According to the key instruments of IHL, notably the Geneva Conventions of 1949 and their Additional Protocols, fixed and mobile medical units cannot be attacked in times of armed conflict. This includes civilian medical units in addition to military medical ones. The respect and protection of medical units is also considered to be a rule of customary international law for both international and non-international armed conflicts. While Additional Protocol I to the Geneva Conventions provides for some requirements for civilian medical units in international armed conflicts, there is no such distinction in Additional Protocol II for non-international conflicts. The focus of this piece is non-international armed conflicts.
Defining medical units
IHL defines medical units as establishments or other units that are permanent or temporary, such as hospitals, blood transfusion centres, medical depots and medical and pharmaceutical stores. Medical units must be exclusively assigned to medical purposes, namely the search for, collection, transportation, diagnosis or treatment – including first-aid – of the wounded and sick.
The use or function of a medical unit at the relevant time determines whether a facility qualifies as a medical unit, regardless of why it was actually built in the first place. For example, family planning mobile posts, which do not offer medical treatment, would continue to fall under this term as long as their function is still health-related. Moreover, medical units regardless of who they are established by – civilian, military or armed non-state actors – fall under this term.
Establishments that do not directly care for victims of armed conflict, namely the wounded and sick, but endeavour to reduce the number of victims by preventing diseases are also considered to be medical units. Therefore, if the function of COVID-19 screening posts and vaccination centres is entirely medical, it is reasonable to conclude that they would meet the definition of medical units entitled to protection under IHL.
The obligation to respect and protect medical units
According to IHL, medical units need to be respected and protected in all circumstances and must not be the object of an attack. The obligation to respect means medical units must not be attacked or harmed in any way; nor may they be interfered with. The obligation to respect medical units extends to COVID-19 screening posts and COVID-19 vaccination centres as long as their function remains health-oriented. For example, a party to an armed conflict would comply with the obligation to respect by not preventing, denying or limiting access to health care or preventing supplies and services, including COVID-19 screening services and/or COVID-19 vaccination offered by specific posts or centres. The obligation to protect means that measures must be taken to facilitate the work of medical units, where necessary, and to provide help, if needed. For example, a party to an armed conflict would be fulfilling the obligation to protect by allowing and facilitating the passage of vaccines, vaccination supplies and designated health personnel to conduct vaccination. Medical units, including screening posts and vaccination centres, may not be used to shield military objectives from attack and should be situated at a sufficient distance from military objectives that can be lawfully attacked.