Detainee Testimonies on Psychologists' Complicity in Guantanamo Torture: "They were not there to help, but to harm"

Introduction

It has been brought to my attention that a group of psychologists at the American Psychological Association are attempting to overturn a ban on work by psychologists at Guantanamo. The ban, in effect only a year, was the result of controversy engendered after the release of the Hoffman Report (PDF), which claimed complicity by high officials at APA in facilitating abusive interrogations at Guantanamo and other military sites.

According to a statement just released by Psychologists for Social Responsibility, a professional group separate from APA, "Participants in this delegitimization campaign include key individuals directly involved in the documented collusion; several past presidents of the APA and past chairs of the APA’s Ethics Committee, most of whom served during the period of collusion; and the leadership of the APA’s military psychology division, which has long advocated for psychologist participation in specific operational roles that raise challenges for the profession’s do-no-harm standard."

The effort to overturn the ban is based on a contention that psychologist work at Guantanamo is humane and ethical. Below I will show by testimony from detainees themselves that the presence of psychologists has been anything but humane.

The Hoffman Report, which gave powerful impetus to those seeking to end APA support of psychologists working with national security interrogators (a member-initiated referendum to end such support was passed years earlier, but had little effect) was not without its flaws.

The report, whose chief investigator-author was a former associate of ex-CIA chief George Tenet, actually understated, if anything, the amount of complicity and ethical misdeeds by APA officials. Even worse, it downplayed collaboration by APA officials, including a number of past presidents, with the CIA's own interrogation program.

But the Hoffman Report did stimulate powerful reform efforts at APA. As a result, last summer a resolution was passed by APA's Council of Representatives that essentially called for removal of psychologists from Guantanamo or other sites of abusive national security interrogations. (Psychologists were pointedly allowed to continue working in any domestic prison sites where abuse might be taking place, such as a SuperMax prison, such policy being a concession, or sell-out, if you prefer, to certain internal APA critics.) And while no one knows exactly how many psychologists might still be left at Guantanamo, or how DoD could still find ways to use psychological knowledge and technique in nefarious ways at the Cuba-based prison and elsewhere, the new APA policy certainly put an obstacle in the way of government-sanctioned abusive interrogations and torture.

The new APA rule read:

It is a violation of APA policy for psychologists to conduct, supervise, be in the presence of, or otherwise assist any individual national security interrogation, nor may a psychologist advise on conditions of confinement insofar as those might facilitate such an interrogation. Furthermore, based on current reports of the UN Committee Against Torture and the UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, it is also a violation of APA policy for psychologists to work at the Guantánamo Bay detention facility, “black sites,” vessels in international waters, or sites where detainees are interrogated under foreign jurisdiction “unless they are working directly for the persons being detained or for an independent third party working to protect human rights” or providing treatment to military personnel.

The backers of the change in rules on psychologists at Guantanamo, which is being voted on as Resolution 23A at an APA Council meeting during the upcoming APA convention in early August, claim that there are no interrogations at Guantanamo any more. Indeed, in a December 31, 2015 James Risen article at The New York Times, a spokeswoman for U.S. Southern Command indicated "only voluntary interviews are conducted when a detainee asks to speak with American personnel."

As I noted in an article last January, "No one questions how, at a facility under total control by the military, with detainees kept under conditions of indefinite detention (which themselves constitute torture), such 'voluntary interviews' can be offered."

Recent U.S. Interrogation Abuse Involving Psychologists

Resolution 23A relies heavily on the supposed fact that torture was banned via Executive Order by President Obama, and that Congress has added the force of law to that ban with the McCain-Feinstein Amendment to the National Defense Authorization Act of 2015. The authors of the resolution didn't state HOW this U.S. policy assured torture was banned. But it has been amply documented that the method of interrogation was to be safeguarded by reliance on U.S. Army Field Manual (AFM) 2-22.3 on interrogation, or, in Pentagon bureaucratese, "Human Intelligence Collector Operations."

But the report of the United Nations Committee on Torture panel, reviewing U.S. interrogation practices in late 2014, found the AFM's Appendix M, and in particular its sleep limitations or deprivation, amounted to use of "a form of ill-treatment." Moreover, a procedure known as "field expedient separation" could “create a state of psychosis with the detainee,” and raised UN concerns over use of torture via the Army Field Manual. UN officials who monitor the torture treaty to which the U.S. is a signatory called for the U.S. “to review Appendix M of the Army Field Manual (AFM) in light of its obligations under the Convention.”

But U.S. officials have defended the AFM, and reviews of Appendix M were put off for another three years by Congressional fiat. This is how things stand, even though the UN official review was if anything too soft on U.S. interrogation practice in the Army Field Manual. See here for a fuller critique. For examples of how Appendix M works in practice, see a recent article by Ali Watkins and Aram Roston at Buzzfeed, which includes links to numerous released documents on Appendix M usage. These documents show that the Obama administration was using Appendix M interrogations into at least 2012. These interrogations directly rely upon presence of medical and mental health personnel, like psychologists, because they are so dangerous.

One could go on and on with this subject. For instance, last summer it was reported that psychologists continued to be part of the forced feeding procedures used by Guantanamo officials. The testimonies reproduced later in this article also reveal the little-noted fact that psychologists also participated in the violent forced cell extractions at Guantanamo. Why could they have been there? Were they recording detainee responses as some perverted kind of research?

Deceased Guantanamo detainee, Adnan Latif, described to his attorney the forced cell extractions he endured at Guantanamo: "I was hurt badly by the IRF teams. Imagine that one night, from sunset until six in the morning, they entered my cell fifteen times. During those times, they tied me to a stretcher and carried me to the clinic in camp five then returned me back to my cell. They repeated that fifteen times until I lost my mind; they broke my bones and made me bleed. This also happened on the second day when they entered my cell ten times hitting my head against the wall and dragging me on the floor and leaving me there in the middle of the cell which was full of water, urine and feces. I was left in this dirty mixture all day with my hands tied firmly behind my back."

Fostering "Anxiety and Dislocation"

The opponents to a psychologist ban at Guantanamo ask in Resolution 23A that APA resolve (bold italics added for emphasis) "in keeping with Principles A and D of the [APA] Ethics Code, [that] military and national security psychologists will be recognized as providers of psychological treatment to military personnel at detention settings, as well as to any other individual or group in need of psychological care, including detainees. Current APA policies (i.e., the first paragraph of Statement 1 of the 2013 policy and the “be it resolved” clause of the 2008 Petition Resolution policy, Psychologists and Unlawful Detention Settings with a Focus on National Security) will be changed accordingly...."

It has always been the contention of the so-called national security psychologists and their supporters that psychologists at Guantanamo and other like detention sites are humane and tend to the needs of detainees when the are under their care. But, as an internally circulated document of defense of current APA policy notes, "Therapy at these sites is inevitably compromised. Recently released policy documents make it clear that the therapists at the [CIA] black sites were not allowed to offer therapy that could 'undermine the anxiety and dislocation that the various interrogation techniques are designed to foster.' In other words, the therapists were prohibited from alleviating the distress caused by interrogators."

Crucially, there exist multiple detainee testimonies which strongly support the contention that psychologist actions at Guantanamo have been anything but therapeutic. Oddly, it seems no one in the press or academia has made a compendium of detainee charges of abuse by psychologists, so I offer the following list as an initial attempt to document in one place such charges. Of course, I do not claim this list is exhaustive. Indeed, I hope others add to it. In the meantime, I hope this list makes it into the hands of APA Council members and other interested parties who may be considering sending APA backwards on the torture issue, rather than forwards.

Detainee Testimonies of Torture by Psychologists at Guantanamo

Testimony 1 - In this first testimony, we see that psychologists are accused of foisting medications on detainees. Normally, psychologists, who are not medical doctors, cannot prescribe medications. But the Pentagon some years ago began a program to train psychologists to prescribe medications, and hence the allegations here that psychologists are giving medicine to detainees is not a matter of confusion by a detainee between a psychologist and a doctor-psychiatrist. The APA had long been supportive of programs to train psychologists to prescribe medications. See this Feb. 2003 article by APA, "Psychology's first prescribers: DoD-trained psychologists have been paving the way so that others might one day prescribe."

Testimony to Witness to Guantanamo (Khaled Ben Mustafa):

"Ultimately, there is no use in seeing a psychologist because he is just going to listen to you and then he will prescribe some medicine. We all know what the problem is; it isn't going to be fixed with medicine. The psychologist knows the problem; he knows what's wrong with you. So, there is some hypocrisy behind all this, because everyone knows what the problem is; it isn't hard to figure out. When you see the living conditions in Guantanamo, you know what the problem is. So, he is going to listen to you; he is going to give you medicine. But he too is an accomplice in the system. You know what I mean? In Guantanamo, everyone you met, they were all part of the system. One cannot trust anyone in Guantanamo; not anyone, because they are all on the same side. They are all fine with the system."

Testimony 2

Youssef

Summary of a medical examination of former Guantánamo prisoner Youssef (not his real name).54 This examination was carried out under the auspices of Physicians for Human Rights by a team consisting of a physician and apsychologist/psychiatrist. The summary is taken from pages 56-61 of the Physicians for Human Rights' report Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and its Impact, published in June 2008.

While in Camp Delta, Youssef asked to speak with a psychologist because he was distressed, and the two spoke about him missing his family and his feelings of sadness. Although Youssef believed the meeting was confidential, he stated that shortly after the psychologist left, he was brought to an interrogator who immediately brought up information connected to his disclosures, such as telling him that he was going to stay at Guantánamo for the rest of his life and discussing his family (“Don’t you want to leave this place and get back together with your family?”...If you do as we tell you, you can get back to your family.”). He stated, “I figured out the reason they had called me for the interrogation was because the psychologist had told them about the meeting.” He stated, “They were stressing these fears very much.” Following this interrogation, Youssef reported that he was moved to the “worst” section in Camp Delta, where he was not allowed to have a blanket or a mattress.

Testimony 3

Testimony to Witness to Guantanamo (Haji Mohammed Ayub)

And then they called probably 20 or 30 guards to come and forcefully get him out. So he said, “I’m not coming out.” He was stubborn. He went on his bed and laid down there. He just laid on his bed. And the person who is not resisting the fight, or he’s lying quietly on the bed…They came in and they sprayed him. They sprayed the block with a gas. And then sprayed him and all that. And he was getting nauseated with that. And they sprayed some chemical on the dishtowel and then put it on his face, rubbing it on his face, putting it on his mouth. Actually the 20 or 30 guards, there was a psychologist, and then the person in charge and translator—everybody was there. They beat him up and they dragged him out of his cellblock. They got him all undressed, took all of his clothes off. He was only wearing underwear. And then he was trying to spit on the guards and he was trying to fight but he was all shackled up. They tied him up. And there were so many people around him, and he was just fighting. He says, “I tried to spit, it’s not going to reach them, but I was just fighting and spitting on people.” And the psychiatrist said, “He is going crazy. He is mentally…he is not stable. So we need to put him in the mental block.” The place where they keep all the people who have mental problems.

Testimony 4

Witnessing Guantanamo: Transcription of Salim Mahmoud Adem's Interview
Interviewer: Amy Goodman
Interviewee: Salim Mahmoud Adem
Interpreter: Isma'il Kushkush
Date of interview: 31 May 2008
Place of Interview: UC Davis (via videoconference with Sudan)

AG: Did you know any, did you meet any psychologists there?

SMA: I did not meet any because we had certain situations. Some accepted to take medicine from psychologists that they were told was medicine, but they gave them drugs, and one would be passed out and in a state of addiction for a long period of time. Many of the prisoners--the psychologists were the ones that tortured them with medicine because they don’t speak during interrogation.

AG: What kind of medicine?

SMA: But I saw my neighbor, who was from Uzbekistan, they would inject into him, and he would sleep for three or four days on the metal in the cell, and then after that he became addicted. His name is Abu Bak [phonetic spelling]. And then Abdurahman from Afghanistan and Sultan al-Joufi from Saudi Arabia, and Yaghoub [phonetic] and Koleidad [phonetic] from Kazakhstan, Koleidad [phonetic] from Afghanistan, and others from Pakistan, and Dr. Eymen [phonetic] from Yemen who was a surgeon...

AG: What about all of them?

SMA: All of them became addicted to the injections. Yaghoub, from Kazakhstan, left Guantanamo, and he became insane.

AG: Where were they injected?

SMA: In their arms or thighs, most in their arms. Once he was injected, he would sleep for days. He would eat and then sleep. He would eat and sleep. This injection might be monthly or semi-monthly. What I saw, one who left before me – Guantanamo before me – was in the chamber who became completely insane, and despite that they would punish him harshly. And because of all of this, we all became afraid of dealing with psychologists. Recently, when I was transferred to the sixth prison [Camp 6?], isolation, it was very cold and [there] were bright lights. We were cut off from the world, a great wall like the Wall of China, and we could not see the sun. Even if they took us to walk out, this room that we are in right now is much bigger than it. Two could barely walk in it.

During this period they would bring psychologists to look at us monthly, and one would come in and say, ‘Do you want to speak to a psychologist?’ And he would come with a translator. People were on guard from psychologists because they lost their specialty as doctors.

Testimony 5 - this example is interesting because it provides multiple testimony to something I didn't know: that psychologists would be present at Forced Cell Extractions (see also Testimony 3 above) - also if you read the entire KSM interview linked below, one will see that psychiatrists were also engaged in some pretty strange abusive stuff;\.

Testimony from Khalid Sheikh Mohammed as part of Military Commissions

Q. Now, as a result of your experience with her, have you met with any other psychologist or psychiatrists?

A. The two after her that they -- I met with them because they forced -- they came to my cell and forced cell extractions and take me medical room. They met with me and talked with me, but I didn't request to talk with them at all because I didn't have issue.

Testimony 6

Witnessing Guantanamo: Transcription of Adel Hamad's Interview

Interviewer: Amy Goodman
Interviewee: Adel Hamad
Interpreter: Isma’il Kushkush
Date of interview: 31 May 2008

AG: Did you ever meet a doctor or a psychologist at Guantanamo?

AH: There were many psychologists, and they are the ones that caused mental illness for us because they don't use them as psychologists, but to destroy our spirits.

AG: Can you give an example, and did you ever learn anyone's name?

AH: An example -- a colleague was suffering from a headache, so we told the authorities that, "This person has a severe headache." So the psychologists came and told him that, "Are you suffering from sleep deprivation? Are you seeing things?" So the psychologists were the first doctors to come to the prisoners. But the normal doctor would not come that easily. So they would say things like, "You were possessed," but we would say that these guys are not possessed, but the doctors are the ones that are possessed.

AG: Did you remember any doctor's name?

AH: They have no names. Not the doctors or the interrogators, they have borrowed names. They have numbers.

AG: Did they have any name on their uniform?

AH: They had a military uniform. It would say "Doctor" and, with a number. And the military rank.

Testimony 7

An Interview With Former Guantanamo Detainee David Hicks
Truthout
By Jason Leopold
February 16, 2011

TO: Did you ever meet separately with a psychologist or psychiatrist when at Guantanamo, for ostensibly psychological reasons, either a psychological test or assessment, or for supposed treatment of any sort?

DH: No, but they did approach me occasionally during the last year or so I spent in GTMO to see if I would talk and cooperate. Apart from their contributions in interrogations they were always lurking in the background, waiting to "help a detainee," but to really act as another prong to interrogation. If a detainee even whispered for such medical intervention a "mental health expert," would appear with a pocket of unknown medication and a long list of probing questions. They were not there to help, but to harm. We knew this and so I always refused to speak with them when they offered. If I did speak with them, such as the period when I eventually, after two years, had limited access to a lawyer for example, the questions would have been centered on how I intended to defend myself and any court actions I was considering. All they wanted was information, or to find a new way to defeat you.

TO: Were psychologists and/or medical professionals present at all interrogations? Were the interrogations ever stopped to check your heart rate and/or pulse?

DH: The major physical beatings I endured occurred in Afghanistan, during transportation and en-route to GTMO. During those sessions, one was around 10 hours, my vital signs were checked often. In GTMO medical personnel were not in the same room as me during actual interrogations but from my understanding they were monitoring my interrogations from behind the one way glass in Camp Delta. For other detainees, such as those being shocked or water boarded, medical personnel were present, or if drugs were being administrated during interrogation as I describe in my book when they extracted false confessions from one of the UK detainees. They were present when I was injected in the spine, but that experience is one that I don't like to talk about.

I credit the great resource of The Guantanamo Testimonials Project at Center for the Study of Human Rights in the Americas, headed by Prof. Alermindo Ojeda, for my ability to quickly find relevant information on the detainee testimonies.

Please feel free to reproduce and post this article. I only ask that a link be provided back to this original post. - Jeffrey Kaye, Ph.D.

Gitmo board refuses to release 'mistaken identity' prisoner after 9 years without lawyer

Reproduced below is a press release from the international human rights organization, Reprieve. It concerns the latest decision of President Obama's instituted Periodic Review Board (PRB) at Guantanamo. The unjust PRB has existed for years, the policies supported by the new Democratic Party presidential presumptive nominee, Hillary Clinton. Obama, who promised to close Guantanamo at the beginning of his term and has reneged on that promise, has after nearly 8 years stepped up the pace of release of prisoners from the torture camp at the U.S. naval base seized from land in Cuba decades ago.

After nine years held at Guantanamo without charges, Haroon Gul, aka Haroon Al-Afghani, who was one of the five last prisoners to arrive at Guantanamo, was finally allowed to meet with an attorney for the first time three days before his PRB hearing! His attorney, Shelby Sullivan-Bennis told medium.com what little he could about his client:

Very little is known to the world about Haroon, and secrecy laws currently ban me from filling in the blanks. What I can say is that he is every bit as heartbroken by the senseless violence in Orlando as I am, and presented for his Monday meeting with tears in his eyes.

According to the Reprieve website:

Haroon Gul is an 33 year-old Afghan citizen who has been held without charge or trial by the US government at Guantanamo Bay since June 2007.

For nine years, Haroon did not have legal representation....

Haroon was raised in a refugee camp in Pakistan, after violence in Afghanistan forced his family to flee their home there. Despite the disadvantages of his upbringing, Haroon was able to educate himself through the college level. He provided for his family by working as a trader in the local marketplace, selling household goods to other refugees.

With an economics degree and fluency in four languages, Haroon had just managed to rise above his difficult circumstances when he was captured by Afghan forces during a business trip to Afghanistan, and passed to the U.S.. He was rendered to Guantanamo Bay in 2007.

According to a January 2016 investigation at Al Jazeera, the U.S. claims "was a senior member of Hezb-e-Islami Gulbuddin, (HIG), an Afghan insurgent group led by Gulbuddin Hekmatyar, a warlord who helped end the Soviet occupation in the country." He was "also said to have been a courier for alleged senior Al-Qaeda operations planner Abd al-Hadi al-Iraqi, who was also transferred to Guantánamo from CIA custody in 2007."

But Al Jazeera investigators Sami Yousafzai and Jenifer Fenton dug deeper and found that the U.S. claim came "from just one source, identified in JTF-GTMO report footnotes as TD-314/08910-07, a CIA report serial number. The information comes from an unidentified human source. The -07 denotes the year 2007."

With a single informant or claim, Haroon was held essentially incommunicado at Guantanamo! Yousafzai and Fenton's reporting makes a strong case that the Afghan detainee was a victim or mistaken identity, or even a victim of some local jealousy. When he was finally allowed after many months to communicate with his family, who had no idea where he was, he wrote to them, "I am in Gitmo. Pray for me... I am OK." Family members had to wait six months before the next communication.

We don't know what was done to Haroon inside Guantanamo, but we do know that the regime inside Guantanamo was tortuous, and that indefinite detention itself is a form of torture. According to the organization Physicians for Human Rights, indefinite detention in prison places individuals at unreasonable risk of serious and long-lasting psychological and physical harm. (See full report here.)

Recently, I've shown, via documents released by The Washington Post, how when the CIA contracted with James Mitchell and Bruce Jessen for their "enhanced interrogation" program, the torture was inflicted on prisoners in part in order to get them to agree to become double agents for the Americans. We do know that when one family member was allowed to see Haroon, according to Yousafzai and Fenton, the Afghan prisoner "looked older than his age, he was complaining of headaches, and he had dark circles around his eyes."

What follows below is the Reprieve press release:

A little-known Afghan prisoner has been refused clearance to leave Guantánamo Bay, despite an apparent case of mistaken identity by the U.S. government.

Guantánamo's Periodic Review Board (PRB) ruled this week that Haroon Gul, 33, must continue to be detained indefinitely without charge or trial because his plan for what he would do post-release was insufficient. The Board also seemed unimpressed by Mr. Gul's insistence that the government's allegations against him are false.

The Board's hearing was the first time in nine years that Mr. Gul has been given the opportunity to defend himself. Yet the process was inadequate and unfair. Neither Mr Gul's attorney nor his military representative were allowed to discuss the allegations with him under attorney-client privilege, nor was he given the chance to rebut the classified allegations against him before the Board.

Mr Gul, who has never been charged nor received a trial since arriving at Guantánamo Bay in 2007, was originally passed to the US military by local Afghan forces, according to a report by Al Jazeera. His wife and young daughter now live in a refugee camp, the report says, but little more is known to the world about him.

Mr. Gul has previously had no defense attorney during his nine years at Guantanamo, despite his desperate and persistent attempts to find one. He was represented at his Periodic Review Board hearing by Reprieve U.S. attorney Shelby Sullivan-Bennis, who met him for the first time only four days before the hearing.

His file will become eligible for review in six months time.

Commenting, Reprieve U.S. attorney Shelby Sullivan-Bennis said:

"We have reason to believe that Haroon is one of the many proven cases of mistaken identity, but without a lawyer, he had no capacity to challenge his detention in federal court, as others did. He was given less than three hours out of the last nine years to prepare with an attorney for this hearing that determined his fate. This is status-quo justice in Guantánamo.

"When I met this bright-eyed, chatty young man I was blown away by his attitude. He was smiling and laughing and making American cultural references that even I didn't get.

"This denial is slap in the face to Haroon's persistent efforts to toe the line the government has drawn for its prisoners. Haroon has learned English from scratch; he learned math and science and computers; he has played soccer with fellow detainees and been kind to the guards that lock his cage at night. To this day, he says he does not understand why he's in there. 'Why me?' But day after day he makes the very best of his situation and treats those who have wronged him charitably.

"Haroon is not a bad man, Haroon is not even an irritable or ill-tempered man. He is a man who was tortured into speaking against himself and held captive by my government for nine years without an attorney.

"The allegations against our clients in Guantánamo, to this day, include information that the government admits is wrong. We are still relying on this torture-evidence to keep men hundreds of miles from their families for years on end.

"I went to law school to be a part of the American justice system, but in Guantánamo, I cannot find it."

How the Press, the Pentagon, and Even Human Rights Groups Sold Us an Army Field Manual that (Still) Includes Torture (updated)

I'm marking the 12th anniversary of the abomination that is Guantanamo with a couple of repostings related to how the Bush administration, with the connivance of key members of the press and the human rights community, sold a continuation of torture as an end to torture.

Such a reposting seems necessary as the entire press, human rights groups, and blogging world continues to ignore the ongoing issue of torture via interrogations. While indefinite detention, forced cell extractions aka beatings, and the painful forced-feeding of hunger strikers still garners attention, and rightly so, the fact the U.S. continues to have an official policy of torture in its interrogation manual continues to be ignored, even though it is the most important issue about torture facing America today.

Eschewing the worst-looking forms of torture, like waterboarding, in 2006, at the same time that "high-value detainees" like Khalid Sheik Muhammad and Abu Zubaydah were transferred out of the CIA black sites and sent to Guantanamo, the U.S. put out a new Army Field Manual (AFM) with instructions on interrogations that claimed to be "humane."

Origin of AFM Rewrite Out of Ashes of Abu Ghraib Scandal

Only recently have I found the possible origin of the new AFM's drafting in the August 2005 recommendations of a Joint Chiefs of Staff panel subsequent to the military investigations into the Abu Ghraib scandal. (See pg. 315-16 of this document.)

Recommend a policy-level review and determination of the status and treatment of all detainees, when not classified as EPWs [Enemy Prisoners of War]. This review needs to particularly focus on the definition of humane treatment, military necessity, and proper employment of interrogation techniques. (e.g. boundaries or extremes)....

Recommend study of the DoD authorized interrogation techniques to establish a framework for evaluating their cumulative impact in relation to the obligation to treat detainees humanely.

The study of "authorized interrogation techniques" was tasked to the Undersecretary of Defense for Intelligence, Stephen Cambone.

But a number of the new techniques that ultimately showed up in the newly written AFM were not humane at all. In fact, they amounted to torture and/or cruel, inhumane and degrading behavior. Over the years various human rights groups recognized this and came out publicly for changes to the AFM. (See here, and here, and here, and here, and here.)

The AFM made changes to its text that allowed wider latitude in use of drugs in interrogations, while eliminating prohibitions against sleep deprivation and stress positions that had been in the pre-2006 AFM. Even worse, a category of prisoners that were not considered subject to Geneva Convention POW protections was singled out for a special kind of interrogation "technique," as described in the manual's Appendix M.

Appendix M allowed for use of isolation for 30 days, and potentially indefinitely; sleep deprivation for up to 30 days, but potentially indefinitely; manipulation of environment and diet (so long as it wasn't "extreme"); and forms of sensory deprivation, so long as every form of sensory input wasn't affected.

There was very little interest in whether or not or how these new techniques were being used. In fact, no one had apparently even thought to ask the government until I did in January 2010 whether or not Appendix M had even been used. Not surprisingly, the Department of Defense confirmed it was using Appendix M interrogations at Guantanamo.

More surprising was my discovery, confirmed by a DoD spokesman, that the use of the Appendix M torture techniques was approved in a Bush-era Office of Legal Council memorandum, and left in place by the Obama administration despite claims that all such memos were withdrawn in January 2009. Even to this day, in a massive political failure, not one human rights group or legal organization has recognized this fact.

The Torture Never Stopped

Intense abusive interrogations continue. We know from a filing by Omar Khadr in his Canadian court case that prior to release from Guantanamo to Canadian authorities, and shortly after his plea deal with Military Commissions authorities in October 2010, Khadr was subjected to prolonged interrogation that likely was conducted, given the key presence of the use of isolation, to Appendix M parameters: "Following the Pre-Trial Agreement, the Americans transferred Omar to a maximum security detention facility restricted for prisoners convicted of offenses. Omar was thrown back into solitary confinement and continued to be subjected to months of prolonged interrogations consisting of a sequence of 9 hours of interrogation per day for 9 days at a time."

With an even dozen years of crimes at Guantanamo -- fully over 1/3 of them under the auspices of the Obama administration -- I think it's time to review just how consensus around torture takes place in actuality. As we shall see, it is a complex story, involving media manipulation, psychological effects such as denial, and subordination of human rights to party politics and an achingly slow platform of reformist change. I say "consensus" because silence about all this amounts to consensus.

The following was published at Alternet and my own blog, Invictus, in January 2009. (My first writing recognizing torture in the AFM goes back to the introduction of the new manual in September 2006, when I wrote under my pseudonym Valtin.) In a day or two, I will publish part two, which will look at how the foreign press saw through what DoD was doing, and how a major blogging news and opinion site helped cover that up.

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How the Press, the Pentagon, and Even Human Rights Groups Sold Us an Army Field Manual that (Still) Includes Torture

A January 17 [2009] New York Times editorial noted that Attorney General designate Eric Holder testified at his nomination hearings that when it came to overhauling the nation's interrogation rules for both the military and the CIA, the Army Field Manual represented "a good start." The editorial noted the vagueness of Holder's statement. Left unsaid was the question, if the AFM is only a "good start," what comes next?

The Times editorial writer never bothered to mention the fact that three years earlier, a different New York Times article (12/14/2005) introduced a new controversy regarding the rewrite of the Army Field Manual. The rewrite was inspired by a proposal by Senator John McCain to limit U.S. military and CIA interrogation methods to those in the Army Field Manual. (McCain would later allow an exception for the CIA.)

According to the Times article, a new set of classified procedures proposed for the manual was "was pushing the limits on legal interrogation." Anonymous military sources called the procedures "a back-door effort" to undermine McCain's efforts at the time to change U.S. abusive interrogation techniques, and stop the torture.

A Forgotten Controversy

Over the next six months or so, a number of articles in the New York Times, the Washington Post, and the L.A. Times described the course of the controversy. By mid-June 2006, the NYT was reporting that, under pressure from unnamed senior generals and members of Congress (including McCain, and Senators Warner and Graham), the Pentagon was rethinking its plan to have a classified annex to the AFM, which would include a different set of interrogation rules for "unlawful combatants," like the detainees at Guantanamo. Included in the discussion about these classified procedures were, reportedly, members of the State Department and various human rights organizations.

According to an article in the L.A. Times, this latest fight over the classified procedures went back at least to mid-May 2006. The manual itself had been written at the U.S. Army Intelligence Center at Ft. Huachuca, Arizona, roughly a year earlier, and then sent to the Pentagon for further evalution. Secretary of Defense Donald Rumsfeld's right-hand man, Stephen Cambone, was put in charge of its final draft. According the L.A. Times article, members of Congress were "keen to avoid a public fight with the Pentagon." The announcement that the controversial and still unknown procedures might not be included in the manual was seen as a success by human rights groups.

Yet the proverbial chickens never hatched, and by early September 2006 the new Army Field Manual was finally released. The section on special interrogation procedures for "unlawful combatants" was included as a special appendix (Appendix M), and published in unclassified format. According to a L.A. Times story on September 8, Cambone was crowing that the new Army Field Manual instructions would give interrogators "what they need to do the job." The article noted:

The new manual includes one restricted technique that will only be used on so-called unlawful combatants – such as Al Qaeda suspects – not traditional prisoners of war.

That technique, called “separation,” involves segregating a detainee from other prisoners. Military officials said separation was not the equivalent of solitary confinement and was consistent with Geneva Convention protections.

As for the proposed secrecy surrounding the new techniques, the Pentagon had decided it couldn't keep them secret forever. Senator Warner was also on record as against any classified annex to the manual.

Not long ago, I wrote about what was included in Appendix M, which purports to introduce the single technique of "separation." In fact, the Appendix M includes instructions regarding solitary confinement, sleep deprivation, sensory deprivation, and, in combination with other procedures included in the Army Field Manual, amounted to a re-introduction of the psychological torture techniques practiced at Guantanamo, and taught by Survival, Evasion, Resistance, and Escape, or SERE psychologists and other personnel at the Cuban base and elsewhere.

The rewrite of the Army Field Manual included other seemingly minor changes. It introduced dubious procedures, such as the "False Flag" technique, wherein interrogators could pretend they were from another country. It also redefined the meaning of "Fear Up," a procedure meant to exploit a prisoner's existing fears under imprisonment. Now, interrogators could create "new" fears. The AFM rewrite was a masterpiece of subterfuge and double talk, which could only have been issued from the offices of Rumsfeld and Cambone.

One would think this turnaround of the Pentagon's position regarding a removal of these controversial procedures would have been a matter of some note. But there was no protest from Congress, no mention of the past controversy in the press, and only vague comments at first and then acceptance by human rights organizations like Amnesty International and Human Rights Watch. Only Physicians for Human Rights protested the inclusion of the techniques listed in Appendix M. For the rest... silence.

[Author's Note, 1/13/2014: By 2009, Amnesty International had clearly come out against Appendix M, as we can see at this posting. In 2010, Open Society Foundations, Human Rights First and Human Rights Watch signed a letter to the Pentagon, along with other groups, asking for the removal of Appendix M. The letter stated, "we are concerned that Appendix M creates a legal precedent that may be used in the future by othergovernments to justify abusing captured U.S. personnel. As we make clear above, Appendix M can be interpreted to allow serious abuse, including months of abnormal sleep deprivation.]

DoD Rolls Out the New Model

On September 6, 2006, a news briefing was held by the Department of Defense, as part of the unveiling of the new Army Field Manual, in conjunction with the then-new Defense Department Directive for Detainee Programs (DoD Directive 2310.01E). Deputy Assistant Secretary of Defense for Detainee Affairs Cully Stimson and Army Deputy Chief of Staff for Intelligence (G-2) Lt. Gen. John Kimmons were the DoD presenters.

Much of the belief that the AFM provides an improvement over previous policies of the Department of Defense is likely due to a confusion between the two documents introduced that summer of 2006, the new Detainee Program Directive and the new Army Field Manual.

DoD Directive 2310.10E made a number of changes in regards to detainee operations and management. It made clear that "All persons subject to this Directive shall observe the requirements of the law of war, and shall apply, without regard to a detainee’s legal status, at a minimum the standards articulated in Common Article 3 to the Geneva Conventions of 1949..." The same type of language appears in the text of the Army Field Manual itself.

During the press briefing on September 6, and a different one the next day for the foreign press, reporters were not so easily fooled.

One unnamed reporter at the DoD briefing challenged Lt. Gen. Kimmons on the "single standard" issue:

Q General, why was the decision made to keep these categories -- the separate categories of detainees? You have traditional prisoners of war and then the unlawful enemy combatants. Why not treat all detainees under U.S. military custody the exact same way?

Kimmons's answer gives us insight into the kind of convoluted legal thinking that went into the Pentagon's rationale for the acceptability of coercive interrogation -- for some (emphasis added):

GEN. KIMMONS: Well, actually, the distinction is in Geneva through the Geneva Convention, which describes the criteria that prisoner -- that lawful combatants, such as enemy prisoners of war -- which attributes they possess -- wearing a uniform, fighting for a government, bearing your arms openly and so on and so forth. And it's all spelled out fairly precisely inside Geneva.

Geneva also makes clear that traditional, unlawful combatants such as in the -- 50 years ago, we would have talked about spies and saboteurs, but also now applies to this new category of unlawful -- or new type of unlawful combatant, terrorists, al Qaeda, Taliban.

They clearly don't meet the criteria for prisoner of war status, lawful combatant status, and so they're not entitled to the -- therefore to the extra protections and privileges which Geneva affords.

But Kimmon's clarification was not very helpful. In fact, if a prisoner is judged not a "lawful combatant", then he or she immediately becomes covered by Geneva IV, the "Civilian Convention," which protects anyone "who, at a given moment and in any manner whatsoever find themselves" held prisoner. According to the International Red Cross Commentary on the Geneva Conventions:

Every person in enemy hands must have some status under international law: he is either a prisoner of war and, as such, covered by the Third [POW] Convention, [or] a civilian covered by the Fourth Convention.... There is no intermediate status; nobody in enemy hands can fall outside the law.

Separation and Sensory Deprivation

One questioner took on the topic of the "Separation" technique. Wasn't it the same as solitary confinement, and wasn't solitary confinement "banned by Common Article 3 in the affront to human dignity, other provisions? "Are you confident," a reporter asked, "that separation is permitted under Common Article 3?"

The Deputy Assistant Secretary of Defense for Detainee Affairs responded by denying that separation amounted to solitary confinement, even though the AFM describes the technique as, among other things "physical separation" "limited to 30 days of initial duration." Extensions for such physical separation must be reviewed and approved the General Officer or Flag Officer who initially approved the original "separation."

Kimmons' reply was even more disingenuous:

We have always segregated enemy combatants on the battlefield at the point of capture and beyond, to keep them silent, segregate the officers from the enlisted, the men from the women, and so forth. That's traditional; it goes back to World War II and beyond.

So, is "separation" a matter of segregating prisoners, or what? In the Army Field Manual itself, one gets that same kind of double talk. At first it is presented thus:

The purpose of separation is to deny the detainee the opportunity to communicate with other detainees in order to keep him from learning counter-resistance techniques or gathering new information to support a cover story; decreasing the detainee's resistance to interrogation.

This description sounds a lot like segregation for security purposes, although there is that phrase "decreasing the detainee's resistance." A page or so later, however, we find the following (emphasis added):

The use of separation should not be confused with the detainee-handling techniques approved in Appendix D [Guide for Handling Detainees]. Specifically, the use of segregation during prisoner handling (Search, Silence, Segregate, Speed, Safeguard, and Tag [5 S's and a T]) should not be confused with the use of separation as a restricted interrogation technique.

Furthermore, we learn that "separation" requires an interrogation plan, and medical and legal review, as well, of course, as "physical separation." If this is not solitary confinement for the purposes of breaking a prisoner down for interrogation, then the English language has lost all purpose in explaining things.

Another line of questioning took on the AFM's contention that it banned sensory deprivation. The entire exchange at the September 6 hearing is worth reproducing here. It represents, among other things, the most thorough line of inquiry I have seen by any reporter in quite some time. The following quote contains added emphases.

Q General, as an expert in interrogations, do you believe that sensory deprivation was abusive, or did it ever prove to be helpful in interrogation?

GEN. KIMMONS: Sensory deprivation is abusive and it's prohibited in this Field Manual, and it's absolutely counterproductive, in my understanding of what we have used productively. Sensory deprivation, just to be clear -- and we define it in the Field Manual, but basically, it comes down to the almost complete deprivation of all sensory stimuli, light, noise, and so forth, and to the point where it can have an adverse mental, psychological effect on a -- disorienting effect on a detainee.

Q So could there be deprivation of light alone for extended periods of time, as opposed to complete sensory deprivation?

GEN. KIMMONS: I think the total loss of an external stimulus, such as deprivation of light, would not fit what we have described here as -- for example, if you're hinting about separation, separation does not involve the darkness or lack of that type of sensory stimulation.

Q That wasn't the question, though. Would sensory -- would the deprivation of light alone be permitted under the current manual, as opposed -- because you described sensory deprivation as total deprivation --

GEN. KIMMONS: That's correction.

Q -- of all senses. So deprivation of light alone for extended periods would be permitted?

GEN. KIMMONS: I don't think the Field Manual explicitly addresses it.

It does not make it prohibited.And it would have to be weighed in the context of the overall environment. If it was at nighttime during sleep hours, then it would make personal sense to turn the lights off.

Q You know what I'm talking about. I'm trying to get at -- because you said specifically total sensory deprivation -- so deprivation of any one sense might be permitted. Like light, for example. They could be kept in the dark for extended periods of time beyond the usual nighttime hours.

This is really too specific and challenging for the DoD briefers, and they turn on their double-talk machine:

MR. STIMSON: Jim, questions like this are good questions to ask. And what's important to remember is that interrogation plans are put together for a reason so that not just one person can decide what he or she wants to do and then run off and do it. They're vetted. It's laid out how they're vetted. General Kimmons could go into that in exhaustive detail. Typically, there would be a JAG, as I understand it, General Kimmons --

GEN. KIMMONS: That's correct.

MR. STIMSON: -- that would have to review that. It goes up through various chains of command. And so, you know, types of questions like this would have to be asked and then vetted through that process.

Burying the Story

With all the hard questioning by the press, you'd think the issues would have been aired in the media in the days and weeks following the introduction of the Army Field Manual. As should be evident by now, that's not what happened.

Here's how the L.A. Times covered it (9/6/06), getting the story exactly backwards (emphasis added):

Bowing to critics of its tough interrogation policies, the Pentagon is issuing a new Army field manual that provides Geneva Convention protections for all detainees and eliminates a secret list of interrogation tactics.

The manual, set for release today, also reverses an earlier decision to maintain two interrogation standards – one for traditional prisoners of war and another for “unlawful combatants” captured during a conflict but not affiliated with a nation’s military force.

There is no mention of Appendix M or any controversy over techniques. Jumana Musa, an "advocacy director for Amnesty International, is quoted as noting, "“If the new field manual embraces the Geneva Convention, it is an important return to the rule of law.'"

The 9/7/06 article in the Washington Post was, if anything, even more laudatory of the new AFM:

Pentagon officials yesterday repudiated the harsh interrogation tactics adopted since the Sept. 11, 2001, terrorist attacks, specifically forbidding U.S. troops from using forced nudity, hooding, military dogs and waterboarding to elicit information from detainees captured in ongoing wars.

The Defense Department simultaneously embraced international humane treatment standards for all detainees in U.S. military custody, the first time there has been a uniform standard for both enemy prisoners of war and the so-called unlawful combatants linked to al-Qaeda, the Taliban and other terrorist organizations.

The article falsely claims the AFM bans manipulation of sleep patterns. Regarding any controversy, the article explains:

Three expanded techniques -- good cop, bad cop; pretending to be an official from another country; and detention in a separate cell from others -- are allowed but require approval from senior officers. Officials originally considered keeping those three techniques classified but decided to make them public for the sake of full transparency.

The Post article also briefly mentions the generally positive response of human rights groups:

"This is the Pentagon coming full circle," said Tom Malinowski, Washington advocacy director for Human Rights Watch. "This is very strong guidance."

As for the human rights organizations, Amnesty International later essentially signed off on the AFM. In an article from the Winter 2007 issue of Amnesty International Magazine, Jumana Musa, quoted in the L.A. Times article above, had this to say about the new AFM:

AIUSA also worked with U.S. representatives and senators to introduce legislation to create a single, transparent standard for interrogations and to limit the CIA to approved interrogation techniques outlined in the Army Field Manual.

In a telephone interview for this article, Mr. Malinowski said he supported using the Army Field Manual as a replacement for the CIA "enhanced interrogation techniques," and described the question of abuse in Appendix M as not entirely clear. The language in Appendix M was "ambiguous," and open to criticism due to a "lack of clarity." He maintained, however, that using the current Army Field Manual as a model was merely a beginning, and that a new overhaul of interrogation techniques was on the agenda.

A call made to Amnesty International's press contact regarding this issue, and an e-mail sent to Jumana Musa, were both unreturned.

Conclusion

Two conclusions can be drawn from the above examination of the "selling" of the Army Field Manual to the American public in the late summer of 2006 and beyond. One is that reporters on the beat were very aware of the origins and implications of the issues surrounding Geneva and the AFM, and the controversies surrounding the use of isolation and other techniques under the rubric of "Separation." The extremely muted or non-existent discussion in the mainstream press of these issues after the AFM was introduced means that a decision to suppress these issues was made at an editorial level, and were not the result of laziness or dilatory reporting on behalf of reporters.

Secondly, the role of some human rights organizations in promoting the new Army Field Manual -- in particular, the actions of Amnesty International and Human Rights Watch -- are curious, to say the least. Press reports and the interview with Malinowski show that inclusion of certain human rights organizations in the vetting of the AFM started at the very beginning. We may not be able to find out what went on in the editorial offices of the nation's top newspapers, but we should know more about the discussions within the human rights organizations on how they advised, or were fooled, by talks with Bush administration and Pentagon personnel.

Meanwhile, other human rights organizations, such as the Nobel Prize-winning Physicians for Human Rights, have criticized the language and techniques described in Appendix M of the Army Field Manual, and called for rescission of the offending text. In a letter to Secretary of Defense Robert Gates in May 2007, Leonard S. Rubenstein, Executive Director of PHR, and retired Brigadier General Stephen N. Xenakis, MD, former Commanding General of the Southeast Regional U.S. Army Medical Command, wrote:

The new Army Field Manual on human intelligence gathering... explicitly prohibits several SERE-based techniques, yet Appendix M of the manual explicitly permits what amounts to isolation, along with sleep and sensory deprivation. The manual is silent on a number of other SERE-based methods, creating ambiguity and doubt over their place in interrogation doctrine....

PHR, therefore, respectfully urges you to take the following actions:

1. Fully implement the OIG’s recommendation to “preclude the use of Survival, Evasion, Resistance, and Escape physical and psychological coercion techniques” in all interrogations. (Id, pp. 29-30.) This includes rescission of Appendix M of the new Army Field Manual and specific prohibition, by name, of each of the known SERE-based methods and their equivalents.

It seems likely that the Army Field Manual, whether by executive order (most likely) or by legislation, will become the new "single standard" for U.S. interrogation. Press reports hint that the Obama administration may yet allow a loophole for CIA interrogators. I don't know how that will sit with the many military lawyers and officers who have been instrumental in opposing Bush/Rumsfeld's torture policies from the beginning. I'm thinking of people like Alberto Mora and Antonio Taguba, or the new nominee for DoD General Counsel, Jeh Charles Johnson, who apparently intends to seriously change the policies set by his predecessor, Jim Haynes.

[Author's note, 1/12/2014: Johnson never did change the Army Field Manual/Appendix M policies. Last month, he was confirmed by the Senate as Secretary of Homeland Security.]

In any case, the full history and controversy behind torture and U.S. interrogation policy deserves a full airing. What happened, for instance, between June and September 2006, allowing for Pentagon acceptance of the Appendix M abusive procedures? When it comes to the implementation of a host of torture and cruel, inhumane interrogation techniques by the U.S. government, both an investigation and prosecutions are needed.

It will be a challenge for our society to bring out the full story, while also bringing to justice those individuals who broke both domestic law and international treaty. We will need both investigations and prosecutions in order settle scores with the past, to understand where we stand now, and what we need to change to move forward.

Senate Hears Testimony on Banning Indefinite Detention of Americans

The following is a transcript (PDF) of testimony given by Dr. Scott Allen, MD at a February 29, 2012 hearing by the Senate Judiciary Committee. Dr. Allen is Associate Professor of Medicine, University of California, Riverside, and a Medical Advisor for Physicians for Human Rights.

The title of the hearing was “Due Process Guarantee Act: Banning Indefinite Detention of Americans.” Indefinite Detention is a form of torture, as Dr. Allen makes clear. The current policy of the Obama administration is to keep certain supposed "war on terror" detainees in indefinite detention, and there are hundreds of such prisoners held at Guantanamo, Bagram, and likely other US military prisons. (H/T to Ulana Odezynsky for sending me this material.)

I am a Clinical Associate Professor of Medicine at the University of California, Riverside and a medical advisor to Physicians for Human Rights. PHR is an independent, non-profit organization that uses medical and scientific expertise to investigate human rights violations and advocate for justice, accountability, and the health and dignity of all people. We are supported by the expertise and passion of health professionals and concerned citizens alike.

I am very grateful for the opportunity to submit my written testimony to the Senate Judiciary Committee in a hearing regarding the “Due Process Guarantee Act of 2011” and I would like to thank Chairman Senator Leahy and Senator Feinstein as well as the other Members of this Committee for holding this important and timely hearing.
I have worked in the field of correctional health for over fourteen years including full-time work in a state prison facility as both a primary care doctor and a medical director. In addition, I have also worked with refugee and immigrant populations in indefinite detention situations. Finally, I worked on and oversaw the report, Punishment Before Justice: Indefinite Detention, which was issued by Physicians for Human Rights in June 2011. This report, as well as my recent letter to the editor of the New York Times regarding the medical effects of indefinite detention, are attached as exhibits to my testimony.1

Indefinite detention refers to a situation in which the government places individuals in custody without informing them when—if ever—the detainee will be released. Indefinite detention is vastly different from imprisonment because the detainee does not know whether he will be charged with crimes, if he will receive a trial or hearing, when he will see his family again (if ever), or if he will ever be released. Yet, a person indefinitely detained is not serving a jail sentence. Naturally, these many attributes of indefinite detention create a heightened degree of uncertainty, unpredictability and uncontrollability over the elemental aspects of one’s life, causing severe harms in healthy individuals, independent of other aspects or conditions of detention.

The harmful psychological and physical effects of indefinite detention have been documented (varying by individual) to include:

-- Severe and chronic anxiety, acute fear, and dread;
-- Pathological levels of stress that damage the core psychological functions of the immune, cardiovascular, and central nervous system;
-- Hypertension;
-- Depression and suicide;
-- Post-traumatic stress disorder;
-- Dissociation, schizophrenia, and psychosis; and
-- Enduring personality changes.

Some individuals even manifest physical symptoms of the psychological trauma they are suffering such as breathing difficulties, physical pain and skin disorders. In cases where the individual who is subject to indefinite detention has also previously experienced trauma, such as war, torture, or abuse, the physical and psychological effects of indefinite detention are exacerbated.

Moreover, indefinite detention affects individuals beyond the detainee himself. When a loved one is indefinitely detained, families are separated. Consequently, parents, spouses and children can and have suffered similar feelings of uncertainty, unpredictability and uncontrollability leading to the physical and psychological effects described above.

As a health care professional, having seen first-hand the physical and psychological effects of indefinite detention, I can attest to the devastating harms an individual suffers. These are medical, documented harms that in some cases may rise to the level of severe abuse of individuals, or torture in extreme cases. As a health care professional, I would conclude that the medical effects of indefinite detention are both physical and psychological and they result in lasting severe harms to individuals. Therefore, as a physician with first-hand knowledge of the real harms caused by indefinite detention, I must recommend that indefinite detention not be utilized as a long-term solution for detaining individuals.

To that end, I would recommend that the United States government reject solutions to national security problems that permit or rely on indefinite detention and, until the time that indefinite detention is abolished as a matter of policy, the United States government should provide measures that mitigate the social, psychological, and physical harms such detention causes among detainees. Further, if indefinite detention of individuals is allowed to continue, I would recommend permitting non-governmental, independent medical and psychological experts to evaluate the mental and physical health of detainees.

Again, I thank you for this opportunity to provide my testimony on this issue of extreme importance to the American people and Congress and am available to answer any questions or further discuss these issues.

1 The full report is also available at https://s3.amazonaws.com/PHR_Reports/indefinite-detention-june2011.pdf.

NRC on Research on “War on Terror” Detainees: “A Contemporary Problem”?

Cross-posted from MyFDL/Firedoglake

A National Research Council (NRC) 2008 report on a conference on Emerging Cognitive Neuroscience and Related Technologies examined briefly what it characterized as a “contemporary problem,” the possibility of doing research on “war on terror” detainees, removed by the U.S. government from Geneva protections against experiments done on prisoners of war.

In a section of the report that looked at the “Cultural and Ethical Underpinnings of Social Neuroscience,” the report’s authors examined the “Ethical Implications” of these new technologies. The section explored the birth of the new field of bioethics, in response to the scandalous revelations of the Tuskegee experiments. The report noted that “On the whole, however, the system of protections for human research subjects is not well designed to capture instances of intentional wrongdoing,” providing “rather… guidance for well-motivated investigators who wish to be in compliance with regulatory requirements and practice standards.”

The report further described the history surrounding the importance of the rules that constitute the need for informed consent of research participants, and how the Nazi-era experiments led to the Nuremberg principle that “The voluntary consent of the human subject is absolutely essential.” While claiming the current “formal procedures in place for the use of military personnel in medical experiments” are “stringent,” that doesn’t imply “that no abuses can occur, nor that convenient alternative frameworks (such as field testing) cannot be used to circumvent the research rules, but only that the official policies and procedures in the military are rigorous.”

But even with such supposedly “rigorous” policies, the report’s authors see a problem. They ominously ask whether “classified research can ever be ethically sound inasmuch as it lacks transparency, such as in the form of public accountability. For example, if a member of an ethics review board disagrees with a majority decision involving a classified human experiment, that member would be unable to engage in a public protest of that decision.”

At this point in the discussion, another interesting, and even more ominous question rises up before the NSC panel (emphasis added):

A contemporary problem is the status of detainees at military installations who are suspects in the war on terrorism. Presumably, the ethical standards that apply to all human research subjects should apply to them as well. But if they are not protected by the provisions of the Geneva protocols for prisoners of war, the question would be whether as potential research subjects they are nonetheless protected by other international conventions, such as the Universal Declaration of Human Rights (United Nations, 1948). Those technical questions of international law are beyond the scope of this report.

Why should the question of research on detainees arise in this discussion at all?

Evidence of Military Research and Experimentation on Detainees

Jason Leopold and I have been investigating the possibility of research being conducted upon detainees at Guantanamo and other “war on terror” prisoners held by the Defense Department and the CIA. Back in September 2009, I published articles at Firedoglake, The Public Record, and Truthout that noted the research on “uncontrollable stress” conducted upon SERE survival school students subjected to mock torture predated the institution of the so-called “enhanced interrogation program of the CIA. The research was conducted by, among others, a CIA-linked psychiatrist, Dr. Charles A. Morgan III, who is affiliated with Yale University and the National Center for Post-traumatic Stress Disorder.

Morgan has denied his CIA affiliation, but for documentary evidence, see this list of participants at this 2004 DoJ/FBI conference.

This research used methods that were similar to those later instituted under a plan developed by James Mitchell and Bruce Jessen, formerly employed by the military’s Joint Personnel Recovery Agency (JPRA), parent organization to the SERE program, to use coercive forms of interrogation on the new “war on terror” detainees, who the White House and their attorneys at the Office of Legal Counsel removed from the protection of Geneva Convention protocols. In a report on CIA experiments on torture, Physicians for Human Rights (PHR) noted in an appendix the existence of the Morgan research, but failed to make public the CIA connections, even though they certainly were aware of them.

Originally, the PHR report was going to include a footnote on the existence of a new protocol on human experimentation protections in the military signed by Paul Wolfowitz in early 2002. While they chose not to follow up on this, Leopold and I conducted a seven-month long investigation into the March 2002 issuance of Department of Defense Directive 3216.02, ”Protection of Human Subjects and Adherence to Ethical Standards in DoD-Supported Research.” We noted that “the Wolfowitz directive weakened protections that had been in place for decades by limiting the safeguards to ‘prisoners of war’.” Even more, it allowed for waivers of informed consent if the head of a DoD department thought it necessary. There had never been such loose rules on informed consent ever explicitly allowed in the history of military research, although no prominent ethicist had discussed this until we published our article. Prominent ethicist Alexander Capron was quoted in our story for calling these changes “controversial both because it involves a waiver of the normal requirements and because the grounds for that waiver are so open-ended.”

While retaining the blanket prohibition against experimenting on prisoners of war, Wolfowitz softened the language for other types of prisoners, using a version of rules about “vulnerable” classes of individuals taken from regulations meant for civilian research by the Department of Health and Human Services (DHHS).

By removing the detainees from Geneva protections, and taking away “prisoner of war” protections, Bush and the White House lawyers, among them Jay Bybee, John Yoo and Alberto Gonzales, opened up the captured prisoners, many of them sold to the Americans for bounty reward, to possible experimentation.

DoD and HHS Acting Together on Experiments?

Buried in the Wolfowitz directive was a provision (4.4.1) that “actions authorizing or requiring any action by an official of the Department of Health and Human Services (HHS) with respect to any requirements” of research on “vulnerable populations” like prisoners “shall be under the authority of the Director, Defense Research and Engineering.” The reason for HHS involvement was because research “supported or conducted by the Department of Defense that affects vulnerable classes of subjects” had to meet the protections of HHS’s Common Rule language that covers protection of human subjects.

When queried whether there had ever been any DoD research on any kind of prisoner, or the use of HHS personnel to monitor such research, a spokesperson for Defense Research and Engineering indicated that they had no comment.

In 2002, there was another assault on prisoner protections for research, when Bush’s Secretary of HHS asked for and received a year later a blanket waiver for all informed consent on prisoner experimentation for “epidemiological” reasons, including the taking of biological samples. In a future article, I will explore the repercussions of this new policy — also never discussed by any ethical panel, and certainly not by the NRC — on research upon prisoners, and more specifically the possibility of experiments done on the detainees at Guantanamo.

This further investigation may throw light upon the Guantanamo SOP wherein all detainees were subjected to a never-before-attempted use of mass administration of treatment doses of the controversial anti-malaria drug mefloquine (Lariam), as also reported in a special investigation by Jason Leopold and myself last December. The scandal was also the subject of an independent investigatory report published at the same time by Seton Hall University Law School’s Center for Policy and Research.

In a 2002 report on mefloquine adverse events, “Unexpected frequency, duration and spectrum of adverse events after therapeutic dose of mefloquine in healthy adults,” published in top medical journal Acta Tropica, it was noted that 73% of the participants suffered “severe (grade 3) vertigo…” which “required bed rest and specific medication for 1 to 4 days.” Nevertheless, DoD maintains that the use of mefloquine was for public health purposes, to prevent malaria from spreading in Cuba. But as our investigation showed, talking with military medical experts, and examining other military responses to malaria threat, including in Cuba, no such use of such mass treatment doses, with its attendant dangers, was ever used or even proposed. Nor did DoD medical officers at Guantanamo demand the same protocols be used on foreign workers from malarial areas brought into the camp at this same time to work on building Camp Delta and other facilities at the naval base. The workers were employed by Kellogg Brown and Root, a subsidiary of Halliburton.

Was the mefloquine use part of an experimental protocol on the adverse side effects of the drug, a subject of much controversy within DoD at the time? Was it a method of softening up prisoners for interrogation? While calls for greater transparency go unheeded, further investigation by the press may bring answers to these explosive questions.

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Ex-Gitmo Official Told Not to Discuss Policy on Antimalarial Drug Used on Detainees

by Jason Leopold and Jeffrey Kaye, reposted from Truthout

Military officials were instructed not to publicly discuss a decision made in January 2002 to presumptively treat all Guantanamo detainees with a high dosage of a controversial antimalarial drug that has been directly linked to suicide, hallucinations, seizures and other severe neuropsychological side effects, according to a retired Navy captain who signed the policy directive.

Capt. Albert J. Shimkus, the former commanding officer and chief surgeon for both of the Naval Hospital at Guantanamo Bay and Joint Task Force 160, which administered health care to detainees, defended the unprecedented practice, first reported by Truthout earlier this month, to administer 1250 mg of the drug mefloquine to all "war on terror" detainees transferred to the prison facility within the first 24 hours after their arrival, regardless of whether they had malaria or not.

The 1250 mg dosage is what is used to treat individuals who have malaria and is five times higher than the prophylactic dose given to individuals to prevent the disease. One tropical disease expert has said there is absolutely no "medical justification" to support the military's decision to presumptively treat all Guantanamo detainees for malaria with high doses of mefloquine.

Mefloquine is also known by its brand name Lariam. It was researched by the US Army in the 1970s during the Vietnam War and licensed by the Food and Drug Administration (FDA) in 1989. Since its introduction, it has been directly linked to serious adverse effects, including depression, anxiety, panic attacks, confusion, bizarre dreams, nausea, vomiting, sores, hallucinations and homicidal and suicidal thoughts.

Although there were two media reports in 2002 that quoted Shimkus saying "war on terror" detainees were given antimalarial medication, neither he nor any other military or Pentagon official ever disclosed to lawmakers or military personnel who raised questions about the efficacy of mefloquine, that mass presumptive treatment was the policy in place at Guantanamo.

"There were certain issues we were advised not to talk about," Shimkus told Truthout in an interview, explaining the reason the policy was never publicly disclosed. He could not recall who told him not to discuss the issue.

Shimkus, who is now an associate professor of national security studies at the Naval War College in Newport, Rhode Island, said officials from the Centers for Disease Control (CDC), the Navy Environmental Health Center (NEHC) and the Armed Forces Medical Intelligence Center at Fort Detrick, Maryland, which is part of the Defense Intelligence Agency, were all involved in the discussions that resulted in the issuance of a January 23, 2002, "Infection Control" Standard Operating Procedure (SOP) that called for the mass presumptive treatment of malaria using mefloquine.

[Added 11/12/2016: Standard Operating Procedure Number 37 (In-processing Medical Evaluation) for the same hospital spells out this therapy in more detail: upon arrival to Camp Delta, all detainees must undergo "empiric treatment" for malaria, where this treatment involves the administration of 1250 mg of mefloquine split in two doses: 750 mg at in-processing time, and 500 mg twelve hours later (see also Standard Operating Procedure Number 29 (Nursing)). - See "The Administration of Drugs with Psychotic Side Effects" at Center for the Study of Human Rights in the Americas.]

Detainees started arriving at Guantanamo two weeks earlier and were held in a detention center known as Camp X-Ray.

The "Infection Control" SOP, which was signed by Shimkus and has not been previously released, says, "detainees are native to a region plagued by a number of infectious diseases. It is estimated that a number of these detainees will carry one or more of these illnesses upon arrival... Empiric therapies will include... mefloquine 1250 mg."

Medical literature usually describes "empiric therapy," or presumptive treatment for malaria, as the administration or self-administration of antimalarial drugs for symptomatic individuals, or occasionally groups of at-risk patients, who do not have access to laboratories or medical facilities and in whom malaria cannot be formally diagnosed.

At Guantanamo, however, all detainees, whether they had symptoms or not, were given laboratory tests to determine if they had malaria, and doctors were accessible "24/7" in the event symptoms started to surface, Shimkus said, calling into question the rationale for mass presumptive treatment.

Shimkus said the NEHC bore the primary responsibility for recommending that mefloquine be administered to all detainees in treatment doses, but there was consensus among the various government agencies about using the drug in this way.

"There was no one that said, 'Captain, this is not the way to go,'" Shimkus said. "I did not do anything in isolation. Any policy would have been approved by a higher authority" up the medical chain of command.

Shimkus could not recall the names of the officials from the various government agencies who agreed with and signed off on the policy. Nor could he identify his immediate medical supervisor, a colonel at United States Southern Command (SOUTHCOM), which is responsible for contingency planning and operations in Cuba, who Shimkus said would have also been involved in the decision.

Cuban Government Concerns

Shimkus said one of the reasons that factored into the decision to presumptively treat war on terror detainees with mefloquine was concerns raised by the Cuban government.

In an interview with Miami Herald reporter Carol Rosenberg in February 2002, Shimkus said he and other medical officers stationed at Guantanamo met with Cuban doctors and government officials on February 8, 2002, to "reassure the government that suspected terrorist prisoners are not introducing malaria into" Cuba, "which has been free of the mosquito-borne disease for 50 years."

Rosenberg reported on February 22, 2002, that steps taken to prevent the spread of malaria at Guantanamo included "impregnating the uniforms of both prisoners and troops who handle prisoners with mefloquin [sic] and other agents to kill the parasite ... " The Herald's February 22, 2002, report was the first and only time mefloquine use at Guantanamo has ever been mentioned. But Rosenberg's report did not state that Shimkus had already signed a policy directive authorizing mass presumptive treatment.

Shimkus told Truthout he could not recall specific details of his discussions with the Cubans. He did not respond to follow-up questions about Rosenberg's characterization regarding the use of mefloquine.

Just three days prior to the publication of the Herald's report, Navy Capt. Alan "Jeff" Yund appeared before the Armed Forced Epidemiological Board (AFEB) and was queried about malaria at Guantanamo.

But Yund, the Navy's liaison officer to AFEB, did not disclose that mefloquine was being administered to detainees. He said he believed detainees who were infected with the disease would be treated on a case-by-case basis with a different antimalarial drug known as primaquine, and that other steps would be taken to protect against mosquitoes.

Yund told Truthout via email that he did not refer to mefloquine during the AFEB briefing because, "I do not recall being involved in any consultations regarding the use of mefloquine at Guantanamo and do not recall being aware that it was being used there."

Yund declined to comment further.

Shimkus could not say why Yund was unaware that mefloquine was being used as a form of mass presumptive treatment at Guantanamo.

The use of mefloquine at Guantanamo was not mentioned during numerous other AFEB briefings, particularly one held in May 2003, where concerns were raised by members of the board about the drug's severe neuropsychiatric side effects, which US military personnel who had taken mefloquine in 250 mg prophylactic doses had been complaining about.

Red Flags Raised

Shimkus said he was aware of the alternatives and noted that at one point the antibiotic drug doxycycline and Malarone were under consideration, but the latter had only been approved by the Department of Defense in 2000 and had not been in widespread use yet. Mefloquine, Shimkus said, was considered efficient and effective.

But at an April 16, 2002, meeting of the Interagency Working Group for Antimalarial Chemotherapy, which included Defense Department representatives, participants concluded that study designs on mefloquine were flawed or biased and based on "sensational or [at] best marketed information."

The Working Group, which included representatives from the State Department, the CDC and FDA, stated, "Sufficient evidence exists to raise the question whether the neuropsychiatric adverse events of mefloquine are frequent enough and severe enough to warrant limiting its use..." The group called for additional research, and warned, "Other treatment regimes should be carefully considered before mefloquine is used at the doses required for treatment."

Additionally, in October 2002, William Winkenwerder, the assistant secretary for defense, admitted that "recent press articles and scientific studies have raised concerns regarding the adverse effects associated with mefloquine use."

Winkenwerder's admission was made in a letter written in response to questions raised by John McHugh, then chair of the subcommittee on military affairs for the House Armed Services Committee. The letter said, "recent peer-review reports" showing adverse events levels associated with mefloquine are "much higher than previously reported." Winkenwerder told McHugh, now secretary of the Army, that the CDC had initiated a review in 2001, which was then still underway, of all chemoprophylactic drugs, including mefloquine.

Shimkus said he did not believe Winkenwerder was part of the consulting team who signed off on administering treatment doses of mefloquine to detainees. But Shimkus said the policy was "well-known in the [military] medical community." Winkenwerder did not respond to calls for comment.< The use of mefloquine as a mass presumptive treatment at Guantanamo continued until at least July 2005, despite the presence of ongoing warnings. In June 2004, the CDC issued a new set of guidelines on malaria treatment, which warned that mefloquine "is associated with a higher rate of severe neuropsychiatric reactions when used at treatment doses," and recommended that mefloquine be used "only when ... [other] options cannot be used."

As far back as 1990, the CDC warned in a set of recommendations for malaria prevention for travelers that mefloquine should not be used for presumptive self-treatment "because of the frequency of side effects, especially dizziness, which has been associated with therapeutic dosages of mefloquine."

"This was a one time treatment only [for detainees]," Shimkus said. "My focus on mefloquine was specifically for preventing malaria from occurring."

However, other Guantanamo documents obtained by Truthout say that on February 28, 2002, 59 detainees allegedly refused to take medication, including antimalarial drugs, and noted that the "series must start over." It is unclear whether this included readministration of mefloquine, or whether the "series" described included further antimalarial doses of primaquine or cholorquine, also administered to the detainees.

Maj. Remington Nevin, an Army public health physician, who formerly worked at the Armed Forces Health Surveillance Center and has written extensively about mefloquine, previously told Truthout the decision to administer high doses of the drug, even as a one-time treatment "is, at best, an egregious malpractice."

Nevin added, "many dozens of detainees, possibly hundreds" likely experienced side effects "as severe as those intended through the application of 'enhanced interrogation techniques.'"

Truthout was unable to locate a single malaria expert who was willing to go on the record to defend the government's policy of mass presumptive treatment of the disease using mefloquine or any other antimalarial drug.

Shimkus told Truthout that, "clinically," he could not recall if any detainees experienced any side effects associated with taking mefloquine, but if they did, that data would have been noted in their medical records.

"We have robust medical records," Shimkus said. "If anything occurred that was a cause for concern it would have been documented in their medical records."

But the government has refused to release Guantanamo detainees' medical records to the media or to their attorneys citing, among other reasons, privacy concerns.

As first documented in a separate report on mefloquine use at Guantanamo published earlier this month by Seton Hall University School of Law's Center for Policy and Research, medical files for detainee 693 released by the Defense Department in connection with his alleged suicide at the prison facility in June 2006, contradict Shimkus's assertions. Those records show that two weeks after the detainee was given mefloquine in June 2002, he was interviewed by Guantanamo medical personnel and reported that he was suffering from nightmares, hallucinations, anxiety, auditory and visual hallucinations, sleep loss and suicidal thoughts.

A Guantanamo medical officer who interviewed the detainee, however, did not state that the detainee may have been experiencing mefloquine-related side effects in notes he took evaluating the detainee's condition.

Shimkus dismissed the significance of the medical officer's failure to connect the detainee's psychological state to the possible side effects resulting from mefloquine, stating that the medical officer may have been unaware "the patient had taken [the drug], because there was a lot of turnover of staff at that point."

Scott Allen and Vince Iacopino, medical doctors affiliated with Physicians for Human Rights, a doctors' organization based in Cambridge, Massachusetts, said, "the questionable use of mefloquine for malaria prevention at Guantanamo underscore the need for transparency of detention policies and procedures" at the prison facility.

"Benefits Outweighed Risks"

Shimkus, who is a nurse by training, acknowledged that the mass presumptive treatment of malaria using mefloquin was unprecedented. However, he said the "benefits outweighed the risks."

When asked, Shimkus did not indicate that contraindications for the use of mefloquine, such as pre-existing cases of post-traumatic stress disorder, anxiety, seizures. or other mental illness, which would have heightened mefloquine's side effects, were ever pursued for the individual detainees. He simply reiterated that the benefits of administering treatment doses of mefloquine outweighed the risks.

Yet, when told that the Defense Department took a radically different approach a decade earlier, when thousands of Haitian refugees housed at Guantanamo were first tested to determine if they had malaria and, only then, were given a treatment dosage of a different medication, chloroquine, if they had the disease, Shimkus said war on terror detainees "were a different cohort of individuals."

"You have to remember that this was in the context of February 2002," Shimkus said. "The detainees came from Afghanistan and other areas that may have been chloroquine resistant."

Moreover, in two articles published in 2002, Shimkus claimed statistics showed that 40 percent of Afghanistan's population was infected with malaria. But according to figures from the World Health Organization, in 2002, the number infected in Afghanistan was about 13 percent.

Shimkus also indicated that malaria cases at Guantanamo could have led to a public health crisis at the base, and reintroduction of malaria into Cuba. Once an outbreak begins, Shimkus told Truthout, one "loses control" of the situation and there is an epidemic.

However, when the CDC examined the influx of tens of thousands of refugees to the United States from hyper-epidemic sub-Saharan Africa, where the falciparum form of malaria kills more than a million people yearly, they concluded that "sustained malaria transmission" in a nonmalarial endemic country, like the US, from this population "would be unlikely."

Still, the CDC called for mass presumptive treatment (with a drug other than mefloquine) of these refugees before they came to the US - mainly because they feared many US doctors wouldn't recognize malaria symptoms - but noted that such mass presumptive treatment from other parts of the world, including Afghanistan, was not recommended, because "the risk and cost of post-arrival presumptive treatment currently outweighs the potential benefits."

Of the more than 700 detainees held at Guantanamo, only four tested positive for malaria, all in January and February 2002.

But Shimkus still defended the mass administration of mefloquine, saying, "One [infection] is too many." Shimkus said he believes he and other military officials "made the right policy decisions based on the information we had to prevent the introduction of malaria" in Cuba and protect the health of the detainees.

Shimkus said after he retired from the military he became involved with the Open Society Institute, funded by the Soros Foundation, and has since taken a role in the work the organization has done to raise awareness about abusive interrogation measures contained in the Army Field Manual.

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