Medical Neutrality as a Contested Legal Concept in the 1899-1902 South African War
Neutrality is both a key principle of the Red Cross movement and at the core of protections offered for medical provision under the Geneva Conventions. Yet as attacks on healthcare mount globally, some have questioned whether the fundamental principles are still relevant to the changing character of war. A closer look at the history of international humanitarian law and the 1899-1902 war in South Africa shows that debates over the meaning of neutrality and its application to guerrilla or unconventional war have proliferated for over a century.
What does it mean to be neutral in warfare for those assigned to provide aid to the wounded? For the International Committee of the Red Cross (ICRC), at the centre of the Red Cross movement, the answer has seemed straightforward. Intertwined with the neutrality of Switzerland, its host State, the neutrality of the ICRC has relied on its historic abstention from politics and non-participation in conflict. This positioning of neutrality as externality, or separation from active participation in war, has generated legal difficulties in how to categorize individual medical personnel, who often sit in the liminal space between “combatants” and “non-combatants.” Writing his commentary on the fundamental principles of the Red Cross movement in 1965 Jean Pictet, former Director-General of the ICRC, described medical neutrality for individuals as a choice, one made between taking up a Red Cross badge and putting down a gun. “One cannot,” he wrote, “at the same time, serve the Red Cross and fight. One must choose.”
On the ground in South Africa, however, neutrality was not always perceived as a choice between participation and non-participation in conflict. There, tensions erupted over neutrality as a description for the status of those providing medical care and as a norm governing their behaviour. The conduct of the war led to a reappraisal of the Geneva Convention in 1906 and the removal of neutrality from its text as part of a shift from volunteering to professionalised and State-directed medical care during war.
Neutrality and the 1864 Geneva Convention
Neutrality was one of the key provisions of the 1864 Geneva Convention which laid out the first protections for providing aid to the wounded during conflict. Having witnessed the aftermath of the battle of Solferino in 1859, Swiss businessman Henri Dunant envisioned a “participatory humanitarianism” where anyone could volunteer to administer aid to the wounded. Returning the injured to the frontlines aligned with the needs of State armies, but governments were sceptical about the prospect of unregulated volunteers on the battlefield. Assurances that these volunteers would be neutral were instrumental in gathering support behind Dunant’s proposals. States could improve their medical services and heed enthusiastic demands for participation in conflict, while ensuring that these volunteers did not engage in the fighting.
The first Geneva Convention provided surprisingly little guidance on how the wounded should be cared for in wartime. Instead, the majority of its ten short articles concentrated on how neutrality could be obtained. Wearing the emblem of a red cross on a white background was devised as a mechanism for signalling neutrality to others. With this emblem, ambulance and hospital personnel could be recognised as neutral so long as they accommodated the sick and wounded. Neutrality travelled with humane conduct and could be extended to others, including chaplains, evacuation parties, and even ordinary civilians, once they engaged in the act of helping the wounded. Protection was given to the act of care, not the personnel who provided it. Just the presence of a wounded combatant would ensure the protection of an entire household. In Article 8, however, the Geneva Convention shifted away from these suggestions of a participatory humanitarianism open to all. In practice, as the South African War would show, the final say on neutrality and the enforcement of these regulations would depend on military commanders in the field.
Despite control for implementing the Geneva Convention’s terms being placed in the hands of governments and military authorities, Dunant’s idea of “participatory humanitarianism” resonated throughout Europe. Legions of volunteer brigades descended on battlefields to aid the wounded, particularly during the 1870-71 Franco-Prussian War and the 1875-78 conflicts in the Balkans. Accusations abounded that the Red Cross emblem was being abused by volunteers, who used it as a convenient cover to participate in the fighting, and that it was being fired on deliberately by belligerents. This practice was so widespread that during the South African War a member of the British Royal Army Military Corps would comment that, “in the mind of the man on the street the Geneva Convention is like the charm from a witch doctor which gives absolute protection to the wearer of the badge.” Faced with this expansive interpretation of the Geneva Convention, the ICRC tried to uphold its role as neutral arbiter of the laws of war while promoting the value of humanitarian relief but was placed in an increasingly subservient relationship to States.
Regulating Volunteers in the South African War, 1899-1902
Medical volunteers who did not participate directly in the fighting were also often guided by political motivations and partisan sympathies. When war broke out in South Africa in October 1899, the wave of participatory humanitarianism that ensued was intimately connected to political stances on the war. After years of bubbling tensions over control of the gold-rich territories around Johannesburg, the Dutch-origin “Boers” launched an attack against British encroachments in their farmer-republics. They quickly found sympathy globally. The conflict was either depicted as a Manichean struggle between a small people and mighty empire or a gentlemanly “white man’s war” against the backdrop of “barbarous” Africa. For many of those who travelled to South Africa, either as medical volunteers or to fight, the conflict evoked an empty plain on which a struggle for the future of civilisation could be waged.
In Southern Africa, the war was conducted along a porous boundary between “imperial” and “international” warfare and so has been largely neglected in histories of the laws of war. Suzerainty treaties signed in the 1880s had granted Britain some jurisdiction over the foreign relations of the South African Republic, and by extension the Orange Free State, though the British showed little interest in the region until the discovery of gold deposits on the Witwatersrand in 1886. Despite British claims of imperial authority over the territories, both republics independently ratified the Geneva Convention in 1890s and established their own national Red Cross societies. In the early stages of the conflict, booklets containing the text of the Geneva Convention were distributed to fighting burghers, while the text was reprinted in the British army’s Manual of Military Law. However, Red Cross badges and certificates were issued almost indiscriminately in South Africa to foreign volunteers, ambulance drivers or self-proclaimed medics without any training or degree.
As fighting morphed into a guerrilla war from mid-1900 onwards, identifying bona fide medical volunteers became more difficult as the line between medics and soldiers blurred. British scorched earth policies extended the impact of the conflict to the civilian population and rendered non-involvement in this total war almost impossible. Foreign volunteers largely abandoned South Africa while medics, like the founder of the Orange Free State Red Cross society, were captured, leaving those remaining to pick up the pieces. Men who had in the early stages of the war acted as ambulance drivers or assistants were now seen as the only available option and employed as doctors and surgeons.
Differing Conceptions of Neutrality
The voices of some of these volunteers appear within the archives of the British Military Police in Pretoria and provide a glimpse at how neutrality was negotiated on the ground in South Africa. During the guerrilla war, British troops routinely detained anyone they felt was fighting with the Boers, including men they suspected were not legitimate medical volunteers with the Red Cross. Many protested their capture, showcasing competing interpretations of the neutrality provisions of the Geneva Convention.
Some, like German Rudolf Krieger (who was described as an “unscrupulous imposter” and a “quack doctor”) seemed to genuinely believe in their medical capabilities and virtuous conduct. Krieger saw no issue in substituting his Red Cross badge for a gun when the situation required. His ambulance assistant offered testimony to British soldiers that “I have often seen that he [Krieger] would take off the Red Cross, from his arm, take up his rifle and bandolier and go to the front to fight and he made no secret of it.” Others were older, retired fighters redeployed from combat roles and given “Red Cross certificates” signed by Boer generals. Though they claimed that they were adhering to the Geneva Convention they were still arrested by the British, who insisted that their hospitals lacked sufficient facilities to be taken seriously. Decisions on the fate of these men did not focus solely on their provision of medical care but took in their character, reputation and conduct during the war. Many were deported as “undesirables” because they had espoused anti-British rhetoric or previously engaged in the fighting.
During questioning, British authorities made clear that they viewed such behaviour coupled with the use of the Red Cross as criminal offences. They sought to punish those who had “broken” the neutrality clauses of the Geneva Convention with trials under martial law or deportation to penal colonies. The idea that the behaviour of individuals could be criminalized under international law may seem surprising for this period, but it was not a novel idea. In the aftermath of the allegations that the Red Cross emblem was abused during the Franco-Prussian war, senior leaders within the ICRC had advocated for an international tribunal that would punish those who violated the Geneva Convention. This would not include sanctions for States who failed to provide information about the convention, just for individuals who violated its terms. Though these plans ran aground, they suggested that medical volunteers in conflict could be sanctioned under international law for failing to comply with the terms of conventions they might know little about.
These plans also failed to take into account how different military traditions and political contexts might frame how neutrality was understood. In the Boer republics, medical provision was viewed as subject to requisition by the State during wartime, so that doctors could not operate independently from the fighting. The fourth edition of the British Manual of Military Law, did not offer an explanation of medical neutrality, but argued that those tending the wounded would divest themselves of their non-combatant character by using arms, rendering them liable to attack. Internally, however, the British War Office was frustrated by the presence of foreign volunteers and argued that medical relief in wartime should be administered solely by States. This may have shaped their interpretation of medical neutrality for Red Cross volunteers as sustained externality, or removal from the conflict. To the Boers, neutrality appeared more ephemeral and temporally contingent. In the files of the military police, British investigators focused on the sum of all wartime activities, Boer defences on the specificity of the moment of capture.
Conclusion
War in South Africa demonstrates the contingent nature of neutrality as a concept in the laws of war, highly dependent on individual interpretations and historical context. Neutrality, and the international laws that relied on it, were wielded by the British as a mechanism for regulating medical relief activities on the ground in South Africa. The existence of the Geneva Convention provided these soldiers with a text through which they could measure how deserving medical workers were of protection. Firmly untethered from Dunant’s dreams of voluntary and participatory humanitarianism, acceptable provision of medical care relied on conforming to a vision of medical and military professionalism.
The controversies over the implementation of the 1864 Geneva Convention during conflicts in France, the Balkans, and South Africa led to its reassessment in 1906. The updated convention placed the operation of national Red Cross societies under the direction of the military. All mentions of neutrality were also removed, whether of wounded soldiers or of medical volunteers. Articles 27 and 28 centred on the repression of abuses and infractions and suggested that such violations of the Convention could be dealt with through military laws. The individual volunteers of 1864 disappeared in 1906, except in their culpability for these breaches. The choice, to serve the Red Cross or to fight, now lay in the hands of States and military commanders, who assessed, sanctioned, and legitimated the provision of medical care. Experiences on the ground in South Africa were crucial in redefining this legislation.
Today, the neutrality of medical personnel in conflict falls under customary international humanitarian law though the term neutrality has not been used in recent revisions of the Geneva Conventions. This neutrality as inviolability is only removed from those who directly participate in conflict, shield ammunition or shelter able-bodied combatants. Yet ever-increasing attacks on healthcare personnel are often justified, for example, by claiming that they had political allegiances or tended to the attackers’ opponents. As this example from the South African War has shown, neutrality has always been a contested concept during conflict and this ambiguity can allow superior military powers to arbitrate what constitutes the “correct” interpretation of international law.
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Dr Lia Brazil is a Leverhulme Early Career Research Fellow at the Humanitarian and Conflict Response Institute at the University of Manchester. From 2027 she will be Assistant Professor at the Keough School for Global Affairs, University of Notre Dame.
The views expressed are those of the author, and do not necessarily reflect the official position of the United States Military Academy, Department of the Army, or Department of Defense.
Articles of War is a forum for professionals to share opinions and cultivate ideas. Articles of War does not screen articles to fit a particular editorial agenda, nor endorse or advocate material that is published. Authorship does not indicate affiliation with Articles of War, the Lieber Institute, or the United States Military Academy West Point.
Photo credit: Wellcome Collection via Wikimedia Commons
