# INTRODUCTION
This toolbox contains ten case studies and a model unilateral declaration related to the protection of health care. It introduces each tool with a description and guidance for its use, whether by armed groups or by individuals or entities that engage with armed groups regarding the protection of health care. This toolbox contains excerpts from the ICRC publication Safeguarding the provision of health care: operational practices and relevant international humanitarian law concerning armed groups. It should be used in reference to that publication.

# CASE STUDIES Description
The case studies address three dimensions of the safe delivery of health care: y Case studies 1 to 3: Respect for health-care personnel y Case studies 4 to 6: Respect for health-care facilities y Case studies 7 to 10: Respect for the wounded and sick and medical vehicles Each case study follows a uniform structure: y Specific situations with a high risk of abuse
The ten situations illustrate the most common patterns of abuse, which have been identified through data collected by the ICRC and accounts provided by armed groups.
y Key laws The IHL rules applicable in each situation are described and explained y Practical measures 1 These measures are examples of actions that can be taken to address common challenges to the safe delivery of health care. They are based largely on the practices and suggestions shared by armed groups.

# Suggested use
Armed groups can use these case studies to: y contextualize and implement the measures proposed; y revise or expand their doctrine by incorporating key rules and practical measures; and y train group members who work in the military, political, legal or communication spheres.
People and entities that engage with armed groups regarding the protection of health care can use these case studies to: y enhance their capacity to build a constructive dialogue with armed groups; and y organize workshops with armed groups and other individuals and entities concerned.

# CASE STUDY 1: ENSURING HEALTH-CARE PERSONNEL HAVE ACCESS TO CIVILIANS SCENARIO
In a remote region, health services were provided by a limited number of health-care facilities supplemented by government-run mobile clinics. When an armed group took control of the region, the mobile services came to a halt. The armed group mistrusted the government health-care personnel, while the health-care personnel themselves were afraid to enter the region controlled by the group. Reduced access to health care came as an additional burden for civilians who were already suffering from the consequences of the conflict. Some of the wounded and sick were left unattended. A solution to resume the delivery of health care had to be found.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligations to respect and protect medical personnel, facilities and vehicles.
These obligations mean that access to health care must not be unduly impeded, and ongoing treatment for the wounded and sick together with health care for the civilian population must not be prevented. Also, measures must be taken to assist medical personnel in their work. 1

# SOME PRACTICAL MEASURES TO ADOPT IN SUCH SITUATIONS
Establish contact with health-care personnel, for example by:
y Making arrangements directly with the health-care personnel. Arrangements can be oral or take the form of a letter of understanding. This type of arrangement would contain: 2 i) The relevant principles and ground rules such as the rules of IHL, the principles underpinning health-care ethics, principles of good faith, etc. ii) The responsibilities of armed groups and health-care personnel
- Responsibilities of the armed group: respecting and protecting health-care personnel and facilities, facilitating the health-care personnel's work, and not interfering in the health-care personnel's work; - Responsibility of health-care personnel: ensuring all their actions are guided by health-care ethics and complying with the rights and responsibilities of health-care personnel. iii) The operational process
- Interaction for preparing and implementing health-care activities (e.g. time frame for notification, required documentation); - Designating mechanisms and bodies for problem-solving. iv) The respective responsibilities of the armed group and health-care personnel to communicate their arrangement to all those who should respect it or benefit from it.
Ensure the safety of patients and health-care personnel, for example by:
y Taking relevant measures to ensure that patients, health-care personnel and facilities are protected from security-and environment-related threats (e.g. hostilities, explosive remnants of war, criminality, natural disasters and accidents).
y Establishing and communicating contingency plans to ensure health-care personnel, patients and facilities are protected (e.g. identifying evacuation routes and places where shelter can be found, making plans to evacuate and transfer the wounded and sick and ensure continued treatment) in the event of changing circumstances or unforeseen events.
Facilitate the work of health-care personnel, for example by:
y Establishing fast-track procedures for identifying, checking and clearing health-care personnel and supplies at checkpoints.
y Allowing direct channels of communication between health-care personnel and relevant individuals within communities and, whenever necessary and feasible, providing access to equipment necessary for such communications.
y Ensuring that the facilities and equipment necessary for health-care personnel to carry out their work are not used by the armed group for other purposes.
A success factor of arrangements between armed groups and health-care personnel is the recognition and/or support of such pragmatic arrangements by the state party to the conflict. The arrangement should not, under any circumstances, be interpreted as signalling or demonstrating the health-care personnel's allegiance to an armed group.
CASE STUDY 2: RESPECTING AND ENSURING THE SAFETY OF HEALTH-CARE PERSONNEL SCENARIO When several members of an armed group suddenly fell seriously ill, the group's own healthcare personnel were not able to help them because they lacked experience in treating illnesses. Some other members of the group went to the health-care facility and asked the doctor to go to the camp to treat the sick. The doctor refused to leave his post because he was the only health-care professional assigned to the facility. The civilian population would be left without any access to medical attention if he left his position.
In such situations, health-care personnel risk being forcibly taken to provide health care to the armed group members. Taking health-care personnel to an armed group's camp can jeopardize their life and safety.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligation to respect medical personnel.
The obligation to respect means that the work of medical personnel must not be interfered with, and the ability to give continued care to the wounded and sick in their charge must not be hampered. 1
The obligation to protect medical personnel and the obligation to take all feasible precautions against the effects of attacks under the general rules on the conduct of hostilities designed to protect civilians not directly participating in hostilities.
The obligation to protect medical personnel and to ensure that they are respected by others means that health-care personnel must not be kept longer than necessary and against their will, as this would put their life at risk.
The obligation to take all feasible precautions against the effects of attacks under the general rules on the conduct of hostilities means that civilians may not be kept longer than necessary among fighters so as to not unduly expose them to the risk of being incidentally harmed in the event of attacks against the fighters by their adversaries.

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE 2
Devise internal regulations and mechanisms, for example by:
y Preparing an internal document defining the circumstances and conditions under which it is permissible to call on the services of health-care personnel not affiliated with the armed group and in a manner that is consistent with the obligations to respect and protect such personnel.
Establish contact with health-care personnel, for example by:
y Identifying health-care personnel who can be contacted in times of need and avoiding those healthcare personnel who are not supposed to provide care outside their duty station.
y Defining the terms of interaction with health-care personnel who can be contacted in times of need. y Establishing channels of communications with these health-care personnel.

# SOME PRACTICAL MEASURES TO ADOPT IF HEALTH-CARE PERSONNEL COME TO ATTEND TO THE WOUNDED AND SICK
Ensure the safety of health-care personnel, for example by:
y Minimizing the likelihood that external health-care personnel will become aware of sensitive information, such as by setting up a location outside of the camp for treating the wounded and sick.
y Stopping operations for such time as to allow the safe passage of health-care personnel. y Identifying roads for safe passage and, if necessary, areas where shelter can be found.
Facilitate the work of health-care personnel, for example by:
y Organizing the safe passage of health-care personnel and medical evacuations. y Whenever feasible and medically advised, assembling all people in need of medical care in one area to allow the health-care personnel to more efficiently attend to them all.
y Assembling all medical material the health-care personnel will need in the health-care facility or at the treatment site.
y Preparing all the information on patients (i.e. their medical file) ahead of the health-care personnel's arrival.
Health-care personnel must not be punished for fulfilling their medical duty under IHL and in accordance with health-care ethics. Armed groups should bear in mind that in some countries, health-care personnel might face domestic legal action for providing health care to the groups' members. In addition, armed groups that request the services of health-care personnel must always consider how this may affect civilians' access to health care.

# CASE STUDY 3: UNDERSTANDING AND RESPECTING THE PRINCIPLES UNDERLYING HEALTH-CARE ETHICS SCENARIO
When a fighter was injured in hostilities taking place in a town, his fellow fighters took him to a nearby hospital. The hospital was full of people waiting to receive medical attention. The fighters were very concerned because the wounded fighter was unconscious and he was the only one able to operate a particular piece of military equipment. They wanted this person to be treated first.
In such situations, there is a risk that health-care personnel will be pressured or threatened as a way of influencing the order in which they treat patients.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligation that impartial medical care be provided to the wounded and sick and the obligation that health-care personnel must not be compelled to act contrary to medical ethics.
The obligation to provide impartial medical care means that differences in treatment, such as giving priority to one patient over another, are only justifiable on medical grounds.
The obligation not to compel health-care personnel to act contrary to medical ethics means that health-care personnel must not be compelled to give a particular person priority unless deemed necessary in view of that person's state of health. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE
Devise internal regulations and mechanisms, for example by:
y Instructing the group in health-care ethics and the obligations of health-care personnel under international and national law.
y Ensuring that the group's own health-care personnel act in accordance with health-care ethics. y Instructing the group in the detrimental effects on health-care personnel and patients of carrying arms in health-care facilities.
Establish contact with health-care personnel, for example by: y Establishing a mechanism through which health-care personnel can address complaints concerning respect for health-care ethics by members of the armed group.
y Guaranteeing that health-care personnel who submit complaints and grievances will not face any negative repercussions.
Limit the presence of fighters within health-care facilities, for example by:
y Establishing contact with health-care personnel who can medically evacuate and accompany the wounded and sick to health-care facilities.
y Creating medical services within armed groups or training some members in evacuating the wounded and sick and delivering them to health-care facilities.
y Establishing clear instructions that define the circumstances under which fighters can enter and remain in health-care facilities.
Ensure the safety of health-care personnel and facilitate the work of health-care personnel, for example by:
y Respecting the medical decisions made by health-care personnel and forbidding members of the armed group from pressuring health-care personnel.
y Instructing fighters to follow the regulations of health-care facilities in terms of armed entry. For instance:
-respect "no-weapon" policies; -if the health-care facility is in a region under the armed group's control, the group could put in place its own system for leaving and guarding weapons at the entrance.

# CASE STUDY 4: RESPECTING HEALTH-CARE FACILITIES AND ENSURING ACCESS TO MEDICAL SUPPLIES SCENARIO
An armed group unexpectedly encountered a group of adversaries, and an armed confrontation ensued. The fighting left several armed group members with gunshot wounds requiring urgent treatment. The health-care personnel accompanying the group did not have enough material to provide care. Some group members made their way to the nearest healthcare facility to get the necessary supplies.
This type of situation presents a high risk that the health-care facility will be looted.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligation to respect medical facilities and the prohibition of pillage, the latter being a war crime.
This means that health-care facilities must never be pillaged, i.e. medical supplies can never be unlawfully and forcibly taken against the health-care personnel's will for use by an individual or a group. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE
Establish a network of contacts to ensure the availability of medical supplies, for example by:
y Developing contact with different sources of health-care materials to ensure that the necessary supplies are available and secure.
y Whenever possible, concluding special arrangements to ensure the availability of medical supplies that would serve the civilian population in the territory of the armed group and the fighters.
y Entering into communication with humanitarian organizations that could provide basic medical supplies needed for emergency care.
Ensure, to the fullest extent possible, that those in need of urgent or life-saving medical care receive it, for example by:
y Devoting part of the budget to the purchase of medical supplies at the armed group's central and unit levels.
y Providing the armed group's health-care personnel operating close to front lines or the armed group's fighters who have first aid and/or medical knowledge with emergency medical kits to treat the injured (e.g. medicine, bandages and supplies to stitch wounds).
y Providing "emergency cash" to health-care personnel or other armed group members who have health-care responsibilities and who accompany combat units, so they can buy supplies if necessary.
y Encouraging familiarity with natural remedies (e.g. locally available plants) that can be used to treat the wounded and sick.
Facilitate the work carried out in health-care facilities, for example by:
y Ensuring that armed group members entering health-care facilities to obtain supplies: -abide by the rules and regulations of the health-care facilities (e.g. no weapons in the facility); -are aware of national laws governing health-care personnel (e.g. the requirement to see a patient prior to providing medication) and take measures to prevent putting health-care personnel in danger; -only buy enough medication to meet the need for which they entered the health-care facility; -refrain from threatening or attacking health-care personnel.

# CASE STUDY 5: MAPPING THE LOCATION OF HEALTH-CARE FACILITIES SCENARIO
In a region where hostilities have been taking place for years between two armed groups, the civilian population only had access to limited health-care services. Public health-care services had stopped before the conflict broke out, and only a few health-care facilities run by non-governmental organizations remained. An organization opened a health-care centre on premises that were previously empty. It identified the premises by placing a flag with its logo on the roof. The parties did not map the location of health-care facilities in the region. During a military operation, the health-care centre was seriously damaged.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligation to respect and protect medical personnel, facilities and transports, and the general rules on the conduct of hostilities, including the principles of distinction, proportionality and precaution.
The obligation to respect and protect medical personnel, facilities and transports means that efforts must be made to spare medical facilities when engaging in attacks.
The general rules on the conduct of hostilities mean that at all times a distinction must be made between civilians and fighters and between civilian objects and military objectives. Moreover, attacks must not be launched on military objectives if such attacks may be expected to cause excessive incidental civilian harm or harm to specifically protected medical personnel or objects in relation to the concrete and direct military advantage anticipated. All feasible precautions must be taken to verify that targets are military objectives (rather than civilians or civilian objects or specifically protected medical personnel or objects), and attacks must not be launched or must be cancelled or suspended where the attack may be expected to cause excessive incidental civilian harm or harm to specifically protected medical personnel or objects in relation to the concrete and direct military advantage anticipated. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT SUCH SITUATIONS
Establish contact with entities providing health care, for example by:
y Appointing a focal point within the group (i.e. a health-care coordinator) to maintain contact with external health-care personnel. This would contribute to the group's up-to-date knowledge about health-care organizations and facilities active in the region.
y Ensuring that health-care personnel active in the region and the civilian population know the focal point.
Ensure the safety of and facilitate the work carried out in health-care facilities, for example by:
y Teaching the armed group members about the recognized protective emblems (red cross, red crescent and red crystal).
y Making sure that the mapping of health-care organizations and facilities is regularly updated and shared throughout the group and that their emblems or symbols are known and respected.
y Referring to the above information when planning and conducting military operations.
CASE STUDY 6: TAKING PRECAUTIONS WHEN PLANNING AND CONDUCTING MILITARY OPERATIONS SCENARIO An armed group learned that the adversary had taken over a health-care facility for military purposes by setting up its headquarters on its premises. The armed group was determined to have the adversary leave the health-care facility. The health-care facility was still operating and patients were still being treated.
In this type of situation, there is a high risk that the health-care facility will be damaged or destroyed and that patients and health-care personnel will be affected as a result of a lack of precaution in the planning and conduct of military operations.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The rule that the protection of medical facilities is not lost unless they are used for committing hostile acts, outside their humanitarian function.
The obligation to respect and protect the wounded and sick and medical personnel.

# The principles of proportionality and precaution in attack under the general rules on the conduct of hostilities.
This means that the principle of protection from direct attack remains intact unless medical facilities are used to commit hostile acts outside their humanitarian function. Protection only ceases after due warning has been given with a reasonable time limit and after the warning has remained unheeded. Taking over a health-care facility for the purpose of launching military operations from it amounts to a hostile act. However, even where a hostile act has been committed from within a health-care facility, the principles of proportionality and precaution must be respected for the benefit of the wounded and sick, medical personnel and civilians in general. An attack on a medical facility that has lost its protection must therefore not be launched if the attack may be expected to cause excessive incidental civilian harm or harm to specifically protected medical personnel or objects in relation to the concrete and direct military advantage anticipated. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE

# Devise internal regulations and mechanisms, for example by:
y Deciding that health-care facilities will not be used for military purposes. y Dissociating access to health care from military tactics. y Establishing a decision-making process for attacking a health-care facility that might have lost its protection under IHL.
y Establishing the reason (military or not) for the presence of adversaries within a health-care facility before considering military action against the facility.
y Suspending the military operation as soon as it appears that the harm to civilians and civilian objects is at risk of becoming, or has become, excessive in relation to the concrete and direct military advantage anticipated.
Ensure the safety of and facilitate the work carried out in health-care facilities, for example by:
y Attempting to resolve the issue without the use of force: -conduct direct negotiations with the commander of the adversary under a flag of truce, if practicable, to have the adversary leave the health-care facility; -if desired, seek the help of a neutral intermediary to negotiate the withdrawal of the adversary from the health-care facility.
y Establishing that the attack is directed at a military objective and is militarily necessary. y Before proceeding with an attack:
-gathering the necessary intelligence on the health-care facility's occupants. It is necessary, in particular, to identify the number of fighters and civilians in it, determine how to distinguish them and identify the type of weapons present in the facility; -carrying out the proportionality assessment (i.e. the balance between military advantage gained from a successful attack and the potential incidental risk to protected persons or objects); -issuing appropriate warnings to the adversary; -issuing appropriate warnings to the civilian population so that they, along with wounded and sick fighters and health-care personnel, can leave the health-care facility and so that patients can be evacuated;
- leave enough time between the warning and launching the attack to allow civilians, wounded and sick fighters and health-care personnel to leave the health-care facility and patients to be evacuated; - provide civilians, wounded and sick fighters and health-care personnel with information on where they can take safe shelter; - continue to respect and protect civilians, wounded and sick fighters and health-care personnel, even those who do not heed the warning to leave the health-care facility.
y Taking appropriate precautions to prevent incidental harm to civilians, wounded and sick fighters, health-care personnel and the health-care facility when carrying out military actions that target or are in the vicinity of a health-care facility.
Armed confrontations resulted in heavy casualties on both sides. In the final push to gain control of an adversary's position, armed-group members came across the opposing commander and his deputy, both injured to the point that they were unable to fight.
As the armed group approached the injured adversaries to capture them, their emotions were running high and thoughts of revenge were in the air.
In this type of situation, there is a high risk that the wounded will be mistreated or summarily executed.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligation to respect the wounded and sick, including those of the adversary, the obligation to treat the wounded and sick humanely in all circumstances, and the obligation to care for the wounded and sick.
This means that the wounded must not be murdered or executed without respecting fundamental guarantees of a fair trial. These acts amount to war crimes.
The obligation to respect the wounded and sick does not preclude arresting a wounded or sick adversary. The obligation to care means that the treatment required by the wounded or sick person's medical condition must be provided to the fullest extent practicable and with the least possible delay, including during the period of detention. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE
Devise internal regulations and mechanisms, for example by:
y Establishing that respect for the wounded and sick is absolute and that they must be respected and taken care of irrespective of their affiliation to a party to a conflict and independently of their acts on the battlefield. y Using pre-operation orders to remind fighters of their expected behaviour towards wounded adversaries and to specifically forbid acts of revenge and summary executions.
y Assigning commanders the task of identifying and acting on situations likely to breed strong emotions and feelings of revenge.
y Excluding fighters who are in a highly emotional state from specific operations. y Establishing a climate that is intolerant of abuses in all circumstances.

# Create a conducive environment, for example by:
y Making sure the group's policy towards the wounded and sick is known and understood by the adversaries to enhance the likelihood of positive reciprocity.
Ensure the safety and facilitate the treatment of the wounded and sick, for example by:
y Establishing and maintaining registers on the adversary's wounded, sick, captured and dead. Such registers can specify the type, extent and speed of treatment provided to adversary fighters who are hors de combat.
y Promptly transmitting all data up the chain of command. y Instructing fighters to deliver wounded and sick adversaries as soon as possible to health-care personnel or, in their absence, to those responsible for dealing with captured adversaries.
y Making sure that the group's own health-care personnel are given access to all the wounded and sick without delay.
CASE STUDY 8: COLLECTING AND CARING FOR THE WOUNDED SCENARIO Armed clashes between two armed groups left numerous fighters from both sides wounded. One armed group had to retreat rapidly and could not collect its injured fighters. The armed group that had just gained control of the territory had limited health-care resources at its disposal. Suspecting that a counter-attack was imminent, time to collect and care for all the wounded was scarce.
In this type of situation, there is a high risk that the wounded will not benefit from adequate and impartial health care.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligations to search for, collect and evacuate the wounded and sick, and the obligation to provide medical care to them.
The obligation to provide medical care means that all possible measures are taken to provide medical care and attention to all the wounded without adverse distinction to the fullest extent practicable and with the least possible delay. The obligation to search for, collect and evacuate the wounded and sick means that whenever circumstances permit, and particularly after a confrontation, each party to the conflict must, without delay, take all possible measures to search for, collect and evacuate the wounded and sick without adverse distinction. Taking all possible measures in this context means also permitting assistance from impartial humanitarian organizations and civilians in collecting, evacuating and caring for the wounded and sick. Such offers must not be arbitrarily refused, and the personnel of such organizations and the civilians must be respected and protected. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE
Create a conducive environment, for example by:
y Devising policies and procedures to establish local truces with the adversary in order to search for, remove and evacuate the wounded and sick.
y Establishing communication channels with neutral health-care personnel such as the ICRC. y Ensuring that the group's health-care personnel abide by health-care ethics.
Ensure the safety and facilitate the treatment of the wounded and sick, for example by:
y Making sure all first-aiders and the group's health-care personnel extend help, to the fullest extent possible, to all the wounded and sick and prioritize by medical need.
y Planning for and transporting first-aid material necessary for emergency care. y In the event that care cannot be provided on-site, being prepared to carry out evacuations to a place where safe shelter can be found and health care provided, and organizing the follow-up treatment;
y Providing training on how to evacuate the wounded and sick. y If evacuating them is not possible, ensuring that the wounded and sick are left with the means of survival such as sufficient water and possibly medicine.
y If adequate care cannot be provided, informing neutral health-care personnel, for example those of the ICRC and National Societies, of the need to care for the injured; and identifying and establishing contact with such health-care personnel before the need arises and informing the group on ways to communicate with them (e.g. phone numbers).
y If adequate care cannot be provided, informing the local population of the need to care for the wounded and sick.
y Making clear to the fighters that all those searching for, collecting and caring for the wounded and sick such as medical personnel belonging to parties to the conflict, humanitarian organizations and other health-care personnel and civilians providing assistance are protected and must not be the object of attack. Ambulances and any other vehicles used to evacuate the wounded and sick are also protected and must not be attacked.
y Sparing fighters who have temporarily ceased to take part in hostilities in order to collect and/or care for the wounded or sick.

# CASE STUDY 9: ENSURING THE SAFE AND SPEEDY PASSAGE OF MEDICAL VEHICLES AT CHECKPOINTS SCENARIO
An armed group manning a checkpoint in a city stopped a private vehicle transporting a wounded fighter from an opposing armed group. The wounded fighter was bleeding heavily. After a lengthy wait, the armed group searched the vehicle and found weapons hidden under blankets. The men manning the checkpoint immobilized the vehicle, contacted their commander and waited for orders.
In this type of situation, there is a high risk that the patient's access to health care will be delayed, jeopardizing proper treatment and the chance of survival.

# THE IHL RULE APPLICABLE IN THIS TYPE OF SITUATION IS:
The obligation that the wounded and sick must receive medical care, with the least possible delay.
This means that access by the wounded and sick to medical care must not be arbitrarily limited or denied. However, the extent of the obligation to ensure medical care "to the fullest extent practicable, and with the least possible delay" also provides leeway to fighters manning a checkpoint to adopt legitimate security measures, including ensuring that vehicles used for evacuating the wounded and sick are not also used for committing hostile acts, such as transporting arms or ammunition. It is a matter for the fighters manning the checkpoints to determine whether a wounded fighter is refraining from committing hostile acts and thus enjoys the status of being wounded and sick, and whether or not a vehicle has become a military objective due to the fact that weapons are found in it. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE
Ensure the safety and facilitate the movement of medical vehicles, for example by:
y Establishing fast-track lanes or procedures to expedite the passage of medical vehicles at checkpoints. y Ensuring that any procedure strikes a balance between security requirements and the necessity for patients to access health-care facilities as quickly as possible. Procedures can include:
-identification procedures: the use of the vehicle, rather than the formal identification of the vehicle, should be the decisive factor in determining whether the vehicle qualifies as a medical vehicle; -security measures to:
- verify the identity of passengers;
- search the vehicle and its occupants;
- retain the driver or occupant (under the appropriate procedure), if that person needs to be captured.
y Ensuring that proper and uninterrupted medical care is provided whenever wounded or sick adversaries are arrested.
y Prohibiting the removal of equipment and supplies necessary for survival (e.g. water, medicine) from medical vehicles.
y In the event that the wounded or sick being transported need to be captured, ensuring that: -they receive appropriate treatment; -their treatment is not interrupted; -if it is not possible to provide appropriate medical treatment on the spot, the patient is accompanied to the nearest health-care facility where the patient can receive treatment and later be arrested.
y Informing the nearest health-care facility of the patient's impending arrival. y Facilitating the safe and unhindered transport of the patient by:
-informing the driver of the best road/route to take; -providing advance warning to other checkpoints of the arrival of the transport.
y When in control of territory and in possession of health-care capacity, providing care to the wounded or sick.
CASE STUDY 10: RESPECTING THE PROTECTIVE EMBLEMS SCENARIO All parties to a conflict frequently misused the distinctive emblem in order to transport supplies and fighters. Trust in the emblem was completely undermined. One of the armed groups decided to attack military vehicles, including those displaying the emblem. While waiting to carry out an ambush, an armed group saw a military medical unit approach displaying the red cross. The armed group attacked the medical unit. The group discovered after the attack that the unit had been carrying only health-care personnel and wounded and sick civilians and fighters.

# THE IHL RULES APPLICABLE IN THIS TYPE OF SITUATION ARE:
The obligation to respect and protect military medical vehicles, the conditions determining the loss of protection, and the obligation not to use the distinctive emblem improperly.
The obligation to respect and protect military medical vehicles means that they must not be attacked. Military medical vehicles are not military objectives. If they have been used to commit hostile acts such as sheltering able-bodied combatants, storing arms and ammunition, or other hostile acts outside their humanitarian function, this protection can be lost, but only after due warning has been given and has gone unheeded after a reasonable amount of time. Using medical vehicles (including those displaying a distinctive emblem such as the red cross, red crescent or red crystal) with the intention of deceiving the adversary in order to launch an attack that kills or injures amounts to treacherous (perfidious) killing or wounding. This is a war crime. 1

# SOME PRACTICAL MEASURES TO ADOPT IN ORDER TO PREVENT THE RISK OF ABUSE
Devise internal regulations and mechanisms, for example by:
y Ensuring that the members of the armed group are able to recognize the emblems used by different organisations (e.g. firefighters, civilian protection, red cross, red crescent, red crystal), and that they respect them.
y Defining the group's practice, consistent with IHL requirements, in using symbols and emblems to identify medical vehicles or personnel.
y Instructing the group that precedents of misuse do not justify violence against medical vehicles nor does misuse automatically transform the object or person into a military target.
y Establishing that the protection of medical vehicles, including those belonging to parties to the conflict, only ceases if they are used to commit hostile acts, outside of their humanitarian function, and only after a warning has been given and remains unheeded.
Create a conducive environment, for example by:
y Ensuring that, within the group, the emblem is only used by those entitled to use it and under the prescribed conditions.
Ensure the safety and facilitate the movement of medical vehicles, for example by:
y Providing clear and detailed instructions on how to react in the case of misuse of the emblem (e.g. warnings to the adversary).
y Documenting instances of potential misuse of the emblem by any party by: -investigating the instance of misuse; -documenting the instance of misuse; -taking pictures or videos of the misuse; -sending information on the case of misuse to a neutral intermediary.

# MODEL UNILATERAL DECLARATION

# Description
Armed groups have legal obligations under international humanitarian law (IHL) to protect the wounded and sick together with health-care personnel, facilities and transports in situations of armed conflict. To express their commitment to abide by their obligations, they may choose to issue a unilateral declaration. 1 Unilateral declarations are exclusively humanitarian in character. They do not affect the legal status of the armed groups concerned, nor do they undermine or replace their legal obligations.
The model unilateral declaration on the respect and protection of the wounded and sick and on access to health care contains a preamble and general principles together with specific principles regarding the obligations to respect and protect: y the wounded and sick y medical transports y health-care facilities y health-care personnel.
It also provides a number of practical measures that armed groups may take in order to familiarize their members with the terms of the unilateral declaration and ensure that they comply with them.

# Suggested use
Unilateral declarations have been made by a variety of armed groups in recent decades. Some armed groups take the initiative themselves and declare their commitment through spoken or written public statements (e.g. in newspapers or on their website or Facebook page). At other times, the ICRC or another humanitarian organization initiates, negotiates and/or receives the declarations.
Armed groups can use this model unilateral declaration to: y express their commitment to abide by their legal obligations to respect and protect health care; y assume responsibility for ensuring that their members comply with the law; and y inform all the groups' members of the terms of the unilateral declaration and of IHL more broadly.
Individuals and entities that engage with armed groups regarding the protection of health care can use the model unilateral declaration: y to strengthen their dialogue with armed groups through the negotiation process preceding such declarations; and y once the declaration has been made, to continue engaging with armed groups regarding compliance with the terms of the declaration and with IHL more broadly.

# UNILATERAL DECLARATION ON THE RESPECT AND PROTECTION OF THE WOUNDED AND SICK AND ON ACCESS TO HEALTH CARE
We acknowledge the need for all wounded and sick persons, i.e. those who require health care and refrain from any act of hostility, to have access to health care, and we are deeply concerned about the devastating impact of hindering such access.
We recognize that the provision of health care must be guided by the principles of humanity and impartiality.
We are convinced that we can play an important and positive role in improving the safe delivery of, and access to, health care and are resolved to do so.
We recognize that this declaration is no substitute for existing legal rules, including Article 3 common to the Geneva Conventions, customary international humanitarian law and, where applicable, Additional Protocol II to the Geneva Conventions.

# In view of the above:
1. We hereby commit to the following general principles: a. respecting and protecting the wounded and sick, and actively supporting and facilitating their access to health care; b. respecting and protecting health-care personnel, facilities and medical transports, whether civilian or military, regardless of their affiliation; c. respecting the impartial, humanitarian character of health care; d. ensuring that health-care personnel, facilities and medical transports remain exclusively engaged in medical tasks; e. refraining from denying or disrupting health care as a military tactic; f. respecting the distinctive emblems of the red cross, red crescent and red crystal, and not using the distinctive emblems improperly; g. disseminating IHL and the terms of this declaration and ensuring that our members abide by them; h. abiding by our obligations and commitments regardless of the behaviour of the adversary.

# We commit to respecting and protecting the wounded and sick. This includes:
a. not attacking, harming or killing the wounded and sick; b. treating the wounded and sick humanely in all circumstances, even if they have engaged in prior military operations on behalf of any party to the conflict; c. searching for, collecting and caring for the wounded and sick without delay and without distinction, to the fullest extent practicable, whenever the security situation permits; d. allowing civilians and impartial humanitarian organizations to assist in this task; e. not preventing medical care, in particular medical supplies, from reaching the wounded and sick; f. taking all feasible measures to ensure that the wounded and sick are respected by others.

# We commit to respecting and protecting medical transports. This includes:
a. not attacking medical transports, even if they are not identified as such; b. allowing and facilitating the medical evacuation of the wounded and sick, including across front lines, to a location where they can receive adequate care; c. allowing unimpeded and fast passage to all vehicles dedicated to health care, even if they are not identified as such; d. not using medical transports for military purposes, such as transporting healthy fighters and weapons;
e. taking all feasible measures to ensure that vehicles used for health care are respected by others.

# We commit to respecting and protecting health-care facilities. This includes:
a. not attacking health-care facilities exclusively performing medical functions, even if they are not identified as such; b. not attacking infrastructure essential for health-care delivery as long as it is not used for military purposes; c. not using health-care facilities for military purposes, such as establishing military posts or storing arms and ammunition; d. taking all feasible precautions, while planning and conducting military operations, to avoid incidentally damaging or destroying health-care facilities; e. taking all feasible precautions to spare health-care facilities from the effects of attack, including avoiding military operations near such facilities; f. not interfering with the work carried out in health-care facilities, a commitment that includes not taking supplies or material from health-care facilities and refraining from armed entry that disrupts the functioning of health-care facilities; g. facilitating the work carried out in health-care facilities.

# We commit to respecting and protecting health-care personnel. This includes:
a. not attacking, threatening or pressuring any health-care personnel providing impartial health care, even if they are not identified as such; b. respecting health-care personnel's obligation to treat all wounded and sick, without distinction on any grounds other than medical ones, including the wounded and sick associated with the adversary; c. not interfering with the work of health-care personnel; d. providing health-care personnel with all possible assistance in the accomplishment of their medical tasks; e. being aware of and promoting the ethical principles of health care and the obligations of health-care personnel under international and national law, and not punishing health-care personnel acting in accordance with their obligations; f. not compelling health-care personnel to carry out acts contrary to the ethical principles of health care; g. ensuring that our health-care personnel abide by the terms of this declaration and the ethical principles of health care.

# We commit to informing the members of our group of the terms of this declaration and of IHL and ensuring they respect them. This includes:
a. integrating the rules contained in this declaration in our doctrine, education and training; b. ensuring these rules are clearly translated into orders and directives; c. setting up an internal system to monitor compliance with this declaration and with the corresponding rules of IHL; d. applying sanctions, which are respectful of the individual's fundamental rights, to anyone in the group who does not abide by the rules contained in this declaration, and taking concrete measures to repair the damage done; e. widely and publicly disseminating the terms of this declaration, including, to the extent possible, to supporters of the group and to people living on any territory that may be controlled by the group.

# MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance. The ICRC also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the Geneva Conventions and the International Red Cross and Red Crescent Movement. It directs and coordinates the international activities conducted by the Movement in armed conflicts and other situations of violence.