A Swiss national, Jean Henri Dunant (aka Henry Dunant), was born into a religious and humanitarian family. The teachings and practices of his elders imbibed in him a deep sense of religious beliefs and values which made him a passionate humanitarian. He was a witness to the Battle of Solferino (24th June, 1859) and its aftermath. By the end of that day, some 6,000 soldiers lay dead and some 40,000 (the figures vary in history from 23,000 to 40,000) lay wounded. The medical services of the warring parties proved totally incapable of administering relief to the wounded as well as of managing the dead.
With hardly any medical personnel available, Henri Dunant, helped by villagers of Castiglione, cared for the wounded. Henri Dunant mobilized a force of local girls and women and attended to the wounded, without discriminating between which side of the battling parties they belonged, for three days and nights continuously. The suffering left an indelible image on his conscience. On his return Henri Dunant published a small account of his experiences at Solferino by the title of Un Souvenir de Solferino (A memory of Solferino). The account, though not very voluminous, carried three themes. The first theme narrates the battle; whereas the second theme depicts the miserable despair in the chaotic aftermath of the battle in the small town of Castiglione where he had undertaken to care for the wounded. The third theme outlined a plan of forming relief societies by nations to be headed by a Governing Board comprising of leading figures from those nations. On 07th February, 1863, The Geneva Society for Public Welfare formed a committee of five people, including Henri Dunant, to put his plan into action and which led to the formation of what is now known as The Red Cross. This Committee’s call for an international conference, and Henri Durant’s efforts in mobilizing governments, culminated in the signing of an international treaty, on August 22, 1864, now known as the Geneva Convention.
His experiences at Castiglione led him to the formation of The International Red Cross Movement. This movement initiated a convention to establish the laws of war which were eventually formalized in 1949 as the Geneva Conventions and sought to protect combatants, prisoners and non-combatants. Additional protocols, passed in 1977, stipulated protection of civilians in international and internal conflicts. Since then, ambiguity has grown over what constitutes a war and what is a criminal act; who is a party to the conflict and who is a civilian or non-combatant. How have the conflicts changed in the 21st century and whether the Geneva Conventions, and subsequent protocols, still hold good when it comes to protecting the civilians?
THE GENEVA CONVENTION
The Geneva Convention envisaged care for all sick and wounded personnel, regardless of nationality, in the event of a war. The signatory nations agreed to guarantee safety to sanitary personnel, expeditious supply of materials for their use and to adopt a special identifying emblem; a red cross on a white background. The Convention further guaranteed the neutrality of medical personnel, ambulances and hospitals carrying the emblem of the Red Cross or the Red Crescent. The Geneva Conventions, finalized in 1949, comprise of four treaties. Three additional protocols were added in 1977. The first protocol takes into consideration the modern means of communication and warfare, aiming to give further protection to civilians. The second protocol provides a code of minimum protection to combatants and the civilian population during civil wars. The third protocol relates to the adoption of an additional distinctive emblem, a Red Crystal, which may be displayed at times of war, by religious and medical personnel, instead of the Red Cross or the Red Crescent. People displaying any of these three emblems are to be treated as personnel performing humanitarian work and must be protected by all parties to the conflict.
The Battle of Solferino was entirely different from the wars and conflicts of today. In that era the armed forces were in conflict with each other, however the civilians remained unaffected by the brutalities of combat. Nowadays the civilians are the main victims of any conflict. It has been observed that wars are not always declared as wars. Prisoners are not declared as Prisoners of War and are kept out of national and international law jurisdictions. This enables the warring countries, to seek immunity from the Geneva Conventions by arguing that these do not apply. Politically motivated affiliations between countries tend to overlook the atrocities, committed by their affiliates, due to which the implementation of international law fails. Unfortunately, such countries include the greatest propagandists of human values. It is these ambiguities which have left a huge question mark over the just implementation of the Geneva Conventions and subsequent protocols.
HEALTHCARE: THE VICTIM
Violence against medical personnel, involved in provision of efficient and impartial health care in areas of armed conflict, has emerged as one of the most crucial issues facing the society. There are several international laws in place which, explicitly and specifically, protect health care and its practical availability to the wounded and the sick. Yet these international laws are often flouted and the warring parties do not hesitate in targeting the personnel, hospitals and ambulances providing health care to their adversaries. The disruption of safe access to health care is affecting millions of wounded and the sick across the globe.
A report, prepared by ICRC, reveals that, during 2012, there were 921 incidents of violence against health care workers and medical facility/equipment, resulting in 1007 victims. Of these 921 incidents, 319 incidents resulted in directly affecting healthcare personnel, patients or by-standers. In 355 incidents, medical facilities or vehicles were affected without anyone being threatened or directly harmed. In another 200 incidents, each incident affected people, infrastructure or vehicles simultaneously. Lastly, in 47 of these reported incidents, the healthcare sector was prevented from providing assistance by banning a particular organization or by restricting movement, even for medical evacuations, by enforcing curfews. In addition there were at least 35 incidents where healthcare personnel were prevented from performing their duties due to uncertain security conditions. Slightly more than 90% of these 921 incidents, directly affected were local healthcare providers i.e. The National Red Cross and the National Red Crescent Societies and local private and public healthcare providers.
The report goes on to reveal that the perpetrators of crimes against healthcare cannot be confined to one set of actors. About 68% of the cases can be attributed to State security forces and armed non-State actors (Militias, Rebels, Guerillas or even private security personnel). In some countries, violence against healthcare has been perpetrated, within and outside the medical facilities, by relatives of the patients. These incidents have been recorded at an alarming 10% of the reported cases.
Out of the 1007 reported victims, about 61% (614) were doctors, nurses and paramedics. The remaining included Patients, Drivers, Bystanders, Patients’ relatives, Aid workers and relatives of medical personnel.
A 2011 study by the ICRC recognizes the attacks against healthcare personnel as “one of the biggest, most complex and least recognized humanitarian issues of our times.” Conflicts disrupt healthcare in many ways and, specially, when it is most needed. Healthcare providers, as well as the sick and the wounded, are prevented from reaching healthcare facilities. Hospitals and ambulances are directly targeted; combatants often take over medical facilities and ambulances, either in search of wounded enemies or for utilizing the vehicles to carry out attacks.
The International Laws on healthcare are, deliberately and systematically, violated. Hospitals have been bombarded in Sri Lanka and Somalia; ambulances have been shot at in Libya and Lebanon; medical personnel providing assistance to protestors in Bahrain have been charged with treason and; in Pakistan polio vaccinations were declared by certain religious groups as irreligious and the vaccinators as infidels resulting in disruption of vaccination services; the indiscriminate and disproportionate bombing by the Israelis in Gaza severally hindered the provision of required medical assistance; from DR Congo and Somalia to Sudan and Colombia to Syria medical services have been put under tremendous strain.
The United Nations have put forth five core challenges that face the world today in relation to civilian and healthcare casualties. Briefly put, these challenges are:
– Enhancing compliance to International Laws by parties to conflicts
– Enhancing compliance to International Laws by non-State armed groups
– Enhancing protection by United Nations Peacekeepers
– Improving Humanitarian access
– Enhancing accountability for violations of International Laws
The Security Council, in its Resolution No. 1998 of 2011 has extended the scope of grave violations of International Humanitarian Law (IHL) to include recurrent attacks on hospitals and schools as well as recurrent attacks or threats of attack against protected persons in relation to schools and hospitals.
In a report presented in May 2012, The Secretary General, United Nations Security Council, proposed several options for humanitarian access to millions of vulnerable people caught in conflicts. These options include:
Temporary Cessation of Hostilities
A Temporary Cessation of Hostilities is a suspension of fighting for a specific period, agreed upon by all relevant parties, for various reasons including humanitarian purposes.
A Humanitarian Pause is a temporary cessation of hostilities for exclusively humanitarian purposes.
Humanitarian Corridors are specific routes and logistics to allow the safe passage of humanitarian goods and/or people from one point to another in an area of active fighting.
De-confliction Arrangements involve the exchange of information between humanitarian actors and parties to the conflict to coordinate the time and location of relief activities so as to ensure that military operations do not jeopardize the lives of humanitarian personnel, impede the passage of relief supplies or humanitarian services or endanger beneficiaries.
Days of Tranquility
Days of Tranquility enable access to health-care services during conflict, for example, to participate in national immunization campaigns or other exclusively humanitarian activities on designated days.
All of these options cannot be imposed on parties to the conflict. These depend on the consent of all related parties to serve as safe, effective and sustainable means of gaining access to those in need.
The solution to most of the problems we see in contemporary conflicts is, relatively, straightforward: Greater compliance by parties to conflict, in letter and spirit, of International Humanitarian Law and Human Rights Law. This would spare civilians from the injurious and deadly effects of hostilities, prevent their displacement and significantly reduce their exposure to violations, degradation and dependency. Ensuring the necessary degree of compliance and, thereby, strengthening the protection of civilians and healthcare personnel is essentially a matter of political will: the will to conduct hostilities within the parameters of international law; to refrain from using explosive weapons in populated areas; to allow engagement with non-State armed groups; to open access to those in need of assistance; to enforce discipline and to hold accountable those who perpetrate violations. It also implies the will, on the part of the Security Council, to consistently use the tools at its disposal and to proactively consider new approaches to prevent and respond, effectively, to violations of International Humanitarian and Human Rights laws.