A report released earlier this week -- Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror -- concludes that post-9/11, doctors and other health professionals working in U.S. security detention centers around the world engaged or assisted in torture and cruel, inhuman and degrading treatment of detainees in violation of medical and ethical principles. The report's authors include 21 doctors, lawyers, and military personnel from across the United States. Among them are the faculty director and two senior fellows from the Human Rights Center at the University of California, Berkeley, School of Law.
My research into detainee experiences confirms the task force's finding that the Department of Defense and CIA improperly demanded that U.S. military and intelligence health professionals collaborate in intelligence gathering and security practices in a way that inflicted severe harm on detainees at Guantánamo and other U.S. military detention facilities.
While a few former Gitmo detainees praised the doctors and nurses they encountered, others said their interactions with medical personnel were among the "very worst." One man concluded, "the biggest criminals in Guantanamo are the doctors." In a particularly egregious episode, two interrogators and a translator reportedly questioned a detainee while he was only partially sedated and undergoing back surgery. When asked if he felt he had to answer his interrogators' questions, the former detainee replied "Yes, of course ... because otherwise the [doctor working on my back] would just go stronger. ... [In that] situation you just answer."
Another former detainee spoke of the "surreal" experience of being shackled to a dentist chair, and then seeing the dentist arrive with drills. "You can imagine what comes into your mind." In the most extreme cases, detainees began refusing to report even excruciating illnesses and injuries to medical personnel for fear that they would be used against them by their interrogators. Some former detainees claimed they received medications that triggered hallucinations. Others said interrogators withheld access to medical and psychological care as a means of manipulating and controlling detainees. At Bagram prison in Afghanistan, U.S. military doctors allegedly made fun of detainees while checking their wounds, mockingly suggesting that if they were unhappy with their treatment they should "write a report."
In some cases, linguistic and cultural barriers triggered poor or delayed treatment. As a consequence, medications were forced upon reluctant detainees who feared their effect. Some former detainees reported having large quantities of blood drawn, a couple of whom were allegedly told that the blood was being extracted "to pay for [their] medicine." Others reported having X-rays taken for no apparent reason. In some of the most extreme cases, even relatively routine practices like cavity searches and prostate exams were construed as something more insidious: Quite a few detainees -- especially those from non-western countries -- spoke of being "raped" by their doctors. For those who had no prior exposure to such exams and were given no explanation, such investigations could reasonably be construed as rapes, especially given the often-violent contexts in which those exams occurred. One such context was intake, during which detainees were kept deliberately disoriented, their clothes cut from their bodies.
Some U.S. military psychologists quietly objected to their role as handmaidens to interrogators. In January 2003, a year after the opening of Guantánamo, an army psychologist said he "had received increasing pressure to teach interrogation procedures and tactics that were a challenge to his ethics as a psychologist and moral fiber as a human being." He reportedly "witnessed many harsh and inhumane interrogation tactics, such as sexual humiliation, stress positions, detainees being stripped naked, and the use of K-9 dogs to terrorize detainees" (Larry C. James, Fixing Hell, 31).
The task force report highlights several ongoing areas of concern and criticism, including the force-feeding of hunger strikers as a violation of World Medical Association guidelines; providing interrogators with access to detainees' medical and psychological records for potential exploitation; the use of isolation; and preventing clinicians from addressing detainees' physical and psychological needs.
I endorse the task force's recommendations:
•First, that President Obama order a comprehensive investigation of US practices regarding detainee treatment, including the role of health professionals in such treatment;
•Second, that the US end its authorization of interrogation methods that constitute torture or cruel, inhuman or degrading treatment;
•Third, that the CIA and Department of Defense ensure that health professionals' treatment of detainees align with professional ethical principles;
•Fourth, that the Department of Defense establish policies and procedures that conform to professional ethical standards for the care of hunger strikers;
•Fifth, that the Department of Defense ensure compliance with professional standards, including the "adequacy and appropriateness of clinical diagnosis, treatment and documentation; confidentiality of information; and refraining from abuse as well as reporting abuse of detainees;"
•Sixth, that the American Psychological Association and other professional medical associations strengthen their ethical standards with regard to detainee care;
•Seventh, that domestic laws ensure that participation in torture or cruel, inhuman and degrading treatment by licensed health professionals constitutes sanctionable misconduct; and
•Eighth, that the Department of Defense reform its training of military health professionals to comply with professional ethical guidelines regarding detainee treatment.
Ultimately, wars are waged on bodies, but it is the responsibility of all doctors -- military or otherwise -- to ensure that their service is to their profession first, and thus to the healing and not the harming of bodies and minds. The Human Rights Center joins the task force in calling for a full investigation of medical practices in detention facilities -- both for the safeguarding of detainees and their doctors -- and for the public release of the Senate Intelligence Committee's review of CIA practices. Such steps are needed to adequately understand the ways in which physical and mental health professionals are failing to meet detainees' diverse needs, and to ensure the better alignment of detention-related practices with medical and ethical guidelines.