As one of very few health professionals who has viewed Guantanamo detainee health files as a consultant to defense and habeas attorneys, I was not at all surprised by the findings of a new paper in PLOS Medicine by Vincent Iacopino and Stephen N. Xenakis: Neglect of Medical Evidence of Torture in Guantánamo Bay: A Case Series. Iacopino and Xenakis report on their examination of the medical records and reports by independent medical and psychological consultants on nine Guantanamo prisoners. They find that, despite strong evidence that the prisoners were subjected to torture, the health professionals examining and treating them made no attempt to determine if the prisoners had been abused and failed in their ethical (and military) duty to document and report torture and ill treatment.
The findings of this study demonstrate that allegations by these nine detainees of torture were corroborated by forensic evaluations by non-governmental medical experts and that DoD medical and mental health providers at GTMO failed to document physical and/or psychological evidence of intentional harm.
In each case we reviewed, detainees alleged forms of abuse that are highly consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time . In one case, unclassified interrogation plans and interrogation summaries provided precise corroboration of the methods of torture and ill treatment that the detainee alleged.
The medical evaluations in this case series revealed evidence of severe physical and severe and prolonged psychological pain as stipulated in the Bybee definition of torture. But, according to the Bybee definition of torture, even if the requisite pain thresholds had been exceeded, the infliction of such pain had to be the interrogator's "precise objective" to constitute torture.
The medical doctors and mental health personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to "personality disorders" and "routine stressors of confinement." Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment.
The documentation of torture and ill treatment in medicolegal evaluations conducted by non-governmental medical experts indicates that each of the detainees continues to experience severe, long-term and debilitating psychological symptoms that are likely to persist for many years, and possibly a lifetime.
The Defense Department has issued a response to Iacopino and Xenakis which, in its failure to even mention their main charges can be taken as an official confirmation that Guantanamo health professionals do no investigate or document the terrible abuses suffered by many prisoners there:
DoD personnel working in detention facilities operate under a high level of scrutiny and consistently provide the most humane and safe care and custody of individuals under their control. The Joint Medical Group is committed to providing unconditional appropriate comprehensive medical care to all detainees regardless of their disciplinary status, cooperation, or participation in a hunger strike. The healthcare provided to the detainees being held at Guantanamo Bay rivals that provided in any community in the United States. Detainees receive timely, compassionate, quality healthcare and have regular access to primary care and specialist physicians. The care provided to detainees is comparable to that afforded our active duty service members. All medical procedures performed are justified and meet accepted standards of care. A detainee is provided medical care and treatment based solely on his need for such care and the level and type of treatment is dependent on the accepted medical standard of care for the condition being treated. Diagnosis of such conditions and medical care and treatment for them are not affected in any way by a detainee's cooperation, or lack thereof, during an interrogation session. Similarly, medical care is not provided or withheld based on a detainee's compliance or noncompliance with detention camp rules or on his refusal to end a hunger strike. Medical decisions and treatment are not withheld as a form of punishment. Additionally, the medical staff has no involvement in discipline decisions made by detention personnel.
This DoD reesponse also neatly elides the Iacopino and Xenakis claims in another way in that it is written in the present tense and thus only applies to current practices. Yet Iacopino and Xenakis, by their methodology of examining medical records, are talking about past practices. The DoD "response" makes no claims whatsoever recording the appropriateness of past practices. It thus seems likely that some of those practices were indefensible, even by Defense Department spokespeople not usually noted for their truthfulness.
The Iacopino and Xenakis findings are entirely consistent with my experience reading medical files on one Guantanamo prisoner on whom I consulted. Despite claims that he had been subjected to abuse, and mental health symptoms consistent with abuse, there was no indication in the hundreds of pages I read that any health professional had made any attempt to find out if he had been abused or to document possible abuse. Rather, the mental heath staff seemed only interested in whether the prisoner might make a suicide attempt. Beyond that, his obvious anguish appeared to be of no interest to the psychologists and other mental health staff.
Further, the Guantanamo medical unit and the Obama Justice Department fought tooth and nail to prevent any independent examination of these records, much less of the prisoner himself. The prisoner's attorneys requested, and the habeas judge ordered, that the records be made available for examination by an independent psychologist, me, to determine if there was a possibility that mental health issues might interfere with the prisoner's ability to cooperate with his attorneys. The Guantanamo medical staff filed a declaration denying any need for independent evaluation. And the Justice Department appealed every step. First they opposed any access to records as too burdensome. Then they appealed access to more than the past few month's records. They appeared to objected to any scrutiny on principle, which in itself in a sign of inadequate transparency at Guantanamo and is the exact opposite of what should occur in an institution run by a democratic government. We cannot take the word of officials at an institution absent meaningful independent scrutiny that abuses and ethical lapses were, or are, absent.
The Iacopino and Xenakis paper contributes to existing evidence, including the questionable use of anti-malarial drugs, that Guantanamo healthcare was often problematic and deserves independent scrutiny. While the Bush and Obama administrations have made every effort to keep those records secret, health professionals should challenge that secrecy. We should demand that Guantanamo medical records be opened, with prisoner consent, to independent inspection. Further, all detainees desiring it should be able to receive independent medical evaluations.
Additionally, independent of the issues of possible abuse, the complete medical records of released prisoners should be made available to those prisoners and/or their current health providers. To suppress medical records for years of a person's life is unethical as it interferes with released individuals' ability to obtain required care in the present and the future. Health professionals from all disciplines should make clear that denial of access to their records by released prisoners is in simply unacceptable.