War and peace: medicine on the frontline

Flickr_-_Israel_Defense_Forces_-_Field_Doctors_Treat_-Wounded-_During_Exercise,_Oct_2010_(1)

If you had developed gangrene from a battlefield injury in 1840, the military surgeon you would want performing your amputation would be Robert Liston. He could fully amputate a leg in less than three minutes, a huge relief considering the usual ten-minute operation time. However his speed came at a cost. One of his operations had an incredible 300% mortality rate as Liston’s frenzied flourishes cut not only the patient, but also the assistant, who both later died of infection. A bystander’s coat was also slashed which caused the man to die of fright on the spot. Liston continued on to have a successful medical career. Interestingly, medical indemnity has changed since the days of Liston. Today doctors subscribe to their chosen Medical Defence Organisation (MDO) and those in the Australian Defence Force (ADF) receive ‘vicarious liability’ from their employer, with the financial extent of the latter determined by the Defence Legal Service (DLS). The pursuit of such a medical malpractice claim requires the adjudicators to consider the duties and customs of modern military service, which is a difficult undertaking. How well do outsiders understand the life of a military doctor?

The role of the Royal Australian Army Medical Corps is to preserve the military’s operational capability through the provision of health care. The special position of doctors as healers grants them special protection during times of conflict; Rule 25 of the customary rules of international humanitarian law (IHL) states that medical professionals conducting their duties must always be respected and protected. However doctors may lose this protection if they deliberately harm the enemy. This is enshrined in precedent and in the ethical codes of the medical profession, the Geneva Convention and the laws of armed conflict.

Furthermore Australian Medical Officers have an ethical duty to care not only for military staff but also civilians and even enemy soldiers. This can create a moral crisis for doctors who have witnessed horrific violence committed by their patients, as was the case in Rwanda where Australia sent 300 peacekeepers after the 1994 genocide. It should be noted that the responsibility of doctors to not commit harm does not restrict them from carrying light weapons, which may be used to defend the doctor or their patients from violence, such as from marauders. However their protection is forfeited if the violence is used in combat against enemy forces under the law of war.

Health care facilities may have to be abandoned if the risks are too high. After the Médecins Sans Frontières trauma centre in Kunduz, Afghanistan was bombed in October 2015, the hospital was evacuated and shut down despite being the only trauma centre in the country. This attack was considered unacceptable as the customary rules of IHL dictates that hospitals in conflict zones are protected spaces. Under the Statute of the International Criminal Court such attacks against medical personnel using the distinctive emblems of the Geneva Conventions are considered war crimes in any international armed conflicts.

Modern military doctors face a number of legal and ethical challenges in carrying out their duty. Despite these, they continue to provide daily, necessary care to military staff and civilians in regions of peace and conflict across the globe.

 

Emma McCormack is a former Senior Consultant with EY and first year UWA medical student. She is Treasurer of the Fremantle Women’s Health Centre, Chair of the Student Advisory Group of the McCusker Centre for Citizenship and UWA Guild Governance Committee member. She is great at tying balloon animals and terrible at parking. 

 

The above image is released under a Creative Commons license by the Israeli Defence Forces Spokesperson’s Unit.

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