THE COSTS OF WAR

Medical Oaths Betrayed

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By Steven H. Miles
Sunday, July 9, 2006

In November 2003, an Iraqi guard smuggled a pistol into the U.S. military prison at Abu Ghraib and gave it to a prisoner, Ameen Saeed al-Sheik. Tipped off, military police quickly began a cell-to-cell search. When they reached his cell, Sheik went for the hidden pistol; gunfire was exchanged and a sergeant was hit. According to sworn testimony, the soldiers wrestled the prisoner to the floor and sent him to the hospital with a dislocated shoulder and shotgun wounds to his legs.

When Sheik returned to prison, he was beaten with a baton and his arms were handcuffed over his head, putting stress on his injured shoulder and leg. On a cold night, a medic, Sgt. Theresa Adams, saw Sheik naked and bleeding from a catheter that should have been connected to a bag to prevent infection. According to a sworn statement, the physician on call (who held the rank of colonel) agreed that the hospital had erred in leaving the catheter open but refused to remove it or to transfer Sheik to a hospital. When Adams asked him whether he had ever heard of the Geneva Conventions, the physician answered, "Fine, Sergeant, you do what you have to do; I am going back to bed."

In May 2004, photographs of prisoners being abused at Abu Ghraib shocked the world. When I saw the pictures, a simple question came to mind: Where were the prison doctors, nurses and medics while this abuse was happening?

Based on my review of tens of thousands of pages of declassified government documents, congressional testimony, press accounts and reports by human rights organizations, the answer is clear: Many armed forces physicians, nurses and medics have been passive and active partners in the systematic neglect and abuse of prisoners. At facilities in Iraq, Afghanistan and Guantanamo Bay, Cuba, the United States often failed to provide prisoners with minimally adequate medical and health systems. Some physicians and psychologists provided information that was used to determine the harshness of physically and psychologically abusive interrogations, which were then monitored by health professionals. Some doctors responsible for the medical records of detainees omitted evidence of abuse from their official reports. Medical personnel who knew of this system of neglect, abuse and torture remained silent.

Certainly, the vast majority of military clinicians are responsible and competent. But even silence or indifference concerning prisoners' injuries was common enough to enable prison abuse to continue in Iraq, Afghanistan and at Guantanamo Bay. My new book on this subject cites incidents involving 120 to 150 clinicians at these locations -- most remaining quiet in the face of abuse, at least 10 delaying or suppressing death certificates in cases of abuse, and at least 30 involved in designing or monitoring harsh interrogations.

These were not isolated acts of medical complicity; rather, they formed a pattern of abuse authorized (or ignored) by senior U.S. officials.

In November 2002, Defense Secretary Donald H. Rumsfeld appointed a working group to develop an interrogation policy for the prison at Guantanamo Bay. Upon receiving the working group's reports, Rumsfeld approved techniques such as isolation, interrogation for 20 hours, deprivation of light and sound and the use of loud sounds, as well as "manipulation of the detainees' emotions and weaknesses."

But his April 2003 directive also proposed three roles for medical professionals in interrogations. First, "the use of isolation as an interrogation technique requires detailed implementation instructions, including . . . medical and psychological review." Second, application of such interrogation methods was contingent on the detainee being "medically and operationally evaluated as suitable." Third, the interrogations required "the presence or availability of qualified medical personnel."

Rumsfeld's vision was fleshed out in Army prisons in Iraq, Afghanistan and at Guantanamo Bay, with health professionals cooperating in all phases of coercive interrogation. Some provided information from medical records and clinical interviews for use in designing interrogation plans. Others recommended ways to break down prisoners, using insights from cross-cultural psychology to degrade and demoralize them.

'The Man Was Old'

Although few records describing interrogations have been declassified, investigative files confirm that clinicians were present during some harsh inquiries. Guantanamo Bay interrogators and officers reported that doctors observed such questioning from behind a mirror or were in the room while it was occurring. And in Samarra, various soldiers offered sworn testimony about a particular interrogation:

[Linguist -- name redacted]: I witnessed concern on the part of the primary interrogator toward preventing the detainee from going into a medical crisis as a result of the questioning. He stopped the questioning several times so that a medical professional could examine him and determine if he was still doing fine. All indications were that, aside from the stress of being captured and questioned, he was suffering no health crisis.

Q: During any interrogations did Staff Sergeant [name redacted] ever have to stop it because of medical problems?


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