Q&A on Medical Neutrality

What is medical neutrality?

PHR promotes the principle of noninterference with medical services in times of armed conflict: warring factions must protect civilians; allow sick and wounded civilians and soldiers both to receive care regardless of their political affiliations; and refrain from interfering with medical facilities, transport, and personnel. This is medical neutrality.

Medical neutrality ensures:

• The protection of medical personnel, patients, facilities, and transport from attack or interference;
• Unhindered access to medical care and treatment;
• The humane treatment of all civilians; and
• Nondiscriminatory treatment of the injured and sick.

Violations of medical neutrality occur when, for instance, civilians are turned into deliberate targets during times of war or civil unrest. Armies shell cities, obstruct the flow of food and medical supplies, and use human shields. Militaries undermine health care and retaliate against the health professionals who treat the sick and wounded. Violations of medical neutrality can rise to the status of war crimes, a grave breach of the Geneva Conventions, which govern the laws of war. As well, during periods of civil unrest, violations of medical neutrality can violate important human rights treaties such as the International Convention on Civil and Political Rights (ICCPR), the International Convention on Economic, Social, and Cultural Rights (ICESCR), and the Convention Against Torture (CAT).

What countries are affected by violations of medical neutrality?

Unfortunately, violations of medical neutrality are not unique to any one country, region, or type of government. PHR has published 27 pieces documenting violations of medical neutrality in over 14 countries from 1988-present, including: Panama (1988); Chile (1988); El Salvador (1990); Kuwait (1991); Somalia (1992, 1997); Thailand (1992, 2010); India (1993); Yugoslavia (1996); Russia (2002); Iraq (2003); United States (2003-2007); Sri Lanka (2009); Saudi Arabia (2010); Libya (2011); and the Middle East and North Africa region (2011). This list is not exhaustive, and does not cover all of the countless conflicts during which violations of medical neutrality have occurred.

What does H.R. 2643, the Medical Neutrality Protection Act of 2011, do?

Introduced in the House in July 2011, the Medical Neutrality Protection Act of 2011 [1] establishes accountability for violations of medical neutrality by: 1) withholding military assistance from violator countries (including bans on the transfer of military weapons or equipment, military education and training, financing to buy US defense items, and licenses for direct commercial sales); 2) placing visa bans on individuals responsible for violations of medical neutrality; 3) encouraging the US to use its voice at the United Nations Human Rights Council to establish a Special Rapporteur on medical neutrality; and 4) mandating the inclusion of medical neutrality in the annual State Department Country Human Rights Reports. This bill does not limit humanitarian aid to any country.

Why do we need this bill?

The principle of medical neutrality draws upon three key categories: international humanitarian law, international human rights law, and professional medical ethics. But there is a gap in the current state of the law. The Geneva Conventions, for example, apply during times of armed conflict, but PHR has documented egregious violations of medical neutrality in countries such as Syria and Bahrain, where the conflict is not categorized as an armed conflict, but instead only rises to the level of civil unrest, which is not governed by the Geneva Conventions.

This bill closes the gap in applicable law and ensures that medical neutrality can be protected at all times, not only in a time of war. This bill will also encourage policymakers to view violations of medical neutrality for the crimes that they are, and not natural collateral damage from civil unrest. The bill authorizes a strong U.S. response to violations of medical neutrality abroad whether they are committed during wartime or peacetime. The bill sends a clear message that the U.S. will not tolerate violations of medical neutrality anywhere they may occur.

What is the bill’s current status?

The bill has been introduced in the House and referred to the House Foreign Affairs Committee and the House Judiciary Committee’s Subcommittee on Immigration Policy and Enforcement. There are 13 cosponsors, or official supporters of the bill. PHR is currently engaging Senate offices to encourage champions of human rights to introduce a Senate version of the bill. For updates on the status of the bill, please contact PHR’s Washington, D.C. office at (202) 728-5335.

What would this bill mean for US policy?

This means that the United States:

• Will consider the protection of medical neutrality a priority in its foreign affairs policies, and will use its influence to further the cause of medical neutrality worldwide;
• Will support the appointment of a Special Rapporteur on the Protection and Promotion of Medical Neutrality in the United Nations;
• State Department must compile a list of nations in violation of medical neutrality, publish the list, and inform the countries that they have been placed on the list of violators; and
• Will not provide certain types of military assistance, including weapons sales, to countries determined to have violated norms of medical neutrality.

Will humanitarian aid be revoked for countries that violate medical neutrality?

This bill would not affect humanitarian aid. In the interest of assisting all those in need, humanitarian assistance may still be granted to nations found to have violated principles of medical neutrality.

What implications would this bill have on the livelihoods of doctors and their patients?

Medical professionals have an ethical duty to provide care and treatment to those in need, without discrimination, even in times of conflict. But during conflict and civil unrest, health care professionals, facilities, and patients too often come under attack. These attacks are not a natural part of conflict, but are deliberate violations of the principle of medical neutrality.

Attacks on medical professionals prevent them from providing unbiased care to those in need, in violation of their ethical obligations. In addition, individuals are often deterred from seeking medical treatment, even when faced with a serious medical condition, for fear that they might be abused when seeking treatment. As a result, medical professionals may be inhibited or even prohibited from providing any medical treatment to patients, and patients may likewise be inhibited or prevented from seeking medical treatment as a result of government attacks on doctors and patients.

Such an outcome would limit a medical service provider’s ability to perform his or her job adequately, and could endanger the health of patients, who may not be able to return to work after falling sick or becoming injured. As a result, a government’s failure to protect principles of medical neutrality can have devastating consequences for the livelihoods of medical professionals as well as their patients.

What can I do?

The most important thing you can do is get the word out about the Medical Neutrality Protection Act (H.R. 2643). You can write or call your Representative and express your support of this important legislation. You can also tell your friends about the bill, and encourage them to get involved.