The Punitive Use of Medical Restraints on Guantanamo Hunger Strikers

A partially redacted set of medical records released in the aftermath of the 2006 deaths of three Guantanamo prisoners shows that the use of "medical restraints" in the use of forced feeding of hunger striking detainees was used as a threat on hunger striking prisoners. At least one detainee was told over and over that use of "medical restraints" was due to his voluntary refusal to eat.

While Guantanamo medical authorities said the need for restraints was due to "medical necessity," such necessity was never documented. Instead, it was clear the use of restraints was punitive in nature.

The use of medical restraints in forced feeding, for which DoD uses a restraint chair, is not a normal procedure at other penal institutions. In a letter nearly one year ago from the Chair of the Senate Intelligence Committee, Sen. Dianne Feinstein, to Secretary of Defense Chuck Hagel, Feinstein noted, "When force-feedings do occur within the Bureau of Prisons, we have been told that nearly 95% of the time they are conducted with a fully compliant inmate requiring no restraints. At Guantanamo Bay, on the other hand, all detainees being force-fed—regardless of their level of cooperation—are placed in chairs where they are forcibly restrained." (Emphasis added.)

In the medical records (PDF) for Ali Abdullah Ahmed (ISN 693) in March 2006, a "Gitmo Nurse" noted in Ahmed's medical chart numerous discussions with the prisoner about his refusal to eat and the policy to feed him forcefully, a policy that insisted that the prisoner's behavior "must change":

Detainee placed in [redacted] Reason for Restraint: Medical Necessity [last two words are circled]

Detainee was advised by the Medical Staff that hunger striking is detrimental to his health. His behavior is due to his refusal to eat and not due to mental status change or illness. Medical Staff/Guards attempted to get the detainee to eat on his own. He is being offered food at every meal, yet he refuses to eat. Because the detainee refuses to eat, restraints were initiated for medical necessity for feeding. Detainee will be observed continually and he will be reminded of how his behavior must change (he must eat voluntarily) to avoid the use of medical restraints for present and future feedings. Detainee was told that he will remain in medical restraints until feed and post feed observation (60-120 minutes)

GITMO Nurse

Elsewhere in the medical notes (3/7/2006), the nurse states, "There is no evidence that medications or a medical process is causing this detainee's refusal to eat."

Other notes show that while Ahmed was kept in restraints, he remained under "Line of Sight Observation." Circulation checks were made every 15 minutes for the first hour, and then hourly thereafter. Vital signs were checked immediately after the restraints are attached, and every hour thereafter. The medical restraints order expired only after 12 hours. No reason why it is medically necessary to restrain the prisoner was ever given in the notes I saw. No evidence of opposition to the process of enteral feeding by Ahmed was ever described.

The policy of keeping Ahmed in medical restraints through his "post feed observation" was not consistent with the SOP for hunger striking as later revealed in the March 3, 2013 Standard Operation Procedure for hunger strikes and forced feeding obtained by Jason Leopold for Al Jazeera last year.

According to the portion of the policy titled "Chair Restraint System Clinical Protocol for the Intermittent Enteral Feeding of Detainees on Hunger Strike," "Medical restraints chair restraint system) should be used for the safety of the detainee, medical staff, and guard force.... Upon completion of the nutrient infusion and removal of the feeding tube, the detainee is removed from the restraint chair and placed in a 'dry cell'. The guard force will observe the detainee for 45-60 minutes for any indications of vomiting or attempts to induce vomiting."

But this is not what happened to Ahmed, who perhaps along with other detainees was kept as long as possible in a five point restraint chair, or possibly a restraint bed. The purpose of prolonging his restraints could only be punitive in nature, to teach him a lesson and get him to "change."

Only three months after the notes quoted above, Ahmed was one of three prisoners found supposedly hanged in their cells. The government maintains the three prisoners hanged themselves in an act of "asymmetrical warfare," but recent revelations by researchers at Seton Hall Law School (and Scott Horton at Harper's) show that the Naval Criminal Investigative Service (NCIS), charged with investigating the deaths, withheld crucial information from their report, hiding information about the deaths that came from witnesses and even the Senior Medical Officer on site which contradicted the government's own narrative.

The new information which has come to light argues that Ahmed and the two other men died with socks or rags stuffed down their throats, possibly part of an interrogation session meant to force the prisoners to turn informants for the CIA or the Department of Defense. The Senior Medical Officer (SMO) at Guantanamo who attended at least two of three high-profile “suicides” at Guantanamo concluded at the time that, contrary to the conclusions of the NCIS investigation, the detainees did not die by hanging but by “likely asphyxiation” from “obstruction” of the airway. His conclusion was never mentioned in the NCIS report, and later interventions by the Department of Justice prevented inquisitive congressional representatives from knowing that fact.

"The Torture Chair"

The secretive, abusive Guantanamo regime is under new scrutiny of its hunger striking procedures, thanks to a lawsuit by a Guantanamo prisoner.

According to Ben Fox at AP, attorneys for Guantanamo prisoner Abu Wa'el Dhiab have been viewing almost three dozen videotapes a federal judge ordered government authorities to turn over to the defense in Dhiab's appeal to stop his forced feeding. Dhiab is one of a number of hunger strikers currently refusing food at Guantanamo in protest of inhumane conditions and their indefinite detention.

Dhiab himself has been cleared for transfer or release from the Cuba-sited prison since 2009. The next hearing in his case is on June 18.

Due to a change in policy last December, DoD will not report the actual number of active strikers, or those refusing food, in what many believe was an attempt by authorities to reduce the political effectiveness of the prisoners' strike technique.

A lot has been written on the torture that is Guantanamo's forced feeding policy, which includes brutal beatings -- so-called Forced Cell Extractions (FCEs) -- to bring the hunger striking prisoner to a restraint chair, where he is strapped down and has liquid food put down a tube forced down his nose and into his stomach. The speed at which the liquid is forced down a prisoner's gullet is something defense attorneys have likened to the ancient "water cure torture."

The UN high commissioner for human rights, the World Medical Association, and other medical and human rights organizations have said forced feeding of prisoners amounts to torture.

In a June 3 filing by one of Dhiab's attorneys, Jon Eisenberg, wrote, Dhiab "does not object to being force-fed in order to keep him alive, as long as the force-feeding is 'civilized.' He states: 'I am willing to be force-fed in a humane manner.' His recent force-feedings, however, have not been humane. He asks: 'Is it necessary for them to torture me? Is it necessary for them to choke me every day with the tube? Is it necessary for them to make my throat so swollen every day? Do I have to suffer every day? Is it necessary for them to put me on the torture chair in order to feed me?'”

A new version of the Guantanamo SOP for use on hunger strikers, who are now called "Detainees With Weight Loss" on "long-term non-religious fasts," placed instructions on use of the restraint chair into its own new SOP. That document, like almost everything else at Guantanamo, is currently classified.

Cross-posted at FDL/The Dissenter