not be adversely discriminated against on grounds of sex, race, nationality, religion, political convictions or any other similar criteria. Only urgent medical reasons will determine the order of treatment.  [emphasis in original]

In combat, the disarmament, rescue of and the provision of first aid to the wounded, sick and shipwrecked begins as soon as the situation allows. … No distinction may be made between friend and enemy or between civilian and military personnel. Purely medical criteria determine the priority in medical treatment. No one may be punished for having cared for the wounded or sick. 

While performing their military duty, military medical personnel shall be guided by the generally recognized rules of international humanitarian law that oblige them … to render medical assistance during armed conflicts as necessary without any discrimination save for medical reasons. 

7.3. The wounded and sick are to be protected and respected. They may not be attacked. They must be treated humanely. They must be provided with medical care. They may not wilfully be left without medical assistance nor exposed to contagious diseases or infection. Priority of treatment is dictated by medical reasons only …

…

7.3.2. Paragraph 7.3 applies to all wounded and sick, whether United Kingdom, allied or enemy, military or civilian. They are entitled to respect and protection, humane treatment and, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. It is forbidden, for example, to give the treatment of United Kingdom and allied wounded priority over the treatment of wounded enemy personnel. The only distinction which is permitted in dealing with the wounded or sick is that founded on real medical need. There is no absolute obligation on the part of the military medical services to accept civilian wounded and sick – that is to be done only so far as it is practicable to do so. For example, the commander of a field hospital placed to deal with casualties from an impending battle would be entitled to refer non-urgent cases elsewhere, even if the hospital had the capacity to treat them at the time. Once the treatment of a civilian patient has commenced, however, discrimination against him on other than medical grounds is not permissible. 

There must be no discrimination on grounds of sex, race, nationality, religion, political belief or any other similar test. Spies, saboteurs, partisans and illegal combatants who are wounded or sick are entitled to the same treatment. 

Wounded and sick personnel falling into enemy hands must be treated humanely and cared for without adverse distinction along with the enemy’s own casualties. Priority in order of treatment may only be justified by urgent medical considerations. 

Article 18. Provision of Emergency Medical Aid.

Health services shall be provided by the nearest health facility to … those whose health condition requires emergency aid, without any discrimination, and by taking into consideration the prioritized status of patients. 

the Armed Forces of the Azerbaijan Republic and appropriate authorities and governmental bodies shall ensure [in all circumstances and with the least possible delay] medical assistance and care, needed for the wounded and sick irrespective of their status.  [emphasis added]

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]. 

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]. 

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. 

A commander who causes serious harm … to the sick, wounded or shipwrecked, by not according them the treatment prescribed by law or by international agreements … shall be punished, unless the act constitutes a more serious offence, by military confinement for not less than three years. 

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. 

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:

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.  [footnotes in original omitted]

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. 

…

International humanitarian law calls on all parties to a conflict to treat the wounded and sick in a humane way, i.e. to shelter, rescue and protect them and to provide medical care. No distinction is to be made, except of a medical nature, and Women are given special consideration. The same rules apply to shipwrecked persons, i.e. to all members of the armed forces and civilians in danger at sea or in any other body of water. 

The access of the only two civilian hospitals which have surgical units, Benadir and Digfer, was blocked on July 17, 1993 by the deployment of United Nations’ tanks.

The military hospitals were reserved exclusively for the treatment of United Nations’ troops, thus setting up an unacceptable discrimination between the wounded.

Only the Moroccan hospital remained open to the wounded Somalis. This building was inaccessible to the residents west of the K6/Digfer axis. Moreover, as the Moroccan troops were involved in front line military operations, the civilian population could expect little help from them.