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The first concern of doctors, probably all healthcare professionals, is the care of patients. This underpins the non-combatant status of military medical facilities and personnel, enshrined in International Humanitarian Law (IHL), medical ethics, moral, and religious codes. The number of papers on military medical ethics (MME) has substantially increased since the start of the 21st century.1 Most of these papers were written in English and cover ethical issues arising from conflicts in Iraq and Afghanistan, United Nations peacekeeping missions, or the Ebola crisis of 2014. Reflecting this, MME has been a prominent topic within BMJ Military Health.
The contemporary war in Ukraine is fundamentally different from recent conflicts, representing a return to peer-on-peer conflict in the heart of the European continent. It is also different because Russia does not seem to comply with its state obligations under IHL; specifically, there are allegations of targeting causing civilian casualties and destruction of medical facilities.2 Does this represent a change in the nature or character of war, and what are the implications for legal and ethical practice in healthcare during conflict? These questions will be considered through the lens of papers previously published in BMJ Military Health and its predecessors to determine whether these are new issues or whether military health professionals from previous generations faced similar dilemmas.
IHL hopes to limit the impact of war through four principles of military necessity, humanity, distinction and proportionality. Medical units and personnel are protected and may be identified by the distinctive emblems of the International Red Cross and Red Crescent Movement. Although health facilities have been directly targeted in recent conflicts,3 this is not new. Macpherson4 summarised the evolution of the Geneva Conventions (GCs). He noted that, while military medical units were neutral and may display the Red Cross for …
Footnotes
Twitter @MartinBricknell, @ChiuyiLin
Contributors MB conceived the paper. CYL and ZB contributed to the literature search. All three authors reviewed the paper and made substantial contributions to the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.