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Commentary - General protection of medical duties
[p.197] Article 16 -- General protection of medical duties


[p.198] General remarks

640 The principle that the wounded, sick and shipwrecked (hereafter referred to as "the wounded"), must be treated and cared for humanely, in addition to the respect and protection to which they are entitled, is one of the pillars of the Geneva Conventions. The first corollary of this principle is that medical personnel must be respected and protected. This is essential for them to be able to act for the benefit of the wounded. A second corollary is laid down in Article 16 : any person able to perform medical activities for the benefit of the wounded should be able to do so without fear or any form of coercion.

641 Article 16 supplements the principle contained in Article 18 , paragraph 3, of the First Convention for the whole population, which states: "no one may ever be molested or convicted for having nursed the wounded or sick", though it does so only with respect to personnel engaged in medical activities.

642 It is no longer only the fact of providing care which is covered here, but any form of medical activities, always provided that they are compatible with medical ethics. As shown in the documentation presented to the Conference of Government Experts in 1971, a doctor is not limited to giving treatment: "He may be called upon also to diagnose (which may reveal that nothing is wrong), report as an expert consultant, give proof of death, or merely advice, and so forth". (1) This is why it is important to cover all medical activities.

643 Moreover, while it is important that medical activities undertaken for the benefit of the wounded cannot be punished, it is even more so to prevent any behaviour conflicting with their interests. Article 11 ' (Protection of persons) ' deals with persons receiving treatment, and prohibits subjecting them to any medical procedure which is not indicated by their state of health. (2) Article 16 , paragraph 2, supplements this prohibition by protecting the potential perpetrator against any compulsion to perform acts -- or refrain from performing acts -- contrary to the patient's interests.

644 Finally, still with the intention of benefitting medical activities for the well-being of the wounded, Article 16 , paragraph 3, is concerned with preventing the use of the privileged relationship which often exists between medical personnel and the wounded to compel such personnel to extract information from the wounded. This restriction is necessary to establish an atmosphere of trust between those providing care and their patients, which is nowadays even considered to form part of the healing process.

[p.199]

645 As to the historical background, it should be noted that the principles on which this article is based were already raised in the context of the "Entretiens consacrés au droit international médical" and were included in the "Draft Rules for the Protection of Wounded, Sick and Civil Medical and Nursing Personnel in Time of Conflict" which resulted from these discussions and were presented by the ICRC at the XXth International Conference of the Red Cross (Vienna, 1965). (3) It is clear therefore that the essence of Article 16 reflects a preoccupation which was already an issue right at the beginning of the work that led to the Protocols.

Paragraph 1

646 The object of this provision is obviously to remove all fear of punishment from persons who may get involved in caring for the wounded who are the true beneficiaries of this provisions. As a matter of fact, the threat of punishment hanging over the head of persons able to help them means that they would be in danger of being left without care.

647 Thus, though the ultimate aim of Article 16 is to improve the treatment of the wounded, this paragraph is directly concerned with persons who have provided care and therefore implicitly those who could get involved in such activities.

648 It may seem that this category of persons could be extremely broad or even include the whole population, since anyone may find himself in the presence of a wounded person who is losing blood and may perform a medical act such as applying a tourniquet in such circumstances.

649 Although the spirit of international humanitarian law is of course opposed to any condemnation of such acts, the present provision is nevertheless more particularly concerned with those performing medical activities or activities directly related thereto, whether or not they are considered to be medical personnel in the sense of the Protocol. On the other hand, Article 17 ' (Role of the civilian population and of aid societies) ' covers the whole population.

650 What meaning can be ascribed to the term ' punishing? ' Article 18 , paragraph 3, of the First Convention uses the terms ' molest ' and ' convict, ' and Article 17 ' (Role of the civilian population and of aid societies), ' paragraph 1, of the Protocol adds the term ' prosecute. ' The draft presented at the Conference of Government Experts in 1971 stated that the exercise of medical activities should not be "considered an offence". (4) The verb ' convict, ' used in the First Convention, and the term ' offence, ' used in the 1971 draft, show that these are concerned only with the criminal law aspects. However, the term ' molest, ' used in the Convention, goes much further. This should prevent any criminal proceedings or even administrative proceedings being brought solely on the basis of such grounds, as is even more clearly prohibited by the term ' prosecute, ' used in Article 17 ' (Role of the civilian population and of aid societies) ' of the Protocol. A fortiori, it should also prevent any administrative measure (particularly a disciplinary measure) [p.200] from being taken, or even any form of annoyance, threat or harassment. By using the term ' punishing ' the prohibition is here restricted to sanctions. However, the verb ' punishing ' is less restrictive than ' convicting; ' it refers not only to penal sanctions, but also to any other sanctions or harassment.

651 The obligation to refrain from punishing is addressed to all authorities in a position to administer punishment, from the immediate superior in the hierarchy of the person concerned who is entitled to do so, to the supreme court of a State. It applies not only to the enemy authorities, but also to the authorities of the Stale of which the person concerned is a national. This is important, because there could be a great temptation for a State to punish its own nationals who have administered care to the enemy wounded.

652 The expression "medical activities" is very broad, and its precise limitations are difficult to define. Ultimately the determining element is that the activities are aimed at improving the health or alleviating the suffering of the wounded. In this way activities which should obviously be excluded, are in fact excluded: activities unrelated to the wounded person's state of health, such as messages which could be transmitted to help him.

653 Medical activities must be "compatible with medical ethics". This point first of all acts as a reminder that the provision under consideration here is aimed at medical personnel. However, it raises two questions. What exactly are medical ethics? To what extent can one require that persons who are not professionally bound by ethical rules, observe and therefore are familiar with such rules?

654 It is possible to define this concept fairly closely. Ethics are defined as "the science of morals [...] the science of human duty". (5) They are not only concerned with the medical profession, though modern usage of the term usually refers to ' medical ' ethics, viz., the science of the professional duties of medical practitioners. (6) These are certainly the ethics with which we are concerned here: there is no doubt about that. (7)

655 Thus the phrase refers to the moral duties incumbent upon the medical profession. Such duties are generally decreed by the medical corps of each State in the form of professional duties. However, this should not be confused with the rules of the internal organization of medicine which obviously are not part of medical ethics.

656 At the international level, the World Medical Association (8) adopted an "International Code of Medical Ethics" (1949) (9); a modern version of the Hippocratic Oath, the "Declaration of Geneva"(1948) (10); the "Regulations in [p.201] time of armed conflict" (11) and the "Rules governing the care of sick and wounded, particularly in time of conflict". (12) These rules have not been adopted by States and have no binding force in international law. Nevertheless, they constitute a valuable instrument of reference and no one contests the principles on which they are laid down. There is no doubt that these are the rules of medical ethics referred to in the context of the provision under consideration here. (13)

657 As these rules were adopted for the medical profession, strictly speaking they bind only the members of this profession. However, an examination of these rules reveals that the underlying principles are simply common sense and that no person administering care could transgress them without being aware of being in the wrong. In fact the more delicate ethical problems, such as those raised by abortion or euthanasia, do not play a part in this context.

658 What is the essential maxim of these principles? It is never to act in conflict with the wounded person's interests, to help him to the fullest extent of the [p.202] means available, whoever he is (principle of non-discrimination), to be discreet regarding his condition and never to abuse his sense of dependence on the person administering care, particularly not with a view to gaining an advantage from him.

659 Thus the meaning of paragraph 1 is clear: it encourages concern for the wounded, provided that this concern remains pure and impartial. (14)

660 The second part of the sentence, "regardless of the person benefitting therefrom" (medical activities), was not indispensable. It simply reveals the absolute character of the principle, to which no exception can be made. There is a right, and even a duty (in any case for medical personnel) to administer care to the worst enemy of one's own Party to the conflict, if he is wounded, even in the middle of the most cruel battle.

661 However, one tricky problem remains: if a national of a State is in service of the enemy, this act may be punished by that State. Should Article 16 be considered as an obligation for a State Party to the conflict not to punish its own nationals serving in the enemy medical service? Without being able to answer this in the affirmative, it is to be earnestly wished. In any case, the act of serving in the ' medical service ' of the enemy should at least be considered an important mitigating circumstance in a case of ' being in the enemy service. '

662 It should also be stated that on the basis of this provision, it is not possible to rule out the prosecution of those who have not answered a call to mobilisation. However, this is another problem which does not belong to international humanitarian law. (15)

Paragraph 2

663 This paragraph is concerned with another aspect of the protection of medical duties. This time it is not a case of preventing medical activities from being paralyzed by the fear of possible punishment, but of preventing compulsion from being exercised on medical personnel to make them behave contrary to medical ethics.

664 Those on whom such compulsion must not be exercised are "persons engaged in medical activities". This refers, first of all, to all personnel caring for the wounded, whether these are doctors, nurses or medical aides. However, it also includes technical personnel whose activities, such as X-ray examinations and the preparation of medicine, has a direct influence on the wounded. It should be noted that this concept only partially covers that of medical personnel. Indeed, on the one hand, it covers members of medical personnel who do not qualify as such in the sense of the Protocol because they are carrying out medical activities without being "assigned, by a Party to the conflict, exclusively" to such medical purposes (cf. Article 8 -- ' Terminology, ' sub-paragraph (c)); on the other hand, some persons considered as medical personnel by the Protocol do not carry out [p.203] medical activities (such as, for example, the personnel assigned to the administration of medical units). Nevertheless, the latter are covered by the general principle of Article 17 ' (Role of the civilian population and of aid societies), ' paragraph 1, third sentence (16)

665 Such persons cannot be ' compelled ' to perform acts or to carry out work, or refrain from so doing. "To compel" means "to urge irresistibly, to constrain, oblige, force" (17) someone to act against his will. People may be compelled directly (by threats of death, of maltreatment, of harassment, of imprisonment) or indirectly (e.g., by threats relating to members of their family). For military medical personnel a simple military order may even constitute a form of compulsion, as refusing to carry out an order is severely punished. However, there should be more than mere pressure, such as that of withdrawing or failing to grant certain material advantages. Moreover, it should be noted that anyone who compelled a person engaged in medical activities to perform acts contrary to medical ethics would not only be violating Article 16 , paragraph 2, but also Article 10 ' (Protection and care), ' and probably Article 11 ' (Protection of persons). ' As regards the person who had been compelled to commit such an act, he would not be automatically absolved from blame. The compulsion would be considered as a mitigating circumstance of the violation of Article 10 ' (Protection and care), ' and probably of Article 11 ' (Protection of persons), ' and depending on the circumstances, might even result in the acquittal of the accused (18)

666 The persons concerned cannot be compelled "to perform acts or to carry out work contrary to the rules of medical ethics" (or other rules: see below). Thus this does not refer only to medical procedures (such as performing an operation, giving an injection, administering medicine etc.), but also to work that is essential for medical treatment (preparation of medicines, analyses etc.)

667 For that matter, it is clearly stated that such compulsion may take either a positive or a negative form. To prevent the performance of an essential operation, administering medicines or disinfecting a wound, clearly constitutes a compulsion which is just as reprehensible as a compulsion to perform certain acts. For example, it is quite clear that preventing an orderly from carrying out an analysis which is essential for medical treatment is also contrary to the provisions of paragraph 2

668 The acts or the work referred to in this paragraph are those which are "contrary to the rules of medical ethics or to other medical rules designed for the benefit of the wounded and sick, or to the provisions of the Conventions or of this Protocol". These are alternative conditions, and it is sufficient for such acts or works to be contrary to one of these three types of rules.

669 It should be noted that in the documentation presented at the first session of the Conference of Government Experts in 1971 reference was made to conduct "contrary to his vocation and professional conscience". The experts attempted to draw up a list of acts which should be prohibited, but in view of the difficulties of such a task, they gave up. Finally, they adopted the solution of including a [p.204] paragraph specifically prohibiting medical personnel from being compelled to violate the provisions of the Conventions or the Protocol, and another paragraph prohibiting them from being compelled to perform acts or carry out work contrary to ' professional rules. ' The concept of ' professional conscience ' was considered to be too subjective and was abandoned. In the draft presented to the CDDH this part of the article was simplified. The two paragraphs were combined into a single one, referring only to ' medical ethics, ' on the basis that this covered all the provisions considered previously. However, various amendments requested the reintroduction of more complete and explicit references. (19) As stated during the CDDH,

"the relevant norms were to be found, first in the Geneva Conventions and the Protocols themselves; secondly, in the rules of medical ethics designed for the benefit of the wounded and sick, as opposed to those rules concerned only with the interests of the profession; thirdly, in other rules designed for the same purpose and applicable in a specific case" .(20)

However, it should be remarked that no attempt was made to list these various rules. The main point in understanding the scope of this paragraph is to be sensitive to its spirit. It is concerned with removing a compulsion which might be exerted on medical personnel to conduct themselves in a way that is contrary to their patients'interests. This is at the heart of the problem, and the seriousness of a breach of this provision should be considered in the light of the harm it could do to such patients' interests and the awareness of harm being done.

Paragraph 3

670 This paragraph is an attempt to resolve an awkward problem which had already been raised during the drafting of the Conventions, and which had been thoroughly discussed in medical circles. It is not the problem of "medical confidentiality", as it has sometimes improperly been described, (21) but the principle that the wounded and sick should not be denounced and that they should not be informed on.

671 This problem arose mainly because of experiences during the Second World War when the occupying forces ordered inhabitants, including doctors, to denounce the presence of any presumed enemy, under threat of grave punishment.

672 During the discussions which resulted in 1949 in the adoption of the Conventions, some delegations would have liked to specify that medical personnel and the civilian population should not be permitted to conceal the wounded whom they had given shelter or care from the control of the authorities. [p.205] They considered that otherwise such personnel and population would be infringing their neutral status. (22)

673 Others were opposed to this point of view, fearing that such a provision would confer legitimacy on measures taken by occupying authorities to compel doctors to denounce wounded members of the enemy forces or of resistance movements. Taking this argument to its logical conclusion, some wished to include non denunciation as a principle. (23)

674 Finally, because of the lack of agreement, this was not mentioned at all in the First Convention.

675 However, the problem was subsequently taken up by the International Law Association, (24) as well as by the IIIrd International Congress on the Neutrality of Medicine, (25) which both recommended that the principle of non-denunciation should be categorically recognized, emphasizing that otherwise the wounded would not take the risk of seeking medical attention.

676 The text proposed by the ICRC during the first session of the Conference of Government Experts does not put the principle of non-denunciation categorically, but leaves the responsibility whether or not to denounce a patient up to the doctor: the doctor cannot be compelled to denounce (but he is under no obligation to refrain from denunciation). (26) In this way the possibility of imposing denunciation has been taken away from the authorities, but a doctor retains the freedom to denounce a patient on the basis that he may legitimately wish to prevent the patient pursuing activities which he considers to be dangerous for other human beings, just as, in peacetime, he may wish to prevent a criminal from continuing his criminal activities. This principle was retained throughout all the stages of the Protocol's drafting and is contained in the final text.

677 However, the experts increased its scope by making it applicable to all persons carrying out medical activities.

678 Furthermore, it should be pointed out that the principle is concerned primarily with occupied territory, and that at first it had been provided that it applied only in such territory. As a controversy had arisen during the second session of the Conference of Government Experts regarding its application to the occupying authority's own medical personnel, the expression "occupying authorities" was replaced by "adverse Party". For that matter, it seemed to be clearly established that nothing in this provision could prevent the occupying authorities from imposing a duty to denounce on its own personnel. However, subsequently some confusion arose whether it was the adverse Party of that of the medical personnel, or of that of the wounded, that was referred to. In the Commentary on the draft Additional Protocols presented to the CDDH, the ICRC opted for the second [p.206] explanation, though this was contested. (27) Replacing the expression "occupying authorities" by the expression "adverse Party", moreover, also resulted in the application of the rule no longer being restricted to occupied territory.

679 Finally, it should be noted that the Government Experts Conference made a reservation to the principle with regard to the notification of communicable diseases and the personnel caring for the wounded may therefore be compelled to make such notification. This reservation was retained and is included in the present text of Article 16 , paragraph 3.

680 Let us now turn to the text to be reviewed.

681 Paragraph 3 applies to any person "engaged in medical activities", i.e., the same wording as in paragraph 2. The French text uses slightly different expressions in paragraphs 2 and 3, referring to "activité de caractère médical" and "activité médicale", respectively. However, this is merely a question of translation. The English text, which is identical in both paragraphs, shows that paragraph 3 is not addressed to a different group of persons from paragraph 2. As regards the meaning of the words quoted, reference should therefore be made to the commentary on paragraph 2. The same applies to the meaning of the verb ' compel. '

682 Such a person cannot be compelled to give "information concerning the wounded and sick who are, or who have been, under his care". This refers not so much to information relating to the health or physical condition of the wounded and sick. In fact, discretion in this respect is required by medical ethics and is therefore imposed by paragraph 2. The information concerned is rather information about the activities, connections, position or simply the existence of the wounded. The provision does not cover only the wounded who are still under the care of the person engaged in medical activities, but also those who have been cared for previously. Thus the protection is not of a temporary nature, but long term, based on the general idea that it is not right to use information obtained in the context of the relationship between the wounded and persons caring for them. This relationship must be free of any suspicion if it is to be truly effective.

683 Nevertheless, this obligation to refrain from compelling a person engaged in medical activities to give information thereon is subject to the condition that "such information, would, in his opinion, prove harmful to the patients concerned or to their families". In other words, the personnel caring for the wounded could not lawfully use this provision as an excuse to refuse to give information for other reasons. However, it is clear that the discretion of the person engaged in medical activities is still very broad, all the more so as it is very difficult, if not impossible in practice, to examine the validity of such reasons.

684 Moreover, as we saw above, there is no obligation upon those exercising medical activities to remain silent. They may denounce the presence of the wounded to the authorities even when they know that this will be prejudicial to the wounded person or his family, if such denunciation is in their view necessary for saving lives. The prohibition is aimed at those who could compel such denunciations.

[p.207] 685 The information must not be demanded under compulsion by "anyone" belonging to the Parties to the conflict, with one reservation which will be examined below. The draft presented to the CDDH referred to the "authorities". Even though only authorities in the wide sense can lawfully be in a position to exercise compulsion, there is no need to regret the wider formulation adopted in the final text, as this avoids any ambiguity.

686 Although compulsion exercised by personnel of the adverse Party is absolutely prohibited, such compulsion exercised on a person by his own authorities is only forbidden insofar as the national law of such a person does not allow exceptions ("except as required by the law of the latter Party"). Without reiterating the historical background of this clause outlined above, it is worth recalling that the draft presented to the CDDH simply imposes a prohibition on the authorities of the adverse Party. During the CDDH the text first adopted by Committee II also referred only to the adverse Party. However, this text presented the Drafting Committee with some difficult problems, and it decided to refer it back to a Working Group. It was this latter which adopted the present wording, maintaining that it was not altering the essential meaning of the preceding text. The Rapporteur of the Committee's Drafting Committee considered that the idea "that no person engaged in medical activities should be compelled to give, even to his own Party, the information in question except if so required by national legislation" had "always been implicit in the former wording". (28)

687 However, this modification was not unimportant as regards the principle involved, as it clearly presumes that in the relationship between the authorities of a Party to the conflict and its own personnel engaged in medical activities, compulsion to denounce is prohibited in principle. Only an explicit provision of national legislation can remove this presumption. It is by no means negligible as the problem of the relationship between the doctor dependent on the authorities of his own Party, and the wounded of the adverse Party (care of persons in occupied territory, prisoners of war etc.) is not a mere academic point. At a purely humanitarian level it is regrettable that the wording did not go even further by adopting the provision without restriction, even with respect to the Party to the conflict of the personnel engaged in medical activities and leaving the sole responsibility whether or not to denounce to such personnel. However, the view prevailed that there could be no question "of interfering with the application of national legislation" (29) once it was decided that the scope of the provision should not be confined to occupied territories, but should be extended to national territories.

688 Finally, it should be mentioned that the solution which was ultimately adopted is not very satisfactory from the purely legal point of view, insofar as it results in an international legal norm varying according to different national legislations. One delegation at the CDDH even stated that "such a provision was contrary to [p.208] the very essence of international law". (30) It remains to be hoped that the national legislation on which the application of the rule depends on this point will exercise as little compulsion as possible with regard to persons engaged in medical activities. In any case they may not impose an obligation to violate the minimum standards imposed by the general rules of medical ethics mentioned above. (31)

689 The final sentence of the paragraph concerns the relationship of the personnel caring for the wounded both with the adverse Party and with its own Party. In fact, in the case of communicable diseases, general interest takes precedence over special interests. Thus it is logical to impose on persons engaged in medical activities an obligation in all circumstances to notify cases of communicable diseases which they can trace. The Protocol itself does not impose this obligation, but refers to domestic regulations, removing any ambiguity with regard to the conformity of these regulations and the present article.

Y. S.


NOTES (1) CE/7b, p. 21;

(2) For further details on this subject, cf. commentary Art. 11, supra, p. 154;

(3) On the subject of these discussions and these "Draft rules..." and their historical background, cf. introduction to Part II, supra, pp. 108-110;

(4) CE/7b, p. 21;

(5) Shorter Oxford English Dictionary, 1973 Edition, p. 685;

(6) The French equivalent "déontologie" in particular refers to "déontologie médicale", cf. Paul Robert, Dictionnaire alphabétique et analogique de la langue française, Paris, 1971, Vol. II, p. 120;

(7) A proposal was made to use the expression "déontologie médicale" in the French text, "medical ethics" in the English text (cf. O.R. III, p. 78, CDDH/II/53);

(8) This Association was set up in 1947. It is constituted of one medical association in each country and has about 700,000 members. On this subject, cf., in particular, M. Torrelli, op. cit;

(9) Ibid., pp. 384 ff., which contains the text of this Code in an Annex;

(10) Ibid., pp. 385 ff.;

(11) These rules, as amended by the 35th World Medical Assembly in 1983, are as follows: "

1. Medical Ethics in time of armed conflict is identical to medical ethics in time of peace, as established in the International Code of Medical Ethics of the World Medical Association. The primary obligation of the physician is his professional duty; in performing his professional duty, the physician's supreme guide is his conscience.
2. The primary task of the medical profession is to preserve health and save life. Hence it is deemed unethical for physicians to:
A. Give advice or perform prophylactic, diagnostic or therapeutic procedures that are not justifiable in the patient's interest.
B. Weaken the physical or mental strength of a human being without therapeutic justification.
C. Employ scientific knowledge to imperil health or destory life.
3. Human experimentation in time of armed conflict is governed by the same code as in time of peace; it is strictly forbidden on all persons deprived of their liberty, especially civilian and military prisoners and the population of occupied countries.
4. In emergencies, the physician must always give the required care impartially and without consideration of sex, race, nationality, religion, political affiliation or any other similar criterion. Such medical assistance must be continued for as long as necessary and practicable.
5. Medical confidentiality must be preserved by the physician in the practice of his profession.
6. Privileges and facilities afforded the physician must never be used for other than professional purposes.";

(12) These rules, as amended in 1983, are as follows:

"A. 1. Under all circumstances, every person, military or civilian must receive promptly the care he needs without consideration of sex, race, nationality, religion, political affiliation or any other similar criterion.
2. Any procedure detrimental to the health, physical or mental integrity of a human being is forbidden unless therapeutically justifiable.
B. 1. In emergencies, physicians and associated medical personnel are required to render immediate service to the best of their ability. No distinction shall be made between patients except those justified by medical urgency.
2. The members of medical and auxiliary professions must be granted the protection needed to carry out their professional activities freely. The assistance necessary should be given to them in fulfilling their responsibilities. Free passage should be granted whenever their assistance is required. They should be afforded complete professional independence.
3. The fulfillment of medical duties and responsibilities shall in no circumstance be considered an offence. The physician must never be prosecuted for observing professional confidentiality.
4. In fulfilling their professional duties, the medical and auxiliary professions will be identified by the distinctive emblem of a red serpent and staff on a white field. The use of this emblem is governed by special regulation.";

(13) For further details in this field, cf. in particular M. Torrelli, op. cit.;

(14) Cf. also Art. 11, para. 1, and its commentary, supra, pp. 152-156;

(15) On this subject, see also J. Pictet, ' Humanitarian Law and the Protection of War Victims, ' op. cit., pp. 78-80;

(16) Cf. commentary Art. 17. infra, pp. 216-217;

(17) Shorter Oxford English Dictionary, 1973 Edition, p. 382;

(18) On this subject, cf. also commentary Arts. 85-87, infra, p. 989;

(19) Cf. O.R. III, pp. 77-81, particularly CDDH/II/36, CDDH/II/53, CDDH/II/209, CDDH/II/ 212;

(20) O.R. XI, p. 183, CDDH/II/SR.19, para. 59;

(21) As a general rule, medical confidentiality refers to the discretion that a doctor must observe with respect to third parties regarding the state of health of his patients and the treatment he has administered or prescribed for them. Cf. also CE/7b, p. 22;

(22) On this subject, cf. CE/7b, p. 22;

(23) Ibid;

(24) Cf. ' Report of the 53rd Conference, Buenos Aires, 1968, ' The International Law Association, London, 1969;

(25) A summary of the reports, debates and resolutions of this congress, which took place in Rome from 16-20 April 1968, can be found in the ' Annales de Droit international médical, ' Commission médico-juridique, Palais de Monaco, No. 18, December 1968, pp. 72-76;

(26) Cf. CE/7b, p. 23;

(27) Cf. ' Commentary Drafts, ' p. 25, and O.R. XI, p. 150, CDDH/II/SR.16, para. 52;

(28) O.R. XII, p. 282, CDDH/II/SR.81, para. 3;

(29) O.R. XI, p. 153, CDDH/II/SR.16, para. 68;

(30) O.R. XI, p. 513, CDDH/II/SR.46, para. 2. This remark referred to a similar provision in Protocol II, but it was repeated with regard to the present provision: O.R. XII, p. 282, CDDH/II/ SR.81, para. 5;

(31) Cf. supra, pp. 200-201, and notes 11-12;