WMA Statement in Times of Armed Conflict and Other Situations of Violence

Adopted by the 10^th World Medical Assembly, Havana, Cuba, October 1956,
edited by the 11^th World Medical Assembly, Istanbul, Turkey, October 1957,
revised by the 35^th World Medical Assembly, Venice, Italy, October 1983 and the 55^th WMA General Assembly, Tokyo, Japan, October 2004,
editorially revised by the 173^rd WMA Council Session, Divonne-les-Bains, France, May 2006, and
revised by the 63^rd WMA General Assembly, Bangkok, Thailand, October 2012 and the 74^th WMA General Assembly, Kigali, Rwanda, October 2023*

*The WMA Regulations of the WMA in times of armed conflict and other situations of violence adopted in 1956 were reclassified as a ‘Statement’ by the 63^rd General Assembly, Kigali, Rwanda, October 2023.

PREAMBLE

The primary task of the medical profession is to promote health and save life; the primary obligation of the physicians is to their patients; in all their professional activities, physicians should adhere to international conventions on human rights, to international humanitarian law and to the WMA’s Declaration of Geneva, International Code of Medical Ethics and other relevant WMA declarations on medical ethics^[1], as well as to the Ethical Principles of Health Care in Times of Conflict and Other Emergencies, elaborated by civilian and military healthcare organisations, including the WMA, under the initiative of the International Committee of the Red Cross.

In situations of armed conflict and other situations of violence, governments, belligerent armed forces and others in positions of power must comply with their obligations in accordance with international law, including, as applicable, Geneva Conventions (1949) and the Additional Protocols to the Geneva Conventions (1977, 2005).

This obligation includes a requirement to protect healthcare personnel and facilities (see e.g. the WMA Declaration on the protection and integrity of healthcare personnel in armed conflicts and other situations of violence, 2022), including any means of transportation devoted to the wounded and sick, to health personnel or medical equipment.

This obligation also includes condemning the targeting of health care facilities and personnel and using denial of medical services, including as a tactic or strategy in war, by any party, wherever and whenever it occurs.

The WMA supports efficient, secure and unbiased reporting mechanisms with sufficient resources to collect and disseminate data regarding assaults on physicians, other healthcare personnel and healthcare facilities, and to provide to the WHO and other relevant agencies the necessary support to fulfill their role in documenting attacks on healthcare personnel and facilities.

Assaults against healthcare personnel must be investigated and those responsible must be brought to justice; to this end, adequate enforcement mechanisms must be used, or where relevant, developed, and necessary resources must be guaranteed.

Physicians must be granted access to all persons in need of care, including those deprived of liberty.

Physicians have a responsibility to press governments and other authorities for the provision of the infrastructure and equipment that is a prerequisite to health and healthcare, including potable water, adequate food and shelter, proper infrastructure, clinical equipment and available healthcare personnel, and the necessary personal protection equipment (PPE).

Where conflict appears to be imminent and inevitable, relevant authorities are responsible for guaranteeing the protection of the health infrastructure and for planning any necessary repair in the immediate post-conflict period.

Respect of professional ethical rules

During times of armed conflict and other situations of violence, the ethical standards of the medical profession apply as in times of peace. The professional duty to treat people with humanity and respect applies to all patients. The physician must always act in accordance with medical neutrality and give the necessary care impartially and without discrimination.

Physicians must never be persecuted for complying with any of their ethical obligations, and may not be compelled by governments, armed forces or others in positions of power, to undertake any action that contravenes the medical profession’s ethical rules.

The privacy of the sick, wounded and dead must always be respected and confidentiality duly respected.

Health care given to the sick and wounded, civilians or combatants, cannot be used for publicity or propaganda.

Physicians must not spread disinformation, or manipulate facts for the public, for the media, or for the social media outlets.

Ethics training on the issue of medical treatment of prisoners of war and detainees should be provided in medical schools and during postgraduate training.

RECOMMENDATIONS

In situations of armed conflict and other situations of violence, the physician must:

General principles

1. Not take part in any act of hostility and refuse any illegal or unethical order;
2. Neither commit nor assist in violations of international law;
3. Not abandon the wounded and sick, while considering the physician’s own safety and competence and the availability of other viable options for care;
4. Promote medical neutrality by advocating for and providing effective and impartial patient care without discrimination; no distinction must be made between patients except based upon clinical facts;
5. Give special consideration to the most vulnerable or marginalized parts of the population in need of care (e.g. women, children, older persons, people with specific healthcare needs, and displaced persons) and to their specific healthcare needs while adhering to triage principles;
6. Respect the individual wounded or sick person´s autonomy, trust and dignity;
7. Respect confidentiality, in line with the Declaration of Geneva and the International Code of Medical Ethics;
8. Give careful consideration to any dual loyalties that the physician may be bound by or conflicts of interest that may be present.

Detention

9. Provide healthcare to anyone taken as a prisoner;
10. Advocate for regular visits to prisons and prisoners by physicians;
11. Never condone, facilitate or participate in the practice of torture or any form of cruel, inhuman or degrading treatment, nor in any form of abuse, including forced feeding, human trafficking or human organ trafficking;
12. In line with the WMA International Code of Medical Ethics, the WMA Declaration of Tokyo, the WMA Statement on the Responsibility of Physicians in the Documentation and Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment, the Istanbul Protocol and the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), denounce acts of torture or cruel, inhuman or degrading treatment and punishments.

Forbidden activities

13. Never use the situation and the vulnerability of the wounded and sick for personal advantage;
14. Never make use of healthcare privileges and facilities contrary to their intended purposes;

Public Health

15. Report to the appropriate authorities if healthcare needs are not met;
16. Respect the legal obligations to report to the appropriate authorities in matters of epidemiology;
17. Respect the WMA Declarations of Helsinki and the WMA Declaration of Taipei on research and data management;
18. Denounce and intervene against any unscrupulous practices, including distribution of poor quality or counterfeit medicines and materials;
19. Be aware of war-related mental health trauma when caring for patients, internally displaced persons and refugees.

^[1] WMA Declaration on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence / WMA Statement on Armed Conflicts