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This article, by Richard Norton-Taylor, was published in The Guardian, October 16, 2009
David Miliband, the foreign secretary, acted in a way that was harmful to the rule of law by suppressing evidence about what the government knew of the illegal treatment of Binyam Mohamed, a British resident who was held in a secret prison in Pakistan, the high court has ruled.
In a devastating judgment, two senior judges roundly dismissed the foreign secretary's claims that disclosing the evidence would harm national security and threaten the UK's vital intelligence-sharing arrangements with the US.
In what they described as an "unprecedented" and "exceptional" case, to which the Guardian is a party, they ordered the release of a seven-paragraph summary of what the CIA told British officials – and maybe ministers – about Ethiopian-born Mohamed before he was secretly interrogated by an MI5 officer in 2002.
"The suppression of reports of wrongdoing by officials in circumstances which cannot in any way affect national security is inimical to the rule of law," Lord Justice Thomas and Mr Justice Lloyd Jones ruled. "Championing the rule of law, not subordinating it, is the cornerstone of democracy."
The summary is a CIA account given to British intelligence "whilst [Mohamed] was held in Pakistan ... prior to his interview by an officer of the Security Service", the judges said. The officer, known only as Witness B, is being investigated by the Metropolitan police for "possible criminal wrongdoing".
The seven-page document will not be released until the result of an appeal is known. However, the judges made clear their anger at the position adopted by Miliband, MI5, and MI6 in their hard-hitting judgment.
An explanation was needed, they said, about "what the United Kingdom government actually knew about what was alleged to be cruel, inhuman or degrading treatment or torture, in particular what Witness B knew before he interviewed [Mohamed] ... in Pakistan". The judges added that it was important to explain what MI5 "and others knew when they provided further information to the United States to be used in the interrogation".
There was a "compelling public interest" to disclose what Miliband wanted to suppress, they said; there was nothing in the seven-paragraph summary that had anything remotely to do with "secret intelligence".
"In our view, as a court in the United Kingdom, a vital public interest requires, for reasons of democratic accountability and the rule of law in the United Kingdom, that a summary of the most important evidence relating to the involvement of the British security services in wrongdoing be placed in the public domain in the United Kingdom."
The judges sharply criticised the way Miliband and his lawyers tried to persuade the Obama administration to back the suppression of the CIA material. Lawyers acting for Mohamed, the Guardian and other media organisations pointed out that Obama had himself set up an inquiry into CIA practices and published details of their interrogation techniques.
In the end, Miliband had to rely for help on a CIA letter to MI6 claiming that disclosure of the document would harm the security of the US and UK.
The judges made it clear they did not believe the claim was credible. "The public interest in making the paragraphs public is overwhelming," they said.
The document would show what Witness B – an MI5 officer who interrogated Mohamed in Pakistan in 2002 – knew about Mohamed's condition before he questioned him incognito in a Pakistani jail, the judges said.
The CIA secretly flew Mohamed to Morocco, Afghanistan and then Guantánamo Bay, the court has heard. The judges criticised MI5 and MI6 for the belated disclosure of documents that revealed an MI5 officer was in Morocco when Mohamed was held there in a secret jail.
Miliband's lawyers continued to argue that a number of passages in the judges' ruling must be redacted as well as the seven-paragraph CIA document.
Jonathan Evans, the head of MI5, admitted in a speech at Bristol University on Thursday that the Security Service had been "slow to detect the emerging pattern of US practice in the period after 9/11".
"But it is important to recognise that we do not control what other countries do, that operational decisions have to be taken with the knowledge available, even if it is incomplete, and that when the emerging pattern of US policy was detected, necessary improvements were made."
He repeated the mantra that MI5 "does not torture people, nor do we collude in torture or solicit others to torture people on our behalf".
However, he said the situation posed a dilemma. "Given the pressing need to understand and uncover al-Qaida's plans, were we to deal, however circumspectly, with those security services who had experience of working against al-Qaida on their own territory, or were we to refuse to deal with them, accepting that in so doing we would be cutting off a potentially vital source of information that would prevent attacks in the west?
"In my view we would have been derelict in our duty if we had not worked, circumspectly, with overseas liaisons who were in a position to provide intelligence that could safeguard this country from attack. I have every confidence in the behaviour of my officers in what were difficult and, at times, dangerous circumstances".
This ... white paper, published August 31, 2009, after the new release of the May 2004 CIA Inspector General's report, shows that the extent to which American doctors and psychologists violated human rights and betrayed the ethical standards of their professions by designing, implementing, and legitimizing a worldwide torture program is worse than previously known.
A team of PHR doctors authored the white paper, which details how the CIA relied on medical expertise to rationalize and carry out abusive and unlawful interrogations. It also refers to aggregate collection of data on detainees’ reaction to interrogation methods. Physicians for Human Rights is concerned that this data collection and analysis may amount to human experimentation and calls for more investigation on this point. If confirmed, the development of a research protocol to assess and refine the use of the waterboard or other techniques would likely constitute a new, previously unknown category of ethical violations committed by CIA physicians and psychologists. (click here to read original report)
Introduction The version of the 2004 CIA Inspector General’s report released on August 24, 2009 provides greater detail on the central role that health professionals played in the CIA’s torture program and reveals a level of ethical misconduct that had not previously come to light.
The report confirms that the CIA inflicted torture on detainees interrogated while in US custody as part of the agency’s counterterrorism activities and exposes additional interrogation techniques that had not yet been reported. It also demonstrates that health professionals were involved at every stage in the development, implementation and legitimization of this torture program.
The doctors and psychologists who laid the foundation upon which attorneys rationalized an illegal program of torture also actively participated in abusive and illegal interrogations, thus betraying the ethical standards of their professions by contributing to physical and mental suffering and anguish. The very premise of health professional involvement in abusive interrogations — that they have a role in safeguarding detainees — is an unconscionable affront to the profession of medicine.
The Inspector General’s report also reveals that medical professionals were directed to meticulously monitor the waterboarding of detainees to try to improve the technique’s effectiveness, essentially using the detainees as human subjects, a practice that approaches unlawful experimentation.
Physicians for Human Rights (PHR) has prepared the following analysis of the Inspector General’s report, building on the 2007 report by PHR and Human Rights First (HRF), Leave No Marks, which assessed interrogation techniques reported up to that time, which have now been confirmed by the Inspector General’s report. This paper provides an introductory summary of techniques newly described in the Inspector General’s report and then offers a more detailed medical analysis of those techniques. The paper then reviews the various ways health professionals were complicit in enabling the torture regime. Summary of Newly Detailed Techniques
The Inspector General’s report describes several forms of abuse not previously reported that CIA interrogators and contractors implemented, and that from a medical and legal perspective constitute torture. These include:
Mock executions and threatening detainees by brandishing handguns and power drills;
Threatening the detainee with harm to his family members including sexual assault of female family members, and murder of detainee’s children; and
Physical abuse including the application of pressure to the arteries on the sides of a detainee’s neck resulting in near loss of consciousness, and tackling or hard takedowns.
These methods have significant harmful physical and mental health consequences.
The report provides new details about previously reported forms of abuse referred to as “enhanced interrogation techniques”. The harmful health consequences of these forms of torture and abuse have previously been described by PHR, including in the reports Break Them Down, Leave No Marks and Broken Laws, Broken Lives.” (1)
The Inspector General’s report clearly questions the efficacy, ethics and legality of these as well as the previously mentioned “enhanced interrogation techniques”. The report also confirms the theory of a “slippery slope” in interrogation settings, namely that torture by its very nature escalates in the severity and frequency of its use beyond the approved techniques.
Medical Analysis of the Interrogation Techniques Described in the Inspector General’s Report
The adverse physical and mental health effects of stripping (forced nudity), isolation, white noise or loud music, continuous light or darkness (sensory deprivation), temperature manipulation, stress positions, sleep deprivation, attention slap, abdominal slap, stress positions and waterboarding have been previously described in the Physicians for Human Rights and Human Rights First report Leave No Marks. The following medical analysis focuses on techniques not previously reviewed by PHR.
As with the techniques previously analyzed, it is important to understand two key points. First, while the techniques are evaluated individually, these techniques were designed to be used in combination in a way that enhanced pain and stress.
Second, to comprehend the severity of the effects of these techniques, it is essential to consider the context of their use. In terms of both long and short term psychological effect, there is no meaningful equivalence between waterboarding when used as part of survival training of service men who have volunteered and consented to the procedure and who know that they are in an environment where they trust the mock interrogator to protect their safety and may stop the procedure at any time, and waterboarding of a high value detainee in a black site where the detainee is in actual fear for his life and safety. As the Inspector General’s report indicates:
“One of the psychologist/interrogators acknowledged that the Agency’s use of the [waterboarding] technique differed from that used in SERE training and explained that the Agency’s technique is different because it is ‘for real’ and is more poignant and convincing.” (2)
Analysis of New Approved Techniques Revealed in Inspector General’s Report
The additional approved techniques listed in the Inspector General’s report and not previously analyzed by PHR include shaving, hooding, restricted diet, prolonged diapering, “walling” and confinement boxes.
As with the previously reviewed techniques, while these techniques can have harmful physical as well as mental health effects, their chief objective is to produce psychological impact, and their chief risk is prolonged mental pain and suffering. 1. Forced shaving
Forced shaving of the head and beard was alleged by two of the fourteen detainees interviewed by the ICRC for its 2007 report.
Mr. Ramzi Bin-al-Shib alleged that, in his eighth place of detention, first his head was shaved and then some days later his beard was also shaved off. He was particularly distressed by the fact that the people who shaved him allegedly deliberately left some spots and spaces in order to make him look and feel particularly undignified and abused. (3)
In 2007, PHR physicians examined a former US detainee, who reported:
“When they finished hitting me... they shaved my hair. The only hair I had was in the middle. This was only to humiliate me.” (4)
Medical Analysis: Forced shaving obviously carries little risk of physical harm, and is chiefly designed to inflict psychological harm by means of humiliation, both personal and religious. Forced shaving was part of a campaign to sever the sense of self derived from religious belief, and was often accompanied by forced removal of religious articles.
In addition to the violation of cultural and religious taboos, forced shaving constitutes an intrusion into the personal space and bodily integrity of the person, infringing on autonomy and self-control. The combined effects of this type of treatment in combination with other techniques have been associated with long-lasting psychological injury such as posttraumatic stress disorder, anxiety and depression. 2. Hooding
Detainees were blindfolded or hooded to instill in them a sense of fear, disorientation and dependency on their captors.
According to the February 2004 report of the International Committee of the Red Cross (ICRC) on treatment of detainees in Iraq:
Hooding [was] used to prevent people from seeing and to disorient them, and also to prevent them from breathing freely. One, or sometimes two bags, sometimes with an elastic blindfold over the eyes which, when slipped down, further impeded proper breathing. Hooding was sometimes used in conjunction with beatings thus increasing anxiety as to when blows would came. The practice of hooding also allowed the interrogators to remain anonymous and thus to act with impunity. Hooding could last for periods from a few hours to up to 2 to 4 consecutive days, during which hoods were lifted only for drinking, eating or going to the toilets.(5)
PHR reported in Broken Laws, Broken Lives that according to former detainees medically evaluated by PHR, hooding was used both during transportation and during interrogation.
Medical Analysis: When not used in transport, hooding is a form of sensory deprivation aimed at causing dislocation and confusion. Research shows that prolonged sensory deprivation can result in depression, depersonalization and psychosis. According to the ICRC report, hooding, and other observed sensory deprivation techniques resulted in
“signs of concentration difficulties, memory problems, verbal expression difficulties, incoherent speech, acute anxiety reactions, abnormal behavior and suicidal tendencies.”(6)
3. dietary Manipulation
Detainees were deprived of solid food for periods ranging from days to months. Mr. Abu Zubaydah alleged that for a period of two to three weeks during his initial period of interrogation, he was kept sitting on a chair constantly and only provided with liquid Ensure (a nutrient formula) and water. Mr. Binal-Shib reported that he went three to four weeks without solid food, and was only provided with Ensure and water. In addition, six other high-value detainees reported being deprived of solid food for periods ranging from days to weeks. (7) Medical Analysis: While physical risks of a liquid diet are minimal as long as appropriate calories and nutrients are provided, the intent of dietary manipulation is to inflict psychological distress by infringing on the detainee’s sense of autonomy and self control and increasing discomfort and a sense of helplessness and dependency. While the risk of death or debilitation may be minimal, the effects on concentration and mood may be substantial. 4. Prolonged diapering
Detainees were placed in diapers and denied access to a toilet for prolonged periods of time. According to the ICRC Report, high value detainees in CIA custody were placed in diapers for prolonged periods for transport.
The detainee would be made to wear a diaper and dressed in a tracksuit... The journey times obviously varied considerably and ranged from one hour to over twenty-four to thirty hours. The detainee was not allowed to go to the toilet and if necessary was obliged to urinate or defecate in the diaper.(8)
he ICRC report states that one of the detainees, Mr. Bin Attash, was compelled to wear a diaper for a prolonged period:
[H]e commented that on several occasions the diaper was not replaced so he had to urinate and defecate on himself while shackled in the prolonged stress standing position. Indeed, in addition to Mr. Bin Attash, three other detainees specified that they had to defecate and urinate on themselves and remain standing in their own body fluids.(9)
Medical Analysis: Prolonged diapering especially when combined with leaving the subject in a diaper soiled with urine and feces can result in both physical and psychological harm. Prolonged exposure of the skin can result in skin infection, skin breakdown and ulceration and urinary tract infections. In addition, the placement of a normally continent adult in a diaper will likely lead to efforts by the adult to resist urination or defecation, which in turn will likely result in bowel cramping and bladder spasm.
Access to toilet is a universally recognized minimum standard for prisoners and detainees. In spite of the physical risks, the chief aim of this technique is to cause psychological stress through humiliation, induced dependency, loss of autonomy, and regression to an infantile state.(10) Like all such techniques, especially when combined with others of the ‘DDD’ type (debility-dependency-dread), these are cumulative and lead to short and long-term debilitation. At Guantánamo, the standard operating procedures included requiring the detainee to ask the interrogator for toilet paper, food, and religious articles. Here, the torturers go even further, returning the detainee to pre-toilet-training levels. When combined with a liquid diet, the experiences of regression, humiliation, and dependency are magnified. 5. Walling
Six of the fourteen high-value detainees interviewed by the ICRC reported being placed in a neck collar or roll and then slammed against a wall. According to the CIA guidelines, slamming against a wall could be used twenty or thirty times consecutively.
During the walling technique, the detainee is pulled forward and then quickly and firmly pushed into a flexible false wall so that his shoulder blades hit the wall. His head and neck are supported with a rolled towel to prevent whiplash. (11)
Although the guidelines require that the wall be a specially constructed flexible one, some detainees alleged that they were also slammed against concrete wall using the collar during transport.(12)
Mr. Bin Attash alleged that during interrogation in Afghanistan:
“on a daily basis during the first two weeks a collar was looped around my neck and then used to slam me against the walls of the interrogation room.” (13)
Medical Analysis: Walling results in blunt trauma and acceleration/deceleration type injuries. Blunt trauma can result in bruises and bleeding from ruptured blood vessels. Studies have observed persistence of musculoskeletal pain cause by blunt trauma even a decade after the trauma has occurred. In rare cases, repeated beating can cause damage to muscle tissue and muscle breakdown resulting in release of muscle enzymes resulting in a life-threatening condition called rhabdomyolisis. In addition, walling can expose the subject to risk of whiplash type injury to the neck and spine. (14)
Psychological stress, which is the primary aim of the procedure, is achieved by use of surprise, generating a startle response, an experience of shock, loss of control and helplessness. Also, rage is engendered which turns to further humiliation, insofar as the detainee cannot fight back. 6. Confinement in a Box
Confinement in a box is a rather extreme version of a stress position with the added potential for claustrophobia.
According to the ICRC report, Abu Zubaydah alleged that in Afghanistan in 2002 he was held in boxes designed to constrain his movement. Mr. Zubaydah stated:
“As it was not high enough even to sit upright, I had to crouch down. It was very difficult because of my wounds. The stress on my legs held in this position meant that my wounds both in the leg and the stomach became very painful.” (15)
He went on to say that a cover was placed over the boxes while he was inside making it hot and difficult to breathe. Medical Analysis: Confinement in a box is an extreme example of stress positions, with the added effect of decreased access to fresh air, temperature changes, light deprivation and isolation. Stress positions have been associated with permanent joint and ligamentous injury, and both acute and prolonged musculoskeletal pain. In addition, use of stress positions following blunt trauma carries the risk of deep vein thrombosis (clotting) and associated and potentially fatal pulmonary emboli. This is not a theoretical risk, as at least two detainees in US Custody in Afghanistan died of pulmonary emboli due to use of stress positions in interrogation settings.(16)
Confinement in a box was devised as a direct appropriation of Martin Seligman’s research on “learned helplessness.” In fact, on at least two occasions, Seligman presented his learned helplessness research to CIA contract interrogators referred to in the Inspector General’s report. In Seligman’s experiment, dogs were confined to boxes in which they discovered that familiar mechanisms of control would no longer have an effect in avoiding pain.
Like their canine counterparts, humans subjected to similar confinement develop psychomotor and cognitive responses that would be clinically diagnosed as depression and, in certain cases, PTSD. Such symptoms include apathy, helplessness, hopelessness, foreshortened sense of future, and a (in this case justified) lack of belief in their ability to affect their future prospects. In Seligman’s experiments, these symptoms were severe and lasting, in that a change to an environment where the dogs could have an effect did not change the symptoms of learned helplessness. (From the DoD’s Joint Personnel Recovery Agency (JPRA) and SERE (Survival, Evasion, Resistance and Escape) Programs.) Unapproved and Improvised Techniques
The Inspector General’s Report contains numerous accounts of interrogation techniques that were not approved for use, including threats with a gun and power drill, threats of harm to loved ones, and choking and carotid artery pressure.
Threats of harm to the detainee or loved ones are reviewed in Leave No Marks. The risks of choking and carotid artery pressure should be self-evident. They include risk of choking death and stroke, as well as high risk of psychological trauma from a near-death experience. Near-death experiences are highly correlated with the risk of developing post traumatic stress disorder. Role of Health Professionals in Torture
Health professionals played central roles in developing, implementing and providing justification for torture.
Health professionals in the Office of Medical Services and psychologist contractors (17) engaged in designing and monitoring harmful interrogation techniques.(18) Such medical participation in torture is a clear violation of medical ethics. Furthermore, health professionals were complicit in selecting and then rationalizing these abusive methods whose safety and efficacy in eliciting accurate information have no valid basis in science. The severe physical and psychological pain and enduring harms associated with these techniques make it evident that they constitute torture and ill treatment. Monitoring of interrogation techniques by medical professionals to determine their effectiveness uses detainees as human subjects without their consent, and thus also approaches unlawful experimentation.(19)
According to CIA guidelines, health professionals including a psychologist and doctor were required to be present during the use of enhanced interrogation techniques.(20) The required presence of health professionals did not make these methods safer, and in fact only served to sanitize their use and enable the abuse to escalate, thereby placing health professionals in the untenable position of calibrating harm rather than serving as protectors and healers as required by their ethical oath.
The report also documents the role of health professionals in participating in initial psychological and physical assessments of detainees in an intake process closely linked to the process of interrogation. By requirement, all interrogations were monitored in real-time by health professionals. Previous reports, including the ICRC report, document allegations that a medical device called a pulse oximeter (a device to measure oxygen saturation in a subject’s blood) was placed on the finger of a detainee to monitor the effectiveness of his respiration during waterboarding.(21) In this way, medical professionals were used to calibrate physical and mental pain and suffering.
Not only were health professionals involved in designing and monitoring the CIA interrogation program, they also played an indirect but essential role in the legal justifications for the program prepared by the Office of Legal Counsel (OLC). The OLC was asked by the CIA whether certain techniques constituted torture under 18 USC §2340 by causing “severe physical or mental pain or suffering.” Since the OLC lawyers had no direct experience of the techniques, they necessarily relied instead on the judgment of health professionals. Yet, in a striking example of bootstrapping, they turned for advice about the pain caused by the techniques to the very health professionals who were implementing them. (22)
In essence, the lawyers were asked if the techniques constituted torture and they replied to the CIA that they only did so if the CIA Office of Medical Services (OMS) informed them that the techniques reached the defined standard of pain. The OMS health professionals obligingly passed on through CIA channels their opinion that the pain was not in fact severe
In an egregious example of this circular process, one OLC memo concludes that waterboarding is not torture because “however frightening the experience may be, OMS personnel have informed us that the waterboard technique is not physically painful.” Scores of similar references to OMS medical judgments about pain and the safeguarding effects of medical monitoring appear throughout the memos. Although OMS did express some concern about some techniques, those objections were limited. Without the cooperation of health professionals in making these assessments, the OLC memos could not have reached the conclusions they did and could not have so easily justified torture.
The intent of the CIA interrogation program was to cause severe psychological distress.(23) Despite citation of unnamed experts who reportedly concluded that these techniques were unlikely to cause significant harm, the notion that these abusive techniques can be used safely has no basis in medical science and is not supported by an extensive peer-reviewed literature.(24) From a medical, scientific and common sense perspective the idea that such abusive and inhumane techniques can be safely deployed is unsupportable. The techniques authorized and deployed have long been documented to cause significant and long lasting psychological pain and suffering including posttraumatic stress disorder, anxiety and major depression.(25) In fact, a recent study demonstrates that abusive techniques employed during captivity which emphasized psychological torture over physical injury, such as psychological manipulation, forms of deprivation, humiliation and stress positions, cause as much mental pain and traumatic stress as does torture designed to inflict physical injury. (26)
The use of these abusive methods violates international human rights standards. The likely illegality of the program was known to the agency and debated within the agency. Those advocating for the use of abusive techniques such as waterboarding should have known that the US had prosecuted these same techniques as torture. Health professionals who were involved in its justification, design and implementation should have known that professional ethics prohibit health professionals from complicity in such harmful acts against prisoners or detainees. It is precisely to avoid such complicity that health professionals have recourse to professional codes of ethics, as well as international standards of medical conduct. Familiarity with these codes – not to mention basic human decency – should preclude such conduct, making clear to health professionals and government institutions both its essentially unethical nature and illegal status under international law.
Not only should interrogators be subject to an investigation of alleged criminal conduct. Health professionals who were involved in this program should be the subject to independent investigation for both criminal and unprofessional conduct. Professionals who have violated professional ethics or the law must be held accountable through criminal prosecution, loss of license and professional society membership, where appropriate. Conclusion
The newly released version of the May 2004 CIA Inspector General’s report on Counterterrorism Detention and Interrogation Activities reveals the use of a number of previously undescribed techniques including:
Confinement in a box
These techniques used alone or in combination may meet the definition of torture under US and international law. Legality aside, they are associated with high risk of physical and psychological harm, including harm that is enduring, in those subjected to these techniques. They also represent clear violations of well-established medical ethics governing the behavior of health professionals.
The report also confirms use of previously reported techniques, covered in the PHR and Human Rights First report Leave No Marks, such as isolation, forced nudity, stress positions, temperature manipulation, waterboarding, and other techniques which were used in ways that violated the torture statute and international law.
The Inspector General’s report confirms much of what had been reported about the essential role played by health professionals in designing, deploying, monitoring and legitimizing the program of torture, but also raises disturbing new questions which require further investigation. The possibility that health professionals monitored techniques to assess and improve their effectiveness, constituting possible unethical human experimentation, urgently needs to be thoroughly investigated.
PHR has long called for full investigation and remedies including accountability for war crimes, and reparation such as compensation, medical care and psycho-social services. PHR also calls for health professionals who have violated ethical standards or the law to be held accountable through criminal prosecution, loss of license and loss of professional society membership where appropriate.
1)Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and Its Impact. 2008. Available at: http://brokenlives.info/?page_id=69 ; Break Them Down: Systematic Use of Psychological Torture by US Forces. 2005. Available at: http://physiciansforhumanrights.org/library/report-2005may.html ; Leave No Marks: Enhanced Interrogation Techniques and the Risk of Criminality 2007. Available at: http://physiciansforhumanrights.org/library/ report-2007-08-02.html. 2) Inspector General’s report p. 37
3) ICRC Report on the Treatment of Fourteen “High Value Detainees” in CIA Custody. International Committee of the Red Cross. February 2007. Available at http://www.nybooks.com/icrc-report.pdf.
4. Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and Its Impact. 2008. Available at: http://brokenlives.info/?page_id=69. The former detainee’s history was deemed credible by examining physicians. He suffers from symptoms consistent with posttraumatic stress disorder.
5. ICRC Report.
6. ICRC Report.
7. ICRC Report.
8. ICRC Report.
9. ICRC Report.
10. “The purpose of all coercive techniques is to induce psychological regression in the subject by bringing a superior outside force to bear on his will to resist. Regression is basically a loss of autonomy, a reversion to an earlier behavioral level. As the subject regresses, his learned personality traits fall away in reverse chronological order...” (Human Resource Exploitation Manual, CIA, 1983)
11. CIA guidelines as reproduced in Inspector General’s report, p. 15
12. ICRC Report.
13. ICRC Report.
14. Leave No Marks
15. ICRC Report.
16. Allen S. Rich J. Bux R. Farbenblum B. Berns M. Rubenstein L. Deaths of Detainees in the Custody of US Forces in Iraq and Afghanistan from 2002 to 2005. Medscape General Medicine: 2006;8(4):46.
17. From the DoD’s Joint Personnel Recovery Agency (JPRA) and SERE (Survival, Evasion, Resistance and Escape) Programs.
18. “Several months earlier, in late 2001, CIA had tasked an independent contractor psychologist, who had [redacted] experience in the US Air Forces’ Survival, Evasion, resistance, and Escape (SERE) training program, to research and write a paper on Al-Qa’ida’s resistance to interrogation techniques. This psychologist collaborated with a Department of Defense (DoD) psychologist who had [redacted] SERE experience in the US Air Force and DoD to produce the paper “Recognizing and Developing Countermeasures to Al-Qa’ida’s Resistance to Interrogation Techniques: A Resistance Training Perspective.” Subsequently, the two psychologists developed a list of new and more aggressive EIT’s [enhanced interrogation techniques] that they recommended for use in interrogations.” Inspector General’s Report p. 13. “CIA’s OTS obtained data on the use of the proposed EIT’s and their potential long-term psychological effects on detainees. OTS input was based in part on information solicited from a number of psychologist and knowledgeable academics in the area of psychopathology” and “OTS also solicited input from DoD/Joint Personnel Recovery Agency (JPRA) regarding techniques used in SERE training and any subsequent psychological effects on students.” Inspector General’s Report p. 14.
19. The Office of Medical Services guidelines for waterboarding state “A rigid guide to the medically approved use of the waterboard is not possible, as safety will depend on how the water is applied and the specific response each time it is used. The following general guidelines are based on very limited knowledge, drawn from very few subjects whose experience and response was quite varied.” They add “NOTE: In order to best inform future medical judgments and recommendations, it is important that every application of the waterboard be thoroughly documented: how long each application (and the entire procedure) lasted, how much water was applied, if a seal was achieved, if the naso- or oropharynx was filled, what sort of volume was expelled, how long was the break between applications, and how the subject looked between each treatment.”
20. “In 2004, when Daniel B. Levin, then the acting assistant attorney general in the counsel’s office, sent a letter to the CIA reauthorizing waterboarding, he dictated the terms: “no more than two sessions of two hours each, per day, with both a doctor and a psychologist in attendance.” Report Shows Tight CIA Control on Interrogations. Mark Mazzetti and Scott Shane. New York Times, August 26, 2009. Available at: http://www.nytimes.com/2009/08/26/ us/26prison.html?_r=1&hpw
21. ICRC report. Note that the use of a pulse oximeter, and the requirement that an emergency tracheostomy kit be kept ready is even more evidence that the procedure is intentionally harmful, risky and potentially lethal.
22. In certain cases the very same JPRA psychologists who designed the torture and implemented the techniques, and, who, as private contractors, profited from the operation, also provided the research that justified the techniques: “You have informed us that your on-site psychologists, who have extensive experience with the use of the waterboard in Navy training, have not encountered any significant long-term mental health consequences from its use. Your on-site psychologists have also indicated that JPRA has likewise not reported any significant mental health consequences from the use of the waterboard.”
23. CIA Inspector General’s Report. Appendix F. “Captured terrorists turned over to the CIA for interrogation may be subjected to a wide range of legally sanctioned techniques, all of which are also used on US military personnel in SERE training programs. These are designed to psychologically ‘dislocate’ the detainee, maximize his feelings of vulnerability and helplessness, and reduce or eliminate his will to resist our efforts to obtain critical intelligence.” In addition, the sanction techniques include so-called “Standard measures” or those deemed to be without physical or substantial psychological pressure and so-called “Enhanced measures,” or those deemed to cause physical or psychological pressure beyond “Standard measures.” (p. 1). “In all instances, the goal of these techniques is psychological impact...” and are “designed to induce shock, surprise and/or humiliation.” (p. 2).
24. See Leave No Marks and Broken Laws, Broken Lives. Although these reports were published in 2007 and 2008 respectively, they summarized scientific literature that was well established in 2001. In a bizarre justification for the safety of the techniques, the OLC report states, “You have also reviewed the relevant literature and found no empirical data on the effect of these techniques with the exception of sleep-deprivation.” OLC August 1, 2002, p. 6. Yet, there is a large body of research on the effects of these and similar techniques, much of it supported by the CIA. See for example The Search for the Manchurian Candidate (c) 1979 by John Marks. Published by Times Books.
25. PHR and HRF previously reported on the harmful effects of many of these techniques in their report Leave No Marks: Enhanced Interrogation and the Risk of Criminality.
26. BasogluM.etal.Torturevs.OtherCruel,InhumanorDegradingTreatment: Is the Distinction Real or Apparent? Archives Gen. Psychiatry 277 (2007).
This presss release, by Jonathan Hutson, was published by Physicians for Human Rights, August 31, 2009
Cambridge, MA — The extent to which American physicians and psychologists violated human rights and betrayed the ethical standards of their professions by designing, implementing, and legitimizing a worldwide torture program is greater than previously known, according to a report by Physicians for Human Rights (PHR).
A team of PHR doctors authored the new white paper, Aiding Torture: Health Professionals' Ethics and Human Rights Violations Demonstrated in the May 2004 Inspector General's Report. The report details how the CIA relied on medical expertise to rationalize and carry out abusive and unlawful interrogations. It also refers to aggregate collection of data on detainees' reaction to interrogation methods. PHR is concerned that this data collection and analysis may amount to human experimentation and calls for more investigation on this point. If confirmed, the development of a research protocol to assess and refine the use of the waterboard or other techniques would likely constitute a new, previously unknown category of ethical violations committed by CIA physicians and psychologists.
"Medical doctors and psychologists colluded with the CIA to keep observational records about waterboarding, which approaches unethical and unlawful human experimentation," says PHR Medical Advisor and lead report author Scott Allen, MD. For example, "Interrogators would place a cloth over a detainee's face to block breathing and induce feelings of fear, helplessness, and a loss of control. A doctor would stand by to monitor and calibrate this physically and psychologically harmful act, which amounts to torture. It is profoundly unsettling to learn of the central role of health professionals in laying a foundation for US government lawyers to rationalize the CIA's illegal torture program."
The Inspector General's report documents some practices — previously unknown or unconfirmed — that were used to bring about excruciating pain, terror, humiliation, and shame for months on end. These practices included:
Brandishing guns and power drills;
Threats to sexually assault family members and murder children;
"Walling" — repeatedly slamming an unresponsive detainee's head against a cell wall; and
Confinement in a box.
"These unlawful, unethical, and ineffective interrogation tactics cause significant bodily and mental harm," said co-author and PHR Senior Medical Advisor Vincent Iacopino, MD, PhD. "The CIA Inspector General's report confirms that torture escalates in severity and torturers frequently go beyond approved techniques."
"The required presence of health professionals did not make interrogation methods safer, but sanitized their use, escalated abuse, and placed doctors and psychologists in the untenable position of calibrating harm rather than serving as protectors and healers. The fact that psychologists went beyond monitoring, and actually designed and implemented these abuses – while simultaneously serving as 'safety monitors' – reveals the ethical bankruptcy of the entire program," stated co-author Steven Reisner, PhD, PHR's Psychological Ethics Advisor.
"That health professionals who swear to oaths of healing so abused the sacred trust society places in us by instigating, legitimizing and participating in torture, is an abomination," states co-author Allen Keller, MD, Director of the Bellevue/NYU Program for Survivors of Torture. "Health professionals who aided torture must be held accountable by professional associations, by state licensing boards, and by society. Accountability is essential to maintain trust in our professions and to end torture, which scars bodies and minds, leaving survivors to endure debilitating injuries, humiliating memories and haunting nightmares."
PHR has called for full investigation and remedies, including accountability for war crimes, and reparation, such as compensation, medical care and psycho-social services. PHR also calls for health professionals who have violated ethical standards or the law to be held accountable through criminal prosecution, loss of license and loss of professional society membership where appropriate.
To download PHR's Aiding Torture, visit http://physiciansforhumanrights.org/library/news-2009-08-31.html.
Since 2005, PHR has documented the systematic use of psychological and physical torture by US personnel against detainees held at Guantánamo Bay, Abu Ghraib, Bagram airbase, and elsewhere in its groundbreaking reports, Break Them Down, Leave No Marks, and Broken Laws, Broken Lives.
This article by Mark Hosenball and Michael Isikoff , Augusrtn 21, 2009
A long-suppressed report by the Central Intelligence Agency's inspector general to be released next week reveals that CIA interrogators staged mock executions as part of the agency's post-9/11 program to detain and question terror suspects, NEWSWEEK has learned.
According to two sources—one who has read a draft of the paper and one who was briefed on it—the report describes how one detainee, suspected USS Cole bomber Abd al-Rahim al-Nashiri, was threatened with a gun and a power drill during the course of CIA interrogation. According to the sources, who like others quoted in this article asked not to be named while discussing sensitive information, Nashiri's interrogators brandished the gun in an effort to convince him that he was going to be shot. Interrogators also turned on a power drill and held it near him. "The purpose was to scare him into giving [information] up," said one of the sources. A federal law banning the use of torture expressly forbids threatening a detainee with "imminent death."
The report also says, according to the sources, that a mock execution was staged in a room next to a detainee, during which a gunshot was fired in an effort to make the suspect believe that another prisoner had been killed. The inspector general's report alludes to more than one mock execution.
Before leaving office, Bush administration officials confirmed that Nashiri was one of three CIA detainees subjected to waterboarding. They also acknowledged that Nashiri was one of two Al Qaeda detainees whose detentions and interrogations were documented at length in CIA videotapes. But senior officials of the agency's undercover operations branch, the National Clandestine Service, ordered that the tapes be destroyed, an action that has been under investigation for more than a year by a federal prosecutor.
The new revelations are contained in a lengthy report on the CIA interrogation program completed by the agency's inspector general in May 2004, around the time that the initial, most intense phase of the CIA effort began to wind down. The purpose of the report was to examine how the CIA program had been conducted, and whether Justice Department guidelines governing the use of harsh "enhanced" interrogation techniques had been followed. According to the sources, the inspector general criticizes some agency interrogators for exceeding official guidelines in the use of extreme tactics on detainees.
Mock executions were not authorized in Justice Department memoranda that outlined the legal parameters that Bush administration lawyers believed should govern the use of "enhanced" interrogations. The Justice Department memoranda, once highly classified, were released earlier this year by the Obama administration in the face of strenuous objections from the CIA and former Bush White House officials.
The inspector general's report, commissioned by then CIA director George Tenet, was sent to the Justice Department and congressional intelligence committee leaders shortly after it was written. But it was not shown to all members of the intelligence committees until September 2006, around the time that President Bush publicly acknowledged the CIA detention-and-interrogation program and instructed the agency, which had been holding detainees in a network of secret overseas prisons, to transfer them to the U.S. military detention camp at Guantánamo Bay, Cuba.
Top Bush CIA officials, including Tenet's successors as CIA director, Porter Goss and Gen. Michael Hayden, strongly lobbied for the IG report to be kept secret from the public. They argued that its release would damage America's reputation around the world, could damage CIA morale, and would tip off terrorists regarding American interrogation tactics. "Justice has had the complete document since 2004, and their career prosecutors have reviewed it carefully for legal accountability," said CIA spokesman Paul Gimigliano. "That's already been done."
The inspector general's report is expected to fuel political debates over whether the tough interrogation methods used during the Bush administration actually worked. According to another source who has seen the document, the report says that the agency's interrogation program did produce usable intelligence.
At the same time the administration releases the inspector general's report, it is also expected to release other CIA documents that assert the agency collected valuable intelligence through the interrogation program. For months, former vice president Dick Cheney has called for these documents to be released. However, a person familiar with the contents of the documents says that they contain material that both opponents and supporters of Bush administration tactics can use to bolster their case. The Senate Committee on Intelligence is now conducting what is supposed to be a thorough investigation of the CIA's detention-and-interrogation program. The probe is intended not only to document everything that happened but also to assess whether on balance the program produced major breakthroughs or a deluge of false leads.