Before the 20th century, individual navies and trading companies, to a greater or lesser extent, took responsibility for providing medical services to sailors in their employ. Very little seems to have been written in the west about the obligations of maritime nations with respect to medical care to enemy combatants or non-combatant personnel on the high seas until the 1907 Hague Convention added sailors to protections given to wounded soldiers under previous Geneva Conventions governing combatant nations.
Of the Geneva Conventions drafted in 1949, the second (“Geneva II”) provides for the amelioration of the condition of sick, wounded and shipwrecked members of armed forces (both combatant and neutral) at sea. Geneva II also obligates its signatory nations to grant protections to medical personnel and chaplains at sea, and to hospital ships. “Geneva IV”, also drafted in 1949, extended protections to civilians and civilian hospitals, in areas of conflict.
With the UN Conferences on the Law of the Sea (UNCLOS) of 1956, 1960 and 1973, nations of the world took significant steps toward establishing international jurisdiction of international waters by defining the rights and responsibilities of nations in their use of the oceans of the world. Medical aspects of these international conventions derive indirectly, in part, from UNCLOS Article 98:Article 98 Duty to render assistance 1. Every State shall require the master of a ship flying its flag, in so far as he can do so without serious danger to the ship, the crew or the passengers: (a) to render assistance to any person found at sea in danger of being lost; (b) to proceed with all possible speed to the rescue of persons in distress, if informed of their need of assistance, in so far as such action may reasonably be expected of him; (c) after a collision, to render assistance to the other ship, its crew and its passengers and, where possible, to inform the other ship of the name of his own ship, its port of registry and the nearest port at which it will call. 2. Every coastal State shall promote the establishment, operation and maintenance of an adequate and effective search and rescue service regarding safety on and over the sea and, where circumstances so require, by way of mutual regional arrangements cooperate with neighbouring States for this purpose.
The modern alphabet soup of international maritime medical conventions and regulations involves the IMO (International Maritime organization), the ILO (International Labor Organization) and the WHO (World Health Organization). The “ILO/WHO Committee on the Health of Seafarers”, established in 1948, was the first step in a process that developed international guidance on such matters as medical examination of seafarers, the ship medical chest, food, water and accommodation for seafarers aboard ship, hospital treatment, social welfare and the like.
More recently, several conventions dealing with aspects of maritime medicine have emerged. These are Safety of Life at Sea [SOLAS] 1974–deals with life saving apparatus aboard ships; Standards of Training, Certification and Watchstanding of Seafarers [STCW] 1978–addresses health, training and competence requirements; International Marine Satellite Organization [INMARSAT] 1976–deals with emergency communications, including the Telemedical Maritime Assistance Services; International Convention on Search and Rescue [SAR] 1979–deals with maritime search and rescue; International Convention for the Safety of Fishing Vessels [SFV] 1977–deals with live saving appliances, emergency procedures and radio communications on fishing vessels.
A host of other conventions touch on such medically related topics as safe navigation (involving medical assessment of night vision, color vision and fatigue), watch schemes (fatigue), construction of ships (hospital construction, man-machine interfaces), impact of work environment upon worker health, and the like.
Finally, while not in the form of a convention, the World Health Organization issues International health Regulations (IHR) which deal comprehensively with the prevention of, protection against, control of and public health response to the international spread of disease. ILO, IMO and WHO collaborated in the development, in 1967, of the first “International Medical Guide for Ships” and has since developed international guidelines for pre-sea and periodic examination of seafarers (1997, with revisions) and the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods [MFAG] (1982).
Today it might be accurately said that the international civilian maritime medicine establishment significantly outnumbers that of the navies of the world.
I depended very heavily on the Norwegian Centre for Maritime Medicine’s online Textbook of Maritime Medicine for my preparation of this post.