Red Cross Report on Medical Complicity With Torture of 14 "High Value" Detainees
In April of 2009, the Obama Administration complied with a Freedom of Information request by the American Civil Liberties Union and released four secret memos outlining the Bush Administration’s justification for various “interrogation techniques” that amounted to torture. These memos are available at the ACLU website. They are essential reading for Americans who want to understand what has been done in the name of our country.
Shortly after the release of these memos, New York Review of Book’s journalist Mark Danzer posted the entire text of the February 2007 report by the International Committee of the Red Cross regarding the interrogration of 14 “high value” detainees by the CIA. The report was published as part of two excellent articles (“US Torture: Voices from the Black Sites” and “The Red Cross Torture Report: What It Means“) written by Danzer.
The report is of particular interest to health care personnel because it details the alleged roles of medical personnel in the torture of the 14 detainees. Rather than summarizing the contents of the ICRC report, we excerpt below the entire text of Section 3 entitled: Health Provision and the Role of Medical Staff.
During the course of their detention, detainees described three principal roles for health personnel whom they encountered. Firstly, there was a direct role in monitoring the ongoing ill-treatment which, in some instances, involved the health personnel directly participating while certain methods were used. Secondly, there was a role in performing a medical check just prior to, and just after, each transfer. Finally, there was the provision of healthcare, to treat both the direct consequences of ill-treatment detailed in previous sections, and to treat any natural ailments that arose during the prolonged periods of detention.
Throughout the course of the initial phase of the detention, the ICRC received allegations that health personnel were directly involved in monitoring the health effects of ill-treatment. In some cases it was alleged that, based on their assessments, health personnel gave instructions to interrogators to continue, to adjust, or to stop particular methods. As with other personnel within the detention facilities, the health personnel did not identify themselves, but the detainees presumed from their presence and function that they were either physicians or psychologists.
For certain methods, notably suffocation by water, the health personnel were allegedly directly participating in the infliction of the ill-treatment. In one case, it was alleged that health personnel actively monitored a detainee’s oxygen saturation using what, from the description of the detainee of a device placed over the finger, appeared to be a pulse oxymeter. For example, Mr Khaled Shaik Mohammed alleged that on several occasions the suffocation method was stopped on the intervention of a health person who was present in the room each time this procedure was used.
Other detainees who were shackled in a stress standing position for prolonged periods in their cells were monitored by health personnel who in some instances recommended stopping the method of ill-treatment, or recommended its continuation, but with adjustments. For example, Mr Bin Attash (the detainee has had a right-sided below knee amputation) alleged that while being held in a form of stress standing position with his arms shackled above his head, and his feet touching the floor, had his lower leg measured on a daily basis with a tape measure by a person he assumed to be a doctor for signs of swelling; the health person finally ordered that he be allowed to sit on the floor, albeit with his arms still shackled above his head. Mr Hambali alleged that, after a period of the same form of prolonged stress standing, a health person intervened to prevent further use of the method, but told him that “I look after your body only because we need you for information”.
As well as the monitoring of specific methods of ill-treatment, other health personnel were alleged to have directly participated in the interrogation process. One detainee, who did not wish his name to be transmitted to the authorities, alleged that a health person threatened that medical care would be conditional upon cooperation with the interrogators.
The second alleged role of the health personnel was to perform a medical check prior to and after each transfer from one detention location to another. The purpose and results of this medical examination appear not to have been divulged to the detainees.
The third alleged role was to provide medical care to detainees, either for injuries resulting directly from the various forms of ill-treatment employed, or treatment for common ailments that arose throughout the course of the detention.
With regard to this third role, when such medical treatment was necessary it appears from the descriptions given that the care was appropriate and satisfactory. In two specific cases, detainees indicated that exceptional lengths were taken to provide very high standards of medical intervention.
Medical ethics are based on a number of principles’ which include the principle of beneficence (a medical practitioner should act in the best interest of the patient—salus aegroti suprema lex), non-malefiance (first do no harm—primum non nocere) and dignity (the patient and the person treating the patient have the right to dignity). These principles guide any relationship between a medical doctor and a person whom he or she is relating to as a medical doctor.
There are accepted roles for health professionals working in recognised, official, places of detention such as police stations and prisons wherein the health professionals have the health care and best interests of the detainee as their primary consideration.’ To this end, when a person enters an official detention facility or system, a medical assessment of their medical status is required in order to meet their current and ongoing health needs. In the case of a normal, lawful interrogation, a physician may be asked to provide a medical opinion, within the usual bounds of medical confidentiality, as to whether existing mental or physical health problems would preclude the individual from being questioned. Secondly, a physician may rightly be requested to provide medical treatment to a person suffering a medical emergency during questioning. This accepted role of the physician, or any other health professional, clearly does not extend to ruling on the permissibility, or not, of any form of physical or psychological ill-treatment. The physician, and any other health professionals, are expressly prohibited from using their scientific knowledge and skills to facilitate such practices in any way. On the contrary, the role of the physician and any other health professional involved in the care of detainees is explicitly to protect them from such ill-treatment and there can be no exceptional circumstances invoked to excuse this obligation.”
With the exceptions detailed in the above paragraph, any interrogation process that requires a health professional to either pronounce on the subject’s fitness to withstand such a procedure, or which requires a health professional to monitor the actual procedure, must have inherent health risks. As such, the interrogation process is contrary to international law and the participation of health personnel in such a process is contrary to international standards of medical ethics. In the case of the alleged participation of health personnel in the detention and interrogation of the fourteen detainees, their primary purpose appears to have been to serve the interrogation process, and not the patient. In so doing the health personnel have condoned, and participated in ill-treatment.
Commentary on the ICRC Report
Medical participation in torture has been discussed in several articles in the medical literature over the past several years. Stephen Mile’s 2004 Lancet article entitled “Abu Ghraib: its legacy for military medicine” pointed to multiple ill effects of medical participation in torture. These included damage to the reputation of the US Army and its medical corps as well as “[t]he eroded status of international law has increased the risk to individuals who become detainees of war since Abu Ghraib because it has decreased the credibility of international appeals on their behalf.“ Calls arose the same year for an investigation of doctors who had been involved in torture.
As of today no health care personnel have been prosecuted or lost their license to practice for these breaches not only of basic ethical principles, but also of international law. Of course, the problem does not reside in a “few bad apples” who did wrong, but rather in the larger system that was designed to torture and abuse. Medical personnel were one part of that machine.
In a 2003 chapter in the book Military Medical Ethics, Volume 1, Drs. Vic Sidel and Barry Levy argued that the concept of a physician-solider contained an irreconcilible ethical dilemma: that of divided loyalties or dual agency.
The overriding ethical principles of medical practice in our view are “concern for the welfare of the patient” and “primarily do no harm.” As we understand them, the overriding principles of military service are “concern for the effective function of the fighting force” and “obedience to the command structure.” Although there may be rare exceptions to these principles, they have been the fundamental bases of medical practice and military service over the centuries. In our view, the ethical principles of medicine make medical practice under military control fundamentally dysfunctional and unethical.
In making this critique Drs. Sidel and Levy were speaking of primarily physician-soliders who were caring for other soldiers. But the situation of the medical personnel operating at the CIA “black sites” is the ultimate expression of the problems of dual agency in military medicine.
More on the ICRC
This posting excerpts only a small portion of the ICRC report which is worth reading in full for its careful documentation of the conditions of detention in the CIA black sites. It is worth pointing out that the ICRC’s involvement in defending prisoners extends far beyond this report. The Committtee’s work can be appreciated on their website. Finally, the ICRC has provided some background in response to the publication of the report. The ICRC statement concludes with the following:
The ICRC is concerned that any information it divulged about its findings in places of detention could easily be exploited for political purposes. It deplores the fact that confidential information conveyed to the US authorities has been published by the media on a number of occasions in recent years. The ICRC has never given its consent to the publication of such information.
posted by Matt Anderson, MD
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