War & Peace
A Brief History of American Doctors & Torture at Guantanamo Bay
Today’s “revelation” that American military doctors and psychologists working at the Guantanamo Bay concentration camp ignored and concealed evidence of detainee torture, including broken bones and sexual assaults, comes as no surprise to longtime GITMO watchers. In the early days of the War on Terror, CIA interrogation specialists armed with new definitions of what did and did not constitute torture relished their new found freedom to subject terrorism suspects, guilty or not (and hundreds were not), to “cruel, inhuman and degrading” treatment– so long as they didn’t do so on US soil.
Enter Guantanamo, that land of legal limbo (at least in the minds of the Bush administration) where interrogators were effectively given carte blanche to torture at will. Anything to prevent the next 9/11. Sure, there were limits to how much cruelty interrogators could inflict. “If the detainee dies, you’re doing it wrong,” explained CIA attorney Jonathan Fredman. Fredman believed that torture “is basically subject to perception” but that “if someone dies while aggressive techniques are being used… the backlash would be severely detrimental.”
If the detainee dies, you’re doing it wrong. Better keep ‘em alive, then. Here’s where medical personnel shamefully enter the picture. A report by the International Committee of the Red Cross found that American doctors and other medical personnel “condoned and participated” in torture in a “gross breach of medical ethics.”
The World Medical Association, of which the American Medical Association (AMA) is a member, spells it out in no uncertain terms: not only are doctors forbidden from participating in any form of cruelty, they were also obligated to report any wrongdoing they see. But this wasn’t the case at GITMO. Not only did doctors provide interrogators with detainee medical records so that they could torture them more effectively, it is also highly likely that they also covered up detainee murders at Abu Ghraib by substituting natural causes such as heart attacks on their death certificates.
The Army’s own textbook, Military Medical Ethics, instructs that military physicians are always first and foremost doctors and thus bound by the Hippocratic Oath to “use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing.” Sadly, this oath was largely ignored. Defense Secretary Donald Rumsfeld’s ethical policy was that detainees who were slated to be tortured had to be cleared by doctors first. A June 2005 memo written by the Pentagon’s top doctor, William Winkenwerder Jr. (later a government health advisor, health insurance executive and lobbyist) gave the green light for doctors to not only be present but to actually participate in the torture of prisoners. The same year he wrote that memo, the AMA presented Winkenwerder with an award for “the betterment of the public health.”
In 2007 the Red Cross reported that C.I.A. doctors oversaw hundreds of waterboardings. And make no mistake: waterboarding is torture. There were doctors that abused detainees just for the sport of it, or by pretending they were actually examining or helping the men. One Navy doctor liked to shove his fingers violently into the rectums of new GITMO arrivals. Others violently force-fed hunger striking inmates.
In July 2009 Harper’s reported that at least 30 prisoners were being force-fed at Guantanamo, a clear violation of the Geneva Conventions. “Doctors should never be party to actual coercive feeding, with prisoners being tied down and intravenous drips or esophageal tubes being forced into them. Such actions can be considered a form of torture, and under no circumstances should doctors participate in them, [even under] the pretext of ‘saving the hunger striker’s life,’” asserted Red Cross adviser Hernan Reyes. In 1975, the World Medical Association issued a declaration advising doctors not to force-feed prisoners who choose to hunger strike and understand the consequences, stressing that “forcible feeding is never ethically acceptable.” Following this guideline from the world’s foremost medical authority, Britain once permitted hunger-striking Irish Republican Army prisoners to starve to death.
The U.S. military euphemistically refers to force-feeding as “assisted feeding.” But this implies that the detainees are asking for help. They most certainly are not. Many Guantanamo inmates are prepared to die if they are not released or at least have their cases brought before a judge. “I am slowly dying in this solitary prison cell,” wrote inmate Omar Deghayes. “I have no rights, no hope. So why not take my destiny into my own hands, and die for a principle?” Of course, the United States would allow no such thing and humanitarian concerns have nothing to do with the reason why.
There is nothing compassionate about the kind of force-feeding that occurs at Guantanamo. Medical personnel often use nasal-gastric (feeding) tubes that are thicker than necessary to deliberately harm detainees. These tubes are sometimes as thick as a finger. Some inmates vomit blood. Tubes are sometimes improperly inserted so that they enter a lung instead of the stomach. Needless to say, the process is excruciatingly painful. Detainees say the only thing that hurts more than when the tube is forced in is when it’s yanked out. One detainee said he passed out from the extraction. Here’s a description:
Nasal gastric tubes [were removed] by placing a foot on one end of the tube and yanking the detainee’s head back by his hair, causing the tube to be painfully ejected from the detainee’s nose. Then, in front of the Guantanamo physicians… the guards took a nasal gastric tube from one detainee, and with no sanitization whatsoever, reinserted it into the nose of a different detainee. When these tubes were reinserted, the detainees could see the blood and stomach bile from the other detainees remaining on the tubes. Medical staff made no effort to intervene. This was one of many incidents.
Another detainee, Farhan Abdul Latif, said the tube insertion felt like a nail going into his nostril, and like a knife going down his throat. He covered himself in his own excrement so that he might avoid the torture of “assisted feeding.” Fat chance. Guards force-fed Farhan through his shit-crusted nostrils.
Guantanamo prisoners are also being over-force-fed. There are reported cases of GITMO personnel lacing the “food” with laxatives so detainees developed diarrhea while they were strapped down to their chairs and had no choice but to relieve themselves where they sat.
Mental health professionals are also guilty of grave ethical violations. It was psychiatrists and psychologists that dreamed up many of the sadistic abuses that occurred at GITMO and other prisons. Isolation, sleep deprivation, sexual humiliation and exploitation of detainee fears were extremely commonplace. The American Psychiatric Association advises its members not to participate in interrogations or torture, but A.P.A president Steven Sharfstein admitted that psychiatrists would not be punished if they disobeyed this guideline.
Not all medical personnel at Guantanamo Bay approved of what was going on there. Retired Army Brigadier General Stephen N. Xenakis was shocked at the indifference of the medical community to the atrocities that were being committed. But his was a rare voice of dissent. A few other military doctors demanded ethical reviews but they were rebuffed by the Defense Department. Worse still, the Pentagon began vetting Guantanamo physicians and only approving those who were willing to go along with their torture program. Dr. Susan Okie actually traveled to Guantanamo where U.S. officials had promised her she’d be able to speak with detainees. But when she arrived in Cuba, she was told she couldn’t meet with the prisoners out of concern for their privacy.
Finally, in late 2006 the American Medical Association declared that doctors were prohibited from any and all participation in interrogations. Even so, many military doctors who were A.M.A. members fought the ruling, asserting that the goal of obtaining useful information from the detainees outweighed the annoying ethical barriers that they admitted they were guilty of breaching. Bioethicist Stephen H. Miles from the University of Minnesota Medical School says this shameful chapter casts a pall over the moral standing of American medicine. “We’re now in an extremely poor position to protest abuse in other countries,” he said. “It will silence us as a medical community.”
Dr. Robert Jay Lifton, a prominent American psychiatrist who is well published in the subject of the psychology of war crimes, sums up the role of doctors and torture in the War on Terror:
American doctors at Abu Ghraib and elsewhere have undoubtedly been aware of their medical responsibility to document injuries and raise questions about their possible source in abuse. But those doctors and other medical personnel were part of a command structure that permitted, encouraged, and sometimes orchestrated torture to a degree that it became the norm– with which they were expected to comply– in the immediate prison environment. The doctors thus brought a medical component to what I call an “atrocity-producing situation”– one so structured, psychologically and militarily, that ordinary people can readily engage in atrocities. Even without directly participating in the abuse, doctors may have become socialized to an environment of torture and by virtue of their medical authority helped sustain it. In studying various forms of medical abuse, I have found that the participation of doctors can confer an aura of legitimacy and can even create an illusion of therapy and healing.
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