Doctors caring for detainees at the Guantanamo prison may have neglected or concealed medical evidence of torture, such as bone fractures, lacerations, and symptoms of post traumatic stress disorder, , according to a study released today by Physicians for Human Rights.
For example, one of the suspected terrorists held at Gitmo who claimed he had been severely beaten with kicks and punches until he was unconcious had evidence of a fracture on X-ray, but the circumstances of the injury were not discussed in his medical file.
"Apparently the clinician did not ask how the injury occurred," says Dr. Vincent Iacopino, senior medical advisor for Physicians for Human Rights and co-author on the study
The study acknowledged that the Gitmo medical staff provided quality medical care for ailments ranging from athletes foot to nearsightedness.
"What was so striking in our investigation," Iacopino says, "was that it's clear the Department of Defense clinicians provided medical care in the way you'd expect at any hospital or clinic, except that whenever an injury implied the possibility of intentional harm or psychological symptoms suggesting torture, the cause of those symptoms were completely ignored."
Researchers evaluated the medical files, medical affidavits, and third-party examinations of nine detainees who claimed that they were tortured during interrogations at Guantanamo. Several of those detainees are still held at Gitmo.
Co-authors Iacopino and psychiatrist and retired Brig. Gen. Stephen Xenakis studied the cases because they were serving as medical experts on behalf of the detainee's attorneys. They would not discuss the nature of the legal cases.
Medical records were thorough when it came to regular health problems, but researchers found that medical professionals failed to inquire about or document the cause of those physical and mental symptoms that suggested possible torture.
The study cites the case of one patient who had what are documented symptoms normally associated with PTSD, nightmares, lapses in memory, decreased concentration and appetite, depressed mood, and suicidal thoughts. He was not diagnosed with PTSD. His clinician gave him antidepressants and told that he needed "to relax when guards are being more aggressive," medical records indicate.
Though PTSD is not necessarily a sign of torture, the clinicians working with the nine patients determined that all nine showed signs of PTSD. Their doctors, however, treated them for non-trauma related diagnoses such as personality disorders or "adjustment disorder."
"In my mind the physicians turned a blind eye. My suspicion is that clinicians were aware on some level of mistreatment, at least the possibility of mistreatment, and for whatever reason – fear, orders from superiors – they didn't want to take their clinical encounters in that direction," says Iacopino, senior medical advisor for Physicians for Human Rights and co-author on the study.
The Joint Medical Group, which cared medically for detainees, is separate from the Joint Detention and Joint Intelligence groups, which guard and interrogated them, says Lt. Col. Don Langley, a spokesperson for the Joint Task Force Guantanamo. All care of detainees was "humane" and consistent with the medical care received by U.S. service members, he said.
Following the Sept. 11 attacks, the U.S. government redefined acts such as waterboarding, forced nudity, sleep deprivation, temperature extremes, stress position and prolonged isolation to be "safe, legal, ethical, and effective" enhanced interrogation techniques . These techniques had previously been considered torture and forbidden by the United Nations Committee Against Torture.
Non-clinical medical monitors were put in place to supervise the application of enhanced interrogations in order to prevent these newly-approved interrogation techniques from crossing into the bounds of torture. Despite this emphasis on holding to new definitions of torture, policy makers failed to include any meaningful provisions that would enable and require monitors to detect and report medical evidence of torture, Iacopino says.
Gitmo Docs Called into Question
It may be that the environment of Guantanamo discouraged doctors from seeking out signs of torture, says Dr. Ramin Asgary, director of the Program in Health and Human Rights at Mount Sinai School of Medicine.
"I don't think these doctors were bad people. It's a mindset of a military base and the system doesn't support their independence as physicians. But it is our oath, as doctors, to treat, irrespective of who we are treating," he says.
"When you're an insider, the group think can take over and you begin seeing things as others do. In a sense, that's more of a process of denial, that you yourself don't see the truth," adds Dr. Stevan Hobfoll, chair of behavioral sciences at Rush University Medical Center in Chicago, Il.
Interrogators would not have necessarily had to break with the revised definitions of torture in order to cause PTSD, Hobfoll says.
"If I have a Muslim man stand naked or even in his underwear with women in the room, that is horribly shaming. Now if he's sleep deprived and someone is yelling at him, that could cause PTSD. At the same time, it's difficult to link PTSD as the outcome of those events, because they could have PTSD from their experience in battle or when they were captured. These are things that are difficult to separate but hence easy to hide behind," he says.
The Joint Task Force Guantanamo website documents the many "life-improving" medical services provided to detainees such as tuberculosis screening, dental care, and access to state-of-the-art equipment and one medical staff for every two detainees.
The study was published in the online journal PLos Medicine.