Education and debate

Abhorrent weapons and "superfluous injury or unnecessary suffering": from field surgery to law

^a Health Operations Division, International Committee of the Red Cross, 1202 Geneva, Switzerland

	Weapons: a surgeon's view

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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.

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 1).

View larger version (113K): [in this window] [in a new window]   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? RED CROSS, GENEVA

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

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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.

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

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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 Montreux, Switzerland, in March 1996. This symposium represented the start of the SIrUS project, which has addressed this responsibility by drawing together data and expert opinion in the domains of weapons, medical ethics, trauma surgery, law, and communications.¹

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.

	Why endorse the SIrUS Project?

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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 weapons.

	References

Top Weapons: a surgeon's view Deeming a weapon illegal The SIrUS project Why endorse the SIrUS... 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, 19 Ave de la Paix, 1202 Geneva, Switzerland (fax +41 22 733 2057).