The Role of Health Professionals in Detainee Interrogation

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A teenager tortured at Guantanamo, and the stalled legislation to ensure clinicians "first, do no harm"

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Sunrise over the detention center at U.S. Naval Base Guantanamo Bay, Cuba; October 18, 2012  [Michelle Shephard / Reuters]

On December 25, 2003, Mohammed Jawad, an Afghani teenager held in Guantanamo Bay, Cuba, repeatedly banged his head against the metal structures of his cell in an effort to kill himself. The dull echoes of the blows attracted the prison's guards. As they reached the cell, Jawad struck the solid surface once again. Even though suicide is prohibited in Islam, Jawad, a devout Muslim, thought that perhaps he could be forgiven in this case. The situation had slipped beyond his control, he told his attorney Eric Montalvo years later.

"Make him as uncomfortable as possible. Work him as hard as possible."

A month earlier, Jawad had been placed in isolation following the recommendations of a psychologist from a Behavioral Science Consultation Team in Guantanamo. A few weeks later, he had been moved to a cell block where no one spoke Pashto -- the only language Jawad knew when he arrived to the island -- in order to further enhance his feeling of loneliness. "He appears to be rather frightened, and it looks as if he could break easily if he were isolated from his support network and made to rely solely on the interrogator," the Army psychologist wrote in a leaked report intended for Guantanamo interrogators. "Make him as uncomfortable as possible. Work him as hard as possible," she continued.

Three days before Christmas 2003, Jawad's "comfort items" -- his mat, a copy of the Quran, among others -- were removed from his cell as a form of punishment for trying to talk to other detainees in the camp, according to court documents. On December 25, reaching a breaking point, he repeatedly slammed his head against the metal objects of his enclosure.

The incident was recorded in the official camp log of that day under the description "attempted self-harm." In March 2004, he tried to communicate with the inmates from his block, and he was punished once again with the loss of his comfort items. The prison, he would later tell his lead attorney, David Frakt, was "like a tomb, like a graveyard."

At least since Nuremberg, scrutiny over the involvement of health professionals with torture has been a critical subject in every war. (The word "torture," of course, is highly charged and its definition is subject to debate. For the purpose of this article, the word refers to the definition found in the United Nations Convention Against Torture, a document ratified by the United States.)

In the aftermath of the wars in Iraq and Afghanistan, ever since leaked reports and testimonies -- including that of alleged 9/11 mastermind Khalid Sheikh Mohammed, currently on trial in Guantanamo -- were published in 2004, the issue has attracted the attention of the media, health organizations, and political activists. Psychologists and doctors have clashed with their peers and with the Department of Defense over the role that health professionals should play in interrogations, given their oath to "do no harm." The Senate Judiciary Committee and numerous military investigations have confirmed that physicians and clinicians played a significant role during so-called enhanced interrogations, either through reverse engineering of the Survival, Evasion, Resistance, Escape (SERE) program, or through monitoring and assisting in CIA black sites and prisons like Bagram and Guantanamo.

Recently, that conflict reached politicians in Albany, New York. This year, State Senator Thomas Duane and Assembly Member Richard Gottfried sponsored a unique piece of legislation that establishes sanctions (including license removal) for state-licensed health professionals who participate in torture or improper treatment of prisoners.

"The bill presents an opportunity to fill a gap in state law on the regulation of health professionals that desperately needs to be filled," Leonard Rubenstein, the former president of Physicians for Human Rights -- an independent organization that fights human rights violations all around the world -- said in a public forum. "Almost everyone agrees that the idea that health professionals can participate in abuse of detainees and prisoners is indefensible. If that is the case, it is also indefensible to exclude such acts from state law on licensing and regulation of health professionals."

The Duane-Gottfried bill was the latest in a series of yet-unsuccessful efforts carried out by committed clinicians and doctors to establish a lasting impediment to torture, and to prevent -- nearly nine years after the fact -- events similar to those experienced by Jawad.

In 2004, Steven Reisner, a psychologist and anti-torture advocate who became one of the Gottfried bill's most outspoken advocates, read a New York Times article about a leaked International Committee of the Red Cross report. "There were two main lines to that document," he said last winter referring to the report. "First, that what was happening was tantamount to torture. And second, that health professionals were overseeing interrogations in violation of their ethics."

"To some extent, the issue is put in very blunt terms, 'Whose side are you on? The terrorists' or Gottfried's?"

On May 7 of that year, a guard interrupted Jawad's sleep a few hours after Vice-Admiral Church visited Guantanamo as part of an investigation into detainee abuse. Jawad was shackled and moved to cell L48, where he went back to sleep. Three hours and 16 minutes later, he was awake once again, walking in chains towards cell L40. Two hours and 59 minutes after that, a guard came, put on his shackles and led him back to cell L48. Just after he arrived in his original cell, he was taken back to L40; two minutes later, he was shackled and returned to L48. The sleepless pattern continued for 309 hours and 53 minutes. In total, according to a log uncovered by Jawad's attorneys in 2008, he was transferred 120 times from cell to cell during 14 days, once every two hours and 50 minutes on average.

This sleep-deprivation technique, referred to as the "frequent flyer" program by Guantanamo guards, owed its inception to a group of psychologists who had been advising the CIA on how to conduct more aggressive interrogations. Via the Office of Legal Counsel of the Department of Defense and a series of executive orders during the Bush administration, the health professionals' recommendations had become standard operating procedure in Guantanamo to either punish or extract information from prisoners (at least 21 prisoners were subjected to the "frequent flyer" program, according to an Amnesty International report). 

This sort of abuse had supposedly been eliminated from the prison camp in March of 2004, when Major General Jay Hood assumed the leadership of the Guantanamo Joint Task Force. Authorities, consequently, denied having any knowledge of the incident. Jawad's treatment had violated Common Article 3 of the Geneva Conventions -- inapplicable to his case because he was denominated an "unlawful combatant." In a 2009 habeas corpus hearing, Ellen S. Huvelle, the federal judge who sealed his release, told U.S. prosecutors, "After this horrible, long, tortured history, I hope the government will succeed in getting him back home." She added, "Enough has been imposed on this young man to date."

Dr. Katherine Porterfield, a psychologist from the Survivors of Torture Program at Bellevue Hospital, learned about the Gottfried bill after she treated Mohammed Jawad while he was still imprisoned in Guantanamo. Jawad's case had first attracted media attention in 2007, when the government announced that he was to be the fourth detainee to be prosecuted under the Military Commissions Act of 2006. The fact that he was under 18 at the time of his arrest, a fact the government accepted, spurred organizations like Amnesty International and Human Rights Watch to raise the alarm about violations of several United Nations treaties regulating the treatment of child soldiers.

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Santiago Wills is a journalist basted in New York City. His work has also appeared in Salon and several South American magazines.

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