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close this bookThe Medical Profession and the Effects of Weapons - Report of the Symposium (International Committee of the Red Cross , 1996, 62 p.)
close this folder4. The Symposium
View the document4.1 Programme
View the document4.2 Opening remarks
View the document4.3 Presentations
View the document4.4 Mission statement
Open this folder and view contents4.5 Working groups
View the document4.6 Conclusions

4.1 Programme

Friday 8 March

Saturday 9 March

Sunday 10 March

09.00

Registration

08.30

Presentations [D]

08.30

Distribution of reports of working groups + discussion

10.00

Welcome

10.30

Working groups:
- Setting up the working groups
- Discussions objectives for each group

10.30

Plenary discussion of reports

10.15

Opening address

12.30

Lunch

12.30

Lunch

11.15

Presentations [A]

14.00

Working groups

14.00

Plenary discussion of reports

12.30

Lunch

16.00

Working groups continued and preparation of working group reports

16.00

Conclusions and Recommendations

14.00

Presentations [B]



17.00

Close of the Symposium

16.00

Presentations [C]





17.30

Summary of first day’s presentations





List of presentations

A.1

Ms Louise Doswald-Beck
Examples of international treaties addressing the health effects of weapons

A.2

Mr Peter Herby
Anti-personnel mines: from surgical statistics to international advocacy

A.3

Dr W. James
The consequences of the impersonal mine

A.4

Mr Peter Herby
Arms transfer: a perspective

A.5

Dr Vie Neufeld
The Health of Children in War Zones project

B.1

Dr Georg Scharf
The use of mortar bombs and similar weapons in limited conflicts.
The effects thereof in military and civilian patients

B.2

Dr Lennart Johnson
Blast over-pressure induced cardio-pulmonary injury in the pig

B.3

Dr Timothy Gillow
The psychological, social and economic consequences of blinding of young soldiers

B.4

Prof. Bo Rybeck
Non-lethal weapons

B.5

Prof. Norman Rich
A senior professor’s reflections through the eyes of a young military surgeon

B.6

Mr Beat Kneubuehl
Wound ballistics: a health science?

C.1

Dr Robin Coupland
Can we define superfluous injury and unnecessary suffering?

C.2

Ms Franse J. Hampson
Giving substance to the prohibition of “superfluous injury and unnecessary suffering” in humanitarian law and human rights law

C.3

Mr William Arkin
Humanitarian issues regarding “non-lethal” weapons

C.4

Dr Peter Knudsen
The moral and legal obligations of the wound ballistician

C.5

Mr Mark Granat
Small-arms ammunition, international law and reality

D.1

Dr Brian Davey
The role of the doctor during investigations of the alleged use of chemical weapons

D.2

Dr Howard Champion
Physician advocacy and weapons control: lessons from the United States

D.3

Ms Anita Parlow
How humanitarian concerns have been or ought to be galvanized by the medical community: case studies

D.4

Dr Vivienne Nathanson
The role of the medical profession in creating a weapons-wise public conscience and influencing government

D.5

Mr Michael Keating
Professional and political awareness of the effects of weapons: a survey

4.2 Opening remarks

Mr Eric Roethlisberger, ICRC

Mr Roethlisberger, Vice-President of the ICRC, welcomed the participants and explained how the Symposium was in keeping with the humanitarian tradition of the ICRC. He described how, from its beginnings on the battlefield at Solferino in 1859, the ICRC has expanded its efforts to prevent the suffering caused by war and weapons both through the development of international humanitarian law and through efforts to ban or restrict the use of certain weapons.

Mr. Roethlisberger explained that the current Symposium was the latest in a series organized by the ICRC on specific issues relating to health in war. In the previous seven years the ICRC had convened groups of experts on blinding laser weapons, anti-personnel landmines, famine, and water in war.

He welcomed the involvement of the medical profession in raising awareness of the effects of weapons. Medical professionals witnessed the effects of weapons and could speak on behalf of the victims, he said. The opinions of medical professionals ought to be heard alongside those of the military, he said, because of the level of credibility enjoyed by the profession and its responsibility not only to treat victims but also to prevent human suffering.

In closing, Mr Roethlisberger said he hoped that by bringing together experts in a number of related fields, the Symposium would help the ICRC to make progress in its work to prevent the suffering caused by weapons.

Dr R Russbach, ICRC

Dr Russbach said that, as in many humanitarian fields, the medical profession had a special role to play with respect to the effect of weapons on health. But, he pointed out, the knowledge gathered by physicians could be used not only to improve the treatment of victims but also to design even more devastating weapons and strategies. In such a situation, how could doctors ensure that their activities would reduce suffering?

Dr Russbach said that doctors enjoyed credibility because of their commitment to the Hippocratic oath, and warned that they should not squander that asset by playing politician. Nevertheless, he pointed out, doctors did have a legitimate role in advocating for controls on weapons, and the Symposium provided an opportunity to define this role and identify potential initiatives within the medical community.

Dr Russbach went on to explain how, from a legal standpoint, much had already been done to define criteria for the types of weapon that should be banned. The question now to be addressed, he said, was whether available medical knowledge could or should be used to give precision to legal criteria by attempting to quantify superfluous injury and unnecessary suffering. The topic was a new one, and the views expressed at the Symposium would lay the groundwork for further work in this area.

Dr Russbach also pointed out that the objectives of the Symposium were entirely in accordance with those of the Geneva Foundation.

Dr Robin Coupland, ICRC

Dr Coupland explained the proposed structure of the Symposium and explained that the presentations had been organized around the four key topics outlined below.

Epidemic. The effects of weapons constituted a global epidemic, Dr Coupland explained. What were the responsibilities of the medical profession in preventing such a public health disaster?

Effects of weapons on health. The impact of weapons was generally considered from a legal or military perspective, he explained. Could their effects on health be defined so as to provide a means of communication and a common denominator between the interests of all concerned with the design, use and effects of weapons?

Ethics. Dr Coupland drew attention to the dilemma arising from the fact that information gained from the study of wounds and wounded people could be used not only to improve medical care but also for the development of weapons. How should the medical community react?

Communication. Dr Coupland emphasized the importance of translating both epidemiological data and ethical baselines into law and of communicating the Symposium’s conclusions in a compelling manner to the relevant audiences.

4.3 Presentations

Participants wishing to make a presentation were asked to submit background papers, which were distributed beforehand. A summary of each paper was presented for discussion by the Symposium. A range of specialized subjects was covered, including medical and legal aspects of weaponry, wound ballistics, scientific research and public advocacy.

The papers served to introduce the participants to the range of interests represented at the Symposium, and underlined the need to synthesize traditionally disparate disciplines into a new, discrete field of study.

The following is a summary of the presentations. The background papers can be obtained from the ICRC Health Division.

A.1 Ms Louise Doswald-Beck

Examples of international treaties addressing the effects of weapons on health.

The presentation began by stressing the important role that the medical profession had in upholding international humanitarian law (IHL). It went on to outline the various international treaties that comprise IHL, from the St Petersburg Declaration of 1868 to the 1980 UN Convention on Certain Conventional Weapons and its subsequent review.

The paper introduced legal concepts including proportionality (the balance between military necessity and humanitarian restraint), superfluous injury and unnecessary suffering, and the Martens clause (which states that the victims of war should at all times be protected by the dictates of the public conscience).

In the ensuing discussion it was noted that the 1972 UN Convention on Biological Weapons and the 1993 UN Convention on Chemical Weapons constitute the first attempts to eliminate a type of weapon completely. States were required to destroy their stockpiles.

A.2 Mr Peter Herby

Anti-personnel mines - from surgical statistics to international advocacy

This presentation outlined how the ICRC’s current international advocacy calling for a ban on anti-personnel landmines had been prompted by surgical statistics gathered in ICRC hospitals. In relation to the review of Protocol II of the 1980 UN Convention on Certain Conventional Weapons, the presentation described how the ICRC had worked closely with a coalition of non-governmental organizations, National Red Cross and Red Crescent Societies and advocacy groups, and was currently launching its own world-wide advertising campaign.

Mr Herby pointed out that in the past it had been sufficient to secure the agreement of governing elites but that now nothing could be achieved without the mobilization of public opinion. This was why the ICRC, for the first time, was taking a public stand on such an issue. He outlined the complexities of the landmines debate and showed examples of the advertisements designed for the campaign.

A.3 Dr W. James

Consequences of the impersonal mine

The paper described the effects of antipersonnel landmines on civilian populations world wide. There were approximately 100 million landmines deployed in the world today, and their effects were indiscriminate. The global casualty rate was estimated at 2,000 per month, and the victims were predominantly civilian. Owing to the lack of medical facilities in many of the affected countries, the mortality rate amongst landmine victims was high. Mine clearance was extremely slow: at the current rate of clearance in Afghanistan, it would take 4,000 years to clear 20% of the country’s territory. Prosthesis and medical care for the victims were generally inadequate in those countries affected by mines.

The discussion focused on the lethality of different types of antipersonnel mines, post-traumatic stress syndrome and the causes of armed conflict.

A.4 Mr. Peter Herby

Arms transfers: a perspective

The presentation drew attention to the extent of arms transfers to the developing world following the end of the Cold War. Ninety per cent of arms transfers started as legal transactions but then became illegal with later onward transfer. The urgency of addressing the arms trade was highlighted by citing arms sales to the third world by industrialized countries attempting to bolster their own economies; there was now an increased flow of small arms fuelling ethnic conflicts. The scale of arms transfers was such that the receiving countries were unable to train enough people to uphold international humanitarian law with respect to those weapons.

The presentation also described the difficulties of policing arms transfers and of controlling the use of small arms by combatants.

The participants discussed the ICRC’s dissemination activities and its role as guardian of the Geneva Conventions of 1949. There was particular interest in the ICRC’s experiences in promoting common Article 1, whereby States undertake to ensure respect for IHL, since this responsibility was seen as encompassing controls on arms transfers.

A.5 Dr Vic Neufeld

The Health of Children in War Zones project

The paper described activities at McMaster University, Canada, within the framework of Health Reach, a joint initiative of the Centre for International Health and the Centre for Peace Studies. The goal of the Health of Children in War Zones project was to improve the health and well-being of children in zones of armed conflict through the integration of data collection activities, health-related action and peace initiatives. The project was currently running programmes in Sri Lanka, the former Yugoslavia, Gaza and the West Bank.

Dr Neufeld described how universities and medical schools in conflict zones were encouraged to undertake research and community service activities which not only documented the effects of war on children’s health, but also fostered peace and reconciliation. Coordination with other academic disciplines was central to the success of the programme.

The paper stipulated that the role of the doctor extended beyond treating the wounded. He or she also had a responsibility to participate in community activities and to document and foster education in the health needs arising from armed conflict.

The chairperson of session A underlined the importance to the Symposium of the link between epidemiological data and the upholding of law.

B.1 Dr Georg Scharf

The effects of mortar bombs and similar weapons in limited conflicts

The paper described the military theory relating to and the use of mortar bombs and their effects on individuals, including injury and death due to shock pressure wave and blast overpressure, primary and secondary missiles, shrapnel and incendiary effects.

The paper noted how mortar bombs and similar devices were extremely cheap and likely to be used increasingly in limited conflicts in developing countries, in which most casualties were civilians. Because of the suffering caused, the use of such weapons should be banned in civilian environments. Moreover, such weapons were most often misused in countries with poor medical facilities.

In the discussion, the correlation between the military effectiveness of a weapon and the ease with which it could be misused was identified as a fundamental principle. The point was made that modern weapons, which are increasingly accurate and “efficient”, could target civilians just as easily as military objectives. While the repercussions of the misuse of such weapons were abhorrent, controlling such misuse was extremely difficult.

One participant suggested that the definition of superfluous injury and unnecessary suffering might be directly linked to the local availability of medical services.

B.2 Dr Lennart Johnson

Blast overpressure-induced cardio-pulmonary injury in the pig

The paper described an experiment investigating cardio-pulmonary injuries in pigs induced by blast pressure. The experiment concluded that blast overpressure caused heart injury and that, of the many reactions to the blast, respiratory arrest was the most dramatic. There was no evidence of air or fibrinous emboli. Dr Johnson concluded that such an effect also occurs amongst human casualties. He confirmed that mortality would increase in the absence of facilities for immediate artificial ventilation.

B.3 Dr Timothy Gillow

Psychological, social and economic consequences of blinding young soldiers

The paper evoked the public revulsion at the concept of blinding in warfare It outlined the various types of weapons systems that could blind either as a secondary effect or by intention. The former included systems designed to incapacitate battlefield electro-optical devices; the latter included laser weapons which were prohibited by the 1995 Review Conference of the 1980 UN Convention on Conventional Weapons.

It was noted that adults received most of their sensory input from vision. Loss of sight not only caused physical disability but also entailed heavy psychological, social and economic costs for the individual and society.

Dr Gillow stressed that, with regard to controlling the effects of weapons on health, the medical community had to focus its efforts on stigmatizing weapons that caused injuries to specific organs or bodily functions. Such injuries included not only eye injury but also brain damage, tetraplegia and burns to the hands and face.

The discussion centred on means of protecting the eyes in the event of laser weapon attack.

B.4 Professor Bo Rybeck

Non-lethal weapons

(Editor’s note: it was agreed with the organizers of the Symposium that Professor Rybeck’s presentation would keep this title in the programme but that he would talk principally about the possibility of genetic weapons.)

The paper focused on the military significance of civilian scientific and medical research, particularly with regard to the development of genetic weapons. Despite the prohibitions on chemical and biological weapons, advances in biotechnology and genetic engineering offered scope for weapons that could be targeted against specific ethnic or racial groups. Genetic research into the human genome and racial differentiation was advancing rapidly, and the results were freely available. Professor Rybeck pointed out that while there were many legitimate civilian uses for such research, it could also be used to develop weapons at low cost that combined chemical or biological agents with genetically-engineered vectors to target specific populations.

Professor Rybeck expressed his own fear of the development of such weapons and the possibility of terrorist use, and warned the ICRC that it should be alert to this type of research.

One participant was of the opinion that if the Symposium were able to produce a solid recommendation on this subject alone, it would be an important achievement.

B.5 Professor Norman Rich

A senior professor’s reflections through the eyes of a young military surgeon

Professor Rich said that, as a young military surgeon, his work had been in response to contingencies, treating the sick and wounded. With greater maturity, he had given thought to the role of communication in preventing violence in society. The complexity of aggression in society, seen for example in the urban violence of the United States and the resurgence of a 600-year-old conflict in Bosnia-Herzegovina, reflected, above all, a failure of communication. The epidemic of violence was a public health issue, and the response should be an effective communication strategy to educate humankind away from violence.

B.6 Mr Beat Kneubuehl

Wound ballistics: a health science?

The paper introduced wound ballistics as a discipline which combined medical and scientific research. Medical professionals could document the effects of weapons on health (a descriptive approach), while scientists built models to explain those effects (a general approach.) Mr Kneubuehl went on to point out that the effect of a bullet was dependent on many factors such as organ hit, angle of entry and point of impact, and so scientific modelling had limitations in relation to the effects on health. However, the effectiveness of a bullet was related to its profile of energy transfer along its track and was hence measurable in a scientific setting.

The paper argued that the science of wound ballistics provided a useful means of measuring the effectiveness of weapons, thus giving a scale of reference for judging what was legal.

It would then be possible to advocate bans on weapons according to their effectiveness rather than their technical specifications. Mr Kneubuehl outlined a proposal for legal consideration which interpreted human damage from missiles in terms of the profile of their energy release in a dense medium.

Participants noted the importance of collecting evidence from the field to support the results of laboratory experiments. One participant pointed out that a weapon’s effectiveness, as described by Mr Kneubuehl, represented a measurable effect on health.

C.1 Dr Robin Coupland

Can we define superfluous injury and unnecessary suffering?

Dr Coupland argued that the measurable effects of conventional weapons as witnessed by surgeons in the field and as documented in the medical literature could be used to establish a baseline against which the legal and yet hitherto philosophical concept of “superfluous injury and unnecessary suffering” could be measured. This could then be related objectively to a weapon’s military utility.

The paper listed certain parameters that could be taken into account for establishing the baseline, such as field mortality, hospital mortality, the number of operations needed and the extent of severe or permanent disability amongst survivors. Another parameter which could be included to differentiate between the effects of conventional and non-conventional weapons was whether a particular aspect of human anatomy, physiology or biochemistry was targeted. A weapon system which overstepped any of these parameters could then be judged as causing superfluous injury or unnecessary suffering.

In the discussion, there was agreement amongst the participants that such objective classification would make an invaluable contribution to the operation of international humanitarian law, and that further work should be undertaken to study the proposal further.

It was also agreed that baselines had to be universal if they were to function effectively as a legal device. Discussion focused on how universality could be achieved in a world in which local conditions - access to medical facilities, geographical location and cultural norms - varied widely. There was a suggestion that psychological injuries should also be included in any clinical parameters.

(The background paper has been published as: Coupland RM. The effects of weapons: defining superfluous injury and unnecessary suffering. Medicine and Global Survival 1996; 3:A1 on the World Wide Web http://www.healthnet.org/MGS.html)

C.2 Ms Franse J. Hampson

Giving substance to the prohibition of superfluous injury and unnecessary suffering in international humanitarian law and human rights law

The paper focused on the importance of quantifying superfluous injury and unnecessary suffering so that proportionality between military necessity and human cost could be effectively judged. Ms Hampson referred to the previous paper in this respect. Pointing out that neither military necessity nor human cost were quantified at that point, Ms Hampson suggested that it was the role of lawyers to encourage such quantification.

She stated that objective criteria for measuring suffering would provide a useful tool for lawyers, and would encourage the military community to quantify military necessity. She pointed out that it would be hard for the military to argue against medical criteria backed by strong supporting statistics. In this regard she emphasized the importance of medical data collection, and added that only the medical profession could quantify injury.

Ms Hampson pointed out that the current international campaign to ban anti-personnel landmines had focused almost entirely on the fact that civilians were often the victims. The fact that these weapons inflicted horrific wounds on combatants and civilians alike had, in her opinion, been largely forgotten; if the problem is the effect on civilians this points to the need for greater restrictions on use but if the issue is the unacceptable nature of the injuries caused, this points to a need for a ban on use.

The participants agreed with the rationale for objective criteria. However, it was noted that in the past weapons had been banned more often for reasons of public abhorrence or political expediency than for reasons of health. The discussion also referred to the ineffectiveness of the Marten’s clause without the opinion of an educated public.

C.3 Mr. William Arkin

Humanitarian issues regarding non-lethal weapons

The paper focused on the definition, development, and potential dangers of non-lethal weapons including acoustic weapons, eye-attack weapons, directed-energy weapons, riot control agents, calmatives, and biotechnological and genetic weapons. Mr Arkin stated that such weapons had been developed for use outside the context of conventional military operations.

He pointed out that many non-lethal weapons were illegal, but that their proponents defended them by comparing them favourably with existing conventional weapons. It was the role of the medical community and lawyers, Mr Arkin said, to counter such arguments with medical data. Potential users would then have to prove the military necessity of the weapon in question. He referred to the ICRC’s approach in seeking a ban on mines and blinding laser weapons; documenting or evaluating a weapon’s effect on individual and public health forced an evaluation of its military utility.

C.4 Dr Peter Knudsen

Moral and legal obligations of the wound ballistician

Dr Knudsen explained that, as a military doctor, he had felt it his duty to investigate the wounds produced by the Danish 7.62 mm military rifle bullet because foreign bullets of similar design had been reported as having a tendency to fragment. Therefore, the legality of the bullet was questionable under the Hague Convention of 1899. Following autopsy investigations and experiments in ordnance gelatin, the Danish bullet had indeed been redesigned.

However, Dr Knudsen questioned whether the Hague Declaration should apply to the police as well as the military. The police fired only in self-defence and to stop criminals from injuring innocent bystanders. The ballistics requirements of a bullet for the police were very different to those of a military bullet. For the police, rapid incapacitation, minimum over-penetration and effectiveness at short range are needed. He argued that bullets which comply with the Hague Declaration do not meet these requirements and therefore it was a mistake to apply this aspect of international law to police ammunition.

Dr Knudsen insisted that a bullet’s legality should be determined by its effect rather than its design.

C.5 Mr Mark Granat

Small arms ammunition, international law and reality

The paper discussed the applicability of the Hague Declaration of 1899 (dealing with bullets which flatten or expand on impact with the body) in the light of modern small-arms capabilities and ammunition design.

When the Declaration was drafted, the paper stated, any rifle had enough stopping power to put an adversary hors de combat. Nowadays this was not always the case. The modern combatant frequently fought alone and had to be able to rely on his personal weapon to stop an enemy with a single shot. In terms of personal survival, Mr Granat argued, this was a military necessity. However, some modern bullets did not have the necessary stopping power because, despite their velocity, they did not release their energy to the victim’s body. To give such bullets adequate stopping power would contravene IHL.

Mr Granat felt that the unique relationship that a soldier had with his rifle justified legal reappraisal of the bullets that the soldier could use. By removing the means of self-protection for the soldier, the law might simply endanger the life of the person it was designed to protect.

While not qualified to say whether or not explosive bullets should be allowed, Mr Granat argued that ammunition should be regulated in terms of energy release rather than design.

One participant said he believed that only a shot to the central nervous system, or possibly to the central chest, would fell a man immediately and that “stopping power” was a myth.

Two participants believed that IHL had suffered from an excessive focus on bullet construction.

D.1 Dr Brian Davey

The role of the doctor in investigations of the alleged use of chemical weapons

Dr Davey spoke of his experiences investigating alleged chemical weapons attacks. He detailed the requirements in terms of logistics and personnel for such investigation. He argued that it was the doctor’s responsibility to ensure that all technical work be carried out in a forensically credible manner even when conditions made this difficult. He also warned that the results of such investigations could be used for further development of chemical weapons. Difficulties encountered during such investigations included the lack of standard procedures for sample collection and analysis, political pressure, and the difficulty of identifying clinical symptoms and of differentiating between the effects of chemical attack and the symptoms of regular ailments.

Dr Davey reported on the establishment of the Organization for Prohibition of Chemical Weapons which was an independent monitoring agency created under the UN Conference on Disarmament of Chemical Weapons Convention.

In the discussion it was asked why the notion of chemical warfare was considered abhorrent. Although there were no clear answers to this question, factors discussed included the indiscriminate nature of chemical warfare, its ability to overwhelm medical services, the possibility of long term effects, and the innate psychological fear of being poisoned.

D.2 Dr Howard Champion

Physician advocacy and weapons control: lessons from the United States

The paper presented the continuing work of the Coalition for American Trauma Care based in Washington, DC, USA, of which Dr Champion was the President.

Detailing the numbers of deaths and injuries from handguns and their availability in the United States, Dr Champion outlined the Coalition’s focus on political advocacy. This was presented as an example of the “data-policy link.” Through political sponsorship and alliances with other health organizations, the Coalition had achieved certain successes. However, opposition from special interest groups and apathy amongst the general population had hampered the Coalition’s work and forced it to compromise.

Dr. Champion pointed out that in the political arena, while it was important to have access to all the facts, logic did not always prevail. Advocates must be patient and make use of windows of opportunity.

In the ensuing discussion, one participant voiced concern about the propagation of the cycle of violence on television and in videos and rap music. The significance of the fact that paediatricians in the US had called for a ban on handguns was underlined.

Another participant pointed out that in Switzerland also most homes had guns and ammunition as part of military policy and that there were few resulting crimes. The hand-gun violence in the US was not due simply to availability of weapons.

D.3 Ms Anita Parlow

How humanitarian concerns have been galvanized by the medical community: case studies

Ms Parlow was of the opinion that the ideological divide inherent in the Cold War had imposed constraints on humanitarian action in relation to weapons. Now there was greater potential for such action. The paper argued that efforts to promote and strengthen international humanitarian law relied ultimately on political will, but that political will could be influenced by the collection and dissemination of data in a credible and professional manner. This was particularly true with regard to weapon-related issues.

The paper documented three studies of cases where the medical profession had played an important role in the international arena: the international campaign to ban anti-personnel landmines; the establishment of torture rehabilitation programmes in the United States and elsewhere; and the recently initiated effort to protect children in war.

All involved medical documentation, the establishment of databases and dissemination of the information to decision-makers.

D.4 Professor Vivienne Nathanson

The role of the medical profession in creating a weapons-wise public conscience and influencing government

Professor Nathanson said that voicing concern and opinion about the effects of weapons on health was a legitimate role for doctors, as it was a form of preventive care. In general, doctors were trusted and so they should accept responsibility for informing the public on health-related issues of weapon use. National Medical Associations are likewise responsible because they are the collective voice of the profession in their countries. However, doctors should take care to avoid becoming embroiled in political aspects of the debate lest they jeopardize their credibility in the eyes of the general public. To be in a position to raise awareness, doctors themselves had to be well-informed. They were then in a position to educate the public and seek its support for efforts to persuade the government to enact relevant legislation.

Professor Nathanson outlined some of the issues on which the British Medical Association had taken action, including smoking, drinking and driving, and the wearing of crash helmets and seat-belts. She stated that a similarly objective approach should be taken towards the effects of weapons and stressed the need for a communication strategy vis-is both the professional and the general press.

The discussion dwelt on human rights abuses and the role of doctors.

D.5 Mr Michael Keating

Professional and political awareness of the effects of weapons: a survey

The paper outlined the results of a survey conducted in France, Sweden, the United Kingdom and the United States, which revealed a low level of awareness of the effects of weapons among politicians, lawyers and the medical profession. Documentation was found to be sparse, and there was little academic publication or teaching. The results showed that while doctors and other professionals shared a common sense of humanity, international humanitarian law was not well understood. As a result there was little understanding of the concept of a weapon exerting superfluous injury and unnecessary suffering in relation to its military advantage.

However, the survey showed that there was undoubtedly great potential to inform and motivate the medical community and a wider public about the effects of weapons. The most effective means of achieving this, according to Mr Keating, would be first to galvanize sympathetic members of the medical profession, then to address the wider medical community, and finally to engage the general public and their political representatives through key multipliers such as the media and other humanitarian agencies.

Mr Keating argued that for such an initiative to be successful the medical community must first focus on documenting the effects of weapons on health, so that it could present its evidence in a professional manner. It also had to ensure that effects on health are recognized by the legal community as a yardstick in decisions affecting weapons. Medical and legal professionals must work closely to achieve this, he said.

The discussion revolved around whether the participants felt that they should express opinion or concern outside their sphere of expertise; some participants felt they might be viewed as unprofessional if they did so. One participant did not believe he should voice his professional opinion about, for instance, arms transfer. Others disagreed; they believed that as weapons constituted a public health issue, responsibility for addressing it fell to all doctors.

Another participant pointed out that the image of the medical profession as representing a conscience was declining.

It was suggested that in discussing the effects of weapons as an epidemic, doctors had a responsibility to determine fact and define the problem as a first step.

Background papers received but not presented

Three additional papers were received (also available from the Health Division of the ICRC) but their authors were unfortunately not able to be present at the Symposium.

Dr Philippe Chabasse

The social and economic impact of anti-personnel mines

Mr Eric Prokosch

Criteria for defining unnecessary suffering

Mr David Guyatt

Some aspects of electromagnetic anti-personnel weapons

4.4 Mission statement

In the discussions following the presentations, the participants drew up a “mission statement” to guide the remainder of the Symposium. The objective set was:

“to identify and communicate the effects of weapons on individual and public health so that the international community can work together to eliminate any superfluous injury, unnecessary suffering and indiscriminate effects associated with the design of weapons, their use in human conflict and their global proliferation.”

(introduction...)

On the second day of the symposium the participants divided into six working groups according to their stated interest or background. Each group focused on a particular issue and prepared a report which was presented to the plenary session on the final day of the symposium.

The objective of the working groups was to use the mission statement and points raised during the presentations to give recommendations for further work in the various subject areas.

The titles of the working groups were as follows:

- Formulating objective criteria for the effects of weapons on individuals

- Formulating objective criteria for the effects of weapons beyond the individual (on society and the environment)

- The role of the military doctor and military medical research (with respect to the effects of weapons on health)

- Future weapons and the role of the medical community

- The effects of weapons on health: what to teach at university?

- Building blocks of a communications strategy (public conscience, professional awareness)

Compiled below are the unedited reports of each working group followed by a distillation of the discussions that ensued. The recommendations of some working groups were adjusted during the discussions, and this is indicated below.

Working group 1 - Formulating objective criteria for the effects of weapons on individuals

Introduction

1. It was considered important to assess and quantify the effects of weapons in order to help in the assessment of what amounts to superfluous injury and unnecessary suffering.

2. It is recognized that it is difficult to establish whether military necessity justifies the health effects of certain weapons.

3. This issue is unfortunately complicated by the lack of objective criteria and sufficient data collection.

4. Some weapons (e.g. nuclear and chemical weapons) are clearly outrageous in their medical effects, but emphasis should be placed on the spectrum of present and future weapons and their physical and psychological impact on individuals. These effects need to be defined in order to justify the limitation and, if necessary, the condemnation of weapons.

Aim

5. The aim of this paper is to present objective criteria for the effects of weapons on individuals.

Scope

6. The effect of weapons considered by the group was limited to their use by the military against soldiers, as the use of weapons against civilians is illegal. The assumption is also made that all injuries will occur in an environment where reasonable rules of engagement are adhered to and where there is an acceptable level of medical care available to the wounded personnel on all sides. The socio-cultural implications of a certain population group should not be ignored, e.g. death by fire in certain ethnic groups is considered to be spiritually disastrous.

Factors considered

7. Various yardsticks were considered:

a. The effect of present conventional weapons in terms of mortality, in the field and in the hospital, the number of operations on an individual, the number of blood transfusions and days spent in hospital.

b. Degree of injuries.

c. Disabilities created.

d. Chance of recovery.

e. Handicap: specifically whether a person can be economically independent in their particular society.

f. Fear, revulsion, abhorrence and psychological suffering.

Assessment

8. The accurate description of wounds is essential to address the degree of injury. Laboratory criteria can be used to determine transmitted energy in wounding, but these findings have limited applicability in the field due to additional complicating factors.

9. It was the consensus of the group that although it was desirable to have several wound classifications like the Trauma Score and the Injury Severity Score, the ICRC wound classification may be more appropriate in a war situation. The severity of the wound can be assessed in terms of the likelihood of death, of permanent disability and of the amount of care that is required for treatment. The scale and extent of the mortality and morbidity of a specific weapon could be determined, the ICRC scale of wounds must be used as well as Dr Coupland’s criteria (presentation C1) which include the number of operations, days in hospital, number of blood transfusions, disabilities and permanent handicaps. In addition the standard available resources should be taken into account.

10. In looking at the effect of a specific weapon, the lethal potential of the weapon has to be considered. It was agreed that an acceptable level of lethal potential could not be agreed on by the medical profession, but a weapon designed to produce an inevitable mortality should be unacceptable.

11. Designing a weapon to target a specific vital organ system should not be allowable if death will be an inevitable result. Equally, weapons designed to target specific organs should also not be allowed if their use will typically result in significant disability.

12. Permanent disability (including limb loss) is found in 12 to 15 percent of all casualties. Including incapacitating burn wounds the disability rate is about 20 percent. A yardstick that could be used is that a new weapon should not cause a substantially greater proportion of permanent disability than the average conventional weapon.

13. In addition it was found that there needs to be a method of measurement so that a permanent disability could be quantified. The following code as published in other ICRC literature was found to be useful:

a. Very severely affected = III
b. Badly affected = II
c. Adversely affected = I
d. Not affected = 0

This is used with the following clinical criteria on the scale of 0 to III namely:

a. Risk of death.
b. Activities of daily living.
c. Mobility.
d. Memory.
e. Information intake.
f. Communication output:

- verbal
- non-verbal

g. Bowel/bladder functions.
h. Physical appearance.
i. Behaviour control.
j. Depression/anxiety.

High scores on the above scale would designate significant impairment and permanent disability.

Recommendations

14. Weapons designed specifically to target vital organs are to be deplored. Likewise any weapon specifically designed to injure or destroy an organ or limb resulting in severe significant permanent disability should be condemned.

15. Psychological factors were considered difficult to define and include abhorrence, fear, knowledge that one would not recover from the effects of wounds and the sense of helplessness, being powerless and being overwhelmed.

Conclusions

16. Indications of injuries must be measurable, reasonably accurate and based on a simple data base. It was found that the ICRC wound classification was usable under normal operational conditions. Injuries must be evaluated in terms of risk of mortality, permanent disabilities and treatability under standard conditions.

17. Organ targeting to cause inevitable death or to impart severe significant permanent damage is to be declared undesirable. The last shall also include injuries to limbs.

18. Pain as such was found not to be measurable but could probably be deduced indirectly from the classification of the disability score. The assessment of psychological implications will need to be undertaken by a specialist group.

Working group 1: plenary discussions

Organ-specific targeting

Weapons designed to target specific organs were discussed at some length.

Recognizing that the language of the text needed careful wording, the participants could not agree as to whether the words “target specific organs” in Paragraph 11 should be changed to “specific anatomical, physiological or biochemical targeting.”

It was pointed out that, legally speaking, the basis for prohibition of a weapon was the result of the targeting rather than the targeting itself. In other words, a weapon designed to target a specific organ was not illegal unless its effects upon that organ were deemed to be excessively injurious. A weapon whose use inevitably resulted in death was contrary to the existing principles of humanitarian law.

One participant noted that weapons designed to target specific organs were a relatively new development, and that their effects could be deemed to be beneficial insofar as they might hasten the resolution of a conflict and limit carnage.

Clinical criteria for assessment

It was agreed that loss of sexual potency should be included in the list of clinical criteria in Paragraph 13.

It was suggested that the level of medical care available for the wounded should be taken into account.

Recommendations

It was agreed that the ICRC should convene a further working group(s) to develop a more stringent metric for categorizing the physical and, if possible, psychological effects of weapons.

Working group 2 - Formulating objective criteria for the effects of weapons beyond individual (on society and the environment)

In defining the scope of discussion, the group decided to limit attention to the effects of weapons on non-combatants. It was agreed that the most productive focus for these discussions would be on the public health effects of certain weapons and methods of warfare, specifically the fact that such weapons and methods of warfare lead to increased mortality and morbidity in non-combatants.

Specific weapons

Certain weapons by their nature are indiscriminate and pose a direct threat to the health of combatants and non combatants alike. Examples of such weapons include weapons of mass destruction (nuclear, chemical and biological) and anti-personnel landmines.

Methods of war

Methods of war which can lead to increased levels of non combatant morbidity and mortality include:

- indiscriminate bombing
- attacks on refugees
- attacks on facilities which contain and could release hazardous substances or materials
- attacks on objects which are indispensable to the survival of the civilian population (or the distribution systems for such objects).

Whereas each of these methods of war is already addressed by international humanitarian law, it was felt that the public health consequences of the last category deserve further examination and greater prominence. Objects of such attacks and their consequences include:

- medical infrastructure, whether curative or preventive;

- food supplies (leading to malnutrition and infant mortality);

- water supplies and sanitation systems (leading to increased prevalence of water-borne diseases);

- energy sources for civilian purposes (with consequent widespread effects on delivery of medical services, nutrition, hygiene and heating); and

- shelter (leading to exposure and its consequences).

Any act of war which can be expected to have such results should be considered to be a deliberate attack upon civilians. Such attacks are already outlawed under international humanitarian law. However, given the nature of modern warfare and the structure of modern societies these public health consequences are frequently the most significant effects of warfare. They are often the primary intention of belligerents.

Role of the medical profession

The consequences of armed conflict for non-combatants is a public health issue, often approaching epidemic proportions. Addressing them is a responsibility of the medical profession whose primary role in this context should be to document objectively the increased morbidity and mortality caused by armed conflict. This would provide a unique and powerful contribution to preventive efforts.

To be most effective, the efforts of medical professionals should form part of a coordinated initiative managed by an appropriate international body. The responsibilities of this body would include the planning and coordination of the following activities:

- identification of sources of reliable public health data in conflict zones;
- raising awareness among the above sources;
- motivating information sources to participate;
- providing the relevant tools and resources for data collection;
- collecting the data;
- analysing the data;
- publishing the results;
- disseminating the conclusions; and
- participation in multi-disciplinary efforts to develop international humanitarian law and norms and other activities to reduce the adverse public health consequences of warfare.

Due to its credibility and ability to mobilize the necessary resources the ICRC is well positioned to assume this role.

Working group 2: plenary discussions

Implementing organization

The recommendations of the working group were accepted, and participants discussed identification of potential implementing agencies.

It was agreed that only two organizations, the ICRC and the World Health Organization (WHO), had the capacity to carry out such work. While the working group had initially considered the ICRC, participants pointed out that since this was a global public health issue it was more the responsibility of WHO whose mandate it was to monitor trends in public health. An ICRC representative also pointed out that the Health Division of the ICRC did not have the capacity to undertake such a task.

It was therefore agreed that the ICRC should contact WHO in this regard, bearing in mind certain reservations that were expressed about the latter during the proceedings, specifically the sensitivity of its involvement with weapons issues, its links with governments and its lack of representation at the Symposium.

Working group 3 - The role of the military doctor and of military medical research (with regard to the health effects of weapons)

1. War is a public health hazard and if possible conflict should be settled by non-violent means, but in the event of war doctors have an obligation to treat the casualties.

2. (Editor’s note: in the light of the mission statement of the Symposium, the working group wished to make a statement about members of the medical profession being involved knowingly in research which relates to the design and development of weapons. Whilst it was felt that the spirit of the desired statement was obvious, the wording has not been finalized despite correspondence since the Symposium. See “Research” and “The design of weapons”, pages 44 and 46.)

Definition of military doctor: There was considerable discussion as to the definition of a military doctor. The broadest definition was that he or she was a doctor who had a medical responsibility to the military. He preserved the fighting strength of the armed forces by the maintenance of health and the treatment of the sick and wounded. This was primarily a wartime responsibility which extended into peacetime. He had to consider medical problems from both a medical and a military perspective. This definition did need clarification as it led to misunderstanding. The idea that a distinction could be made between humanitarian doctors and military doctors was unacceptable. There was no contradiction in being both military and humanitarian.

In the discussion, the group identified and recognized certain dilemmas. These were:

· Confidentiality
· Objective of the military medical services
· International humanitarian law
· Experience of military doctors
· Research

Confidentiality: A military doctor may have to disclose certain confidential facts to a non-medical commander if he felt that the information had a bearing on the military effectiveness of the individual or the unit as a whole. The patient should be aware of this. An example of this was drug taking. There were similarities with medical examinations for civilian airline pilots.

Objective of the military medical services: It was agreed that the primary objective of the military medical services was supporting the military mission. There was however some difficulty in accepting that the priority was the military mission - in other words keeping the fighting force fit to fight - rather than the treatment of patients. The military doctors could not accept this as a dilemma as in practice the two roles were not in conflict and were inextricably interlinked. Maintaining the health of the soldiers and treating and evacuating casualties who were not fit to fight helped to maintain the fighting effectiveness and provided care for the sick and wounded.

International humanitarian law: Military doctors were in a special position, which is recognized by the Geneva Conventions. This position did give them some authority to be the conscience of the military. This was the case when doctors reminded the military of obligations under the Conventions that might be breached by particular actions. This in no way meant that non-medical soldiers were relieved of their responsibility to comply with IHL, but the authority of the doctor should not be underestimated.

The doctor had a duty to report breaches of IHL to higher authority but would face a dilemma when reporting actions or effects of weapons that were legal. Ideally all wounds should be avoided but in warfare they were unavoidable. Doctors had a responsibility to report clinical observations but did not have an individual responsibility and may not be able to make immediate judgements as to whether certain weapon systems cause superfluous injury and unnecessary suffering. However, at a later date, when military objectives could no longer be compromised, and after reflection and evaluation, he may be obliged to draw the attention of his non-medical military superiors of such ethical considerations. These must be based on his accurately and clinically recorded observations. A doctor could only open the eyes of the military commanders to the effects of weapons and listen to the arguments for their military necessity. Presentation of the facts was a collective responsibility of both the military and medical communities and the military doctor, spanning both, was in a position to ensure that this took place. This would include objective reporting in the medical and scientific press.

Experience of military doctors: In many developed countries military doctors lacked experience in treating the war-wounded as major conflict had been avoided in the last 25 years. Most treatment and reporting of war wounds was now done by civilian surgeons. This had led to a loss of authority on the part of the military doctor when speaking about the effects of weapons. Opportunities to teach military surgery had receded. This gave rise to the paradox that most war-wounded in modern conflicts, because of the nature of those conflicts, had inadequate medical facilities and developed countries are unable to train military doctors in peacetime. This might be addressed by military surgeons working outside their traditional military role.

Research: The group recognized the dilemma that research into the mechanism of wounding, protection against wounding or treatment of wounds could unintentionally lead to modification of weapon design with more drastic consequences. However, the same problem might occur in other medical research (genetic engineering, pharmaceutical). On balance, research into wounds with the intention of improving the lot of the casualty was important.

The group underlined the importance of ethical and scientific review of military medical research and stated that this should include non military experts. This was already the case in many countries such as Sweden, the UK and the USA.

The group also recognized that underlying wound ballistic research there was a trade-off between the benefits of improving clinical management of wounds and encouragement of alternative weapon system design. There was disagreement as to whether this was important or not.

Working group 3: plenary discussions

The military doctor and the Geneva Conventions

An ICRC representative pointed out that under the Geneva Conventions military doctors had certain duties and responsibilities on the battlefield. Discussion focused on what exactly those responsibilities were (including the duty to report breaches of the Geneva Conventions by commanding officers; the duty to share with other medical professionals information about the effects of weapons on health; and the duty to alert military commanders to the potential effects on health of a particular weapon or tactic), and how feasible it was to enforce them on the field of battle.

Participants with military medical experience explained the procedure whereby reports of breaches of the Geneva Conventions should be passed up the chain of command. They also stressed that discussions about the responsibilities of military doctors had to take into consideration the extraordinary circumstances in which these doctors practiced. One participant felt that expecting a doctor both to treat the wounded and to promote international humanitarian law was expecting too much.

The decision-making process

There was consensus among participants that doctors should be in a position to voice their concerns for individual and public health in relation to decisions about military tactics and the use of weapons.

One participant pointed out the particular relevance of medical involvement during the deployment of new weapons. In such instances there may be unforeseen and excessive effects on health which a doctor would be the first to witness. The doctor would then have a responsibility to relay such information to his military commander.

One participant stressed that military commanders generally had a good idea of what the health-related effects of their tactics might be, and that a doctor might not have much to contribute to a battle planning session. The point was accepted by the participants, but they agreed that a doctor’s presence in such situations was nevertheless important.

The design of weapons

There was considerable debate regarding doctors’ involvement in the design of weapons. It was pointed out that in many cases doctors had a legitimate role to play - for instance in the design of seats in tanks to increase the driver’s comfort - and that some distinction had to be made between ethical and unethical involvement. However, no appropriate wording was found for statement 2 of the group.

One participant pointed out that in his country the use of ammunition made of depleted uranium had been decided against expressly because of the possible effects on health.

Working group 4 - Future weapons and the role of the medical community

The working group began by looking in some detail at the various papers involving ideas for future weapons. It analysed the likelihood of development and use of these weapons, distinguishing two classes: those in the more distant future, if not in the field of fantasy, and those that exist now or are on the threshold of existence. Then the discussion concentrated particularly on biotechnology and the potential use of genetic research, which seems to be very much in the weapons threshold category.

It was also said that perhaps the ICRC could take a leading role in organizing regular small closed meetings of the scientific community involved in gene technology.

The group came up with two main ideas for the direct involvement of the medical community in the question of future weapons. First, and considering all future weapons, it suggested that medical evaluation be systematically included as a part of the review process at all decision-making levels.

Second, to deal with the special and particularly complex questions of bio-medical and gene technology, the group suggested looking into the possibility of establishing an international body provisionally called the IBTSA, “International Bio-Technological Safeguards Agency”. The medical profession would in such an organization play a preponderant role as technical and medical advisers. A broad analogy might be drawn with the role of the chemical profession in the establishment of controls over chemical weapons, who ensured that a difference is made between chemistry and chemical weapons. The IBTSA’s first role would be to ensure that research is monitored. If there is any perception of real danger, then there would be a need to look further towards the creation of a non-proliferation regime that of course remains to be established.

Finally the group also felt that a useful tool for analysing the superfluous injury/unnecessary suffering aspect of future weapons could be provided by more systematic studies of effects of present weapons. The framework proposed by Dr Coupland (presentation C.1) could serve as a basis for such studies.

Working group 4: plenary discussions

Monitoring research

Discussion focused on the distinction between monitoring the development of weapons and monitoring research which could lead to further weapon development.

With respect to possible abuse of genetic engineering, it was pointed out that biological weapons are already illegal, and that future monitoring efforts should therefore focus on improving verification of the ban on biological weapons, and increasing the transparency of existing civilian/commercial research.

A comparison was drawn with the monitoring of chemical weapons. Since any toxic chemical could be used to manufacture weapons, criteria for monitoring chemicals had been drafted on the basis of the likelihood of their production being linked to weapons manufacture. In the realm of biotechnology the products under examination were far less tangible, and it would therefore not be possible to apply this formula. Emphasis should instead be placed on ensuring transparency in all biotechnological research. It was pointed out that some chemists had made statements to the effect that they wished to be dissociated with chemical weapons.

It was noted that since biotechnological research was conducted in the commercial sector it was often patented and therefore confidential. The implications of this would clearly have to be considered when drawing up a monitoring system.

A monitoring agency

It was pointed out that organizations already existed, or were being planned, to carry out the task of monitoring biotechnology, in particular the International Bioethics Committee. It was agreed that any initiative arising from the Symposium should proceed in conjunction with existing efforts.

When asked for details on the establishment of the international body the working group representative replied that the group had not discussed specifics, but the intention had been that the organization should remain independent of the United Nations system.

A legal participant pointed out that the drawing up of an international convention is generally a lengthy process and that it can lead to a much weaker final instrument than originally intended. The participant suggested that, rather than proceed through intergovernmental channels, it would be more effective to establish a body within the biotechnology industry itself that would voluntarily monitor the industry’s research.

It was agreed that more investigation and discussion on this subject was needed.

The involvement of doctors

Medical representatives pointed out the sensitivity of involving doctors in monitoring biotechnological research. It was agreed that, while doctors should not knowingly participate in the design of an offensive weapon, they could contribute to the development of a defensive capability without compromising their medical integrity. This distinction would have to be made in any statements emerging from the Symposium.

Working group 5 - The effects of weapons on health: what to teach at university?

Because the problem of the effects of weapons (and of war) on health requires multidisciplinary action in the “real world”, we propose the development of a multidisciplinary education program for universities to consider.

Specific recommendations:

1. We recommend the development of an integrated curriculum on the effects of war on health (including its links with public policy), beginning with a focus on the effects of weapons on health.

See Figures:

#1: General framework
#2: Example of a problem-based module

The curriculum would have the following features:

- It would build on existing programs and projects; examples, include:

ICRC-related university courses on “Humanitarian Action”;
MEDACT curriculum on War and Health;
courses at the LSHTM.

- It would be multi-disciplinary, both in how it is designed and taught, and in how it is experienced (that is, by multidisciplinary groups of learners). The curriculum would be available at several levels:

undergraduate (for example, the second university year)
graduate (for example, a multi-disciplinary seminar series)
continuing, post-professional education (for example, a multi-disciplinary workshop)

- A modular approach would be based on specific problems/ situations (for example small arms, landmines, new weapons)

- Experimental use of modern information technology (e.g. electronic conferencing, World Wide Web documents).

2. We recommend the creation of an international working group, coordinated through the ICRC, which would develop a proposal with two objectives:

a. to prepare an inventory of available educational materials, courses, and resource persons or groups;

b. to design and conduct a pilot project to test the model for the utility of its approaches to the subject matter and the degree of interest.

The working group members also agreed to contact certain institutions, individuals and groups:

Douglas Holdstock:

MEDACT group. University of Bradford peace studies programme.

Members of the Finland and Sweden IPPNW (who are preparing a book on “Health and War”)

Natasha Palmer:

Interested individuals at the LSHTM

Robert McAfee:

Dr Ian Field (World Medical Association)

Mark Granat:

The departments of International Law and International Relations at the Hebrew University of Jerusalem

Lennart Johnson:

Stockholm University Faculties of Law and Medicine

Anita Parlow:

George Mason University

Vic Neufeld:

McMaster University “War and Health Program”

Pierre Perrin:

Universities which are already associated with the ICRC; also, various departments and groups within ICRC.

The working group would also welcome suggestions from others concerning individuals and institutions who could contribute to this project.


Figure 1


Figure 2

Working group 5: plenary discussions

Multi-disciplinary approach

Participants emphasized the importance of involving non-medical professionals - particularly lawyers and soldiers - in the design and teaching of any academic curriculum relating to the effects of weapons on health.

Academic research

It was noted that the report was limited to education, and did not discuss academic research. The group chairman explained that research had certainly been considered, but for reasons of time the group had decided to confine its report to university education.

WHO involvement

Participants felt that WHO should be involved in the development of any curriculum, and that the notion of weapons as a public health problem should be fostered within that organization.

Curriculum development

A spokesman for the working group suggested that the most constructive next step would be to develop a curriculum. There was some discussion concerning the most effective way to introduce a new subject or a new curriculum into universities. A pilot scheme was suggested, as was the idea of a “module” that could be incorporated into a broader curriculum as an option for students. It was also suggested that further symposia on the effects of weapons on health should be organized.

Working group 6 - Building blocks of a communication strategy (public conscience, professional awareness)

The Group considered the communication strategy in the context of the four objectives identified, which were broadly accepted, and in the light of the eight communication elements raised in the morning’s presentation.

Element 1: Decision to do something

The Group felt that a communication activity is both appropriate and necessary, on the assumption that the whole Symposium agrees that an initiative on the impact of weapons on health needs to be taken.

Element 2: Establish the objectives

These were agreed to be:

1. identify the “ology” - in other words the discipline relating to the impact of weapons on health, “vulnerology” was suggested.

2. establish a yardstick for the measurement of the health effects of weapons. This objective was seen as the cornerstone upon which all other activities depend.

3. galvanize a body of support from professional groups for stronger controls on weapons on the grounds of their impact on health (see Element 3 below).

4. use this support to strengthen the humanitarian voice in weapons debates at all levels.

Element 3: Target audiences

There is a need to identify target audiences, the objective being not merely to inform but to mobilize those who have been informed.

Target audiences should initially include individuals and professional associations in the following fields:

- medics and health workers
- lawyers
- members of the armed forces

The second stage target audience should include:

- journalists and other opinion shapers
- National Red Cross and Red Crescent Societies

The third should include:

- politicians
- the general public

Coalitions would need to be created but may need to be kept loose on account of the varying needs of particular groups.

Element 4: Tone and positioning

It was agreed that the tone should be ‘cool’, neutral, balanced, factual and respectable, rather than emotive, speculative and ‘political’. It was also agreed that the positioning should be professional and open to support and dialogue with any interested individual or group willing to accept the tonal ground rules.

Element 5: What is the target audience supposed to do?

Primary target audience - individuals and professional associations:

- To propose and make secure the adoption of resolutions and motions of support for efforts to measure the impact of weapons on health;

- to use them to reduce unnecessary suffering and superfluous injury;

- to engage in efforts to educate their constituency in the health effects of weapons which cause unnecessary suffering and superfluous injury;

- to supply the ICRC database (see below) with any relevant information to create the required body of knowledge.

Other target audiences:

- the response required will be consistent with the above but can only be elaborated in the light of progress made with primary target audiences

Element 6: How to reach them

Primary target audience:

The group recommends that a 3 - 5 page summary of the issues and proposed actions resulting from the Montreux Symposium be drawn up and circulated to all participants, invitees unable to attend, and to individuals/organisations known to be interested in the issues.

Decisions on what further steps to take need to be reviewed in the light of the response to the summary.

Element 7: Resources required

It was felt that ICRC must be the lead institution and therefore must:

- identify a co-ordinating committee (of, say, 10) members drawn from the first Montreux meeting in 1996;

- foster and ensure the development of an acceptable and scientifically valid metric and methodology for measuring the health effects of weapons;

- create and maintain a database of the required body of knowledge to disseminate information to stakeholders and primary target audiences;

- plan and hold a meeting (Spring 1998) to review progress and to plan a global communication and policy implementation strategy;

- develop a budget;

- to assign a full time co-ordinator to realize the above.

Element 8: Measurements of success

1. Progress in achieving a credible and accepted means of measuring the health effects of weapons;

2. Creation of a database held by the ICRC of the required body of knowledge;

3. Stakeholder consensus with respect to methods and goals;

4. Active networks to proselytize the above;

5. Achieving a global policy;

6. Diminution or abolition of superfluous injury and unnecessary suffering.

Working group 6: plenary discussions

The recommendations of the report were accepted. It was agreed that much of the content had already been discussed following presentation D5.

The suggestion that “incorporation in educational agendas” should be included under element 8 was accepted, as was the notion that this should include the education of young children as well as university students.

One participant promised to contact a leading weapon manufacturer in his own country to request that funds be made available for follow-up to the initiatives decided upon by the Symposium.

4.6 Conclusions

The Symposium, while expressing the wish that all disputes could be settled by non-violent means, recognized that the medical profession had an important role to play in limiting the suffering caused by weapons.

It also recognized that the world was witnessing an epidemic of the effects of weapons.

The participants agreed that to study and communicate the effects on health of weapons both present and future was primarily the responsibility of the medical profession. The subject deserved further attention because:

- the global epidemic of the effects of weapons should be a viewed as a public health issue;

- the effects of weapons on the health of individuals, groups and societies are measurable;

- discussion of the effects of weapons on health provide an objective means of communication and a common language among doctors, lawyers, scientists and military decision-makers;

- weapons of the future should be assessed in terms of their effects on health;

- abuse of knowledge of human genes and genetic engineering could lead to the development of weapons whose effects are race-specific;

- doctors documenting or researching the effects of weapons could be faced with an ethical dilemma which was as yet undefined;

The Symposium recognized that documentation of the effects of weapons on health is essential to generate public conscience which in turn influences political decision-making and international law relating to weapons.

The participants agreed that if progress was to be made, the effects of weapons on health must come to be accepted as a legitimate field of study by their peers. Using credible, professional channels, the effort should be co-ordinated in three particular areas:

Documentation

The effects of weapons on individual and public health must be systematically recorded, analysed and published so as to build up a significant body of evidence to support arguments for control of the design, transfer and use of weapons.

Definition

The effects of weapons on health must be classified, and a universal metric developed, so that the legality of weapons can be assessed in an objective, non-partisan manner. An important

distinction should be made between such an assessment and judging whether or not a weapon or means of warfare was “acceptable.”

Communication

Amongst professionals and the general public alike, there is an urgent need to reconcile common perceptions of violence using weapons with the realities of modern war. Only with an informed public opinion should decisions regarding the legality of weapons be made. Incorporation of the subject into educational agendas is seen as an important part of this strategy.

The recommendations of the Symposium, as outlined in the Executive Summary of this report, reflect these conclusions and identify specific action to sustain the momentum created by the Symposium.