BMJ No 7120 Volume 315
Education and debate Saturday 29 November 1997
Abhorrent weapons and "superfluous injury or unnecessary suffering": from field surgery to law
Robin M CouplandWeapons: a surgeon's view
Buried or "point detonating" antipersonnel mines are the only conventional weapons which cause specific and severe injury resulting in specific and permanent disability. The treatment of the injury requires, on average, twice as many operations and four times as many blood transfusions as injury from other weapons. This is a surgeon's view.
| Summary points |
| Antipersonnel mines are an example of weapons that cause more injury than is necessary militarily to disable a soldier |
| The Geneva Conventions prohibit the use of weapons that cause "superfluous injury or unecessary suffering" |
| The SirUS project, run by the International Committee of the Red Cross, uses the nature of the injury it causes to deem a weapon illegal |
| Individual doctors and medical organisations are asked to endorse the SIrUS project |
| There was no particular point at which I became interested in the global problem of antipersonnel mines: I was just confronted with people injured by mines. From 1987 to 1991 I worked in hospitals set up by the International Committee of the Red Cross on the borders of Afghanistan and Cambodia, two of the most heavily mined countries in the world. During those last years of the cold war the full extent of the impact of mines on whole societies was yet unknown. New international legislation to ban the devices was not being discussed; I simply found myself dreading the radio call announcing that another mine injured person was on his or her way to hospital. The dread was generated by the knowledge that my team would be faced with a long and difficult operation which entailed excising large amounts of damaged tissue or amputating a limb. This quickly turned into abhorrence for the weapons which caused such injury as a function of their design. In brief, my own reason for finding these weapons abhorrent was the nature of the injury they caused: it was appalling and somehow excessive (see figure). |  | |
| Injury from a buried "point detonating" antipersonnel mine. Is this necessary to put the soldier hors de combat? Is this injury not superfluous if it is the foreseeable effect? |
Passing through Geneva in 1990, I heard that the International Committee of the Red Cross had been alerted to the development of blinding laser weapons, a development founded on the notion that it would be better to blind an enemy soldier than to kill him or her. Expert opinion informed us that even in the best ophthalmological centres there was no effective treatment for laser induced retinal haemorrhage. Here we had another weapon system which, as a function of its design, would produce a severe permanent disability. (Fortunately, such weapons were banned by a UN Convention in 1995; unfortunately, this ban came after the first blinding lasers had been produced.) It was becoming clear to me that however bad the effects of bullets or fragmentation munitions, there existed weapons which were, in some indefinable way, worse. This was the first time I heard of "superfluous injury or unnecessary suffering" in relation to weapons. Nobody could tell me what it was, but I was sure I had seen it caused by antipersonnel mines.
Deeming a weapon illegal
The stigmatisation of antipersonnel mines as abhorrent and much of the subsequent thrust of the campaign to ban them have quite rightly been based on the argument that they kill or injure both combatants and non-combatants without distinction and continue to do so long after the conflict has ended. However, I urge those who have worked hard on the mines campaign not to lose sight of the nature of injury as a means of deeming a weapon illegal. This is important because, if the injury or suffering resulting from a weapon's nature or technology could be proved to be excessive compared with the military advantage gained from its use, the weapon would be illegal whoever its victims - soldier or civilian.
This legal concept exists to protect the combatant from injury or suffering greater than that necessary to put him or her hors de combat. It originated in the St Petersburg Declaration of 1868, which prohibited the use of exploding bullets. Military and political leaders had become concerned about the effect such munitions would have on their troops. It was also the rationale behind the prohibition of poison gas in the Geneva Protocol of 1925. This concept has been given a more modern expression in the 1977 Protocol I additional to the 1949 Geneva Conventions. Upholding this element of international humanitarian law is in the interests of combatants.
|
1977 Protocol I additional to the Geneva Conventions of 1949
Part III. Section I - methods and means of warfare.
Article 35 - Basic rules (2) It is prohibited to employ weapons, projectiles and material and methods of warfare of a nature to cause superfluous injury or unnecessary suffering. |
Weapon development continues. Other technologies are appearing on the horizon such as beams and waves that could produce specific effects on the central nervous system, including depression and convulsions. Do armies really need these? Are they "abhorrent"? What can or should doctors do about them? Lawyers tell me that they cannot give governments and their military advisers a definition of what constitutes "superfluous injury or unnecessary suffering."
Doctors trying to understand this phrase step into the no man's land between the effects of weapons on health and the international law of war. I can see only one way to navigate this no man's land and that is to translate a field surgeon's concept of abhorrent weapons into a legal determination of "superfluous injury or unnecessary suffering." Taking its name from "superfluous injury or unnecessary suffering" (SIrUS), a project is now under way to do just such a translation.
The SIrUS project
The medical profession has a responsibility to use health
related data to help the international community define objectively
which weapons are inherently abhorrent and which weapons cause
"superfluous injury or unnecessary suffering." This was one of the
major findings of a symposium on "The medical profession and the
effects of weapons" organised by the International Committee of the
Red Cross in M The project is not "anti" anything other than the extraordinary and
incomprehensible human urge to find more and more sophisticated ways of
killing and wounding members of our own species. In particular, it is
not antimilitary; many military people agree with its aims and have
given sound advice. The SIrUS project simply seeks to place on an
objective and comprehensible basis what is already obvious: that the
effects on human beings of weapons commonly used by armies now are bad
enough, and that if possible, anything worse should be prevented.
An important legal concept in laws and
treaties relating to the conduct of war is that a weapon should not
cause "superfluous injury or unnecessary suffering" beyond the
military advantage of the user. There has never been an objective means
of determining what constitutes "superfluous injury or unnecessary
suffering"; some weapons have been deemed "abhorrent" or
"inhuman" but exactly what these terms mean has not been defined
either.
The twentieth century has seen enormous human suffering caused by
weapons and there is no sign of any decrease. This suffering results
from a combination of factors dependent on the design of weapons and
factors which are user dependent. Any use of any weapon against human
beings carries an intent to cause bodily harm. Understanding and
quantification of that bodily harm can help to limit more effectively
the suffering caused by weapons, both current and future. In relation
to policy and law, considering the real effects that weapons have on
human beings before the weapons' nature or technology is logical, but
at the same time is a reversal of current thinking
Conventional weapons - for which there is no formal definition - utilise
projectiles or (non-nuclear) explosions and, as a function of their
design, inflict physical injury by imparting kinetic energy but not
foreseeably to a specific part of the body. Treatment requirements for
such injury are well defined. The ICRC has a database containing
information on 26 636 war wounded admitted to hospital. This database
has been analysed to measure the collective effects of different
conventional weapons - ie the effects measured as a proportion of all
people injured by a certain type of weapon. The parameters whereby
these collective effects are measured include: the proportion of large
wounds, mortality, the relative proportion of central and limb
injuries, the duration of hospital stay, the number of operations
required, the requirement for blood transfusion, and the extent of
severe and permanent disability in the survivors. The data relating to
"point detonating" antipersonnel mines show how the measured
effects represent the foreseeable effects resulting from their design;
these effects distinguish them from other conventional weapons. (In
this document, therefore, the term "the effects of conventional
weapons" does not include the effects of antipersonnel mines.)
By collating these data with data from military publications,
The proposal is that what constitutes "superfluous injury and
unnecessary suffering" be determined by design dependent, foreseeable
effects of weapons when they are used against human beings and
cause:
(1) Specific disease, specific abnormal
physiological state, specific abnormal psychological state, specific
and permanent disability or specific disfigurement, or
(2) Field
mortality of more than 25% or hospital mortality of more than 5%,
or
(3) Grade 3 wounds as measured by the Red Cross wound
classification, or
(4) Effects for which there is no well
recognised and proved treatment.
One or more of these criteria apply to all weapons which have
already been prohibited. Blinding as a method of warfare, "point
detonating" antipersonnel mines, and the possible effects of new
weapons are examined with these criteria in mind.
Endorsement of the SIrUS Project will have two major implications.
First, it will give recognition to the distinction between the effects
of conventional weapons and the effects of other weapons; second, it
will promote the criteria as an instrument for determining the meaning
of "superfluous injury or unnecessary suffering" in the context of
law. Endorsement may also provide an objective and precise means of
substantiating the public notion of "abhorrent" or "inhuman"
weapons.
The SIrUS Project does not propose any new laws. It is not intended as
a substitute for arms control and disarmament negotiations; but if
endorsed by a significant body of professional opinion it may act as a
supplement to those processes.
One of the major turning points of the campaign to ban
antipersonnel mines came when military officers reassessed the real
utility of these weapons and found them to be of limited value. This
military reassessment was prompted by the emergence of objective data
about the human cost of deploying these weapons, strongly reinforced by
public pressure from a coalition of non-governmental agencies (who
received the 1997 Nobel Peace Prize for their work). The data
substantiated the indiscriminate nature of mine warfare, the specific
nature of the injury caused, and the resulting
disability.
The policy being created by the "Ottawa process" (the move by
governments towards a prohibition on the production, transfer,
stockpiling, and use of antipersonnel mines) is thus founded on data.
If weapons can be regarded as a health issue, can the principle of the
"data-to-policy link" not be applied to weapons whose effects may
constitute "superfluous injury and unnecessary suffering"?
The days when health professionals said that the issue of weapons was
not their affair are past. Many professional associations, such as the
World Medical Association and the International Society of Surgery,
have registered their concern about antipersonnel mines. They can
register their concern about the effects of other weapons, present or
future, by endorsing the SIrUS project. Only a unified body of opinion
within the international medical and academic communities will
encourage governments to recognise the grave implications of continued
research and development of new means of warfare.
How to endorse the SIrUS Project is clearly set out in the full
document.(1) Essentially endorsement, by individual doctors
and medical organisations, involves writing to the SIrUS Project at the
International Committee of the Red Cross in Geneva. With enough
endorsements, governments may come to recognise the proposed criteria
as a means to determine which weapons cause "superfluous injury or
unnecessary suffering." Endorsement, in its simplest form, is an
attempt at preventive medicine in the domain of w
Health Operations Division,
References
1 The SIrUS Project: towards a determination of which
weapons cause "superfluous injury or unnecessary
suffering." Geneva: International Committee of the Red Cross,
1997.
The document can be found at http://www.icrc.org or ordered
from the:
ICRC Publications Department,
(fax +41 22 733 2057).
Executive summary of the SIrUS Project Why endorse the SIrUS Project?
International Committee of the Red Cross,
1202 Geneva,
Switzerland
Robin M
Coupland, surgeon
19 Ave de la Paix,
1202 Geneva,
Switzerland
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