Elizabeth Wilmshurst CMG KC
Well, welcome. Welcome to those here in the hall and to those online. My name’s Elizabeth Wilmshurst and I’m a Fellow with the International Law Programme here at Chatham House. Just to say that the meeting isn’t under the Chatham House Rule, it’s on the record and it’s being livestreamed. If you tweet, use the hashtag #CH_Events and @ChathamHouse, and to those online, do submit questions throughout the meeting if you wish, using the Q&A function.
Now, this year, as you probably all know, marks the tenth anniversary of Security Council Resolution 2286 on the protection of medical care in armed conflict. The Security Council demanded that all parties to armed conflicts comply with their obligations under international humanitarian law to ensure the respect and protection of medical personnel, their means of transport and equipment, as well as hospitals and other medical facilities. But what’s happened in the decade since that?
The UN Secretary-General’s report last month on the protection of civilians had a section on the protection of medical care and it really makes gloomy reading. In 2025, the UN recorded 1,356 conflict-related attacks on healthcare in 18 conflict settings, resulting in nearly 2,000 deaths and over 1,000 injuries. Those were attacks on healthcare, compared with 802 incidents in 2018, when monitoring began. The Sudan saw the highest number of fatalities, with targeted violence against health infrastructure and personnel. And on the whole, and interestingly, the significant increase in violence against healthcare since 2016 has been driven by state actors, rather than non-state actors, and the UN has reported that supplying health centres remained a major challenge. I could go on. So, in the last decade, since that resolution, things have got worse, not better.
Now, this meeting marks the launch of a Chatham House paper, which is now online, “Addressing the crisis of medical care in armed conflict,” clarifying the law on respecting and protecting provision of healthcare.” It was just online today, so do read it, and we have a great panel here to discuss the matter. Françoise. Françoise Bouchet-Saulnier, who is IHL and Strategy Senior Advisor in the Legal Department in Médicins sans Frontières. Edward Holder, a Deputy Director from the UK Ministry of Defence, and we’ve lost our Defence Secretary this afternoon. Sigrid. Sigrid Redse Johansen, Director-General in the Legal Department in the Norwegian Ministry of Defence and Emanuela-Chiara Gillard, Associate Fellow in the International Law Programme here at Chatham House and the writer of the paper.
So, we’re going to have a discussion here with, of course, pre-prepared questions, and then we hope that you will be asking questions, making comments, later on. I see we have some very distinguished members of the audience, so I hope you will be able to participate. But I’m going to start off by asking Françoise, MSF, what are the key challenges that medical organisations face when operating in armed conflict, would you say?
Françoise Bouchet-Saulnier
Thank you very much for raising this question. It’s both a legal and a very operational question about security. To run a hospital in warzone, you need to, you know, be able to refer to the law, but you need also to be able to give guarantees to make it concrete, to manage your own safety and security with parties that conflict. It goes through two main element, establishing and maintaining the special status of protection for hospital and medical. We are a pro – I mean, a NGO, we’re not Military Doctors. We are an international – a non-governmental organisation. We claim to be a impartial humanitarian organisation, that is define under the Geneva Convention for providing this medical special status of protection. So, we claim that.
And when we have established this status with the parties to the conflict, let them understand that we are impartial, that we are neutral, that we treat – we are civilian, that we’ll treat every wounded and sick, included wounded enemies, wounded fighters. But, you know, when you’re wounded, it’s not always obvious who you are, so for us, they are all wounded, as is said under IHL. And we treat all of them without distinction, including a wounded enemy, and this is not easy to understand and to get agreement. While this is very clear under IHL, this is always difficult at the level. We are supposed to treat only civilians. The other, they are either terrorist, rebels, criminal. Why are you losing your time with those people? We also treat, of course, military from the states, Policemen, all those who do not have – don’t have access to healthcare through the official state system. In most country at war, MSF runs hospital that are really providing this.
So, getting this agreement, getting this understanding that we are acting under the law and should be protected under the law, is the first element. And of course, to show that we are neutral, we go further or – you know, we implement concretely the law by saying, if this is a MSF hospital, there is a strict no weapon policy. So, “No-one shall enter with weapon, whether military or fighters. This is a neutral place. Please don’t bring weapons.” So, the no weapon policy is not strictly wit – written in IHL, but this is a practical guarantee for us to ensure that our decision remain medical decision. You never act in an independent way when you have a gun on your chest.
So, the no weapon policy is the second guarantee that we negotiate everywhere, with success. It’s not because it’s not written in the law. That is – it’s difficult to understand and everyone understand that this is the best way to proceed. Of course, there are breaches, but they are breaches of something that is agreed. We have the stickers, “No weapon” and no-one challenge that per se. So, the breach is perceived as a violation, even by those who make it. We prohibit also all kind of military interference entry, even for lawful purpose like arrest, interrogation. The principle is that no-one with guns enter the hospital, whatever the motives.
We also need, as humanitarian, like for the military, to have simple rules to get them implemented at field level, and we prohibit all pressure and threat and punishment on the medical staff. Meaning that when this happen, we treat it as a security incident and we revert to authorities. So, since they agree, they also acknowledge that this is implicit rules for the functioning, proper functioning, of a hospital in the battlefield.
Then we try also to avoid the military misuse of hospitals, because, you know, first, they need to acknowledge that we are – our hospital protected and we need, then, also, to avoid the military misuse. This is complex because we have very little key, what is the misuse? The military knows, but it’s difficult to know. So, we have the no weapon, which is the first misuse, and we try to interact to establish communication channel with the parties to the conflict, to identify, first, say where is the hospital, it is a protected one, and what are – we try to say what are the guarantee we propose to keep the hospital protected? So, we say the no weapon, we say all that and if it’s not enough, we expect the military to turns back to us and say, “This is not enough. Something wrong happened in your hospital, and this should be a change.”
But this, again, is not exactly the law. The law say that parties to a conflict should not abuse, but they should discuss that among themself. It’s never written specifically that they should turn to the Medical Director of a hospital to say, “I know that there are weapons that are stored in your hospital. Maybe you don’t know, but I tell you and please, you need to do something about that.” So, establishing this connection is a way for us to be aware when something goes wrong before we get attacked. So, this is something, establishing the communication channel is something that is very difficult, because since it’s not written in the law, it always required a serious incidence, like a big attack, to have the military agree after that to establish channel of communication. Otherwise, they don’t bother with civilians, not even with NGOs.
So, we give them our location, but then they come back and say, “Ah, you gave us just a GPS co-ordinated point. Please give us the whole perimeter of your hospital because what we think happened within the hospital may happen next to the hospital and this matter.” So – but frankly, it requires, unfortunately, big, big incidents with many people dead to be able and allowed to interact with the military channel, to have military outline, even for Commanders to know that we are under attack. We may be under attack, while the IUS Commander are not informed. So, we need this system to be in place even for them to implement their own discipline.
And of course, we are very much avoi – involved in preventing and managing those security incident based on the law and on the dialogue. Dialogue, it’s a big word, engagement, I would say, with the military, and basically, it’s really based on incident, and it is based on incident that actually, we create our own caselaw saying, ah, this was perceived as a loss of protection for the wounded. This was perceived maybe as a loss of protection for the hospital or for the Doctor. But this is really very difficult at the moment. We are working, frankly, in a situation where it’s not foreseeable for us to know and to be sure that our wounded are effectively protected, that our hospital are effectively protected or that the Doctor are effectively protected.
Because they are cases, like the – for instance, the wounded should not – should abstain from a hostile act, but there’s no clear definition. It’s clear when it’s a wounded at the battlefield and he still had a rifle, but when it is inside the hospital recovering from surgery, what kind of hostile act and how could we know that this person that we consider as a wounded is, in fact, considered by the other party to the conflict as a target? Either because he’s taking – he’s having hostile or because he’s a high-value target, a terrorist or, you know, going within a grey area of the conduct of hostilities.
So, all this element were really very important to share together to put into discussion, because we all think that thing are clear, and we discover that the law is far more complex. And notably, the distinction between the protection of medical mission under military rules, the Military Doctors, military hospitals, and the civilians’ Doctor and the civilian hospital, we thought that all that had been harmonised. It is not, not fully, not precisely. There are gap, there’s misunderstanding, so there’s an urgent need of clarification for those that are good-willing people, of course. And there’s still room for the rest but – and even for good-willing people, we have gaps in our common understanding of the law, and we have gaps or lack of experience of what is a good implementation, one that works, to keep hospital functional in warzone. Thank you.
Elizabeth Wilmshurst CMG KC
Thank you very much. No, that’s very interesting. Manu, we’ve heard some of the difficulties, some of the lack, some of the gaps. Your comments on the law.
Emanuela-Chiara Gillard
Yes, hmmm, many of the issues that Françoise have flagged are addressed by international humanitarian law, some of them in a very clear and absolute manner. So, for example, the entitlement of the wounded and sick to receive medical care is a foundational principle of IHL and this care needs to be provided to all, to friend and foe, to civilian and combatant and without discrimination. Equally clear is the fact that those providing medical care must not be punished or intimidated for having provided medical assistance.
When we come to how military operations can impact medical facilities and medical vehicles that are essential to providing that medical care, the rules do become, as Françoise said, more complicated, more complex and at times, less absolute. So, as far as civilian rather than military providers of medical care are concerned, IHL foresees two layers of protection. First, they are entitled to all the protections afforded to civilian objects and these include most notably, the prohibition of direct attacks, the rule on proportionality that prohibits attacks on military objectives if they are expected to cause excessive civilian death, injury or damage to civilian objects compared to the anticipated military advantage. The obligation to take constant care to spare civilians and civilian objects and to adopt feasible measures to minimise such harm or damage. So, these are the general rules that are applicable.
In addition, some military facilities and vehicles, but not all, are entitled to specific protection that goes over and above this general protection and imposes additional obligations on belligerents to respect and protect them and to facilitate, or at least not unduly impede, their operations. And clearly, a key part of this obligation to respect and protect is a prohibition on abusing the medical facilities.
However, as is always the case for the rules that regulate the conduct of hostilities, some of these protections can be forfeited. So, for example, if a hospital is used in a manner that turns it into a military objective, it is no longer protected from direct attack. But even then, if you look at the rules, they strictly regulate the circumstances in which this loss of protection can occur and put limits on the nature of the response that takes into account the reality that it’s likely to still be a functioning hospital.
It’s important to realise that the law doesn’t provide absolute immunity from damage. So, for example, in terms of indirect damage, when an attack is being conducted against a military objective in the neighbour – in the vicinity of a medical facility, or there’s fighting in the vicinity of it, there may be damage to a medical facility. It doesn’t benefit from absolute immunity, but what matters is that a proportionality assessment is conducted that duly takes into account the anticipated immediate and longer-ter – foreseeable longer-term injury and death to civilians.
Not all obligations are absolute. Some depend on what is feasible in the circumstances, again, something we need to bear in mind. And then, some of the issues are simply not addressed in the rules of IHL on medical care. So, for example, a key problem is frequently, the movement of goods and equipment that’s necessary for the functioning of medical facilities. You’re not going to see anything specifically about this in the rules on protection of medical care. Maybe it’s implicit in the obligation to protect. Instead, we need to look at other areas of IHL and draw guidance from the rules that, for example, require the rapid an unimpeded passage of humanitarian relief consignments.
So, if today, states were to sit down and draw up a treaty on the protection of medical care from scratch, it would look very different to what we’d have. Ideally, it would bring together all these rules and protections that address the variety of ways in which military operations in conflict can impede midical – medic – the provision of and access to medical care, but that’s just not what we have. What we have is the existing law where the rules developed in a progressive manner and are scattered across different instruments. Not ideal in terms of clarity, in terms of understanding, but that’s what we have.
Elizabeth Wilmshurst CMG KC
Thank you very much. Now, we’re fortunate to have on the panel two members of two different Ministry of – Ministries of Defence. So, it’ll be interesting to hear from them how the IHL protections are put into their law and practice. Sigrid, could you start us off on that?
Sigrid Redse Johansen
Thank you. Yes, I will, but first, thanks for inviting me back. I’ve been here before. It’s a pleasure to be here again and for the ability to, like, take part in this. It’s a very topical, regrettable, crucial topic to ensure the respect and strengthen the actual protection of medical facilities. And the report that was referred to initially here, which is now online, it’s both – I had a sneak peek of it and it’s both in-depth, as well as practical, so it’s recommendable to read it, so from the very capable team here at the Chatham House.
And the measures that we do require from our Armed Forces and the major challenges, it’s a bit the – a twofold question that we are posed. It’s also a twofold perspective from my side, and the – yeah, of course, in the following I refer to – I have brought, actually, our manual, which also address medical facilities and medical personnel. It’s updated in 2025. The previous one is in English. The second one is not yet in English, but it’s online and free. So, we, of course, we train our personnel in that one. Everything that I refer to in this one is public statements, of course. Otherwise, it’s reflections from my side.
But two perspective. One is, of course, the behaviour of implants and implementation by our Armed Forces. The requirements, or the measures that we require concerns, of course, how they behave. We are responsible, the Ministry, for their behaviour and they are in the position to give overall instruction and guidance. The other perspective from my side is our public healthcare system in times of war on our territory and that perspective is a bit different from the very important challenges brought up by Françoise, but this is perhaps most in our foreheads nowadays. So, in the unlucky event of war on our territory, we are very, very concerned about the ability for our healthcare system to actually work.
So, these two aspects will follow throughout my remarks and the measures, of course, our Soldiers and everyone in the chain of command, they need proper training and knowledge, because what we experience, of course, is that knowledge makes people more secure and the difficult questions raised by Françoise are, of course, raised. It’s not unique questions and the more certainty that our uniformed personnel have, the more confident the experience that they feel in the meet – in meeting these questions.
And some of the questions posed by, and actually highlighted by both Manu and Françoise, that the equal treatment of anyone on medical terms, it’s not always intuitive, I believe, from – especially from young Soldiers and from – you know, everyone has a party. Everyone is a party to a conflict, so it’s their own perspective and that humanitarian guarantee to equal treatment, it’s not always intuitive. So, it’s very, very important to stress and for that one, it’s training. Training, training, training and to implement and co-ordinate between military and civilian side. That’s a very big focus on our side. Our Norwegian Armed Forces Medical Services had a big exercise now in 2025, training their role to enhanced field hospital, consisting of both our Soldiers, as well as ordinary health personnel. So, the co-exercise in a big exercise.
Here we are at the core of the challenges. I thought that I had already perhaps listed them a little bit, but from our side, we are a small country, we have one healthcare system, and that healthcare system is supposed to work in peace, crisis and war. And we have – because of our geography and our topography, we have transportation issues, we have logistical challenges and these become even more crucial in terms of crisis and war. So, that – and our resources are, of course, limited. So, this challenge is very much a factual challenge which also may give legal challenges, because since we have limited resources, both when it comes to logistical issues and people, we need to decide who peo – what people to draw on for what tasks and that’s, in a way, a current challenge to us to try to adapt in our preparedness perspective.
So, one example to finalise from my side, is that we, for example, how one search and rescue service, which is manned by the – and run by the Armed Forces and it’s owned by the Ministry of Justice. So, in peacetime is the search and rescue operations for people at need, especially at sea, and in wartime, it belongs to the Armed Forces. And it’s a choice we made, and we have public open debate about the function of that one, but it’s a lively question. So, with that, I think…
Elizabeth Wilmshurst CMG KC
Thank you, and in the latter part of your remarks you were talking about military preparedness in the…
Sigrid Redse Johansen
Yes.
Elizabeth Wilmshurst CMG KC
…event of a conflict on your territory.
Sigrid Redse Johansen
Yes.
Elizabeth Wilmshurst CMG KC
Which of course, you are thinking about far ahead of some other countries.
Sigrid Redse Johansen
Yeah, what we refer to as the “total defence concept,” this is an regional public concept. I think perhaps also by some states, referred to as the “whole of government approach,” meaning that our entire society needs to be prepared and assist each other, both military and civilian side. We call it total defence. We don’t acknowledge total war, but we call it a total defence concept. And we have that concept since the aftermath of the Second World War and it has been revised in the latter – yeah, between six – five/six/seven years, it has been revised.
This year, at home in Norway, it’s the year of – the “Total Defence Year,” we call it. So, it’s a highly, highly public focus on the Total Defence Year. We try to make heightened awareness on everyone to be able to understand, in a way, how we, as a nation, will protect ourselves, how we will protect each and every one of us, as citizens. Not me as a public official, but everyone is also part of the total defence concept.
Elizabeth Wilmshurst CMG KC
So – sorry to come back to you. So, you mentioned the search and rescue organisation…
Sigrid Redse Johansen
Hmmm hmm.
Elizabeth Wilmshurst CMG KC
…being taken over by the military…
Sigrid Redse Johansen
It…
Elizabeth Wilmshurst CMG KC
…in the event of, and are there other bits of civilian infrastructure that you are preparing to be taken ove – so, does the question arise, were the…?
Sigrid Redse Johansen
Well, the question is, I think it’s always in the air, in a way, for us, since we are a small nation. The search and rescue is a very particular service. It’s, as I said, it’s run by the military, but it’s owned by the Minister of Justice.
Elizabeth Wilmshurst CMG KC
Oh, okay.
Sigrid Redse Johansen
So, it’s military personnel.
Elizabeth Wilmshurst CMG KC
Okay, so…
Sigrid Redse Johansen
…who’s driving the helicopters, but we also have, for example, our Coastguard, who is the Military Coastguard and there’s also civilian functions. So – and there are warship and they have specially assigned by law functions which are also civilian.
Elizabeth Wilmshurst CMG KC
Thank you very much. Edward, how does the UK entrench military – oh, sorry, protection of medical care?
Edward Holder
Well, thank you, Elizabeth, and thank you for the invite to join the panel. I must just say that although I’m speaking from an informed position, the views I will express this evening are, of necessity, my own and not necessarily the official position of the UK Government. The UK gives effect to IHL protections in four ways. Preparation, that is to say regular training on IHL matters, planning, performance in the manner in which we conduct military operations and precautions, the requirement on Commanders at all levels to take feasible measures. I’d like to concentrate my remarks this evening on the planning aspect, as I think that is perhaps an area which is less understood, or most misunderstood, outside of military circles.
So, the UK has adopted NATO Doctrine on Planning condain – contained in Allied Joint Publication-5, which is readily available on the internet. Underneath that sits comprehensive direction to the military on how they conduct planning, that less available publicly. One of the key parts of the planning process is called Intelligence Preparation of the Environment and I emphasise the word ‘environment’, because this is perhaps the key development in the planning space over the last 20 to 30 years. Previously, the focus would’ve been on the adversary, but now it is about analysing the entirety of the environment in which you expect to operate, both physical and non-physical.
The end-to-end system of medical infrastructure is considered in this analysis process. How does the provision of medical services work? Is it primarily state or private provision? How does it function in relation to other aspects of state and local infrastructure? And similar considerations. It looks specifically at medical infrastructure, the locations of facilities, the nature of those facilities, what their interdependencies are, and it provides the military with a rich and detailed level of understanding. And so what, you may ask?
What follows from this analysis is the creation of, primarily, a no-strike list and that contains – will contain a number of locations, not just medical ones. And UK targeting processes designate medical facilities, both civilian and military, as Category I non-strike entities, ensuring that rules of engagement and targeting processes reflect their special status. Secondly, when developing military courses of action, one of the considerations will be, where are you going to operate? And that could be influenced by proximity to or how that will interact with medical facilities, relevant supply routes, energy supply and other such considerations.
All of this requires information and intelligence, which may be more difficult to obtain than one might expect if you’re operating in overseas environments. In the current situation with the UK focus on NATO and the anticipated operating environment being within the territory of NATO states, the analysis may be more straightforward but will come with it a greater complexity of healthcare provision.
In terms of challenges, while the plan may be to avoid conducting military operations in the vicinity of medical facilities, it is simply not always that straightforward, particularly if the adversary deliberately chooses to operate in the vicinity of, or actually within, medical facilities. Opportunities to shield, to provide them opportunities for the misinformation and intelli – information operations contrary to our objectives, abound. Additionally, the operating environment is dynamic, and locations of medical facilities may move about or med – more medical facilities may be established to meet the need in times of conflict. And as such, is an ongoing requirement to constantly update and review the initial analysis. Hmmm.
Elizabeth Wilmshurst CMG KC
Okay, thank you very much. Now, both you and Françoise have mentioned this problem of abuse of medical protection, abuse of the facilities of a hospital, whether by conducting your campaign from within a hospital or by other means. Manu, what does the law have to say about that?
Emanuela-Chiara Gillard
So, granting particular objects specific, so additional protection, brings with it the clear risk that an unscrupulous belligerent will take advantage of this at the expense of the wounded and sick and medical practitioners that the law was striving to protect, and this is something that the drafters of the rules were well aware of. So, to try and minimise this, the rules do include express prohibitions, as well as provisions that ideally establish a system of supervision that should prevent such abuse.
The prohibitions are clear and we have an express prohibitions, medical facilities and vehicles must not be used in an attempt to shield military objectives from attack. We have a rule that specifically addresses this. More implicitly, the obligation to respect medical facilities means refraining from other forms of abuse that could undermine their safety and their capacity to operate. Similarly, there are clear prohibitions on the misuse of the distinctive emblems of the Red Cross, the Red Crescent and the red crystals. So, for example, vehicles displaying the emblem must not transport weapons, ammunitions or able-bodied combatants, or the perfidious use of the emblem. And in fact, this kind of conduct is criminalised, it’s a war crime.
In addition, the whole framework of specific protection and in particular, the fact that it is granted to medical facilities that either belong to a party to the conflict or are recognised and authorised by a state, is intended to bring with it a continuing degree of control and supervisions. The authorities overseeing – granting such authorisations were intended to supervise their operations, to prevent abuse and for putting to an end instances of abuse. It was intended to generate trust in the system. However, despite these very clear rules, it is frequently those operating the medical facilities that are caught between a rock and a hard place. They are the ones that may be confronted with unscrupulous belligerents trying to take advantage of the protections or with allegations of such abuse.
Elizabeth Wilmshurst CMG KC
Yeah. Françoise, you’ve mentioned the kinds of things you put in place to, yeah, guard against it. Do you want to add anything?
Françoise Bouchet-Saulnier
Yeah, yeah, I think – oh I want, just want to go back a little bit on two element, because we are always discussing the issue of the abuse of the medical facilities to hide or to get military advantage. I want to go back to what Sigrid mention, the fact that treating wounded enemies is not intuitive. Actually, it was at the origin of the First Geneva Convention, 80 – 1864, where it was decided by law to make the wounded enemy neutral, but by law, because obviously, in practice, it’s not intuitive at all and still today. So, the second big trend for attack on hospitals is unfortunately, less debated because it is a way to deprive the enemy access to healthcare and this is never mentioned per se, why it is maybe for us the major and first trigger for attack on a hospital and on medical personnel.
So, the tree should not hide the forest, and this is why debating the issue of the protection of hospital should be presented as it’s not only that some are abuses the protection, because since they are abusing, they do not trust the protection, as well. So – but the main trigger needs to be reminded. This is why, for us, to remain alive in warzone since decade for MSF, we have developed practice that is no weapon policy, which is not [inaudible – 43:09], and we say, “You, the war must stop at the entrance of the hospital. If you search and arrest people,” and I remember very well in Yemen, discussing that, I say, “you will just turn the hospital into a battlefield because they will not remain, you know, still. If you are going to arrest them, the gang, the other will come to protect them. So, you will just turn the hospital into a battlefield while the law try to preserve the hospital.” So, we should also not, you know, go too quick in huh, the hospital has been abused, it is attacked.
This is why I think the work you’ve done is very useful, so to say it’s not because it is abused that it is turn into a military objective. There are sequence that must be taken, but today, the issue of the warning and all that only apply if it is a authorised and recognised medical facility and not a healthcare place. So, this is technical issue, but a legal one that carries a lot of threat if we give it up. This is why I want to make clear hospital in warzone cannot survive only through their civilian status of protection. They must be granted special protection for medical care. There’s, I mean, there’s no debate on that, we will not stay.
And even with this special status of protection, we are at risk. In Kunduz we had 42 person killed by US under NATO Rules of Engagement. So, what happened? We spend two years discussing what makes such mistake possible, and this is why and where, first they say there was fire from the hospital. The hospital was a Command and Control Centre. Command and Control Centre, CCC, for us for the medical people running the hospital, we’re not crazy, one. If there’s fighting into the hospital, we escape, we don’t stay, and we take the – I mean, the Doctors flee, they’re not stupid.
So, it’s easy for us to see if the hospital is used as an active base for combat. What is not visible and less easy to analyse is whether or not it’s used for communication, or there are Commanders inside, but maybe for medical purposes, since you trace people based on their cell phone. Their cell phone do not give you their medical condition. Yes, they may be inside, but for other reason than the one that is obvious in a military mindset. So, this is why we need to, you know, remain quiet and calm and not, you know, cry about abuse of hospital all the time by the adversary that is not respecting anything.
So, this is our reality. There’s a number of thing that we can see if the hospital is abused and of course, take action, but there are less obvious criteria that are kept within the military intelligence system, not shared and they may also be abused. Either it’s a mistake of intelligence, because the intelligence may also be wrong, or it is something else while we should be informed. So, usually, after mistake, we ask to be given the information, and we can act on information. If there’s, you know, a weapon that are stored or just next, we can go to the other and say, “Please remove it, otherwise we will have to close.” It’s not a big argument, but it is an argument that makes sense for a number of people and that works in practice.
Elizabeth Wilmshurst CMG KC
Thank you very much for that. Sigrid, how do you deal with that? I mean, is that a matter for case by case, or do you have any sophisticated guidance about what happens when there is abuse, that it doesn’t automatically turn into a military objective, that one has to…?
Sigrid Redse Johansen
Yeah, well, not automatically. I think what we try, at least, to teach and it has been – I – Françoise mentioned the example of the terrible bombing of the Kund – hospital in Kunduz in Afghanistan. And I think that the long period in Afghanistan within the NATO presence illustrated a lot of these problems of – or the dilemmas between shielding and let’s say a revolving door of protection and the concern for the protection that the emblem actually gives. And it – we have spent, from our side, quite a lot of energy, actually, in training our forces and heighten the awareance [means awareness] of the problem that you raise, Elizabeth, that of course, the careful approach to what’s a one-time abuse.
So, that’s one aspect and the other aspect that I wanted to highlight is actually the twofold, in a way, problem of – or challenge of protection when the protected entity is not protect – is not res – when the protection is not respected. One aspect is, of course, that we have seen in many conflicts that it – that our hospital facilities, medical facilities, are actually targeted at, because as you say. And of course, it’s – our personnel sees it, and of course, it may create a distress that if we, in a way, refer to the protection, then we will become even more a target.
So, the concern on the healthcare side is that the protection by law is not really in effect and what do we do about that? And that can create, again, a twofold problem, what shall we do if the protection is not really respected? Shall we a) not use – not claim the respect or the protection, or shall we, in a way, use the emblem on and off when it suits us, to put it bluntly? And that latter problem came up, of course, in the Afghanistan period and I believe it’s not really gone. And we made – from our side, it was given instructions to our Armed Forces on criterias for when to take the emblem off, the level of authority to order it off and the period of time it was allowed to – that had to be – to have to go before you could take it on again, in order not to, in a way, create a situation of abuse. To create a shielding situation.
So, that issue is now addressed quite detailed in our manual. It was an instruction that is now ex – quite detail laid out in our manual in order to, in a way, have – to try to balance between the need to some flexibility, if the – if you don’t – if you experience that the protection is not respected and not to make that flexibility go into abuse.
Elizabeth Wilmshurst CMG KC
Thank you.
Sigrid Redse Johansen
Yeah.
Elizabeth Wilmshurst CMG KC
Edward, do you have anything to add on this one?
Edward Holder
I mean, yes, I think as I alluded to previously, it’s imperative to keep updating the intelligence picture on medical facilities. Without that, Commanders are not presented with all the options for dealing with the problem, including the dialogue that Françoise refers to. To me, there are two aspects to this question. What is a medical facility and what constitutes abuse? As a matter of law, as Manu has mentioned, not all medical facilities benefit from the specific protection, although they are clearly protected as civilian objects.
Emanuela-Chiara Gillard
Yeah.
Edward Holder
And as Françoise has said, it – the law is complex here and it’s difficult to establish what is a medical facility as a matter of law. I think from the UK’s perspective as a matter of policy and good practice, we endeavour to protect all medical facilities to the highest degree possible but recognise that standards are going to differ. The function of a facility is open to interpretation, but it also must be under the authorisation of a belligerent state, as we’ve heard mentioned. And this comes with a continuing obligation, in our view, on the party, to take measures to ensure that those facilities are not abused.
Medical facilities, as we all know, lose their protection if they’re used for acts harmful to the enemy and yes, it is not well defined and it can be interpreted either widely or narrowly. As Françoise says, would a hospital having a command post inside it be an act harmful to the enemy? And that’s an open question. The commentary to Additional Protocol I suggests that it refers not only to direct harm inflicted on the enemy by, example, for firing on him, but also to any attempts at deliberately hindering his military operations in any way whatsoever. This is pretty broad, and for us, all I can say is it – that that is a higher threshold than simply qualifying as a military objective.
In the warning provisions, if a hospital is to lose its protections, there’s a degree of specificity required as to what the acts harmful are considered to be, ‘cause the warning must address that actual conduct and not just be a broad assertion that the facility is being used by a party to the conflict. The way to deal with this is clearly set out in Article 13 in terms of the delivery of a warning and the timeline to cease the activity, which must be specified as set out. It must be reasonable and response mu – if it’s not heeded, must be graduated in relation to the harm that is being suffered.
The other difficulty with this, though, is that it assumes that the medical unit authorities are in a position to stop harmful acts which they may not have it in their power to do. I mean, I’m just happy to say that UK forces would not seek to conduct acts harmful to the enemy from a medical unit, nor abuse the broader protection of medical facilities, but of course, we have seen examples of this in recent conflicts.
Elizabeth Wilmshurst CMG KC
Yeah. Before opening the floor to questions, I want to ask each of our panellists, we’ve mostly been talking about – well, you know, we’ve got two respectable countries who try to obey the law, but of course, there are many who ignore the law or actively disobey it. So, I want to ask each panellist, what more could be done to encourage compliance with the law by those who are not? Shall we begin with you, Sigrid, because you’re at the end there?
Sigrid Redse Johansen
Thank you. What can be done? Now, of course, I thought about this and there is a lot of discussion out today about the challenges to international law in general and whether the, in a way, the respect for law in total is at stake? Of course, I strongly argue this, not only because I’m obliged to as a public official, but that the law actually works and that it’s still important. And I think that it’s difficult – no, it’s not difficult, it’s important, it is difficult, but it’s most, I wanted to stress that it was important, it’s important in a way to go a bit back to the roots and to the big pictures when it comes to the strengthening the law. And that is, you know, the protection for wounded, sick and medical services is among the core really basic rules of international humanitarian law. It’s in both the Geneva Conventions and the Additional Protocol and they are – their – in their core, they’re undisputed and globally accepted, so at – by law.
The problem is now the respect and there – I think it’s – in that frame, it’s important to highlight again the basic foundation, in a way, inherent in the International Humanitarian Law Institute, and that is the mutual interest of states to abide by the law. That the reciprocity aspect, that it benefits us because it benefits the other. So, in a way, to find the trigger points where it’s mutually an advantage to abide by the law and that, of course, is very difficult in I – asymmetrical warfare, it always has been. Challenges to promote this kind of mutual interest in abiding by the law. But as said by Elizabeth at the outset, a lot of these violations, the report are also committed by states, and I think that we have a common responsibility to try to lift up the areas where the reciprocity in abiding by the law is of a mutual interest.
And there is – dialogue is very important and it’s also important to recall and not to just have, you know, mark – well, I will focus on violations, but also to highlight in what areas of life that the law still works. So, also where there are violations, there are also, you know, actors that are still using the system of international law all the time, every day. So, this means that the law in total, it works and our cha – common challenge is to make it work better on the areas where there are also violations.
Elizabeth Wilmshurst CMG KC
Great, thank you. Manu.
Emanuela-Chiara Gillard
I have a number of additional next steps that can be taken by states that do want to comply with the law, but that wasn’t your question.
Elizabeth Wilmshurst CMG KC
No.
Emanuela-Chiara Gillard
So, I’m not going to say this, and I – what was striking when preparing this report is how very few – the minute number of investigations and prosecutions that have been conducted for alleged violations. We see very few internal admin – investigations by states and in terms of in proceedings before courts, international/domestic, the international tribunals, there was only one that looked at a case relating to medical care and it was because of looting. That was the only case, and similarly, very few in terms of – in domestic law. I’m giving the example of Ukraine, because it’s currently carrying out really significant investigations of military conduct of 800, when I last counted, notices of suspicion, so beginning of investigations. None of them related to medical care, which is really striking, even though there’ve been a number of incidents, and it’s really unwarranted. It’s difficult to understand why there have been so few, either internal administrative reviews or criminal investigations, ‘cause the…
Elizabeth Wilmshurst CMG KC
Have they…?
Emanuela-Chiara Gillard
…law’s – yeah.
Elizabeth Wilmshurst CMG KC
Have you heard any comment on that from a Ukrainian…
Emanuela-Chiara Gillard
No.
Elizabeth Wilmshurst CMG KC
…Prosecutor? Okay.
Emanuela-Chiara Gillard
No, no, no, no.
Elizabeth Wilmshurst CMG KC
Oh, well, that’s interesting.
Emanuela-Chiara Gillard
So, it’s really striking that there are so few. The law’s clear, violation of many of these rules is potentially a war crime, and yet.
Elizabeth Wilmshurst CMG KC
Okay, so that’s – anything else…
Emanuela-Chiara Gillard
That’s up to now.
Elizabeth Wilmshurst CMG KC
…for – yes, Françoise.
Françoise Bouchet-Saulnier
Thank you.
Elizabeth Wilmshurst CMG KC
For the baddies, we’re talking about.
Françoise Bouchet-Saulnier
Yeah, yeah, yeah, yeah, for sure. I think, yeah, we are very used in MSF with working with situation where parties to conflict do not care that much respecting IHL. They respect hospital or not, but they do not – what is really dangerous and new for us is to have states who destroy hospital massively, pretending that they abide by IHL. I mean, this is a major threat to IHL, because others do violate without a number of investigation, without too much. I think the low number – I mean, the – almost no investigation that are happening is linked to the fact that interpretation of the law is very complex. Making it a criminal case with proof beyond the threshold of doubt, knowing that the fact and the intention are usually covered by medical – military secret, not medical one, this make it almost impossible for Judges to go.
So, the rules is there, but I think what can be done is to lead by example and to ask states who do not take all legal protect to go for attack and to show that they show restraint, because the consequences are very, very dangerous. Maybe there are some military advantage taken by one side – my – one party to the conflict using hospital. But the consequences of the destruction goes far beyond and the proof of the abuse is not given in an open, transparent and I would say, contradictory manner. It belongs to one party. So, I think showing restraint, showing that the interpretation of the law should keep in mind that it is a restrictive interpretation of what is an exception to the protection and not the principle is that it’s always abuse so you can always attack. This is really a very important role to play for responsible states.
Elizabeth Wilmshurst CMG KC
That’s for responsible states. However, Edward…
Edward Holder
Responsible states…
Elizabeth Wilmshurst CMG KC
…the irres – no.
Edward Holder
…or irresponsible states?
Elizabeth Wilmshurst CMG KC
Irresponsible states, that’s what I’m wanting.
Edward Holder
I mean, I was struck by Françoise referring to the need for dialogue and it’s – for all belligerents, civil military dialogue, not just out of armed conflict, but on the ground, in an operational situation, no matter how you are framed in the – in that conflict, is important, and real-time conversation and that is the way to bridge the gaps in understanding and to improve protections. Greater clarity and a shared understanding, again, not just between states, all states, but on the ground, on what constitute acts harmful to the enemy and how to address them, and I think documentation of decisions and warnings which ultimately, would lead to, I think, greater accountability…
Elizabeth Wilmshurst CMG KC
Yeah, great.
Edward Holder
…in more ways.
Françoise Bouchet-Saulnier
Hmmm.
Elizabeth Wilmshurst CMG KC
Thank you. I’ve been getting some interesting questions online. Unfortunately, I can hardly read them because it’s so small, but while I’m trying to read this, is there anyone – yes, have we got a microphone? Oh dear, quite a lot. There’s someone right at the back put their hand up first and while you’re getting the microphone there, I am going to read this one out by Jann Kleffner. “Is” – and it’s back to abu – “Is the mere presence of able-bodied combatants enough for a loss of the specific protection of a medical facility?” Surely, we’ve answered – oh, ‘able-bodied combatants’. Manu, that comes to you, because it’s a reference to your report and you say to ‘shelter’ would cause…
Emanuela-Chiara Gillard
That’s to me…
Elizabeth Wilmshurst CMG KC
…a loss of specific protection.
Emanuela-Chiara Gillard
Yes, I would say…
Elizabeth Wilmshurst CMG KC
When is the presence turning into a sheltering, or is there no material difference between…?
Emanuela-Chiara Gillard
That’s a very goo – and why are we thinking of sheltering?
Elizabeth Wilmshurst CMG KC
Because you used the word.
Did I use – well, I think there’s a clear prohibition on using the facilities to shield military objectives. So, is the mere presence in the hospital, does that amount to shielding? That’s the rule that’s expressly covered, but I would – I’d be tempted to say that hospitals shouldn’t be used as a place for able-bodied combatants to rest and recuperate. Ideally, they shouldn’t be there at all and – even without weapons, ‘cause it does put the facilities at risk.
Elizabeth Wilmshurst CMG KC
But does it lead to a loss of specific protect…?
Emanuela-Chiara Gillard
Yes.
Elizabeth Wilmshurst CMG KC
It does, okay, in your…
Emanuela-Chiara Gillard
It doesn’t…
Elizabeth Wilmshurst CMG KC
…view.
Emanuela-Chiara Gillard
…mean that they are liable to attack.
Elizabeth Wilmshurst CMG KC
No.
Emanuela-Chiara Gillard
That’s a different step.
Elizabeth Wilmshurst CMG KC
Okay, thank you. Now I’m turning to one and if you wouldn’t mind giving your affiliation first.
Noel Maurer Trew
Noel Trew, British Red Cross. Thank you very much to the panellists. So, this is a toss-up question and are there any differences in the way that the law treats military hospitals compared with civilian hospitals and if so, how much do those differences actually matter in practice? Thank you.
Elizabeth Wilmshurst CMG KC
Thank you so much and you have, Noel, given me the opportunity to thank the British Red Cross for supporting us in this project.
Karen
Thank you. Hi, and my name’s Karen [inaudible – 65:18]. I’ve been previously with MSF and ICRC. So, my question’s about what are the consequences for the state actors who are increasingly targeting health facilities and – as well as health workers? And there’s so many more cases these days. I mean, what were the consequences for the Ethiopian Government in Tigray? What are the consequences for the Israeli Government? There have been so many – so much evidence about deliberate targeting of health facilities and health workers. I mean, we’ve all seen the video of those guys in the ambulance getting shot last year. You know, what are the consequences?
Elizabeth Wilmshurst CMG KC
Well…
Karen
Who’s going to – you know.
Elizabeth Wilmshurst CMG KC
Thank you for that.
Karen
‘Cause there don’t seem to be any.
Elizabeth Wilmshurst CMG KC
Thank you, and here in the front.
Jamil Gusul
Jamil Gusul, Chatham House member. I’m very grateful to the panel and different professions. We have the government representatives here, we have Lawyers and of course, Doctors. The question is in regards to international law itself, what is the point having international law if there is no punishment and if it is not implemented? That’s it.
Elizabeth Wilmshurst CMG KC
Super, thank you. So, we really have got – we’re going to answer these ones, the difference between civilian and military hospitals in terms of protection and basically, an implementation question, what are the consequences? Those last two questions were saying the same.
Sigrid Redse Johansen
Oh, we don’t treat them very differently.
Elizabeth Wilmshurst CMG KC
And Manu, are you going to answer that one about the civil military or…?
Emanuela-Chiara Gillard
I…
Elizabeth Wilmshurst CMG KC
Or would Sigrid like to?
Sigrid Redse Johansen
Oh, I guess I – perhaps we have the same approach, if – I’ll – because we don’t treat them differently. We – if we…
Elizabeth Wilmshurst CMG KC
As a matter of policy?
Sigrid Redse Johansen
Policy, I’m – I actually, I checked yesterday whether we have taken a position in the matter of distinction and we haven’t.
Elizabeth Wilmshurst CMG KC
Okay, oh, okay.
Sigrid Redse Johansen
So, Edward, what have you done?
Edward Holder
We would draw no distinction.
Elizabeth Wilmshurst CMG KC
Okay, no distinction, so that’s great. Now, consequences, I mean, this is a problem for all of us as International Lawyers in so many consequences of breaches of international law and it’s particularly poignant in this area. Manu has been saying that there aren’t enough prosecutions and there aren’t enough investigations. So, does anyone want to give a happy answer?
Sigrid Redse Johansen
No. I think the problem is, of course, a general one with violations that to uphold respect for the law, there should be consequences, of course, when there are violations and that touches upon every layer among the – in the chain of command and at state level, of course, that implementation is one thing and consequences for violations is another one. And of course, as the state representative, I must say that, of course, it’s our responsibility, of course, to both train our own and discipline our own and to take a look at measures if we are informed of violations. So, that’s our state responsibility, as well as the responsibility we expect from our chain of command.
But when it comes to, of course – the real big question is that when there are states, if states don’t – because the obligation, of course, lies upon states first. It’s a – that’s – I mean, that’s the – a point of the impartial international law, of course, is that it’s – the obligation lies upon the state. So, of course, the very difficult one is that this international community doesn’t consider that the state is doing enough, of course, so – and I don’t have a – of course, if I had the solution to that, it will be served. But that is – yeah, so I guess that’s the big dilemma, is that when the mechanisms that international law has placed there doesn’t work, it’s our responsibility as the state, so…
Elizabeth Wilmshurst CMG KC
Yeah, and – alright, Manu.
Emanuela-Chiara Gillard
I just wanted that there are – in addition to criminal responsibilities, there’s the possibility of the imposition of sanctions and we have instances where gross violations have read [means led] to restrictions on the provisions of weapons to particular countries. So, there is a range of measures we should look at.
Elizabeth Wilmshurst CMG KC
Thank you. Okay, back here, we’ve got three here. Yeah, thank you.
Lt Louis Lillywhite BC MBE CStJ
Hmmm. Thank you very…
Elizabeth Wilmshurst CMG KC
We hear you.
Lt Louis Lillywhite BC MBE CStJ
Thank you very much. Is it working? Yeah.
Elizabeth Wilmshurst CMG KC
Yes, it is, thank you.
Lt Louis Lillywhite BC MBE CStJ
Right, Louis Lillywhite. I was Associate Fellow here and was previously 50 years in the Armed Forces. Thank you for the presentations, and many of I’ve heard before, of course and have been involved. Interestingly, in the 50 years in the Armed Forces, probably only ten to 15% of the issues concerning international humanitarian law and the medical services was in respect of hospitals. The overwhelming number were actually in front of hospitals.
Elizabeth Wilmshurst CMG KC
Ah.
Lt Louis Lillywhite BC MBE CStJ
And this is becoming more important, because all the increase in our survival has been due to the effectiveness of medical support in front of hospitals. If you don’t get a live patient to a hospital, the Surgeons can’t do anything, however much they might think so. So, I’ll give an example of – just one example, very short. In one conflict I was in, of the first six enemy armoured ambulances with red crescents on, all of them were carrying heavy ammunition.
Now, if the enemy is abusing its position, we’re told that we’ve got to give them a warning before we do anything, but how, if you’ve got a lot of ambulances over the Armed Force – in the enemy Armed Forces, no centre that you can actually go to, to say, “You’re abusing your position,” what advice was I supposed to give to the Commanders and came to me and says, “Is it right that we can now target all enemy ambulances?” Because if you found eight with heavy ammunition and none without, then clearly, it is being used.
Now, that is – it is that type of area that is actually quite difficult to address, because very little attention is being paid to it. So, what I’m asking the panel is, are we giving enough attention to the issues of international humanitarian law in front of hospitals or not?
Elizabeth Wilmshurst CMG KC
Okay, thank you very much for that and there’s someone here, two people in this row. Thank you.
Member
Hi, my name’s [inaudible – 71:59]. Thank you for the overview. A student at King’s College London, studying master’s in public policy and management. My question is, is the pressure to investigate such a violation because of funding? Are funding cuts responsible to violate – to investigate such issues of violation of this law? Thank you.
Elizabeth Wilmshurst CMG KC
Thank you for that. Over here.
Lachlan
Thank you. There’s been some discussion from both of the government Legal Advisers about how your work informs proactive and reactive, you know, legal advice and guidance. I’m curious whether the Legal Advisers have a role in active military operations and whether you’re called to give advice in active scenarios, let’s say in interaction and operational interaction with the MSF, for example? What does that process look like in a live operational context?
Elizabeth Wilmshurst CMG KC
Sorry, and your affiliation?
Lachlan
My name’s Lachlan, but I’m just here in a personal capacity.
Elizabeth Wilmshurst CMG KC
Thank you. Right, well, and I’m going to add a fourth question which is online, but I don’t know if anyone here can answer it. “What are some contemporary challenges in the maritime domain when there are increased tensions and less clear distinction between medical and non-medical actors?” So, we can throw that in. Edward, we’ve got the problem – is enough attention being given to the problem in front of hospitals? Is funding cuts the problem of investigation, and well, perhaps you could answer the last one at least, what do you do – what do Legal Advisers – how much are Legal Advisers involved, rather briefly?
Edward Holder
I mean, ye – the answer is yes, they are involved and the British Armed Forces will deploy in different sizes and contexts and depending on the structure of the deployed force, there will be Legal Advisers at various stages. Now, they’re not going to be there with all Commanders at all times, but within a practical formation, a brigade headquarters or a divisional headquarters, there will be Service Lawyers who will be able to provide advice on specifically these issues.
And if I might deal with the gentleman’s question as a, sort of, flip onto that, would be that – and I recognise your experience, but one would hope in today’s context, the improved identification of the issue and communication up the chain of command, for a swift position taken by the United Kingdom on that, you – whilst you might not be in a position to communicate tactically with the opposition, there are always going to be channels open for communication between belligerents. And so, there is a means of doing it, accepting the fact that there is going to be, unfortunately, a delay in being able to identify the problem and communicate the need for a warning.
Elizabeth Wilmshurst CMG KC
Thank you. Françoise, do you want to add anything?
Françoise Bouchet-Saulnier
Maybe on the issue of emergence because I’ve been confronted with another issue just in front of the Emergency Room. It was more a series of attack. They were coming because wounded were brought in, you know, normal vehicles. I mean, there was no ambulances, so they knew that they were coming from the battlefield, so they were wounded enemies and they would strike at the very entrance of the Emergency Room in a – it was a pattern, because it was not an ambulance, but there were real wounded inside. So, we need to be reactive, because everyone is, you know, getting advantage of the tactic situation in all sense.
Elizabeth Wilmshurst CMG KC
Do you want to say anything on funding cuts, ‘cause I don’t know that – I think you’d have to ask prosecution authorities about funding cuts, but I don’t know that we’ve got an explanation for why there are not more investigations and prosecutions of the kinds of violations that we see, but Edward…
Edward Holder
I…
Elizabeth Wilmshurst CMG KC
…you do.
Edward Holder
…wouldn’t say that it is simple as a question of funding cuts.
Elizabeth Wilmshurst CMG KC
No.
Edward Holder
I mean, I think we do need to recognise, in a modern operational environment, that there are going to be real challenges in terms of properly investigating criminal acts or alleged criminal acts. Operational recordkeeping, availability of witnesses, chain of evidence, all of these are challenges that are recognised. The UK’s looked at this issue significantly. We have had the Henriques’ Review in recent years, and we’ve had the establishment of the – of a new operational command for – in operational investiga – Police operational investigations. So, it’s not just, I think, a question of money. It’s access to the scene of the issue, to recordkeeping and to witnesses.
Elizabeth Wilmshurst CMG KC
Thank you, that’s helpful. I think we’ve got time – we’re going up for drinks in five minutes – three minutes. I think there’s time for one more question. Does anyone have a really burning – right in the front here. Thank you.
Shamilah Nakaweesa
Oh, hello, I’m Shamilah Nakaweesa and I’m a member here at Chatham House. My question is, many conflicts involve non-state armed groups, for example in the Democratic Republic of Congo, so the M23. Well, what approach have been most successful in encouraging armed groups to comply with international humanitarian law regarding the protection of Medics?
Elizabeth Wilmshurst CMG KC
Great, that’s a good question, thank you, and there’s one online about non-state actors. “How to we – how do we operationalise IHL training in respect of them and in respect of operations against them?” Geneva Call?
Emanuela-Chiara Gillard
Yes, there’s one organisation that’s particularly engaged with non-state armed groups, both in terms of training them and it’s Geneva Call, both in terms of training them and also encouraging them to sign Deeds of Commitments. So, even though they are bound by international law, it’s binding on states and organised armed groups, they haven’t themselves ratified it. And through this process of the conclusion of Deeds of Commitment, Geneva Calls thinks it gives them more ownership in the law and therefore, a greater inclination to comply with it. And there – Geneva Call has elaborated a specific Deed of Commitment that focuses on the protection of medical care.
So, really, there is work in process to engage with armed groups specifically on this issue, but I know that you on the ground frequently…
Françoise Bouchet-Saulnier
Yeah, yeah.
Emanuela-Chiara Gillard
…engage with organised…
Françoise Bouchet-Saulnier
Hmmm hmm.
Emanuela-Chiara Gillard
…armed groups.
Françoise Bouchet-Saulnier
Maybe another comment on that. I think we’ve mentioned the fact that major attack come from states and this is a pattern, not because they are, you know, they are more complying with IHL, but they have more interest to maintain medical facilities because they need it for their Soldiers, also, for their fighters. So, in history of MSF, we have – it’s easier to negotiate with them…
Elizabeth Wilmshurst CMG KC
With non-state…
Françoise Bouchet-Saulnier
With…
Elizabeth Wilmshurst CMG KC
…actors?
Françoise Bouchet-Saulnier
…the non-state actors because they are depending on external supp – medical support. Because actually, the state’s health system is sometime, you know, cut from – you know, people are taken back or the supply do not come from the Minister of Health in area that are not under the state control. So, they have an interest to get that. Part of the issue is, also, the asymmetry of IHL, because for instance, they do not res – I mean, if they are liable to arrest and capture inside hospital, they will be tempted to do the same because they have no, you know, protection from that. This is really an issue, this is why we always argue that there is no arrest and interrogation in MSF hospital, because otherwise, everyone is playing his own, you know, pick and choose system.
So, it’s more or less, easier, and I want to stress, also, an element in term of looting. Looting is a crime, yes. Sometime they loot hospital not to destroy or to spoil, but to get some supply that they will use for medical purposes, not for selling or getting, you know, dark money. And this is also a grey error in IHL, the fact that you loot medical supply, if it is for medical use, this should not be completely considered as an attack on the medical mission. It’s sometime because that they are completely deprived of access to the emblem, protected places, protected medical facilities, so they only rely on actually NGOs, and they have very little rights in heal – med – state healthcare system.
Elizabeth Wilmshurst CMG KC
Thank you, good question, and of course, the ICRC is in touch with non-state actors. Do you know, it’s quarter past.
Emanuela-Chiara Gillard
Hmmm.
Elizabeth Wilmshurst CMG KC
Were you nodding to someone that you wanted to…
Emanuela-Chiara Gillard
I was nodding to…
Elizabeth Wilmshurst CMG KC
…answer?
Emanuela-Chiara Gillard
…the ICRC.
Elizabeth Wilmshurst CMG KC
Oh, right, okay, yeah. Yes, well, I’m glad that I mentioned you. Good. Look, we – please join us for drinks upstairs and please join me with thanking our panellists for coming here and for a very interesting discussion [applause].
