Friday, September 9, 2011

Military medics: protected or not?

Gulliver's post yesterday on the definition of terrorism started a very interesting Twitter conversation about the delineation between terrorism targets and legitimate military targets. This led to the discussion of legitimacy of targeting military medical personnel. On the one hand, these personnel are protected under the Geneva Conventions and tradition among state combatants. On the other hand, they aid the war effort by getting combatants back into the fight and recently have been armed, ostensibly for self-defense given the increased disregard for their protected status in recent decades. Arming them tends to un-blur their status towards combatant, in my opinion, but I'm certainly not one deny them their right to defend themselves. As Petulant Skeptic noted last night, they are all soldiers first.

I'm not up on all of the literature on this topic, save the basics in the Geneva Conventions that I was taught many years ago. So what I'd thought I'd do is provide my perspective on how I saw medical personnel treated on both sides during the course of the invasion of Iraq in 2003.

U.S. Medical Troops - Equipment and Markings
Being a brand new LT, I can only really speak about the forward medical personnel in my troop and Squadron Aid Station. I saw a Corps Support Hospital in Camp before we went to our tactical assembly areas, but not enough to comment on what happened to them once we launched over the berm. Anyway, the medical personnel in our squadron consisted of one platoon for the Aid Station, including a Medical Service Corps platoon leader, physician's assistant and a doctor (we were lucky to have a gynecologist for our battalion surgeon - but to be fair, he was a very good doc), who were equipped with light-skinned M998 HMMWVs, HMMWV ambulances (for transport and the nomenclature of which I don't know), M577s (for treatment), and M113s (for transport). We also had one section of medics in each of the ground troops (not sure what the air troops had) which were three medics in a M113. None of the medical vehicles had crew served weapons, and only the M577s and M113s were marked with red crosses. The personnel were not marked as a medical personnel in any way and carried a personnel weapon - usually rifles for the medics and pistols for the doc, PA, and PL. Other than their vehicle being marked, once the medics got off of their track, there was no way to discern them from other soldiers.

Iraq Medical Troops - Equipment and Markings
I didn't see a single Iraqi military medic or vehicle. Even in longer battles (which lasted up to four days), we never saw any Iraqi soldiers try to get to and help their buddies out. This isn't a condemnation on their bravery, it's just quite possible they didn't have any medical staff to do this. Or if they were like our medics and not marked, then we would have shot them at first site as a legitimate military target and not knowing what they were there for. We treated the Iraqis we could (I'm guessing follow-on units did more of this - we were often moving to fast to assess battle damage).

U.S. Policies on Engaging Military Medical Personnel/Equipment
The policy was we don't do that as signatories of the 1949 Conventions. If we identified injured Iraqis, Iraqi medical staff of personnel, we were not to engage them. As I mentioned above, we never had to test this theory. But here's where things became difficult: civilian ambulances. At first we left these along as civilian and therefore not targets - their medical status gave them extra protection. And then the Saddam Fedayeen started using them to pace out artillery distances and in a couple of cases as car bombs. As a leader, it was difficult to ensure the protected status of the Red Crescent when the soldiers were a little scared of them, but the policy was then to restrict their movement until their legitimacy could be verified. But they were protected from engagement.

Iraqi Army Policies on Engaging Military Medical Personnel/Equipment
Of course, we never saw the memos, but as far as the Republican Guard and Saddam Fedayeen were concerned as indicated by their actions, not only were medical vehicles legit targets in spite of their great big red crosses, they were preferred targets because they were light skinned and lightly armed. It was also a huge morale let down to see an ambulance get hit, because if there were any casualties, they'd have be taken out of fire by something needed in that fight. I should also note that once our soldiers were dismounted, I doubt the Iraqis could have discerned medical from combat arms soldiers, if they cared anyway.

Here's the big so what that I get from all of this. The U.S. will always consider military medical personnel and equipment as protected on the battlefield and will not willfully engage them. We belong to the gentlemen's club of war because we can afford to. The U.S. also understands that our adversaries will not be so "civilized" on this topic and will not afford our medical personnel and equipment protected status, if not actively find and target them. So we've armed our guys to defend themselves and let our combat arms guys do their best to protect them by force. It's not quite fair, but this is the case. So are military medical personnel protected? If you're the big kid on the block, they are because you can afford to make that discernment. If you're the underdog, everything is fair game - and there's a good argument of medical personnel as legitimate military targets. But to call attacks against military medical personnel, equipment, or facilities as "terrorism" would be a stretch from an active imagination.


  1. Last year I did an embed with a USAF combat search-and-rescue unit, the "Pedros" who are very popular with U.S. and UK ground troops in Helmand and Kandahar. Their grey HH-60 Pave Hawks do not have red crosses, and are armed with twin .50-caliber machine guns, and their combative approach endeared them to ground troops - in Sangin District, the day before I arrived, an HH-60 called "Pedro 67" had been shot down, and British marines at a rural outpost told me that before the aircraft was hit, its crew had been chucking hand grenades and firing M4s at an insurgent position as they passed over it. The Army MEDEVAC UH-60s have red crosses on them, and they are not armed, although they fly with an armed escort.

    The USAF crew said there was a terminology difference in the U.S. military, too, although I'm not sure if it's accurate: that their armed aircraft were CASEVAC craft, and the Army's unarmed, red-cross-bearing aircraft were MEDEVAC craft. Maybe they were conflating an Army-USAF terminology difference with something deeper, I don't know.

    I imagine most insurgents don't much care whether the helicopters coming in are armed or unarmed or have red crosses or not - in Iraq, one of the first helicopters shot down with heavy loss of life was "Witch Doctor 11," a UH-60 MEDEVAC downed by MANPADs near Fallujah. But an infantry officer who served in Pech District in 2008-9 told me something interesting in an interview once: "One thing I’d like to say about the Korengalis, though, was very rarely would they try to shoot down the MEDEVACs. It was almost chivalrous. They shot at a lot of aircraft" - they shot down a CH-47 in the Korengal during his tour - "but they did not shoot at the MEDEVACs."

  2. Tintin - thanks for these. Interesting stuff, especially about the Korengal.

    There is a difference between CASEVAC and MEDEVAC, but it's not about weapons or services. CASEVAC is moving a patient without medical care, MEDEVAC includes enroute medical care.

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