WMA Declaration of Rotterdam on the Protection of Medical Neutrality in times of Armed Conflict and Other Situations of Violence

Adopted by the 77th WMA General Assembly, Rotterdam, the Netherlands, October 2026

PREAMBLE

Medical neutrality is a combination of the duty of the physician and other medical personnel[1] to provide impartial care with the duty of States and de facto authorities, including parties to a conflict, to protect medical personnel and healthcare in general in times of conflict.

The physician’s duty is to “practice medicine fairly and justly and provide care based on the patient’s health needs without bias or engaging in discriminatory conduct on the basis of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, culture, sexual orientation, social standing, or any other factor.” (WMA International Code of Medical Ethics, principle 2). This is known as medical impartiality.

Physicians are bound and protected by medical neutrality at all times.

The duty of States and de facto authorities, including parties to a conflict, is to ensure that healthcare can be delivered safely, independently, and without interference, attack, intimidation, coercion, or obstruction.

Healthcare may lose protections under international humanitarian law if engaging in acts harmful to the enemy. However, medical neutrality does not require physicians or medical institutions to be politically neutral during a conflict, recognizing the obligation to practice and provide healthcare impartially.

Physicians and other medical personnel retain the right and, where ethically or legally required, the responsibility to document and report suspected violations of IHL and international human rights law affecting patients, medical personnel, and/or facilities.

Protection of healthcare[2] by International Humanitarian Law

International humanitarian law (IHL) is a set of rules which seek, for humanitarian reasons, to limit the effects of armed conflict. It is comprised of international treaties, primarily the 1949 Geneva Conventions (which have been ratified by all States and are universally applicable), their 1977 Additional Protocols and customary international law.

In times of armed conflict, medical personnel and infrastructure benefit from the protection afforded by IHL and may be identified by the distinctive emblems of the Red Cross, Red Crescent and Red Crystal. This protection is essential to allow medical personnel to carry out their duties safely while respecting the ethical principles of their profession. Nevertheless, it must be emphasised that healthcare benefits from IHL protection regardless of whether or not they are displaying the emblems.

It is well documented that direct and deliberate attacks continue to be carried out against healthcare in conflict zones in clear violation of IHL.

The WMA emphasises that ‘attacks on healthcare’ are not limited to traditional attacks and include cyberattacks and the use of artificial intelligence, as well as the denial of essential supplies.

Violations of medical neutrality also include the arbitrary arrest, prosecution, detention, torture, or ill-treatment of medical personnel.

The challenges of armed conflict settings may exert particular pressures on physicians and their professional duties. Nevertheless, the principles of medical ethics in times of armed conflict remain identical to those in times of peace.

Undue pressure may be exerted on medical personnel by parties to a conflict to prioritise medical care for military personnel and/or to not provide medical care for opposing military personnel. Furthermore, medical personnel who provide medical care to opposing parties may face reprisals from parties to the conflict.

The protections afforded to healthcare under IHL are abused and therefore undermined when parties to a conflict misuse healthcare.

Though there are very limited circumstances under which healthcare facilities and medical personnel can lose their protections under IHL, parties to a conflict continue to break IHL by attacking or interfering with healthcare, without a required warning to stop misuse and/or without properly applying IHL principles of precaution, distinction, and proportionality.

Misconceptions, misinformation and disinformation surrounding medical neutrality persists in the international community. In particular, parties to a conflict have often failed to effectively educate their militaries on IHL, including the protections afforded to healthcare.

The international community fails to hold to account those who breach IHL and attack healthcare, while parties to a conflict fail to hold to account members of their forces who have violated these laws.

The WMA unreservedly condemns the ongoing violence targeting healthcare and the misuse of healthcare and distinctive emblems, and reiterates its recommendations as published in its Declaration on the Protection and Integrity of Medical Personnel in Armed Conflict and Other Situations of Violence.

The WMA reiterates that any violation of IHL relating to the protection of healthcare must be promptly and impartially investigated, and that alleged perpetrators of serious violations of IHL, i.e. war crimes, be prosecuted before competent national or regional courts or, where applicable, referred to the International Criminal Court (ICC).

Advice for physicians and other medical personnel working in areas of conflict is available in the WMA Toolkit for Doctors Working in Situation of Violence.

RECOMMENDATIONS

1. Recalling the Ethical Principles of Health Care in Times of Armed Conflict and other Emergencies, endorsed by civilian and military healthcare organizations in 2015, as well as the United Nations Security Council Resolution 2286, the WMA calls on parties to a conflict to act in full compliance with IHL and to:

• Respect medical neutrality at all times, so that medical personnel can treat patients regardless of their role in the conflict, and freely and independently carry out their ethical and professional duties without fear of sanctions, intimidation, or interference.
• Respect the distinctive emblems and ensure that healthcare is never misused for military purposes or the target of attacks.
• Ensure that all patients have unhindered and safe access to healthcare and treatment.
• Ensure that adequate resources, including essential medicines and equipment are available.
• Immediately release and exonerate, without condition, all medical personnel who have been detained, arrested, or sanctioned by any party to the conflict solely for providing healthcare to any individual, including opposing combatants, in accordance with their professional medical ethics and ensure that they are not prosecuted or sanctioned for providing such care.

2. The WMA calls on States and de facto authorities to:

• Take robust measures to ensure that their national legislation reflects their international obligations to protect access to and the provision of healthcare in times of conflict.
• Ensure, in collaboration with associations representing health professions, that medical personnel receive specific education on their ethical duties in situations of conflicts, as stipulated in IHL.
• Ensure that their militaries are educated on their duties under IHL, notably the protections afforded to healthcare.
• Ensure that allegations of violations of IHL affecting healthcare, are subject to independent and impartial investigations under national law and/or are referred to competent international accountability mechanisms, such as the ICC, when required.

3. The WMA calls on the United Nations to:

• Ensure that allegations of violations of IHL affecting healthcare are subject to independent and impartial investigations under the ICC where it has jurisdiction, or by other competent international accountability mechanisms.
• Name all member states and armed groups that engage in attacks or threats of attacks against healthcare in relevant UN reporting mechanisms, irrespective of political considerations and pressures by UN member states.
• Establish a UN Special Rapporteur on the protection of health in armed conflict and other situations of violence.

4. Recalling the WMA International Code of Medical Ethics and the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies, the WMA calls on all healthcare providers to provide care based on medical need, and to strive to maintain professional independence and clinical judgement despite pressure from parties to a conflict, authorities or other actors.
5. The WMA calls on medical associations to:

• Publicly oppose violations of medical neutrality, including those committed by their own State, and refrain from endorsing or remaining silent on such violations.
• Uphold the ethical duties of the profession above national, political, or military allegiance, and support colleagues who face reprisals for providing impartial care.
• Review their own policies to ensure they are consistent with this statement.

[1] The term “medical personnel” is used as defined by the ICRC under Customary IHL Rule 25: “personnel assigned, by a party to the conflict, exclusively to the search for, collection, transportation, diagnosis or treatment, including first-aid treatment, of the wounded, sick and shipwrecked, and the prevention of disease, to the administration of medical units or to the operation or administration of medical transports. Such assignments may be either permanent or temporary.”

[2] For the purposes of this policy, “healthcare” refers to health personnel, facilities, supplies, transports, and other relevant infrastructure.