[T]he ‘healing hand’ can also be the ‘hurting hand.’

Albert Jonsen and Leonard Sagan
in THE BREAKING OF BODIES AND MINDS (Stover & Nightingale, 1985)

Why “health professionals” and not “doctors”?

Medical doctors, including psychiatrists and medical examiners, are health professionals, but so are psychologists and nurses. All of these professions have been implicated in the torture and abuse of prisoners in CIA secret prisons and in military detention centers, such as those in Guantánamo, Afghanistan, and Iraq. The term “health professionals” refers to anyone who is trained or licensed in a healing profession.

Do we know for a fact that health professionals participated in torture and cruel, inhuman or degrading treatment of prisoners?

Yes. For years, prisoners have alleged abuse by health professionals that amounts to torture and cruel, inhuman or degrading treatment (CIDT), and official documents, now being disclosed in steadily increasing numbers, confirm their accounts. For example, we know that the International Committee of the Red Cross – the legal body charged with ensuring compliance with the Geneva Conventions – reported to high-level U.S. administration officials on credible allegations of medically assisted torture in CIA detention. Most recently, declassified Justice Department memos and a bipartisan report issued by the Senate Armed Services Committee confirmed that psychologists and doctors were essential to rationalizing and carrying out the government’s torture policy. As New York State Assemblymember Richard Gottfried said, these papers

documented that [health professionals] … were involved ‘whenever’ these techniques were used. The Justice Department and the CIA made it clear that the program was – for legal and practical reasons – entirely dependent on the participation of health care professionals….The documents shatter any illusion that the physicians were somehow protecting the prisoners.

In the case of force-feeding, policymakers openly acknowledge and defend the involvement of health professionals in forcibly feeding hunger striking prisoners, but question instead the charge that the practice is illegal and unethical. The force-feeding program at Guantánamo conflicts with the World Medical Association’s Malta Declaration on Hunger Strikers, updated in 2006 specifically to address U.S. policy at the Naval Base prison.

How were health professionals involved in torture and cruel, inhuman and degrading treatment?

Among other things, health professionals:

• crafted abusive tactics and falsely legitimized their use;
• advised interrogators on methods of abuse that would exploit prisoners’ vulnerabilities;
• used medical procedures to harm prisoners;
• gauged pain and monitored interrogations that risked leaving prisoners in need of treatment;
• checked prisoners to certify that they were capable of surviving additional abuse;
• conditioned medical or mental health treatment on cooperation with interrogation;
• shared confidential patient information that was used to harm patients;
• covered up evidence of torture and abuse; and
• turned a blind eye to cruel treatment.

Click here for more information.

Did the abuse – and health professional involvement in it – end with the Bush Administration?

No. Even today, under President Obama’s watch, Guantánamo physicians, nurses and prison guards continue to forcibly feed hunger strikers through the use of a 6-point restraint chair and the brutal forceful insertion and removal of thick nasogastric tubes. For many of the men in GTMO, solitary confinement, sensory deprivation, environmental manipulation and sleep deprivation are daily realities that have led to severe mental and physical suffering. Camp officials have refused to acknowledge clear suicide attempts. Instead, they classify them as “manipulative self-injurious behavior,” downplaying injuries and, in some cases, mental illness. Unless forced by court order, President Obama has denied prisoners access to independent medical experts and often even to their own medical records. Instead, the men are left to the exclusive care of medical personnel whom they distrust and who have a record of grossly mistreating and mismanaging the mentally ill.  The Immediate Reaction Force (IRF), a team of military guards comparable to a riot squad, continues to beat men in response to allegations of disciplinary infractions and during unnecessarily brutal “cell extractions,” with no sign that health professionals are objecting to or reporting such abuse.  Click here for CCR’s Report on Current Conditions of Confinement at Guantánamo (January 2009).

It seems like many people were responsible. Why focus on health professionals, especially if they weren’t the ones at the very top?

Because holding these health professionals accountable is important to

• survivors of medically assisted torture.  The relationship between patients and health professionals is based on trust,  and torture survivors can feel particularly violated when those professionals participate in their abuse.  Some develop fear and mistrust of all health care personnel that leads them to avoid seeking the mental and physical treatment vital to their recovery.
• health professionals, most of whom take seriously their commitment to do no harm.  Torture by health professionals, particularly when not adequately addressed by the professional associations, ultimately corrupts the profession itself.
• the rest of us – as patients and members of civil society, we have a right to treatment by health professionals who we can trust, and a right to a government that upholds the law.

Elected officials relied heavily on both legal and health professionals to design and execute their torture program.  As CCR continues its campaign for the prosecution of the “torture lawyers,” it now adds health professionals to its call for accountability. Some health professionals did in fact hold positions of great responsibility.  Others worked lower down the chain of command, but the principles established for the Nuremberg Trials set the precedent that following orders is not a valid defense.   Additionally, widespread complicity does not absolve any one group or individual of responsibility.  On the contrary, when so many people are responsible, the importance of examining everyone’s role is paramount.  As sociologist Martha Huggins points out:

Systemic torture is fostered and perpetuated by actors and organizations inside and outside the local torture environment. The direct perpetrators of Abu Gharib [sic] torture— some guards and some interrogators, government and private—could not have serially tortured without a range of facilitators who provided organizational, technical, legal, and financial support for their violence.  In the immediate torture environment, facilitators included translators, medical doctors, nurses, medics, guards, and dog handlers, among many others. … Asking why someone would torture another therefore only explores a small part of the problem. Understanding that direct perpetrators’ violent actions can only occur within a system that includes facilitators and their organizations, makes it clear that facilitators are even more essential to the long-term stability and protection of a torture system than its more visible direct perpetrators.  [emphasis added]

Health professionals contributed to systematic torture by lending a stamp of legitimacy and scientific credibility to otherwise vile conduct. Their oath to do no harm affords them a particular respect and status in our society. Because of this, the public is often less inclined to believe that terrible things could happen at a prison staffed with health personnel. The Bush administration seemed keenly aware of this. Although government lawyers provided the legal cover, they used doctors and psychologists to pull off the abusive detention and interrogation program, using medical personnel to attempt to create a golden shield from liability. For example, according to the lawyers’ contrived logic in one memorandum, the crime of torture required specific intent to cause a prisoner severe pain or suffering. Under this theory, as long as medical officers were there, interrogators and policymakers could point to them as proof that causing severe pain or suffering was not their specific intent. The lawyers also explicitly relied on psychologists’ assessments that techniques such as suffocation by water (waterboarding), stress positions, and sleep deprivation did not cause “prolonged” mental harm.

Finally, when health professionals working in closed institutions become part of a system of abuse, those institutions lose their front line of defense against torture. Incorporating them into the machinery of harm is an effective and pernicious way to stop them from identifying and reporting torture. Resistance on the part of health professional societies – often influential civil society groups – can prove instrumental in countering that effect and undermining a torture regime.