Buried or “point-detonating” anti-per-sonnel mines are the only weapons inwidespread use that cause specific and

severe injury resulting in specific andpermanent disability. The treatment of

the injury requires, on average, twice asmany operations and four times as manyblood transfusions as an injury from otherweapons [1].

During the last years of the Cold War,the full extent of the impact of mines onwhole societies was as yet unknown. Newinternational legislation to ban the deviceswas not being discussed. Meanwhile, hospi-tal teams in the field were faced with longand difficult operations which entailed excis-ing large amounts of damaged tissue oramputating limbs. The appalling and some-how excessive nature of the injuries caused asa function of the design of these weapons ledto abhorrence for the weapons themselves.

In 1990, the International Committee ofthe Red Cross (ICRC) was alerted to thedevelopment of blinding laser weapons, adevelopment which was founded on thenotion that it would be better to blind an

enemy soldier than to kill him or her.According to expert opinion, even in the bestophthalmological centres there was no effec-tive treatment for laser-induced retinal hem-orrhage. Here was another weapon systemthat, as a function of its design, would pro-duce severe, permanent disability.(Fortunately, blinding lasers were banned in1995; unfortunately, this ban came after thefirst such weapons had been produced.) Itwas becoming clear that however severe theeffects of bullets or fragmentation munitions,there existed weapons that were, in someindefinable way, worse, causing “superflu-ous injury or unnecessary suffering”--a fun-damental concept of international humani-tarian law governing weapons [2].

The stigmatization of anti-personnelmines as abhorrent, and much of the subse-quent thrust of the campaign to ban them,have quite rightly been based on the argu-ment that they kill or injure both combatantsand non-combatants without distinction andcontinue to do so long after the conflict hasended. The nature of the injuries caused by aweapon, however, should also be a basis fordeeming a weapon illegal. If the injury or suf-fering resulting from a weapon’s nature ortechnology could be proved to be excessivecompared with the military advantagegained from its use, according to this argu-ment, the weapon would be illegal whetherthe victim were a soldier or a civilian.

New weapon technologies are appear-ing on the horizon, such as beams and wavesthat could produce certain specific effects onthe central nervous system, including depres-sion and convulsions. Do armies really need

Medicine & Global Survival, June 2000; Vol. 6, No. 2 SIrUS Update 110

The SIrUS Project:Progress Report on "Superfluous Injury orUnnecessary Suffering" in Relation to the

Legality of Weapons

Robin M. Coupland, FRCS, and Peter Herby

At the time of publication RMC was a surgeonand adviser on the effects of weapons with theICRC Chief Medical Officer. PH was coordinatorof the Mines-Arms Unit in the ICRC LegalDivision.

Adapted from articles originally published in theInternational Review of the Red Cross1999;835:583-592.

© 1999 International Committee of the RedCross. Reused with permission.

§

such weapons? Are they “abhorrent?” Whatcan or should doctors do about them? Whatconstitutes “superfluous injury or unneces-sary suffering?”

Doctors trying to understand this phrasestep into the no-man’s land between theeffects of weapons on health and the interna-tional law of war. One way--perhaps the onlyway--to navigate this no-man’s land is totranslate a field surgeon’s concept of abhor-rent weapons into a tool that can be used formaking a legal determination of whether aspecific weapon will inflict “superfluousinjury or unnecessary suffering.”

The Origins of the SIrUS ProjectThe medical profession has a responsi-

bility to use health-related data to help theinternational community define objectivelywhich weapons are inherently “abhorrent”and which weapons cause “superfluousinjury or unnecessary suffering.” This wasone of the major findings of a symposium onthe medical profession and the effects ofweapons, organized by the ICRC inMontreux, Switzerland, in March 1996 [3].

The Montreux symposium, which repre-sented the start of the SIrUS Project,addressed this responsibility by drawingtogether data and expert opinion from thefields of weapons, medical ethics, traumasurgery, and law. The project takes its namefrom that which it seeks to prevent. It is anattempt to bring objectivity to the legalnotion of “superfluous injury or unnecessarysuffering” and so aims to facilitate the reviewof the legality of weapons [4].

A Study of the Effects of WeaponsThe group of experts who worked on

the SIrUS Project, most of whom were healthprofessionals, collated data relating to theeffects of weapons used in conflicts over thepast 50 years. These data originated fromboth military medical publications and theICRC wound database of 26,636 weaponinjuries. In relation to different causes ofinjury, the following information wasretrieved:

* the proportion of large wounds(according to the Red Cross woundclassification);

* overall mortality;* the relative proportions of cen-

tral and limb injuries;* the duration of hospital stay;

* the number of operationsrequired;

* the need for and volume ofblood transfusions;

* the number of lower limbsamputated among the survivors.

From these data, the expert group foundthat the weapons which cause injury byexplosions or projectiles but which do nottarget a specific part of the body as a functionof their design:

* do not cause a field mortalityof more than 22% nor a hospital mor-tality of more than 5%;

* cause grade 3 wounds (as mea-sured by the Red Cross wound classifi-cation) in less than 10% of those whosurvive to hospital ; and

* cause wounds that can be treat-ed for the most part by well estab-lished medical and surgical methods.

High-mortality or large wounds can becaused by legitimate weapons such as riflebullets and fragmentation munitions undercertain circumstances. Whether an individualis wounded slightly or severely, or is killedby such weapons, is determined by thedesign of a weapon, how it is used and ran-dom factors such as his or her proximity tothe detonation (of a munition) and the part ofthe body that is hit. The data in the SIrUSProject about the effects of weapons com-monly used in recent conflicts take all thesefactors into account.

The SIrUS Project has established thatthe following effects of weapons on humanshave not been seen commonly as a result ofarmed conflicts in the last five decades:

* disease other than that result-ing from physical trauma from explo-sions or projectiles;

* abnormal physiological state orabnormal psychological state (otherthan the expected response to traumafrom explosions or projectiles);

* permanent disability specific tothe kind of weapon (with the excep-tion of the effects of point-detonatedanti-personnel mines--now widelyprohibited);

* disfigurement specific to thekind of weapon;

* inevitable or virtuallyinevitable death in the field or a highhospital mortality rate;

* grade 3 wounds among thosewho survive to hospital;

* effects for which there is nowell-recognized and proven medicaltreatment that can be applied in a well-equipped field hospital.

Some weapons can be expected to inflictcertain effects virtually all the time. Theseeffects result specifically from the nature or

111 SIrUS Update Coupland/Herby

technology of the weapon, i.e., they aredesign-dependent. Examples include:

* exploding bullets, which areusually lethal or cause grade 3 limbwounds;

* chemical and biologicalweapons, which inflict specific dis-eases or abnormal physiological states;

* blinding laser weapons, whichcause specific permanent disability tothe eyes and have effects for whichthere is no proven medical treatment;

* “point-detonated” anti-person-nel mines, which result in a severe(grade 3) injury to the foot or leg,which in turn results in specific dis-ability and disfigurement.

International Law and the SIrUSProject

States have an obligation to review thelegality of the weapons they intend to use.This principle, as it applies to new weapons,is enshrined in Article 36 of Protocol I addi-tional to the Geneva Conventions of 1949.One reason that a weapon might be deemedillegal is that it causes “superfluous injury orunnecessary suffering.”

Since the 1868 Declaration of St.Petersburg, the principle that the only legiti-mate purpose of war is to weaken the mili-tary forces of an opponent has been anaccepted fundamental principle of interna-tional humanitarian law [5].1 It was estab-lished that this purpose would be served bydisabling enemy combatants and that it“would be exceeded by the employment ofarms which uselessly aggravate the suffer-ings of disabled men, or render their deathinevitable” [5]. This principle has been reaf-firmed in various international instrumentsin the form of a prohibition on the use of“weapons, projectiles and material and meth-ods of war of a nature to cause superfluousinjury or unnecessary suffering” [6,7]. In1996, the International Court of Justice statedthat this rule constitutes one of the “intrans-gressible principles of international custom-ary law” and is a fundamental rule to beobserved by all States [8].

Despite the firmly established nature ofthis prohibition, its application has oftenbeen difficult or has not even been attempted

due to the difficulty for lawyers, weapondesigners, and political leaders to determinethe degree of human injury or sufferinginflicted. Judgments as to whether a specificweapon causes “superfluous injury or unnec-essary suffering” have most often been madeprimarily on the basis of subjective influ-ences, often prompted by generalized publicabhorrence of a particular weapon, ratherthan an appraisal of whether the weapon’seffects might outweigh military need.

The notion of “superfluous injury andunnecessary suffering”2 relates to the design-dependent effects of specific weapons onhealth. Indeed the prohibition refers toweapons “of a nature to cause”3 these effects.Although much of humanitarian law isaimed at protecting civilians from the effectsof armed conflict, this rule of customaryinternational law constitutes one of the fewmeasures intended to protect combatantsfrom certain weapons which are deemedabhorrent or which inflict more sufferingthan required for their military purpose.

All weapons whose use is already con-trolled or prohibited under internationalhumanitarian law cause injuries that exceedthe baseline of weapon injuries seen in recentconflicts, as described by the SIrUS Project.Had such an approach existed when theproblems related to these weapons werebeing discussed, their control or prohibitionmight have occurred through a more rationaland efficient process. Subsequently, consen-sus on and universalization of the relevantrules might also have been achieved morerapidly.

ICRC ProposalsIn May 1999, the ICRC convened a meet-

ing of government experts in internationalhumanitarian law and of military and civilianmedical experts to consider the proposalscontained in the SIrUS Project. On the basis ofdiscussions in this meeting and bilateral con-sultations, the ICRC made a set of proposalsfor consideration by the States, the

Medicine & Global Survival, June 2000; Vol. 6, No. 2 SIrUS Update 112

1. Even before 1868, the ancient laws of war inIndia, Greece, Rome, and the Middle East hadprohibited poison weapons because of theirexcessive effects. The 1863 Lieber Instructions :Instructions for the Government of Armies ofthe United States in the Field (General OrdersNo. 100, of 24 April 1863) also “wholly exclud-ed” this means of warfare on the same grounds.

2. Both terms are translations from the singleFrench concept of “maux superflus” containedin the 1899 and 1907 Hague RegulationsRespecting the Laws and Customs of War onLand, Article 23 (e). The French text is the onlyauthentic text of the 1899 and 1907 HagueRegulations.3. This term is translated from the originalFrench “propres à causer.” The term was incor-rectly translated into the English “calculated tocause” in the 1907 Hague Regulations, whichintroduced the subjective element of theweapon designer’s intention. This error wascorrected when the original “of a nature tocause” was restated in Protocol I of 1977,Article 35, para. 2.

International Red Cross and Red CrescentMovement, and other concerned organiza-tions. The proposals were submitted to the27th International Conference of the RedCross and Red Crescent, held in Geneva inOctober-November 1999.

Proposal 1States, when reviewing the legality of a

weapon, should take the above facts intoaccount by :

* establishing whether theweapon in question would cause anyof the above effects as a function of itsdesign, and if so:

* weighing the military utility ofthe weapon against these effects; and

* determining whether the samepurpose could reasonably be achievedby other lawful means that do not havesuch effects.

Proposal 2States should make new efforts:

* to build a common under-standing of the norms to be applied inthe review of new weapons, and

* to promote transparency in theconduct and results of such reviews.

The ICRC has presented the SIrUSProject and the above proposals to nationalgovernments, the medical community, andconcerned organizations and individuals as ameans of promoting, over time, both debateand consensus on a health-based approach toweapons under international humanitarianlaw. States will be encouraged to take theavailable data concerning the nature of injuryin recent conflicts into account when deter-mining, as called for under Article 36 ofAdditional Protocol I of 1977, whether a pro-posed weapon, by its design, causes effectson health which may constitute “superfluousinjury or unnecessary suffering.”

The ICRC will also ask States to makenew efforts to build a common understand-ing of the norms to be applied in the reviewof new weapons, and to promote transparen-cy in the conduct and results of such reviews.National Red Cross and Red CrescentSocieties and national medical associationswill be urged to strengthen respect for theprohibition of weapons that are inherentlyabhorrent or of a nature to cause “superflu-ous injury or unnecessary suffering” and topromote effective implementation of interna-tional humanitarian law through discussionand endorsement of the SIrUS Project.

The SIrUS Project has been endorsed bya growing part of the international medical

community. In October 1998, the WorldMedical Association called on all its membernational medical associations to endorse thecriteria contained in the SIrUS Project.Thirteen national medical associations and 16other medical institutions had endorsed theSIrUS Project as of April 1999. By doing so,these institutions recognize the validity of thestudy and recommend that the findings beused when making a determination of whichweapons cause “superfluous injury or unnec-essary suffering.”

References1. Coupland RM. Abhorrent weapons and“superflous injury and unnecessary suffering”:from field surgery to law.” BMJ 1997;315:1450.2. Coupland RM. Towards a determination ofwhich weapons cause “superfluous injury orunnecessary suffering.” M&GS 1998;5:27-34.3. International Committee of the Red Cross.The medical profession and the effects ofweapons (symposium in Montreux,Switzerland, 1996). Geneva: ICRC. 1996.4. International Committee of the Red Cross.The SIrUS project: Towards a determination ofwhich weapons cause “superfluous injury orunnecessary suffering. Geneva: ICRC. 1997.5. Declaration renouncing the use, in time ofwar, of explosive projectiles under 400grammes weight. St. Petersburg. 1868.6. Protocol additional to the Geneva conven-tions of 12 August 1949, and relating to the pro-tection of victims of international armed con-flicts (Protocol I).7. Convention on prohibitions or restrictions onthe use of certain conventional weapons whichmay be deemed to be excessively injurious or tohave indiscriminate effects. 1980.8. International Court of Justice. Advisory opin-ion on the legality of the threat or use of nuclearweapons. New York: UN General AssemblyA/51/218. 15 October 1996.

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