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Commentary - Art. 91. Part III : Status and treatment of protected persons #Section IV : Regulations for the treatment of internees #Chapter IV : Hygiene and medical attention
    [p.398] ARTICLE 91. -- MEDICAL ATTENTION


    It will be remembered that under Article 81 the Detaining Power is bound to provide free of charge for the maintenance of internees, and specific mention is made of the necessity of granting them medical attention. When all is said and done, the health of the internees is the best indication of the way in which the Detaining Power has fulfilled its international obligations in regard to them. The five paragraphs of Article 91 concern the practical fulfilment of the obligations mentioned.

    [p.399] PARAGRAPH 1. -- INFIRMARY

    The first step in providing adequate medical care will obviously be the establishment of infirmaries in the places of detention. They must not be established merely for show; the text of the Article requires each infirmary to be under the direction of a qualified doctor.
    In certain cases medical treatment includes the provision of a diet designed to help the patient's recovery. If the diet cannot be followed in the internees' ordinary living quarters, they must be admitted to the infirmary.
    Because of the danger of diseases spreading, particularly in view of the conditions under which the internees live, it is laid down that isolation wards shall be set aside for contagious cases. The same provision appeared in the Stockholm text, but the words "if necessary" accompanying it might have been taken as reducing the force of the obligation laid on the Detaining Power, and the International Committee of the Red Cross accordingly proposed omitting those two words in order to avoid all ambiguity (1). The Diplomatic Conference fell in with their views and added the further obligation of isolating mental patients. Segregation may seem somewhat cruel in this case, especially when it is remembered that internment itself may have been the cause of mental affliction (or have aggravated an already disturbed mental condition); the decision of the Conference nevertheless commands approval, for the crowded living conditions in internee camps made the adoption of such a solution absolutely necessary in the interests of the internees as a
    whole.

    PARAGRAPH 2. -- MATERNITY CASES. SERIOUS DISEASES

    The infirmary mentioned in paragraph 1 will only be suitable for the treatment of illnesses which can be readily cured. In cases where a surgical operation becomes necessary, internment must not be allowed to prevent it being performed. In order to fulfil its international obligations the Detaining Power should arrange for internees suffering from serious illnesses to receive care not inferior to that provided for "the general population". This rule will moreover be applied with due allowance made for the social status of the internees whenever there is any variation in the treatment accorded to different classes of the population. It must be remembered that internment is not a punishment. It is a precautionary measure adopted in the [p.400] interests of the Detaining Power. It cannot be allowed to cause serious prejudice to the persons interned and the fact of not being able to receive the care required would cause such prejudice.
    The reference to maternity cases was inserted in the text at the request of the International Union for Child Welfare. Such cases can obviously receive greater and more methodical care in special maternity homes than in internment camps.
    It should furthermore be noted that the establishments referred to in paragraph 2 may, unlike the infirmary, be outside the place of internment and even at some considerable distance from it. The difficulties which arise in moving prisoners of war do not exist in the case of civilians; it is reasonable to suppose, therefore, that if contagious or mental diseases treated in the infirmary were to become serious or chronic, requiring "special treatment", the internees concerned should be taken from the infirmary to one of the institutions described in paragraph 2.

    PARAGRAPH 3. -- NATIONALITY OF THE DOCTOR
    IN CHARGE OF THE CASE

    The stipulation that internees shall, for preference, have the attention of medical personnel of their own nationality applies mainly to medical treatment which can be given in the infirmary, for there may be one or more doctors among the internees and their services may be called upon for their fellow-countrymen. In spite of the honourable traditions of the medical profession, patients naturally prefer to be looked after by a compatriot rather than by some other doctor, if only because he speaks the same language. The interests of the patient demand that he should be able to make himself clearly understood by his doctor.
    This statement of preference in no way invalidates the principle of the neutrality of doctors in face of suffering, a principle on which the Red Cross and the First Geneva Convention are founded. It in no way relieves the doctor provided by the Detaining Power from his obligation to care for the sick without discrimination, and it does not authorize him to neglect to give care to an interned enemy while awaiting the arrival -- perhaps not certain -- of a doctor of the patient's own nationality.
    When the treatment has to be given in one of the institutions referred to in paragraph 2, perhaps at some distance from the place of internment, it is still preferable for medical personnel to be of the same nationality as the internees; but the preference is necessarily less binding.

    [p.401] PARAGRAPH 4. -- MEDICAL EXAMINATION

    Although the fact is not mentioned in this paragraph, a daily medical inspection will take place in places of internment. This follows, as will be seen further on, from Article 125 . Internees will thus be able to report sick when they are ill, so as to receive medical attention without delay.
    The provisions of paragraph 4 are of particular importance in deciding questions of responsibility in case of accident or sickness. In order to receive the benefit, should occasion arise, of grants payable by insurance companies under private contracts or by private persons or the State in accordance with the law, it is necessary to be in possession of a medical certificate. In the absence of such a certificate, the man concerned, being unable to prove his entitlement, would be liable to have payment refused. It was therefore essential to relax the strict conditions of surveillance, whenever necessary, to allow internees to have themselves examined by a doctor. The Convention does this and goes still further by obliging the medical authorities of the Detaining Power to issue an official certificate with all necessary details of cases submitted to them. It will be noted that the obligation is laid on "the medical authorities of the Detaining Power". To safeguard the interests of the patient, the Central Agency provided for in Article 140 is to receive a duplicate copy of the medical certificate. The duplicate will be kept in a neutral country and the person concerned will be able to produce it after the close of hostilities in order to obtain redress, should he have been unjustly deprived of his rights or of the means of proving them.

    PARAGRAPH 5. -- DENTURES, SPECTACLES AND OTHER ARTIFICIAL APPLIANCES

    During the Second World War the International Committee of the Red Cross noticed when visiting prisoner of war camps that the absence of artificial appliances inflicted the greatest discomfort on men who had undergone operations. Even when temporary artificial limbs were provided, arrangements were not always made to educate the wounded in their use. Some regulations permitted the issuing of dentures only to prisoners who had lost at least fifteen teeth while in captivity; this led to numerous cases of gastric trouble due to insufficient mastication (2). Spectacles are also needed, for without [p.402] their help some people are unable to read, and reading is an important safeguard against the boredom arising from inaction. Taking account of the experience thus gained, the Conference made it incumbent on the Detaining Power to provide internees with permanent artificial appliances. Relief societies will undoubtedly try to assist the Detaining Power to fulfil this obligation by supplying, in particular, dentures and spectacles (they set an example in this
    respect during the Second World War); it was nevertheless essential, in the interests of internees, that the responsibility of the Detaining Power in this matter should be clearly laid down.


    Notes: (1) [(1) p.399] See ' Remarks and Proposals ' submitted by the
    International Committee of the Red Cross, Geneva, 1949,
    pp. 46, 79;

    (2) [(1) p.401] See ' Report of the International Committee of
    the Red Cross on its activities during the Second World
    War ', Vol. I, p. 266;