Steven Miles - Oath Betrayed: Torture, Medical Complicity, and the War on Terror

CONTENTS

FOOTNOTES

To return to the corresponding text, click on the reference number or "Return to text."

* Citations to other documents, with Web addresses, appear in the bibliography. Return to text.

Prisons mentioned in this book.

INTRODUCTION

WHERE WERE THE DOCTORS AND NURSES AT ABU GHRAIB?

In May of 2004, pictures of abused prisoners at Abu Ghraib, a U.S. Army prison near Baghdad in Iraq, shocked the world. When I first saw these pictures, a simple question came to mind and became the genesis of this book. Where were the doctors, nurses, and medics while these abuses were happening?

Medical personnel are always present in military prisons. Even if they did not personally witness the beatings, suspensions, and kickings, they certainly saw the injuries, distress, and fear that resulted from them. The clinicians were responsible for the prisoners well-being. Medical ethics and international codes of conduct oblige them to prevent and disclose torture. Why had they not blown the whistle? Or did they raise alarms that went unheeded? The question became more troubling as investigators reported that abuses like those photographed at Abu Ghraib were not limited to a fortnight, a cellblock, or a few bad apples among the guards. Similar abuses had occurred for at least two years across an archipelago of U.S. military prisons stretching from Guantnamo Bay, to Iraq, to Afghanistan, and throughout CIA interrogation centers scattered over Europe, the Middle East, Asia, and North Africa. The abuses were pandemic. And so, apparently, was the failure of doctors, nurses, and medics to raise their voices to stop them.

The ensuing congressional, military, and media investigations did not pay much attention to military medical personnel. The initial government inquiries were carefully focused on the photographed events and then on the Abu Ghraib facility as the Department of Defense endeavored to contain the scandal to low-ranking frontline personnel. As the scandal unfolded, others asked the same question that was troubling me. Where were the doctors of Abu Ghraib or Guantnamo?13

In August 2004, The Lancet, a prestigious British medical journal, published my initial review of the evidence for medical complicity with human rights abuses in the war on terror.4 That paper was based on a thousand pages of declassified government documents, congressional testimony, media accounts, and reports by human rights organizations. I found evidence that armed forces physicians, nurses, and medics had been passive and active partners in the systematic neglect and abuse of prisoners. Although medical personnel have played similar roles in other countries, such actions departed from the United States tradition of medical care for prisoners of war. In Iraq and Afghanistan, the United States failed to provide prisoners with minimally adequate medical and public health systems. Physicians and psychologists gave information that was used to set the degree of harshness of physically and psychologically abusive interrogations, which were then monitored by health professionals. Military pathologists delayed releasing information from death certificates and autopsies, and these delays enabled the Pentagon to claim, falsely, that prisoners who died of torture had died from natural causes. Medical personnel who knew of this system of neglect, abuse, and death by torture had remained silent.

The Lancet article received international media attention. It was discussed within medical and human rights groups, including the World Health Organization, the International Committee of the Red Cross, Human Rights Watch, and Physicians for Human Rights. The U.S. Defense Department forwarded it to medical officers in Iraq.5 A Pentagon spokesman, Lieutenant Colonel Joe Richard, of the U.S. Army, gave the official rebuttal: The Department of Defense takes strong exception to these allegations and [Miless] wholesale indictment of the medical care rendered by US personnel to prisoners and detainees. [The article is based on] carefully selected media reports and excerpted Capitol Hill testimony and not firsthand investigative work or accounts.6

Since the summer of 2004, a vast amount of additional information has become available. New investigations have been conducted. The press, especially The Washington Post, The New York Times, the Los Angeles Times, The Guardian, and Time, has done solid investigative reporting. Groups including Amnesty International, Physicians for Human Rights, a special United Nations Working Group, Human Rights First, and Human Rights Watch have produced well-documented reports. Most important, a Freedom of Information Act lawsuit filed by the American Civil Liberties Union secured the release of tens of thousands of pages of documents. This book is mainly based on what I found in thirty-five thousand pages of this material.

These primary source documents are not dry bureaucratic records. They include records of Army criminal investigations; FBI notes on debriefings of prisoners; interviews with witnesses; sworn recollections of conversations; e-mails dashed off in the middle of the night; autopsy reports; statements of military-base policies; and prisoners medical records. They tell the story with an immediacy and authority that would have been difficult to obtain from interviews with a few dozen people who reluctantly talked for the record.

This is not a book about ethical conduct on the battlefield. It is about the treatment of those who were disarmed and imprisoned. I disagree with those who believe that the abuse of prisoners of war is merely rough justice for terrorists or excusable as simply another part of the intrinsic brutality of war. Those who excuse the Abu Ghraib abuses as merely an aspect of the brutality of war fail to grasp the crucial legal and moral distinction between the conduct of combat and the treatment of disarmed captives. The Geneva Conventions phrase hors de combat, literally out of combat, which applies to all persons imprisoned during war, hostilities, or occupation, precisely names this distinction.

This is not a comprehensive history of the human rights abuses committed in the war on terror. It does not address the abuses perpetrated by our Iraqi or Afghan allies or enemies. Tens of thousands of pages of U.S. documents, including many of the appendices to existing investigations, remain classified by judgments that seem designed more to shelter officials from embarrassment than to protect national security. The story of CIA and Special Forces involvement in prisoner abuses remains almost entirely hidden. The prisons that the United States maintains in Afghanistan largely remain cloaked. As of today, the United States continues to refuse to allow Red Cross or UN monitors to interview prisoners privately about their treatment. Almost nothing is known about the fates of those persons secretly transported to countries like Pakistan, Egypt, and Uzbekistan for imprisonment and interrogation. Most important, all of the prison investigations have been chartered and performed by personnel belonging to the very institutions whose actions are challenged. This has affected both the major investigations and the criminal investigators of individual cases. For example, Army investigators routinely gave less weight to allegations by prisoners, 80 percent of whom were unjustifiably detained, than to a soldiers reflexive I did not see anything or I cannot recall. The Defense Department conferences discussing prison reforms are closed.