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means of control (such as directing the aircraft to land and submit to search) have beenexhausted. 359A medical aircraft that is not flying pursuant to a special agreement that seeks to claimprotection as medical aircraft shall make every effort to identify itself and to inform the enemyState of its status and its operations, such as its flight times and routes. 360 For example, anunknown aircraft within a theater of military operations would often be reasonably presumed tobe a military objective, and the aircraft must take affirmative steps to rebut this presumption. 361In order to maintain its entitlement to protection, such aircraft must obey the directions of theenemy State, such as directions to land and to submit to search.7.14.2 Exclusively Employed for the Removal of the Wounded, Sick, or Shipwrecked,and for the Transport of Medical Personnel and Equipment. In order to receive protection asmedical aircraft, the aircraft must be exclusively employed for the removal of wounded, sick, orshipwrecked combatants and for the transport of medical personnel and equipment.For example, such aircraft, while designated or operating as medical aircraft, may not beused also for military purposes, such as to transport able-bodied combatants or to carryammunition to combat forces. 3627.14.2.1 Conversion of Aircraft To and From Use Under a Special Agreement forMedical Purposes. If medical aircraft are flying pursuant to an agreement, it is not necessarythat the aircraft should have been specially built and equipped for medical purposes. 363 There is359 1976 AIR FORCE PAMPHLET 110-31 (“Generally, a medical aircraft (identified as such) should not be attackedunless under the circumstances at the time it represents an immediate military threat and other methods of controlare not available.”).360 Consider AP I art. 27(2) (“A medical aircraft which flies over an area physically controlled by an adverse Partywithout, or in deviation from the terms of, an agreement provided for in paragraph 1, either through navigationalerror or because of an emergency affecting the safety of the flight, shall make every effort to identify itself and toinform the adverse Party of the circumstances. As soon as such medical aircraft has been recognized by the adverseParty, that Party shall make all reasonable efforts to give the order to land or to alight on water, referred to in Article30, paragraph 1, or to take other measures to safeguard its own interests, and, in either case, to allow the aircrafttime for compliance, before resorting to an attack against the aircraft”).361 Cf. BOTHE, PARTSCH, & SOLF, NEW RULES 155 (AP I art. 27, 2.2) (“The question then arises whether an aircraftwhich is operating without such agreement (or in deviation from the terms of such agreement) is a legitimate target,a military objective within the meaning of Art. 52, para. 2. Article 27, para. 2, is based on the (correct) assumptionthat it is, even if it is a true medical aircraft. … An aircraft flying over areas controlled by an adverse Party is, incase of doubt, a military objective. Anything else is unrealistic.”).362 Compare § 7.12.2.2 (No Use for Military Purposes). For example, First Lieutenant Edward R. Cummings, TheJuridical Status of Medical Aircraft Under the Conventional Laws of War, 66 MILITARY LAW REVIEW 105, 115(1974) (“It has been said that during the Second World War ‘Article 18 [of the 1929 GWS] was … more or less adead letter,’ even though air evacuation flights were used extensively during the war. One and a half millionAmericans alone were evacuated by air during the war. The United States primarily used aircraft that were notdevoted exclusively to the care or the wounded and sick. It was able to do so because of its air supremacy. Eventhough these aircraft would not have been entitled to juridical protection under the 1929 Geneva Convention, noneof the aircraft used to convey casualties ‘suffered any mishap during the war.’”) (ellipsis in original).363 1956 FM 27-10 (Change No. 1 1976) 237b (“It is not necessary that the aircraft should have been specially builtand equipped for medical purposes.”).467