The Proadi-SUS Program and the Application of International Humanitarian Law in the Israel-Gaza Conflict

The Proadi-SUS Program and the Application of International Humanitarian Law in the Israel-Gaza Conflict

Introduction:
The Proadi-SUS program, which supports the institutional development of the Brazilian Unified Health System (SUS), offers an alternative means for healthcare entities to obtain the Certificate of Social Assistance Beneficiary Entity (Cebas). The program is funded by social contributions that these entities are exempted from paying due to tax immunity. It focuses on four strategic areas: technology evaluation and incorporation, human resources training, public health research, and healthcare management development. On the other hand, the Israel-Gaza conflict raises questions about the application of international humanitarian law. The Fourth Geneva Convention of 1949 establishes principles such as the distinction between civilians and combatants, proportionality in attacks, precaution in attacks, and the prohibition of unnecessary harm.

The Proadi-SUS Program:
The Proadi-SUS program allows healthcare entities of recognized excellence to fulfill the requirements for obtaining the Cebas. The program operates in three-year cycles, during which entities must demonstrate their investment in non-remunerated support projects and services for SUS. The investment should be equivalent to the amount of tax immunity enjoyed by the entities. However, the expenditure on non-remunerated services should not exceed 30% of the total tax immunity value. The program aims to transfer, develop, and incorporate new knowledge and practices in four strategic areas: technology evaluation and incorporation, human resources training, public health research, and healthcare management.

International Humanitarian Law in the Israel-Gaza Conflict:
International humanitarian law, also known as the law of armed conflict, is based on several founding texts ratified after World War II. The Fourth Geneva Convention of 1949 is the most important text, outlining fundamental principles for the protection of civilian populations during war. These principles include the distinction between civilians and combatants, proportionality in attacks, precaution in attacks, and the prohibition of unnecessary harm. The law aims to minimize the impact on civilian populations during war by limiting the methods and means of warfare employed by parties to the conflict.

Distinguishing Between Civilians and Combatants:
Under international humanitarian law, combatants include members of armed forces, excluding medical and religious personnel. Non-state armed groups may also have individuals who have been recruited, trained, and equipped, and they are considered combatants. On the other hand, individuals who have left the armed forces are no longer considered combatants unless they return to active service. Civilians, in contrast, refer to individuals who are not members of armed forces, but they lose their protection if they participate in hostilities. The law also prohibits targeting individuals who do not have a military responsibility, even if they work for a non-state organization with an armed branch.

Protection of Civilian Buildings and Healthcare Facilities:
International humanitarian law protects all civilian buildings from any form of aggression, including bombing, looting, invasion, shootings, encirclement, and deprivation of basic services. Healthcare facilities are specially protected, including hospitals, medical laboratories, clinics, first aid posts, blood transfusion centers, and pharmacies. However, this protection does not apply if these places are used for actions harmful to the enemy. The presence of weapons or armed guards alone does not constitute a hostile act. If an enemy uses a hospital to protect combatants or store ammunition, it is considered an abuse of the facility. The attacking party must first demand that the abusive use cease within a reasonable time before taking legitimate action.

Precautions in Attacks:
International humanitarian law requires attackers to take all feasible precautions to avoid or minimize harm to civilian lives and civilian objects. These precautions include verifying that the attack targets military objectives, warning the surrounding civilian population of impending attacks, refraining from attacks if the civilian casualties are likely to be disproportionate to the military advantage sought, and avoiding attacks on military objectives in densely populated areas. Whenever possible, civilians near the targets should be evacuated before an attack. The law prohibits deliberately targeting an entire area as a single military objective when the targeted military objectives are clearly separated and distinct.

Actionable Advice:

1. Entities participating in the Proadi-SUS program should ensure that their projects align with the objectives and goals of the National Health Plan to maximize their impact on the Brazilian Unified Health System.
2. Healthcare entities should prioritize investment in technology evaluation and incorporation, human resources training, public health research, and healthcare management development to contribute effectively to the improvement of the healthcare system.
3. In the Israel-Gaza conflict, parties should adhere to international humanitarian law by distinguishing between civilians and combatants, protecting civilian buildings and healthcare facilities, taking precautions in attacks, and avoiding unnecessary harm to civilian populations.

Conclusion:
The Proadi-SUS program offers a valuable opportunity for healthcare entities to support the development of the Brazilian Unified Health System. Meanwhile, the Israel-Gaza conflict highlights the importance of adhering to international humanitarian law to minimize harm to civilian populations. By understanding and implementing these principles, healthcare entities and parties to the conflict can contribute to the improvement of healthcare systems and protect the lives and well-being of civilians in times of war.