The ambivalence of wearing the Red Cross

ABSTRACT

This article, based on research into primary sources, describes and analyses the experiences of Australian Army stretcher-bearers and medics who wear the Red Cross brassard. This humanitarian symbol is supposed to ensure the safety of personnel engaged in humanitarian work. The testimonies of those who wear the Red Cross, in fields of conflict, show that they believe it makes them vulnerable to attack and that they believe themselves to be safer without it. This article compares the experiences of stretcher-bearers in World War One, and that of medics in the more contemporary War in Afghanistan.

KEYWORDS:

• Afghanistan
• Australian Army Medics
• conflict zones
• Red Cross
• Red Cross Brassard
• World War One

Introduction

The Red Cross Brassard is a sign of humanitarian work and is the identifying feature of army medics. This symbol, usually on an arm band, marks the medics in their paradoxical situation of being troops in uniform, as well as being health care providers. While the Red Cross has always had a high level of recognition and respect wearing the Red Cross Brassard has not always been favoured by army medics themselves. This paper provides an analysis of the experience of the wearing of the Red Cross Brassard, by members of the Australian military, in World War One and the recent War in Afghanistan.

Our research into the history of medic service by soldiers has shown that individual narratives speak of disliking the vulnerability of wearing the Red Cross, and also testify to a habit of taking it off, and hiding it away, as soon as possible when in a conflict zone. The actual experience of wearing the Red Cross for some individuals can be diametrically opposed to its purpose.

Background

The Red Cross brassard was worn in World War One on the arm of stretcher bearers as they went onto the battlefield to transport the wounded to an aid post for care (Johnston 2015a). It defined the humanitarian mission of the soldiers entrusted with the care of the wounded. From the time of its first use, wearing the Red Cross has been part of medical service in the Australian military. While the Red Cross can also be marked on vehicles and buildings, the sole focus of this research is on the experience of individuals wearing it as part of a military uniform.

Currently, under the Geneva Conventions of 1949, and Additional Protocols (1977 and 2005), health professionals can be identified by symbols such as the Red Cross or Red Crescent or the Red Crystal (ICRC 2014) as a protective sign that they must not be the target of enemy attack (Gulam 2005).

The status of non-combatant, yet active member of the military, poses unique challenges to nurses and medics who are described in some literature as ‘warrior nurse’ (Griffiths and Jasper 2008). Carol Acton (2004), in her analysis of written narratives by nurses in war zones, stated that ‘… the psychological and emotional stressors of combat nursing transcend time and place’ (2004), and accordingly she compared World War One sources with those from the Vietnam War. We found similarly comparable themes in our research into Australian Army Medics in World War One and the contemporary War on Terror.

In both World War One (1914–1918) and the War in Afghanistan (2001–2021), Australian troops were involved from first to last, and were volunteers to the military. Their overseas service, in support of the nation’s allies, was decided by the governments of the day. Popular discourse in Australia was generally, but not unanimously, supportive of these wars. A similar combination of nationalism, military obedience, and appeals to ethics conditioned Australian participation in very different spheres of conflict. These wars are differentiated spatially, in time, and in terms of available military technology. Yet the unique nature of medic service can be invariably discerned in primary sources from both conflicts.

Symbol

The Red Cross symbol was created as part of the establishment of the first Geneva Convention in 1864 and was in general use in Europe by the 1870s. Within the military, a brassard featuring the Red Cross should only be worn by military personnel and their transport and facilities (ICRC 2022). It is a distinct design, memorable and honourable and designed to transcend specific loyalties. In this study, we shall confine our analysis to the secular significance of the emblem.

As noted by the Australian Red Cross in current teaching materials for schools:

‘…the red cross emblem has bought hope and protection and medical care/relief to millions of people caught up in the worst of armed conflict. It is a unique international symbol, and it saves lives’. https://www.redcross.org.au/parents-teachers/under-the-red-cross-emblem/

This established view lacks the perspective of some army medics. Also, the historical context, as Laure Humbert has pointed out, would be enhanced by consideration of ‘the neglected issue of attacks on healthcare in wartime’ (Humbert 2023) and whether these are in any way associated with the emblem.

Our sources for this study are letters and diaries of World War One servicemen, preserved at the Australian War Memorial and National Library of Australia and interviews with service personnel who served as medics in the Australian Defence Forces during the conflict in the Middle East Area of Operations (MEAO) specifically in Afghanistan (A table giving details of all informants is published on page 64 and pages 66–7 of Griffin 2022). A total of five stretcher bearers, from World War One, and twelve currently serving Australian Army medics, provide the primary source material for this article. The World War One primary sources are letters and diaries, and the War in Afghanistan sources are structured oral interviews.

These sources were accessed as part of a doctoral research project. The thesis was an analysis of the conflicting duties of Australian army medics and did not initially consider the topic of the wearing of the Red Cross. The research confirmed that medical care in the context of military service has distinctive themes worthy of specific analysis. It was noticed that mentions of the Red Cross brassard, by medics narrating their service in the field, were consistently negative. These reflections are the basis of this article.

First person accounts of lived experience are different from the formality of institutional records, and both contribute to a complete historical context. The subjectivity of our sources enhances insight into the emotional and the self-created world in which many human decisions are made. All of the quotations from witnesses, in this article, stand as records of experience, and of the decisions made by individuals encountering the violence of warfare, as well as the creative reflections of memory.

Our methodology is phenomenological; it foregrounds experience, and we proceed by scrutinizing individual records for evidence of shared social trends. We do not seek to apply controls for subjective perceptions, but rather to foreground such emotive interpretations as valid in themselves, and indeed, essential to a complete scholarly understanding. The historical context of Australia’s involvement in the First World War (1914–1918), versus the War in Afghanistan (2001–2021), is entirely different. For this very reason, a comparison of the issue of wearing the Red Cross brassard is significant, even between those with different roles, because we demonstrate that similar themes are evident across such diverse circumstances. We hypothesize that the wearing of the Red Cross brassard is viewed with ambivalence by some serving military personnel and that this is linked to the larger issue – the paradox – of service as a medic.

The testimonies documented in our research elaborate themes found in other scholars’ research on warfare – the displacement of ethics and the diffuse expression of repressed trauma. Studies of clinical care in battlefields show a particularly sharp interaction of the subjective self and the fixed ideals of military-related service and nursing. It is a recognized fact that army medics experience higher than normal rates of PTSD (Department of Defence 2017). The medics exist in an ambivalent zone. To be working as a medic, while wearing a military uniform on a battlefield, is sometimes to live through an ordeal.

Wearing the Red Cross

Propaganda about the misuse of the Red Cross symbol began during the earliest decades of its use. On 10 December 1870, the British Medical Journal published an unattributed story ‘Firing On and Under the Geneva Badge’ about a German sentinel in France (during the Franco-Prussian war) deliberately shooting a French surgeon, and German troops themselves: ‘going into action with loaded arms and fixed bayonets and the red cross brassard bound to their arms’ (Notes of the War 1870). This story is impossible to prove, but it has evident potency in intentional or non-intentional attempts to draw a distinction between ‘us’ and ‘them’.

Discussions about respect for the Red Cross assume that it is always recognizable and visible. Given the chaotic conditions of armed conflict, this is unlikely. The person wearing the Red Cross brassard knows that it is there, but others might not.

In 1902, a surgeon who had served in the Boer War wrote to the British Medical Journal with an unusual insight. He had experienced coming under fire and noticed that the Boers were being traduced in the British media for their attacks on medical staff. However, when Dr Cheatle experimented, he found that the Red Cross brassard could not be seen clearly from any great distance:

… even under the best possible conditions of South African light and also in the most favourable position on the arm on which it was worn, we could only be sure of its presence with the naked eye at 200 yards, and 400 yards was the limit of visibility with the Zeiss field-glass. The knowledge of these facts compelled me to forgive the Boers for making me the zone of fire … when we were under the comparatively close range of 900 yards. (Cheatle 1902)

The insight offered by Dr Cheatle – that the emblem is probably not visible anyway, in many conflict situations – seems to have rarely been considered, but it is a practical, important point.

It is significant that this source was published in the letters column of a magazine. The doubts, ambivalence and impracticality of wearing the brassard tend to appear only in less formal texts, and in conversational form.

From the First World War onwards

Australian troops who enlisted for combat in World War One were supported by stretcher bearers who had no formal training, and very little mechanical support. The letters and diaries of the troops serving in Field Ambulance units record the exhaustion of carrying the wounded on wooden stretchers, and the struggle to arrive at the dressing stations within time. They wore the Red Cross brassard, but it was probably only useful in identifying them to their patients. They certainly had no impression that it elevated them out of combat status.

Allan Allsop, a stretcher bearer with the 8th Australian Field Ambulance from 1915 to 1919 stated ‘the Germans, beyond doubt do not recognise the Red Cross’. He stated that when entering the fighting in 1916 in Fromelles, France, ‘prior to coming into action we have been ordered to leave our Red Cross brassards off because they present a target’ (Allsop 1917). Langford Colley-Priest, who also served with the 8th Australian Field Ambulance from 1914 to 1919, recounts a story of an allied hospital being bombed in France by German shelling. He describes this action as ‘a dirty trick shelling a hospital … Fritz is too fond of shelling the Red Cross’ (Colley-Priest 1919).

These accounts reflect the anti-German propaganda of the era, and believing in the wicked nature of the opposing forces would have been a motivation for the Australian troops. They unify their own experiences with the larger nationalistic rhetoric of their culture. There is no evidence that the German military deliberately attacked medical staff or hospital facilities. But the violence of the front line made everyone vulnerable, and the Red Cross brassard was no more, for some stretcher bearers on the front line, than a reminder that they were defenceless.

For their part, the German medical staff in the Feldlazarett – the field hospitals – believed that they maintained high ethical standards while enduring the same conditions that we read of in the Australian accounts. Christoph Zischek, et al. quote the memoirs of a German war surgeon:

Dr. H. Hölscher … described the hardships of following the troops, and providing care, at the same time during mobile warfare. This was hindered by the lack of motorized transport capacities. Dr. Hölscher described the equal treatment of French and British prisoners of war, who were nursed in the same facilities. (Zischek, Grunwald, and Engelhardt 2018)

The allegations about the enemy forces with no common ethical values swirl through most military conflicts. In 1941, a Nazi newspaper in occupied Holland found it convenient to claim that: ‘In the East, Germany and its allies meet a foe that by tradition and ideas has no respect whatsoever for the sacred sign of the Red Cross’ (Van Bergen 2009).

A singular anecdote about personnel describing military encroachments on Red Cross medical work – from their own side – is offered by historian Laure Humbert’s analysis of medic volunteers during World War Two. The international Hadfield Spears Ambulance unit was based in Britain and provided support to Free French forces in Europe and the Middle East. This unit had unique features. It was multi-national and staffed by volunteers. Predictably: ‘Despite displaying Red Cross symbols, the Ambulance facilities were repeatedly bombed, shelled and machine-gunned’ (Humbert 2023).

Staff of Hadfield Spears Ambulance unit included members of the British Friends’ Ambulance Unit – the FAU – who were especially independent. The FAU boldly reproached the allied forces for placing hospitals near ammunition stores, and in 1942, ‘they refused to transport arms in their vehicles’, causing a dispute (Humbert 2023).

Across most nations, and certainly in Australian military history, medics find limited protection in their Red Cross brassard, and look outward, deploring the ethics of their opponents, to explain the risks they face.

In Afghanistan

Currently serving Australian Army medics, who fought and provided healthcare in Afghanistan, are trained soldiers with additional qualifications in nursing and paramedicine. They are unlike their World War One counterparts who went to war largely unprepared. The education of Australian army medics includes a study of the Geneva and Hague conventions. The reasons why the symbol of the Red Cross should offer inherent protection are well understood by them.

For these soldiers, the wearing of the Red Cross is an important, and emotive, issue bound by history, doctrine, and regulation. Despite the brassard being a component of their uniform, medics interviewed for the research study were unanimous in their reluctance to wear the symbol in the field.

One reason for this was that the medics had difficulty in discerning the beginning and end of their medical role. They have served where circumstances alter constantly, and engagements with irregular forces are common. The conflicting demands of their role can shift them from health care provider to soldier – and back again – in minutes.

Studies of US personnel who served in Afghanistan have noted that:

CMs [combat medics] are expected to take the life of an enemy in combat, which requires a warrior’s mindset, and to save lives, which requires a healer’s mindset. The dual approach is complex and necessitates CMs to have a thorough understanding of the rules of engagement as well as clarity of thought regarding decisions of when to transition between their medic and soldier roles. Consequently, such conflicting responsibilities can result in primary and secondary psychological stressors …’ (Abraham et al. 2018).

This is also true for Australian personnel and was strongly confirmed in our research.

Some Australian medics commented on the Geneva Conventions. The Conventions set out strict principles regarding protected status. They state that medical personnel are entitled to carry arms to defend themselves and this is their protection (Gulam 2005), but they must not participate in direct combat as part of a fighting force (Frisina 2008). If military personnel wish to be protected under these regulations as non-combatants, they must adhere to these requirements.

This creates ethical dilemmas for soldiers who feel they are in a combat unit as an essential armed member. As one medic reflected

you are integrated with the team, you are essentially one of them, so you have to carry a weapon to protect yourself and your patients and basically be an asset … if you were someone that didn’t carry a weapon you would be a liability (Pyper 2016). Another encapsulated the duality of the soldier medic ‘you can’t be a good medic without being a good soldier’, further explaining: ‘It is not my role to go looking for a fight; however, as a soldier my job is to be prepared to fight until I receive casualties, then I become a medic’ (Chat 2017).

In addition, several respondents echoed the feelings of persecution recounted by their World War One forebears who wore the Red Cross. When asked for his thoughts on wearing the symbol Jayden Pyper emphatically responded: ‘Nope absolutely not, no way at all’. He reasoned that: ‘… the Taliban or whoever you were fighting, would see the Red Cross and take it out thinking then that is their medical element gone. … If you wore the Red Cross they would know you are different … . So that they tend to target you. So not ever’ (Pyper 2016). This was amplified by comments such as that they ‘don’t adhere to the Geneva convention and they will happily shoot you as a medic’ and ‘if they know you are a medic they target you’ (Nothdurft 2016).

Other medics interviewed in the study reiterated the word ‘target’ (Sanders 2017) and ‘its shoot the medic first … . It’s a massive morale hit (to the platoon) because if the medic’s gone who is going to look after them?’ (Chat 2017). Others went as far to say that the opposing forces ‘put a premium on medics’ (Kuskopf 2017).

Whether this was truly a tactic of the Taliban forces cannot be determined from any of the available evidence. What is indisputable is that the activities of army medics were shaped by these suspicions.

Through Afghan eyes

The purely humanitarian significance of the Red Cross also brought its own problems for Australian medics: ‘wearing the Red Cross stands out a lot it really bloody does it – stands out twofold – so the civilian populace know that you are the medic … ’ Afghan civilians would approach them for assistance, which they very much needed: ‘as soon as you showed you had something in health care you would be inundated because the next Med Centre is 100 km away, and so … ’ (Pyper 2016)

Medics were alarmed by the numbers of civilians. As one said: ‘and they will just come flooding for help health-care with some extremely chronic conditions’ (Sanders 2017).

The Afghans were probably approaching in numbers because they needed to support each other, when trying to get aid. But their crowded presence was viewed with anxiety:

you just get inundated and then that compromises the battle group because there will never be a time when that Red Cross wouldn’t be seen and then villagers would just approach, actually we were approached by kids all the time for food. (Chat 2017)

The appeals by Afghan civilians are a poignant note to narratives of this war. Studies of American medics’ service in Afghanistan have noted Local National Medical Needs as a specific source of stress and burn out and have nominated this as significantly stressful for 9% of such encounters. (By contrast, air evacuations were stressful on 7% of occasions and mass casualty events, 31%.) Although the dilemma of meeting the medical needs of Afghan civilians is thus recognized in the literature, it is not linked to how a medic is recognizable, and we posit that the wearing of the humanitarian symbol would be a significant aspect of such scenarios (Adler et al. 2017).

The dilemma of the medics trying to combine their duties on patrol, with their role as carers approached for clinical care, continues to haunt their memories. They could neither fully meet the expectations raised by the humanitarian symbol on their arm, nor feel confident of its notional protection.

One Australian medic believed that the Taliban members were ignorant of the exact significance of the Red Cross. This is unlikely, as Afghan civilians knew of it. He credited them with only a vague awareness: ‘if we wore the Red Cross they would know that we were different they did not know how we were different but they know that you were something different so that they tend to target – so, not ever’ [not ever willing to wear the brassard] (Nothdurft 2016).

Reflections

Laure Humbert (2023) has noted that a primary source which preserves the words of a French medical worker during World War Two: ‘challenges us to consider further how trained and untrained medical workers responded to instances of violence, negotiated contradictory obligations of care, and faced ethical dilemmas’. Humbert very effectively argues that an ‘ethos of stoicism’ developed in the surgical units working in war zones (2023). This ethos both sustained their commitment and prevented them from speaking to outsiders about the truth of their experiences.

A study of human rights and warfare in Afghanistan has noted that:

All in all, in the history of armed conflict there have been many examples of neglect and failure to comply with international humanitarian law, relating to members of the armed forces, medical personnel, humanitarian workers (ICRC), as well as civilians. This is because of a lack of respect for the signs of the Red Cross and Red Crescent under which the medical professionals operate … (Goniewicz and Goniewicz 2013)

The only proposed remedy is to communicate knowledge: ‘Educating societies in the field of international humanitarian law may help to prevent attacks on medical facilities and personnel …’ (Goniewicz and Goniewicz 2013)

Conclusion

Conventions and treaties make up the public face of warfare. The actual events are often different, and troops are expected to keep quiet about it. Research in Australia shows that the contradiction of feeling endangered by the very symbol which marks a medic as protected, is part of the memory of war. It is a private history, often going on the record only when medics break down, protest or speak informally.

There is no safety on the battlefield. Attempts to create boundaries, and enforce ethics, in warfare are never fully effective, and may be resented by troops already grappling with the crisis of combat. The ambiguity and fear of wearing the Red Cross brassard for some is another example of this.

The duality of the roles of the army medic runs through every aspect of their work and the rhetoric which surrounds them. Warriors, yet healers, they participate in a project which destroys and saves human lives, at the same time. Their essential work often leaves them with conflicted memories, as sharp and contrasting as the red on white of their Red Cross brassard.

Australian War Memorial. Red Cross brassard: 2 Field Ambulance, AIF, c 1914-1918. Accession Number REL31247. Reproduced with Permission.

Acknowledgments

The authors thank the Australian Department of Defence, and the Ethics Committee of the Research Office at Charles Sturt University, who approved our applications to interview members of the Australian military.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are transcripts of interviews with Australian Army Medics. Access to specific points from the interviews is available on request from the author. The full transcripts of the interviews with Army Medics were not made publicly available due to their containing information that could compromise the privacy of the research participants.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13623699.2024.2353180

Additional information

Funding

The authors report that there is no funding associated with the work featured in this article.

Notes on contributors

Kristina Griffin

Kristina Griffin, RN, MN, PhD is an academic in the school of Nursing, Paramedicine and Healthcare sciences at Charles Sturt University. She is a nurse historian whose PhD thesis “Healer or Warrior: An Historical Account of the Role Duality of the Australian Army Medic in Warzones” explores the role duality of the Australian Army medic as both a soldier and a healer from a historical perspective.

Therese Taylor

Therese Taylor lectured in Contemporary History at Charles Sturt University. She has retired from teaching and is now a full-time writer. She is the author of a scholarly biography of a French saint: Bernadette of Lourdes, Her Life, Death and Visions (Bloomsbury Press 2008), and numerous articles.