1. PROTECTION OF CIVILIAN POPULATIONS

Civilian populations are doubly affected by armed conflicts - directly, by the attacks on them, and indirectly, by the deterioration of the essential services on which their survival depends: agriculture, medical services, water supply services. Moreover, civilian populations are often forcibly displaced and their fundamental rights are violated (summary executions, abductions, etc.).

The use of legal instruments can have a decisive impact on the intervention strategy used in the field of health. Numerous studies have shown, for example, that during massive population movements, the mortality rate may be up to 15 times higher than normal. ²⁸ Knowing these facts, health workers can warn authorities about the risks of population displacement, and back up their arguments with the legal instruments cited below.

²⁸ "Centers for Disease Control, Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues," Morbidity and Mortality Weekly Report 41, No. RR-13 (24 July 1992).

The Protection of Civilian Populations against Forced Displacement

Protocol II, Article 17, provides:

"1. The displacement of the civilian population shall not be ordered for reasons related to the conflict unless the security of the civilians involved or imperative military reasons so demand. Should such displacements have to be carried out, all possible measures shall be taken in order that the civilian population may be received under satisfactory conditions of shelter, hygiene, health, safety and nutrition.

2. Civilians shall not be compelled to leave their own territory for reasons connected with the conflict."

According to Article 85, line 4a, of Protocol I, the following acts are considered grave breaches:

"the transfer by the Occupying Power of parts of its own civilian population into the territory it occupies, or the deportation or transfer of all or parts of the population of the occupied territory within or outside this territory, in violation of Article 49 of the Fourth Convention."

Keeping civilian populations in their normal environment depends on such factors as security conditions and the scope of "military necessity." Finally, if the civilian population remains on its home ground, its means of subsistence must be protected. Here again, health-care personnel can turn to legal instruments.

Protection of Means of Subsistence

Article 14 of Protocol II guarantees the protection of goods indispensable to survival:

"Starvation of civilians as a method of combat is prohibited. It is therefore prohibited to attack, destroy, remove or render useless, for that purpose, objects indispensable to the survival of the civilian population, such as foodstuffs, agricultural areas for the production of foodstuffs, crops, livestock, drinking water installations and supplies and irrigation works."

This article is clear. However, a point brought out by the Commentary on the Additional Protocols of 8 June 1977 to the Geneva Conventions of 12 August 1949 merits reflection; it refers to failures to take the necessary measures to supply a population with goods indispensable for survival. ²⁹ Such an omission could become a sort of combat method by abstention, which is contrary to the spirit of the article. It remains to be determined whether the omission is due to a deliberate desire to starve the civilian populations, or whether it is a result of a material inability to implement the measures required. Protocol I includes similar provisions (Art. 54).

²⁹ Commentary on the Additional Protocols of 8 June 1977 to the Geneva Conventions of 12 August 1949, p. XXXIV.

The constitution of neutral zones may also be contemplated as an intervention strategy to guarantee the protection of the means of subsistence, the health-care services, and the civilian populations as such.

The Concept of Neutral Zones

"The idea here is to shelter civilian populations from hostilities, mainly by creating hospital or neutralized zones and by forbidding attacks on hospitals and civilian medical transport, which are permitted to use the protective emblem for this purpose." ³⁰

³⁰ Y. Sandoz, "La notion de protection dans le droit international humanitaire et au sein du Mouvement de la Croix-Rouge," in Swinarski, ed.. Etudes et essais sur le droit international humanitaire, p. 978.

Civilian populations, however, often have no choice. As the ICRC has pointed out, ³¹ in a conflict civilians are often caught between two evils. If they stay in their homes, they are exposed to the dangers of war (bombing, landmines, attacks, famine) and are apt to find themselves without means or medical care. If they flee, they are still at the mercy of the combatants, as potential hostages risking arrest, summary execution, or "disappearance." Such population movements, spontaneous at first, are apt to become forced, where the armed forces seek to isolate insurgents.

³¹ "Personnes déplacées et droit international humanitaire," ICRC declaration to Human Rights Commission, 48th session, ICRC (19 Feb. 1992).

People displaced within their own country are protected by Article 3 and Protocol II.