Аннотация: Wrote for this: 14th ICMM Workshop on Military Medical Ethics 2025
International Humanitarian Law and Medical Ethics in War
The intersection of international humanitarian law (IHL) and medical ethics in armed conflicts represents a critical nexus where legal obligations and moral imperatives converge to guide the actions of military healthcare providers. As Cicero famously stated, "Inter arma enim silent leges" - "in times of war, the laws fall silent" (Cicero1967: 138). Yet, despite the chaos of warfare, IHL, particularly through the Geneva Conventions, strives to uphold the sanctity of human dignity, especially in protecting medical personnel and ensuring ethical medical practice. As someone from Ukraine, I have witnessed firsthand how IHL operates in the ongoing conflict, observing both its adherence and violations. From February 2022 to May 2025, the application of IHL has been inconsistent, with regular armies generally respecting its principles, while irregular units often flout them, creating profound ethical challenges for military healthcare providers.
Keywords: International Humanitarian Law, Medical Ethics, Geneva Conventions, Military Healthcare, Red Cross Emblem, Proportionality, Moral Injury.
The Framework of International Humanitarian Law
The Geneva Conventions of 1949, along with their Additional Protocols, form the cornerstone of IHL, explicitly protecting medical personnel, facilities, and patients during armed conflicts. Article 8(c) of the First Geneva Convention mandates that medical personnel "shall be respected and protected in all circumstances" (International Committee of the Red Cross [ICRC], 1949: 54). This legal protection is intended to ensure medical neutrality, allowing healthcare providers to operate impartially, treating both combatants and civilians without discrimination. Medical ethics, grounded in principles such as beneficence, non-maleficence, and impartiality, align closely with these legal obligations, yet their application in war is fraught with challenges.
In Ukraine, since the escalation of conflict in 2022, IHL has been both upheld and violated. The year 2022 was relatively "soft," with initial efforts by regular armed forces to adhere to IHL principles, such as respecting the neutrality of medical units. However, 2023 marked an intensification of hostilities, with increased violations, particularly by irregular units composed of former convicts, including murderers and robbers. These groups often disregarded IHL, targeting medical facilities and personnel. By 2024, the conflict reached a peak of violence, where, as the French phrase goes, "à la guerre comme à la guerre" - "in war, as in war -brutality" often overshadowed legal and ethical norms (Dunant 2006: 47). In 2025, the period from January to March saw continued intensity, but by May, a relative lull has emerged, suggesting a temporary stabilization.
Ethical Challenges in Military Healthcare
Military healthcare providers face unique ethical dilemmas when navigating the demands of IHL and battlefield realities. The principle of impartiality, enshrined in the Geneva Conventions, requires medical personnel to treat all wounded individuals based on medical need, regardless of their status as combatants or civilians (ICRC 1949: 62). However, in Ukraine, I have observed through conversations with medics and paramedics that this principle is often tested. For instance, the Red Cross emblem, a sacred symbol of protection under IHL, is frequently misused. Ambulances bearing the emblem have been used to transport not only the wounded but also ammunition and weapons, undermining the emblem"s sanctity and exposing medical personnel to increased risk (Baccino-Astrada 1982: 93).
Regular armies, staffed by professional soldiers, tend to respect IHL, honoring the neutrality of medical units and personnel. In contrast, irregular units, particularly those composed of recidivists, have been responsible for egregious violations, such as attacking hospitals or using medical facilities as shields, actions explicitly prohibited under Article 19 of the First Geneva Convention (ICRC 1949: 66). These violations create ethical quandaries for healthcare providers, who must decide whether to continue operations in compromised environments, risking their lives and those of their patients, or withdraw, potentially abandoning those in need.
Proportionality and the Protection of Medical Facilities
The principle of proportionality in IHL, which requires that the anticipated military advantage of an attack outweighs the harm to civilians and protected objects, is particularly relevant to medical ethics (ICRC 1977: 37). Attacks on medical facilities, whether deliberate or incidental, have long-term consequences, eroding trust in healthcare systems and exacerbating civilian suffering.
Mental Health and Moral Injury
The psychological toll on military healthcare providers is another critical ethical issue. The concept of moral injury - distress caused by witnessing or participating in actions that violate one"s moral beliefs-is prevalent among those working in war zones (Litz et al. 2009: 700). In Ukraine, medics I"ve spoken with describe the anguish of treating patients in environments where IHL is disregarded, such as when wounded civilians are denied care by irregular forces. The constant threat of violence, combined with the pressure to uphold medical ethics, contributes to burnout and mental health challenges. Supporting the resilience of healthcare workers requires robust psychological support systems, which are often lacking in conflict zones (Fink 2016: 204).
The more doctors and medical staff immerse themselves in the act of saving others, the more they risk becoming hollowed out, their empathy eroded by the unyielding weight of suffering. In this crucible warthese "caregivers" can become unwitting executioners, their depleted spirits undermining the very care they strive to provide.
The Hippocratic Oath, with its solemn vow to do no harm and uphold the sanctity of life, feels like a distant ideal in the chaos of Ukraine"s war zones. I have spoken with medics and paramedics who describe a creeping numbness, a desensitization that takes hold as they stitch wounds, amputate limbs, and witness death daily. Each act of healing, each life saved, draws from a finite well of emotional strength. Over time, this well runs dry, leaving behind a shell of a person-a machine driven by routine rather than compassion.
The paradox is heartbreaking: the more they give of themselves to save others, the less of themselves remains.
Conclusion
The war has been a crucible, forging within me a tumultuous duality-an aching desire to both destroy and to heal. This internal conflict, born from the chaos of war, has revealed the fragile boundary between vengeance and compassion, a boundary that frays under the weight of relentless violence.
The war"s brutal face - etched with mud, blood, and injustice - has shattered the reasoned composure of the modern mind. Each day, I have witnessed scenes that defy the moral certainties I once held dear.
The injustice of it all - the indiscriminate destruction, the violation of sacred symbols like the Red Cross, the betrayal of trust in humanity - has been a relentless assault on my psyche. I have seen how war distorts the moral compass, turning neighbors into enemies and compassion into a luxury few can afford. My beliefs, once anchored in hope and reason, have been battered by the grim reality of survival. The modern mind, trained to value logic and fairness, crumbles when confronted with the raw, unfiltered cruelty of conflict. Yet, amidst this despair, there is a stubborn spark of resilience-a refusal to let the war"s darkness extinguish the impulse to help, to rebuild, to believe in a future where humanity prevails over hatred.
My heart aches for a peace so profound, so serene it feels like a distant dream-one I imagine flourishing in a place like Switzerland, where mountains stand in quiet majesty and life unfolds with unhurried calm. The vision of Switzerland"s calm - its villages nestled in valleys, its people untouched by the chaos that defines my daily existence. Yet, the cry for peace at any cost carries a heavy weight. It is a plea born of exhaustion, of witnessing too many lives lost and too many futures shattered. It is a willingness to surrender pride, to forgive the unforgivable, if only to silence the guns and still the chaos. I crave peace at any price.
History will not forgive those who violated the sanctity of human dignity, who turned hospitals into targets or used sacred symbols like the Red Cross to mask their treachery. It will remember the sacrifices of those who, despite the horrors, chose compassion over hatred, who risked their lives to save others in the face of overwhelming odds. I trust that history will honor the resilience of those who stood firm against injustice. In its ledger, it will record the truths we cannot yet fully grasp, separating the righteous from the wrongdoers with a clarity that only time can provide.
References:
Baccino-Astrada, A. (1982). Manual on the rights and duties of medical personnel in armed conflicts. International Committee of the Red Cross.
Cicero, M. T. (1967). Pro Milone (N. H. Watts, Trans.). Harvard University Press. (Original work published 52 BCE)
Dunant, H. (2006). A memory of Solferino. International Committee of the Red Cross. (Original work published 1862)
Fink, S. (2016). War hospital: A true story of surgery and survival. PublicAffairs.
International Committee of the Red Cross. (1949). Geneva Convention (I) for the amelioration of the condition of the wounded and sick in armed forces in the field. ICRC.
International Committee of the Red Cross. (1977). Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the protection of victims of international armed conflicts (Protocol I). ICRC.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706. https://doi.org/10.1016/j.cpr.2009.07.003
World Health Organization. (2024). Attacks on health care in Ukraine: 2022-2024. WHO.