Giving up the Ghost: Detainees, Doctors and Torture

JURIST Special Guest Columnist and British human and medical rights activist Dr. David Nicholl, a neurologist at Queen Elizabeth Hospital, Birmingham, UK, says that Amnesty International's new report into the rendition and torture of one-time "ghost detainee" Khaled al-Maqtari by the CIA highlights yet again the complicity of doctors in the US detention and rendition process....



How does a torturer know a prisoner being 'waterboarded' is not so close to death that they will die before the tap is turned off?

One way is to have a medical professional standing by. The same with beatings, sleep deprivation, starving, extremes of heat and cold, and use of deafening sounds or blinding lights. Enlist the services of a doctor or psychologist and not only can you keep a torture victim alive (if that is your intention), but you can also calibrate their suffering in a way that suits you. And, if things 'go wrong', it's handy to have a doctor who might be prepared to list 'natural causes' on a death certificate as documented in Dr Steve Miles' book "Oath Betrayed".

Not exactly ethical behaviour for anyone, never mind someone sworn to tending the sick, but in fact there's a shameful history of medical collaboration with torture. From medieval cruelty towards the mentally ill centuries ago, to Nazi doctors in WWII and the Dirty War against political opponents in 1970s South America — a good knowledge of pharmacology and physiology helps aid deliberate assaults on the body and mind by torturers interested in administering measured doses of pain and suffering.

Recently there was public shock when a British nurse was convicted of multiple murders. But that was a roundly condemned crime, defended by nobody. Instead, in the USA's 'war on terror', the military and CIA have highly-trained doctors and psychologists working side by side with interrogators and torturers. No one has been punished for these crimes. Here are just a few examples.

In the interrogation log of 'Detainee 063', the alleged 20th 9/11 hijacker Mohammed Al-Qatani, medics were clearly present throughout his prolonged interrogation. The word 'doctor' is mentioned no less than 45 times during November 2002-January 2003 alone. A 'strap was hung from the ceiling in anticipation of the doctor's arrival', states one entry, and 'medical' interventions included assessments of the detainee's level of hydration and pulse rate to ensure that he was 'physically able to continue' with interrogation.

Or take the case of Yemeni Khaled al-Maqtari, detained when US army soldiers raided a suspected arms market in Fallujah, Iraq, in January 2004, arresting at least 60 people. In a report issued this week, Amnesty International says al-Maqtari was initially transferred to the infamous Abu Ghraib prison as an unregistered "ghost detainee" before being rendered to Afghanistan. In late April 2004, he and a number of his fellow detainees were transferred to another CIA "black site", possibly in Eastern Europe. He was held there for a further 28 months, before being sent to Yemen where he was detained until May 2007 when he was released without charge. He has recounted a regime of beatings, sleep deprivation, suspension upside-down in painful positions, intimidation by dogs, induced hypothermia and other forms of torture. At the secret "black site", he says he saw at least five doctors or medics and a dentist, as well as half a dozen psychologists. Towards the end of his CIA detention, in 2006, he developed stomach pain and bleeding that left him largely unable to eat solid food, and, in early August 2006, he was taken by plane from the secret detention centre to a distant hospital facility, where he had what he was told was an endoscopy. There were few clues as to the location of the medical facility, but it was likely to have been a considerable distance away from the "black site". Al-Maqtari first flew on one plane for about five or six hours, then transferred to a second plane, which seemed to fly for some eight hours before landing. After the return flight, about three weeks after his hospital visit, he was taken from the secret detention centre and returned to Yemen and subsequently freed.

The human rights group Reprieve has affidavits from a former 'war on terror' detainee Marwan Jabur who was held in various secret prisons from May 2004 until July 2006. These describe the involvement of doctors in secret 'rendition' flights and interrogations without lawyers, as in the al-Maqtari case.

As long ago as 2005 the New England Journal of Medicine confirmed that doctors at Guantánamo Bay were screened to ensure that they had no ethical scruples over force-feeding prisoners at the military prison.

Dr John Edmondson, the chief medic at Guantánamo from July 2003 to January 2006, was a willing practitioner of a regime of force-feeding scores of prisoners with nasal tubes while they were held down in 'restraint chairs'. For his willingness to disregard an international medical ethical prohibition on force-feeding prisoners, Dr Edmondson earnt a medal for 'inspiring leadership and exemplary performance (which) significantly improved the healthcare for residents of Guantánamo' (as the camp newspaper reported it).

Two years ago I and over 250 eminent doctors from around the world denounced the corruption of medical ethics at Guantánamo in The Lancet. Yet, little has changed. More medals have been awarded since Dr Edmondson left Cuba in 2006, and force-feeding at Guantánamo under the gaze of military doctors continues to this day.

Why do some US military doctors dispense with deep-seated medical-ethical principles and practise torture? It is not that they are 'evil' medics or uniformed 'Doctor Deaths'. All doctors recognise that their first duty is to the patients in their care, but doctors obeying orders are sometimes faced with an acute conflict of interest between the medical needs of their detainee-patients and the orders of their superiors up the military food-chain. The Hippocratic Oath versus their military oath.

The American Medical Association guidelines are quite specific. Doctors should neither participate in, nor monitor detainee interrogations. Indeed if 'physicians have reason to believe that interrogations are coercive, they must report their observations to the appropriate authorities'.

Overall there is mounting evidence that doctors in the US military and intelligence community have breached their own and international ethical guidelines. These are not isolated incidents and they suggest a concerted programme based on specific orders. The Pentagon's 2006 guidance for medics - Medical Program Support for Detainee Operations - makes no explicit mention of the Geneva Conventions. Indeed the guidance notes say that informed patient consent can be ignored on grounds of 'national security-related activity'.

That the policy guidelines were written by a Dr William Winkenwerder who has no military experience and whose career has been largely spent in the healthcare insurance industry rather than in direct patient care, suggests that ethics weren't exactly a top priority at the Department of Defense.

Meanwhile, the US medical establishment appears paralysed. The AMA has failed to take any action against renegade doctors, merely admitting in The Lancet that it has been 'unable to determine with any certainty whether ethics policies prohibiting physicians' involvement in torture are being adhered to' by the Defense Department.

It is time for America's professional medical bodies to denounce its members who use their skills to facilitate torture. Physicians who ill-treat the healthy rather than treat the unhealthy should be drummed out of their profession.

They're deserving of criminal investigation, not Guantánamo medals.


Dr David Nicholl, MBChB FRCP PhD is a consultant neurologist and honorary senior lecturer at City Hospital Hospital & Queen Elizabeth Hospital, Birmingham and the University of Birmingham, England. He grew up in Belfast, Northern Ireland and has been active as a human rights activist on Guantanamo and as a supporter of Amnesty International and Reprieve. He can be reached at david.nicholl@blueyonder.co.uk
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