The effects of weapons and the Solferino cycle

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7214.864 (Published 02 October 1999) Cite this as: BMJ 1999;319:864

Where disciplines meet to prevent or limit the damage caused by weapons

  1. Robin M Coupland, surgeon (rcoupland{at}icrc.org)
  1. Unit of the Chief Medical Officer, International Committee of the Red Cross, 1202 Geneva, Switzerland

    When designers of weapons want to know if their creations are effective they observe the simulated effects of those weapons so they can modify and develop them and, in a cycle of activities, test them again. They then want to observe the real effects after the weapons have been produced, transferred into the hands of users, and used against their intended human target. Observing and documenting the real effects of weapons in the field, however, falls to health professionals rather than to weapons designers. The observation and documentation of the effects of weapons then forms an essential part of another cycle of activities. Instead of providing feedback about weapon design, this second cycle works in the interests of the victims of weapons by generating policies and laws that impose limits on the design, production, transfer, or use of weapons.

    The original turn of this second cycle was initiated by Henry Dunant, who observed the effects of munitions on soldiers at the Battle of Solferino in 1859. Until then Europe's aristocracy had seen war as glorious. Dunant's documentation of the reality in AMemory of Solferino changed this perception.1 In 1863 he and four other Genevan dignitaries created the International Committee of the Red Cross and drew up the First Geneva Convention, which protects sick and wounded soldiers and those caring for them from further attack.2

    The past 100 years have seen many turns of the second cycle. Dum-dum bullets were prohibited in the Hague Declaration of 1899: their efficacy when used against “semi-civilisedor barbarous races” equated to being excessively cruel and inappropriate for use in wars between “civilised nations.”3 The use of chemical weapons was prohibited by the Geneva Protocol of 1925 after observation of the horrific effects—and limited military utility—of gas in the first world war. Aerial bombardment of cities in the second world war made urgent the addition of a Fourth Geneva Convention in 1949 to protect civilian populations in war.2 The destruction of Hiroshima and Nagasaki emphasised this need and provided the sad opportunity to document the effects on humans of a nuclear attack. Physicians have projected the effects of nuclear war on public health and have inevitably become effective advocates for restraint and international treaties about nuclear weapons.4 5

    The Solferino cycle involves:

    Recognising that the effects of weapons on humans are determined by the design, production, transfer, and use of weapons

    Observing and documenting the effects of weapons and their use

    Communicating the observations to bring about changes in behaviour, law, or policy to protect victims and potential victims from the effects of weapons

    The most recent example of a complete turn of the second cycle is the campaign to ban antipersonnel mines. Knowledge of the effects of the design, production, transfer, and use of mines on human lives and limbs initiated and fuelled the process which mobilised unprecedented public opinion and led to the Ottawa Treaty of 1997. In two cases the cycle was completed early and the weapons never used. The effects of exploding bullets and blinding lasers only had to be foreseen before governments agreed to prohibit their use in war (in the St Petersburg Declaration of 1868 and the 1995 Protocol IV of the 1980 UN Convention on Conventional Weapons, respectively). Such conventions, declarations, protocols, and treaties together make up a part of international humanitarian law.6 In brief, it is the effects of weapons which have generated the need for legislation about them.

    The two cycles described above have a common feature: observation and documentation of the effects of weapons. If health professionals document their observations of the effects of weapons which cycle are they going to turn? This dilemma and the responsibilities of health professionals beyond treating the wounded were recognised at a symposium in Montreux, Switzerland in 1996.7 The symposium examined the responsibilities of the medical profession in turning the second cycle and, in particular, applying and helping to develop international humanitarian law.

    The symposium recognised that the subject of the effects of weapons, firstly, fell within the broad field of health and, secondly, occupied a central position in relation to other disciplines interested in weapons. Participants attempted to give a name to the subject which refers not only to the observation and documentation of the effects of weapons but also to all activities exclusive to the second cycle Hence, the “Solferino cycle.” By recognising the interdisciplinary nature of the Solferino cycle, different disciplines can identify better how their activities relate to those of others. The cycle should be recognised as an academic focal point and a section of any library where people study law, medicine, sociology, history, communications, strategic and peace studies, or military affairs. At the same time it provides the frame and the fuel for advocacy.

    Observing and documenting the effects of weapons does not bring about changes in belief, behaviour, or law unless communicated compellingly to both policymakers and the public. Though the observation of the effects of weapons is an essential activity within the Solferino cycle, health professionals can turn it one step further by communicating these observations in the context of the cycle. Examples include: establishing that acquiring a weapon does not bring the personal security that is intended8; documenting that weapons designed for war exact a human toll through indiscriminate use outside war 9 10; and arguing from casualty data that increased distance between the users of weapons and their victims increases the chance of civilian injury.11 Turning the Solferino Cycle also includes, for example, pointing out that the effects of new weapons may not be understood12; the potential abuse of biomedical knowledge 13 14; and endorsing the SIrUS Project.15

    The Solferino cycle has shaped human history in response to some of our worst moments; it continues to turn and is important for our future. It is the basis of all elements of restraint when humans go to war or, more importantly, think about going to war.

    On 5 October 1999 the BMA is holding a seminar on the role of the medical profession in relation to weapons and international law


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