text: Army Health System and the Effects of the Law of Land Warfare and Medical Ethics
  USE OF SMOKE AND OBSCURANTS
  3-28. The use of smoke and obscurants during MEDEVAC operations for signaling or marking landing zones
  does not constitute an act harmful to the enemy, however, employing such devices to obfuscate a medical
  element’s position or location is tantamount to camouflaging; it would jeopardize its entitlement privilege
  status under the GWS. Refer to Army doctrine for MEDEVAC for additional information on the use of
  smoke and obscurants for medical operations.
  CONDITIONS NOT DEPRIVING MEDICAL UNITS AND
  ESTABLISHMENTS OF PROTECTION
  3-29. Article 22 of the GWS reads as follows: “The following conditions shall not be considered as depriving
  a medical unit or establishment of the protection guaranteed by Article 19: (1) That the personnel of the unit
  or establishment are armed, and that they use the arms in their own defense (sic), or in that of the wounded
  and sick in their charge. (2) That in the absence of armed orderlies, the unit or establishment is protected by
  a picket or by sentries or by an escort. (3) That small arms and ammunition taken from the wounded and
  sick and not yet handed to the proper service, are found in the unit or establishment. (4) That personnel and
  material (sic) of the veterinary service are found in the unit or establishment, without forming an integral part
  thereof. (5) That the humanitarian activities of medical units and establishments or of their personnel extend
  to the care of civilian wounded or sick.”
  ACTS
  3-30. These five conditions are not to be regarded as acts harmful to the enemy. These are particular cases
  where a medical unit retains its character and its right to immunity, in spite of certain appearances which
  might lead to a contrary conclusion or, at least, create some doubt.
  DEFENSE OF MEDICAL UNITS AND SELF-DEFENSE BY MEDICAL PERSONNEL
  3-31. A medical unit is granted a privileged status under the law of land warfare. This status is based on the
  view that medical personnel are not combatants and that their role in the combat area is exclusively a
  humanitarian one. In recognition of the necessity of self-defense, however, medical personnel may be armed
  for their own defense or for the protection of the wounded and sick under their charge. To retain this
  privileged status, they must refrain from all aggressive action and may only employ their weapons if attacked
  in violation of the Conventions. They may not employ arms against enemy forces acting in conformity with
  the law of land warfare and may not use force to prevent the capture of their unit by the enemy (it is, on the
  other hand, perfectly legitimate for a medical unit to withdraw in the face of the enemy). Medical personnel
  who use their arms in circumstances not justified by the law of land warfare expose themselves to penalties
  for violation of the law of land warfare. Provided they have been given due warning to cease such acts, they
  may also forfeit the protection of the medical unit or establishment which they are protecting.
  * Medical personnel are not authorized crew-served or offensive weapons. They may carry small
  arms, such as rifles, pistols, squad automatic weapons, or authorized substitutes in the defense of
  medical facilities, equipment, and personnel/patients without surrendering the protections
  afforded by the Geneva Conventions. Further, Army Medicine and non- Army Medicine
  personnel in medical units are not required to train and qualify on crew-served weapons, however,
  Army Medicine personnel attending training at Noncommissioned Officer Education System
  courses will receive weapons instruction that is part of the curriculum. This will ensure the
  successful completion of the course is not jeopardized by failure to attend the weapons training
  portion of the curriculum. (Refer to AR 350-1 for further information).
  * The presence of machine guns, grenade launchers, booby traps, hand grenades, light antitank
  weapons, or mines (regardless of the method by which they are detonated) in or around a medical
  unit or establishment would seriously jeopardize its entitlement privilege status under the GWS.
  The deliberate arming of a medical unit with such items could constitute an act harmful to the
  enemy and cause the medical unit to lose its protection, regardless of the location of the medical
  unit.