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Handbook of WMA Policies
World Medical Association ⏐ S-1956-01-2012
WMA REGULATIONS
IN
TIMES OF ARMED CONFLICT AND OTHER SITUATIONS OF VIOLENCE
Adopted by the 10th
World Medical Assembly, Havana, Cuba, October 1956
and edited by the 11th
World Medical Assembly, Istanbul, Turkey, October 1957
and revised by the 35th
World Medical Assembly, Venice, Italy, October 1983
and the 55th
WMA General Assembly, Tokyo, Japan, October 2004
and editorially revised by the 173rd
WMA Council Session, Divonne-les-Bains, France,
May 2006
and revised by the 63rd
WMA General Assembly, Bangkok, Thailand, October 2012
GENERAL GUIDELINES
Medical ethics in times of armed conflict is identical to medical ethics in times of peace,
as stated in the International Code of Medical Ethics of the WMA. If, in performing their
professional duty, physicians have conflicting loyalties, their primary obligation is to their
patients; in all their professional activities, physicians should adhere to international con-
ventions on human rights, international humanitarian law and WMA declarations on medi-
cal ethics.
The primary task of the medical profession is to preserve health and save life. Hence it is
deemed unethical for physicians to:
• Give advice or perform prophylactic, diagnostic or therapeutic procedures that are
not justifiable for the patient’s health care;
• Weaken the physical or mental strength of a human being without therapeutic
justification;
• Employ scientific knowledge to imperil health or destroy life;
• Employ personal health information to facilitate interrogation;
• Condone, facilitate or participate in the practice of torture or any form of cruel, in-
human or degrading treatment.
During times of armed conflict and other situations of violence, standard ethical norms
apply, not only in regard to treatment but also to all other interventions, such as research.
Research involving experimentation on human subjects is strictly forbidden on all persons
deprived of their liberty, especially civilian and military prisoners and the population of
occupied countries.
The medical duty to treat people with humanity and respect applies to all patients. The
physician must always give the necessary care impartially and without discrimination on
the basis of age, disease or disability, creed, ethnic origin, gender, nationality, political af-
filiation, race, sexual orientation, or social standing or any other similar criterion.
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S-1956-01-2012 ⏐ Bangkok
Armed Conflict
Governments, armed forces and others in positions of power should comply with the
Geneva Conventions to ensure that physicians and other health care professionals can
provide care to everyone in need in situations of armed conflict and other situations of
violence. This obligation includes a requirement to protect health care personnel and
facilities.
Whatever the context, medical confidentiality must be preserved by the physician. However,
in armed conflict or other situations of violence, and in peacetime, there may be cir-
cumstances in which a patient poses a significant risk to other people and physicians will
need to weigh their obligation to the patient against their obligation to other individuals
threatened.
Privileges and facilities afforded to physicians and other health care professionals in times
of armed conflict and other situations of violence must never be used other than for health
care purposes.
Physicians have a clear duty to care for the sick and injured. Physicians should recognise
the special vulnerability of some groups, including women and children. Provision of such
care should not be impeded or regarded as any kind of offence. Physicians must never be
prosecuted or punished for complying with any of their ethical obligations.
Physicians have a duty to press governments and other authorities for the provision of the
infrastructure that is a prerequisite to health, including potable water, adequate food and
shelter.
Where conflict appears to be imminent and inevitable, physicians should, as far as they are
able, ensure that authorities are planning for the protection of the public health infra-
structure and for any necessary repair in the immediate post-conflict period.
In emergencies, physicians are required to render immediate attention to the best of their
ability. Whether civilian or combatant, the sick and wounded must receive promptly the
care they need. No distinction shall be made between patients except those based upon
clinical need.
Physicians must be granted access to patients, medical facilities and equipment and the
protection needed to carry out their professional activities freely. Such access must include
patients in detention centres and prisons. Necessary assistance, including unimpeded
passage and complete professional independence, must be granted.
In fulfilling their duties and where they have the legal right, physicians and other health
care professionals shall be identified and protected by internationally recognized symbols
such as the Red Cross, Red Crescent or Red Crystal.
Hospitals and health care facilities situated in areas where there is either armed conflict or
other situations of violence must be respected by all combatants and media personnel.
Health care given to the sick and wounded, civilians or combatants, cannot be used for
publicity or propaganda. The privacy of the sick, wounded and dead must always be res-
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Handbook of WMA Policies
World Medical Association ⏐ S-1956-01-2012
pected. This includes visits from important political figures for media purposes and also
when important political figures are among the wounded and the sick.
Physicians must be aware that, during armed conflict or other situations of violence, health
care becomes increasingly susceptible to unscrupulous practice and the distribution of
poor quality / counterfeit materials and medicines, and attempt to take action on such
practices.
The WMA supports the collection and dissemination of data related to assaults on phy-
sicians, other health care personnel and medical facilities, by an international body. Such
data are important to understand the nature of such attacks and to set up mechanisms to
prevent them. Assaults against medical personnel must be investigated and those res-
ponsible must be brought to justice.
CODE OF CONDUCT: DUTIES OF PHYSICIANS WORKING IN ARMED CONFLICT AND
OTHER SITUATIONS OF VIOLENCE
Physicians must in all circumstances:
• Neither commit nor assist violations of international law (international humanitarian
law or human rights law);
• Not abandon the wounded and sick;
• Not take part in any act of hostility;
• Remind authorities of their obligation to search for the wounded and sick and to
ensure access to health care without unfair discrimination;
• Advocate and provide effective and impartial care to the wounded and sick
(without reference to any ground of unfair discrimination, including whether they
are the “enemy”);
• Recognise that security of individuals, patients and institutions are a major
constraint to ethical behaviour and not take undue risk in the discharge of their
duties;
• Respect the individual wounded or sick person, his / her will, confidence and his /
her dignity;
• Not take advantage of the situation and the vulnerability of the wounded and sick
for personal financial gain;
• Not undertake any kind of experimentation on the wounded and sick without their
real and valid consent and never where they are deprived of liberty;
• Give special consideration to the greater vulnerability of women and children in
armed conflict and other situations of violence and to their specific health-care
needs;
• Respect the right of a family to know the fate and whereabouts of a missing family
member whether or not that person is dead or receiving health care;
• Provide health care for anyone taken prisoner;
• Advocate for regular visits to prisons and prisoners by physicians, if such a me-
chanism is not already in place;
• Denounce and act, where possible, to put an end to any unscrupulous practices or
distribution of poor quality/counterfeit materials and medicines;
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Armed Conflict
• Encourage authorities to recognise their obligations under international humani-
tarian law and other pertinent bodies of international law with respect to protection
of health care personnel and infrastructure in armed conflict and other situations of
violence;
• Be aware of the legal obligations to report to authorities the outbreak of any noti-
fiable disease or trauma;
• Do anything within their power to prevent reprisals against the wounded and sick
or health care;
• Recognise that there are other situations where health care might be compromised
but in which there are dilemmas.
Physicians should to the degree possible:
• Refuse to obey an illegal or unethical order;
• Give careful consideration to any dual loyalties that the physician may be bound
by and discuss these dual loyalties with colleagues and anyone in authority;
• As an exception to professional confidentiality, and in line with WMA Resolution
on the Responsibility of Physicians in the Documentation and Denunciation of
Acts of Torture or Cruel or Inhuman or Degrading Treatment and the Istanbul Pro-
tocol1
, denounce acts of torture or cruel, inhuman or degrading treatment of which
physicians are aware, where possible with the subject’s consent, but in certain
circumstances where the victim is unable to express him/herself freely, without
explicit consent;
• Listen to and respect the opinions of colleagues;
• Reflect on and try to improve the standards of care appropriate to the situation;
• Report unethical behaviour of a colleague to the appropriate superior;
• Keep adequate health care records;
• Support sustainability of civilian health care disrupted by the context;
• Report to a commander or to other appropriate authorities if health care needs are
not met;
• Give consideration to how health care personnel might shorten or mitigate the
effects of the violence in question, for example by reacting to violations of interna-
tional humanitarian law or human rights law.
1
Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment, OHCHR, 1999
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