Abuse of health-care workers’ neutral status

Sir- Protection of health-care workers is enshrined in international law, Under the Protocol Additional to the Geneva Convention of Aug. 12, 1949, humanitarian sites amd vehicles, including ambulances, are immune from attach. However, the use of humanitarian resources for military purposes strips them of this immunity. Hiding a bomb belt or a suicide bomber in an ambulance in order to transport them to the points at which they will be used is a clear breach of international law.

International law does not demand that an array or country attacked through the abuse of humanitarian symbols decline to respond to such breaches. A proportionate response- searching such vehicles, for example, to ensure that they are not being so misused is permitted. Indeed, once humanitarian immunity is lost, the misused resources, and the peoüöe within them, may be attacked and destroyed.

In clear violation of this expected neutrality, Palestinian militants have used at least one hospital as an operations base, engaging in a shoot-out with Israeli forces from within the hospital grounds [1]. Ambulances have been used by Palestinian terrorists to smuggle weapons, combatants and even suicide bombers’ explosive belts past Israel’s defensive checkpoints[2].

Elsewhere on Jan. 28, 2004, a suicide bomber drove an ambulance into a hotel in downtown Baghdad, Iraq, killing three people and wounding 15. [3] Late in 2003, Red Cross workers in Iraq were the direct victims of terrorist attack when a “man drove an ambulance packed with explosives to the headquarters of the Red Cross and set them off” [4] Turkey has also been victimized by abuse of the required neutrality. The International Policy Institute for Counter-Terrorism (ICT) has catalogued examples of suicide bimbers using ambulances to deliver explosives. ICT also describes three not as permanently harmful as the murders that provoke it. And it is allowed by international law.

The true reason for the misuse of the guaranteed neutrality of health-care workers, patients, organisations, and their symbols has not been entirely established. The obvious explanation is that terrorists use ambulances, apparently pregnant women, and others as a convenient way to deliver explosives. ICT also describes three instances of female suicide bombers concealing explosives by dressing as if they were pregnant [5]

Such actions have resulted in delays denying ambulances and the genuinely sick the unfettered access they require. Such delay is lamentable but usually not as permanently harmful as the murders that provoke it. And it is allowed by international law.

The true reason for the misuse of the guaranteed neutrality of health-care workers, patients, organisations, and their symbols has not been entirely established. The obvious explanation is that terrorists use ambulances, apparently pregnant women, and others as a convenient way to deliver explosives in a war in which they feel that any action is justified. Alternatively, women disguised to appear pregnant and ambulances might be used for the express purpose of provoking a response, even one that is proportionate and appropriate, in a calculated effirt to incite people to join the perpetrators’ cause.

The problems that relief workers and non-combatant civilians face in war-torn areas are troubling to all people of good conscience. However, like the allegorical child who kills his parents and then pleads for mercy because he is an orphan, terrorists have created an environment in which the sick and injured, along with every pregnant woman and every ambulance, is a potential terrorist weapon. The health-care community must not satisfy itself with deploring the unfortunate consequences of this abuse of neutrality in violation of international law. We must insist that parties to conflicts, no matter how justified they perceive their cause, not use civilians and ambulances as weapons of war.

John R. Cohn, Asaf Romirowsky, Jerome M. Marcus
Thomas Jefferson University Hospital,
Philadelphia, PA 19107, USA (JRC); Middle East
Forum, Philadelphia, PA, USA (AR); and Berger
and Montague PC, Philadelphia, PA USA (JMM)
e-mail: john.cohn@mail.tju.edu

[1] Dudkeritch M. Pessah suicide attacks foiled. Jerusalem Post April 1, 2004.

[2] Siegel,J. ICRC “shocked“ by explosives in Palestinian ambulance, Jerusalem Post Mar 31, 2002

[3] Gettleman, J. Bo,nb carried by ambulance kills 23 in Iraq, New York Times Jan 28, 2004.

[4] Filkins D. 34 die in Iraq as terrorists bomb Red Cross, Iraq Police. New York Times Oct 28, 2003.
5 Beyler C. Chronology of suicide bombings carried out by women. Herzliya: International Policy Institute for Counter-Terrorism, 2003. http://www.ict.org.il/ articles/articledet.cfm?articleid=G1 (accessed Apr 7, 2004).