Sample text for Oath betrayed : military medicine and the war on terror / Steven H. Miles.

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chapter 1


In November 2003, an Iraqi guard smuggled a Chinese pistol into Abu Ghraib and gave it to a prisoner, Ameen Sa’eed Al-Sheikh. An informant promptly told MPs, who locked down the cellblock and began a cell-to-cell search. When they got to his cell, Al-Sheikh went for the pistol hidden in his bedding. Gunfire was exchanged. Sergeant William Cathcart was hit, but not injured, by a ricochet. The soldiers wrestled Al-Sheikh to the floor and sent him to the hospital with a dislocated shoulder and shotgun wounds to his legs. When Al-Sheikh returned to the cellblock after several days in the hospital, Specialist MP Charles Graner beat his wounded leg with a baton while demanding that the prisoner renounce Islam. He then suspended Al-Sheikh by his injured shoulder even though the prisoner’s wounded legs could not bear weight to protect the shoulder from further injury. Staff Sergeant–Medic Layton Reuben and another medic saw the beating while providing health care in the cellblock. On three occasions, Medic Layton found Al-Sheikh handcuffed with his arms over his head, putting stress on his injured shoulder and leg. Each time, he says that he told Graner to remove the handcuffs. Layton considered that to be the extent of his responsibility: he stated, “I feel I did the right thing when I told Graner to get the detainee uncuffed from the bed.” Under oath, Medic Layton said that he examined Al-Sheikh in his cell with two officers, a Captain Williams and a physician named Ackerson who held the rank of lieutenant colonel, to confirm that Al-Sheikh had a dislocated shoulder from having his arms handcuffed over his head in his cell. Investigators do not record looking at, or for, the medical record of this examination. There is no evidence that any of these persons reported or tried to stop the abuse, either. Months later, an Abu Ghraib investigation recommended that Medic Layton be disciplined for failing to stop or report the ongoing abuse. The released file says nothing about any scrutiny of Dr. Ackerson.

On a cold night, another medic, Sergeant Theresa Adams, saw Al-Sheikh naked and without a mattress or a blanket. The prisoner was bleeding from a drain that should have been connected to a bag to prevent an infection. Sergeant Adams took Al-Sheikh to see the physician on call, who held the rank of colonel. The physician agreed that the hospital had erred in leaving the catheter open but refused to remove the catheter or to transfer Al-Sheikh to the adjoining hospital. When Sergeant Adams asked him whether he had ever heard of the Geneva Convention, the physician answered, “Fine, Sergeant, you do what you have to do; I am going back to bed.” Later, the physician told investigators that he remembered Al-Sheikh’s dislocated shoulder but not the catheter incident, although he agreed that such a catheter should have been removed. That physician also claimed that during four months at Abu Ghraib at the peak of the abusive incidents, he never observed or heard of any abuse, although he did recall the Red Cross complaining about the treatment of the prisoners.

“Torture” comes from the Latin word for “twist,” an origin that conveys both a common technique of bending a victim’s body or the contortion of a person in agony. The torsion and stretching applied by the medieval “strappado,” a ladderlike device that stretched extremities and joints into abnormal and extreme directions, or the shackled “stress positions” widely used in the prisons of the war on terror epitomize the ancient sense of the word. Torture acquired its present meaning of pain inflicted by government officials in France about eight hundred years ago, when the church or governments applied “the torture” to extract confessions or testimony. The English adopted the French noun in about 1550. In 1591, William Shakespeare is credited with first using “torture” as a verb, in Henry VI: “Alas, master, I am not able to stand alone: You go about to torture me in vain. [Enter a Beadle with whips].” However, the many appearances of the verb in the years immediately after the play suggest that the Bard simply recorded an existing colloquial use, rather than originating one.

Definitions of torture bear close reading. The UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment defines torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by, or at the instigation of, or with the consent or acquiescence of a public official or other person acting in an official capacity.

Similarly, the World Medical Association’s “Guidelines for Medical Doctors Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment” defines torture as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason.

Both of the preceding documents and the Geneva Conventions definetorture as a government practice rather than as suffering that is inflicted by a criminal sadist. By defining torture in relation to the reasons that nations use it (for example, to secure information), they emphasize that torture is not justified by any purpose or rationale. Torture is a crime against humanity, but its occurrence is not confined to war: many of the 130 governments that practice torture do so while they are at peace.

Although it is customary to think of torture as a set of techniques, torture is better understood as a social institution. Torturing societies create laws, policies, and regulations to authorize the practices. They establish, empower, and protect specialized practitioners and places. With fear, incentives, and propaganda, they secure the assent or acquiescence of the press, the judiciary, the professions, and the citizenry. This view of torture as an institution means that moral blame may not be simply laid on the individual soldiers or police who employ horrific techniques. Those officials are agents, acting on behalf of national leaders, public policies, and a social and political consensus. Condemning, convicting, or sacrificing low-ranking soldiers as rogues or bad apples neither eradicates nor expiates the crime. Moral responsibility in a torturing society is broadly shared. Reforms and prevention must look up the chain of command and out into the society at large.

The Case for Torture

Governments rationalize torture in various ways. Stalin, Saddam Hussein, and the generals of Argentina’s Dirty War used terror to suppress dissent and maintain political control. Hitler used anti-Semitism and the eugenic ideology of “race hygiene” to mobilize a political base and justify genocidal policies. Nigeria amputates the hands of thieves to punish (and putatively deter) crime. Submerging women in water to see whether they floated (guilty of witchcraft) or sank (innocent) is perhaps the most notorious use of torture to answer a question independent of a victim’s testimony. The present war on terror rationalizes torture and harsh treatment to facilitate interrogation. In his novel Waiting for the Barbarians, the South African writer J. M. Coetzee has a magistrate define faith in interrogational torture this way: “Pain is truth.”

There are two general types of coercive interrogation. Pain nterrogation posits that a person will tell the truth in order to escape pain. Here, a physician may be asked for advice to prevent a prisoner from dying or to ensure that the prisoner remains conscious during questioning. Or a physician might advise on how to decrease the risk of evidential scars or physical disability (the long-term psychiatric consequences of torture, such as post-traumatic stress syndromes, are rarely taken into account). Toward a similar goal of concealing torture, a physician might ensure that medical records or death certificates do not note evidence of trauma. Psychiatric stress interrogation endeavors to cause a prisoner to regress and become psychologically dependent on the interrogator. Such captives supposedly become submissive to the interrogator and thereby less resistant to questioning, or less inclined to be deceptive. Here, behavioral scientists, psychiatrists, or psychologists devise plans to psychologically “break” a prisoner without impairing his or her ability to speak the truth. For example, the dose of a barbiturate “truth serum” must be sufficient to relax a prisoner but not so large as to cause an exhausted prisoner to fall asleep or a malnourished prisoner to stop breathing. Alternatively, sensory deprivation must not make a prisoner so psychotic or disoriented that she cannot respond to questions. The techniques encompassed by these two incompletely distinguishable approaches vary according to the torturer’s technology and imagination. All are psychologically stressful. Some deprive a prisoner of basic needs. Some cause pain and injury. Most have been used in prisons in the war on terror.

In the “Ethical Issues” section of his investigation of the Abu Ghraib abuses, the former secretary of defense James Schlesinger wrote, “For the U.S., most cases for permitting harsh treatment of detainees on moral grounds begin with some variant of the ‘ticking time bomb’ scenario. The ingredients of such scenarios usually include an impending loss of life, a suspect who knows how to prevent it—and in most versions is responsible for it—and a third party who has no humane alternative to obtain the information in order to save lives.” Mr. Schlesinger continues,

An excellent example [of a ticking time bomb scenario] is the case of a 4th Infantry Division battalion commander who permitted his men to beat a detainee whom he had good reason to believe had information about future attacks against his unit. When the beating failed to produce the desired results, the commander fired his weapon near the detainee’s head. The technique was successful and the lives of U.S. servicemen were likely saved. . . . He was punished in moderation and allowed to retire.

Schlesinger’s anecdote is incomplete and misleading—disingenuously so in light of the records of an Army investigation of this incident, completed six months before Schlesinger wrote his report. Those records include an investigative report supported by eight concurring statements by participating soldiers, among them a sworn statement by Lieutenant Colonel Allen West, clearly describing what happened.

Lieutenant Colonel West was never trained to interrogate. He had never even witnessed an interrogation. In August 2003, an Iraqi informant said that Mr. Yehiya Hamoodi, a Shiite police officer working with West’s unit, was plotting to ambush West and some of his soldiers. At that time, many Iraqis were giving false tips to the U.S. Army to curry favor or to use the Army to settle their personal gripes. As a military intelligence training slide show used in Iraq at that time put it,

Personal vendettas against different ethnic groups have caused an influx of bogus reporting from interrogators. . . . Recommendation: Tactical patience is critical when taking action to detain host nation personnel during Stability and Support Operation. It is more of an Art than a Science, and usually learned after the unit makes mistakes.

West promptly sent his soldiers to arrest Mr. Hamoodi. They beat and shackled him and loaded him into their vehicle. When they arrived at the base in Taji, Iraq, they threw him off the Humvee. A medic cleared Mr. Hamoodi for questioning even though his ribs had been hurt by the beating.

Soldiers took Hamoodi to an interrogation room. Colonel West told the nterrogators that they had one hour to obtain information or he would come down and do it himself. Hamoodi was kicked and beaten by four soldiers for forty minutes. During the latter part of this interrogation, Colonel West sat facing the prisoner with a cocked pistol on his lap that he would occasionally point at Mr. Hamoodi. Colonel West tells how he became increasingly angry and threatened Mr. Hamoodi’s life. In a sworn statement, a soldier reported that West told the prisoner, “I have come here for one of two reasons: one, to get the information I need or two, to kill you.” A soldier displayed a knife and the translator told Mr. Hamoodi that his toes or fingernails would be cut off if he did not tell the truth. An appalled soldier left the room after reminding West of the Geneva Conventions, an appeal that West rejected. Finally, Colonel West had his soldiers blindfold Hamoodi and escort him outside, where six soldiers surrounded him with guns as the interrogation continued for another fifteen minutes. A translator told Hamoodi, “If you don’t talk, they will kill you.” West counted down from 10 and shot into the air. Two soldiers forced Hamoodi’s head into a barrel. West did another countdown and, angling his gun close to the prisoner’s head, fired into the barrel.

Hamoodi became hysterical and “admitted there would be attacks and called out names.” A physician’s assistant then examined him and found bruises but no serious injuries or bleeding. Colonel West’s violation of Army interrogation regulations was investigated and charges were filed against him. West then asked to retire. Ultimately, he was removed from command, fined $5,000, and allowed to retire with benefits. Ninety-five congressional representatives wrote a letter on his behalf. He is fêted with dinners in the United States.

Mr. Schlesinger did not report that no plot was found and that the men whom Hamoodi named were released without being charged. Hamoodi later told investigators that there was no plot and that he gave untrue information.

Mr. Schlesinger also omitted a troubling epilogue to his story. Three months before the Hamoodi incident and in the same area, Master Sergeant Lisa Girman and several soldiers beat and kicked several prisoners at Camp Bucca. At least one detainee was pinned to the ground while soldiers spread his legs and kicked him in the groin. Battalion and brigade commanders as well as Army lawyers strongly recommended that the soldiers be court-martialed. A rationale for excusing Colonel West and punishing the Camp Bucca soldiers was that West acted to obtain information for the purpose of “force protection” whereas Girman and her colleagues were simply abusive. However, the Army chose not to prosecute some participants in the Girman matter, and it nonjudicially discharged three soldiers. Why did the Camp Bucca abusers get off with such light sanctions? A company commander told Brigadier General Janis Karpinski, who at that time was in charge of Abu Ghraib, “Ma’am, everybody knows that the reason it didn’t go to court martial was because they were protecting that Lieutenant Colonel” (of whom Schlesinger wrote so approvingly). Soldiers from that same unit were not retrained in the rules for treating prisoners. Their unit was transferred to Abu Ghraib.

Library of Congress subject headings for this publication:
Prisoners of war -- Medical care -- Moral and ethical aspects.
Medical personnel -- Professional ethics -- United States.
Medicine, Military -- Moral and ethical aspects.
Torture -- Moral and ethical aspects.
Prisoners of war -- Abuse of -- Iraq.
Prisoners of war -- Abuse of -- Afghanistan.
Prisoners of war -- Abuse of -- Cuba.
War on terrorism, 2001- -- Moral and ethical aspects.
Abu Ghraib Prison.
Gua‚ntanamo Bay Naval Base (Cuba)