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Military Instructions on the protection of health care

March 17, 2021

Ten years after the revolution, the majority of the parties to the armed conflict in Syria have been involved in serious violations of international law, and one of the sectors that has been subjected to egregious violations, including war crimes, has been the health-care sector, which has been subjected to serious violations by various parties of the conflict, from targeting hospitals, health facilities, staff and medical personnel, and denying citizens fair access to them.

The SDF, as one of the main parties to the armed conflict in Syria, has been very careful in all areas under its protection to comply with international law and UN Security Council resolutions, particularly resolutions on protecting schools, medical facilities, staff and medical personnel and protecting them from the effects of armed conflict, unlike in other areas in Syria.

The SDF stress their commitment to protecting the health care infrastructure and also calls on all parties to the conflict in Syria to comply with the relevant international law and UN resolutions, and to define their policy in this regard and fully comply with it in the public interest of the Syrian people in all its different aspects and components, on the basis of the universal right of the population to health, without prejudice or discrimination. These military instructions have been elaborated in cooperation with Fight for Humanity, in the framework of the action plan signed between the United Nations and our forces in June 2019.ssued by the General Command of the Syrian Democratic Forces.

“Confirmation of Our Policy towards the Protection of Health Care”

In accordance with the Law of Armed Conflict (in particular the Geneva Conventions of 1949, and their Additional Protocols of 1977), International Customary Law, International Human Rights Law, the United Nations Security Council Resolution 1998 (2011) regarding children and armed conflict and notably concerning attacks on schools and hospitals and their implications for the safety of children, and the relevant law of the Autonomous Administration of North and East Syria (AANES) regarding health care, the Syrian Democratic Forces (SDF) pledge to take all measures to ensure safe access to, and delivery of, health care.

For the purpose of these military instructions:

‘Health care’ refers to activities that aim to preserve or restore health through the promotion, prevention, diagnosis, treatment, cure, recovery and/or rehabilitation of any physical and/or mental health condition.

‘Health-care facilities’ include primary health centres, hospitals, laboratories, clinics, first-aid posts, trauma stabilization points, blood transfusion centres, forensic medical facilities, and the medical and pharmaceutical stores of these facilities.

The SDF pledge to ensure that health care personnel, transports, and facilities are not negatively affected in areas under its security and military control, and that those wounded and sick are protected and have access to health-care services.

The SDF are acutely aware that any incident threatening or affecting health-care provision not only jeopardizes the lives of those directly concerned, but also risks negatively impacting curative, promotional, and preventative health-care programmes, putting at risk the universal right to health of the population. The disruption of health-care services has a particularly negative impact on children, who are already suffering disproportionally from the consequences of armed conflict and economic hardship. The protection of health care is always a crucial obligation, but even more so in the light of the ongoing COVID-19 pandemic, which requires a different level of coordination and cooperation between civilian and military actors.

The SDF, in particular, affirm their commitment:

  1. To respect and protect the wounded and sick without discrimination and regardless of affiliation, and actively support and facilitate their access to health care:
    • To treat the wounded and sick humanely in all circumstances and protect them and their property from ill-treatment and pillage.
    • To ensure that adequate medical care is provided to them as far as practicable and with the least possible delay.
    • Within the context of military operations, to search for and collect the wounded and sick without delay and distinction, whenever the security situation permits, and allowing medical actors and humanitarian organizations access.
    • To treat the wounded and sick without discrimination. If distinctions are to be made among them, it can be only on the basis of their medical condition. This does not exclude the special care and consideration required for the needs of women, children, gender minorities, and persons with disabilities. These groups of the population, as the most vulnerable groups, will be attended with positive discrimination when necessary.

  1. To respect and protect health-care personnel (at any point in time, before, during and after their work), facilities and medical transports, irrespective of their affiliation:
    • To always respect and protect any personnel providing health care. This protection will be a priority especially when they are attending the sick and the wounded.
    • To always facilitate the work of health-care personnel, including providing access to the wounded and sick, and the necessary assistance and protection.
    • Not to compel health-care personnel to carry out acts contrary to the ethical principles of health care. The health-care professionals should not be punished for having carried out activities compatible with medical ethics, such as providing impartial care or medical care to injured adversaries. This should be particularly applied in case of collective triage based on severity.
    • To respect and protect medical transports, regardless of whether they are visibly identified as such.
    • To allow and facilitate the medical evacuation of the wounded and sick to health-care services.
    • To allow unimpeded and fast passage to transports dedicated to health care.
    • To respect and protect health-care facilities in all circumstances, regardless of whether they are visibly identified as such. They shall not be attacked and access to them shall not be limited.
    • To respect the distinctive emblems of the red cross and the red crescent and those of the health-care providers and not to improperly use them.
    • To ensure that health-care personnel, facilities and medical transports remain exclusively engaged in medical tasks.
    • To take all feasible precautions to avoid carrying out military operations near health-care facilities and not to incidentally damage or destroy them. All members of the SDF should be in full compliance with the Principles of Distinction between Civilian Objects and Military Objectives and the Principles of Proportionality and Precautions against the Effects of Attacks, as stipulated in the Law of Armed Conflict.
    • Not to attack infrastructure essential for health-care delivery (including for instance water and electricity supplies) as long as it is not used for military purposes. If such infrastructure is used for military purposes by an opposing party and considered for attack, the above principles should still be respected.
    • Not to use health-care facilities for military purposes and not to place military forces, equipment or weapons near civilian health-care facilities. Health-care facilities will lose the protection to which they are entitled if they are used, outside their humanitarian function, to commit acts harmful to the enemy.
    • To refrain from any behaviour that disrupts the functioning of health-care facilities, in particular using them for military or other non-medical purposes. Armed personal or devices should not enter the civilian health-care facilities.
    • Not to interfere with the work carried out in health-care facilities, including not taking supplies or material from health-care facilities and refraining from searches and arrest operations in medical facilities. Such searches and operations should only be carried out in exceptional circumstances.
    • To take precautions and protection measures in the situation of an imminent or possible attack on health-care personnel, facilities or vehicles by other conflict actors, making sure not to alter their civilian nature.
    • To give warnings in the case that health-care personnel, facilities or medical transports are used outside their humanitarian functions to commit militarily harmful acts, allowing for sufficient time for it to be observed.
  2. To coordinate and cooperate with civilian authorities and relevant humanitarian and development actors:
    • To create a Commission for Protection of Health Care for civil-military coordination, including the military and the civil representatives of the AANES, with authority to decide in any events. In this commission, international observers will be invited to participate and contribute to its meetings.
    • To identify, map, and regularly update information on the location of health-care facilities, providers and their vehicles and, to the extent possible, personnel, through coordination with the AANES Health Committee, and the concerned organizations within the framework of the Commission, in order to minimize the impact of military or security operations and measures on health-care services.
    • To allow regular access to health-care facilities and personnel for these organizations, making sure that the health-care system remains functional.
    • To identify and implement measures for prioritized passage through checkpoints (notably for medical evacuations).
    • To take all measures to minimize the impact on both patients and medical personnel if searches and/or arrest operations in health-care facilities can’t be avoided. Such searches and operations require previous authorization from the Health Care Authority of AANES.
  3. To take all measures to implement these instructions:
    • To train all relevant members of the SDF on these instructions: all military commanders in headquarters, as well as field officers and military personnel under their command, must be fully aware of these instructions and include them in all training programs in military schools and academies of the SDF.
    • To incorporate these instructions in the Rules of Military Engagement, related military policies, and in the overall military planning, preparation, and implementation of military operations by the SDF.
    • To abide by what is stated in this document. All SDF commanders and officers will face penalties if they do not adhere to the above-mentioned instructions.
    • To receive and handle complaints through a joint mechanism between the AANES, the Internal Security Forces and the Military Police, which in turn will consider any complaints about non-compliance with these instructions provided by individual or collective actors.
    • To cooperate fully with specialized organizations for the implementation of these instructions.

We pledge to abide by our obligations and commitments regardless of the behaviour of other parties.

These instructions shall come into force with effect as from the date of their publication.

General Command of the SDF

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