Deprivation and Despair: New Report Details Crisis of Medical Care at Guantánamo

5.7.19

The cover of ‘Deprivation and Despair: The Crisis of Medical Care at Guantánamo,’ a new report by the the Center for Victims of Torture (CVT) and Physicians for Human Rights (PHR).

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Many thanks to the Center for Victims of Torture (CVT) and Physicians for Human Rights (PHR) for their new report, Deprivation and Despair: The Crisis of Medical Care at Guantánamo.

As CVT state in their introduction to the report on their website, “the experiences of detainees and independent civilian medical experts with medical care at the Guantánamo Bay detention center not only broadly refute the claim that detainees receive care equivalent to that of U.S. service members, but also evidence specific violations of the Nelson Mandela Rules, the universally recognized UN standard minimum rules for the treatment of prisoners, which the United States has championed.”

In the introduction to the report itself, CVT and PHR provide a summary of Guantánamo now, “in its eighteenth year”, explaining, “Forty Muslim men still languish there, 31 of whom have never been charged with a crime. Five detainees have long been cleared for transfer by consensus of the Executive Branch’s national security apparatus, which determined that the men pose no meaningful threat, if any at all, to the United States. Many of the remaining detainees are torture survivors or victims of similarly significant trauma. All of them are either suffering from or at high risk of the additional profound physical and psychological harm associated with prolonged indefinite detention, a form of cruel, inhuman, and degrading treatment. As the men age under these conditions, they are increasingly presenting with complex medical needs.”

The authors proceed to explain how, in April this year, Rear Adm. John C. Ring, the Joint Task Force-Guantánamo (JTF-GTMO) Commander, “expressed concern to a gathering of reporters about Guantánamo’s ability to provide medical care to the remaining detainees as time passes and with seemingly no prospect of their release.” As he said, “Unless America’s policy changes, at some point we’ll be doing some sort of end of life care here … A lot of my guys are prediabetic … Am I going to need dialysis down here? I don’t know. Someone’s got to tell me that. Are we going to do complex cancer care down here? I don’t know. Someone’s got to tell me that.”

Adm. Ring’s tenure as Commander was terminated shortly after, although it has not been possible to establish that it was his remarks that led to his departure. Noticeably, six years previously, Gen. John F. Kelly of the U.S. Marine Corps, who was the Commanding General of U.S. Southern Command, testifying before the House Armed Services Committee, had referred to “a ‘major challenge’ facing the United States at Guantánamo: ‘complex issues related to future medical care of detainees.’” He explained that “the medical issues of the aging detainee population are increasing in scope and complexity,” and that “aging detainees could require specialized treatment for issues such as heart attack, stroke, kidney failure, or even cancer,” and warned that “Guantánamo did not have the ‘specialists and equipment’ necessary for that level of care.”

The 58-page report features a number of powerful case studies of current and former prisoners, The three men still held are Nashwan al-Tamir (Abd al-Hadi al-Iraqi), one of the last prisoners to arrive at Guantánamo, in 2007, who has been charged in the military commission trial system, Sharqawi al-Hajj, a “forever prisoner,” held since 2002, and Abd al-Rahim al-Nashiri, also facing a military commission trial. All three were held in CIA “black sites” before being brought to Guantánamo. The former prisoner is Tarek El-Sawah, released in January 2016, whose medical state I wrote about in 2013, in two articles, Lawyers Seek Release from Guantánamo of Tariq Al-Sawah, an Egyptian Prisoner Who is Very Ill and How the Egyptian Media Has Reported the Story of Tariq Al-Sawah, a Severely Ill Prisoner in Guantánamo. Other prisoners’ experiences are referred to throughout the report.

As the report states, The case that perhaps best illustrates the state of medical care at Guantánamo is that of Abd al-Hadi al-Iraqi (aka Nashwan al-Tamir) … On September 5, 2018, Mr. al-Tamir collapsed incontinent in his cell from a degenerative spinal condition — one about which he had told Guantánamo’s medical personnel more than 10 years earlier, they had independently diagnosed at Guantánamo in 2010, and that outside medical experts concluded had obviously required urgent surgical intervention years earlier. To avoid paralysis, a team of specialists from the mainland had to fly to Guantánamo on a moment’s notice and perform emergency surgery. Four additional surgeries later — all performed at Guantánamo, but again by off-island specialists — Mr. al-Tamir’s spinal condition is still not resolved, he continues to suffer, and he may require additional surgery.”

The report adds, “Nevertheless, the government has pushed forward with Mr. al-Tamir’s prosecution in the military commissions, which has required him to attend court on a gurney, take pain medication during legal proceedings, and sleep in the courtroom when the predictable effects of that medication set in. Because of Mr. al-Tamir’s fragile state, Guantánamo’s senior medical officer repeatedly recommended that Mr. al-Tamir not be forcibly extracted from his cell to attend court proceedings (or otherwise). Prosecutors assured the judge in Mr. al-Tamir’s case that he did not need to issue an order to the same effect because Guantánamo’s non-medical staff would respect the recommendation. They were wrong. At the next hearing, prosecutors conceded that, in fact, Guantánamo’s non-medical commanders ‘are not bound by the [senior medical officer’s] opinions nor will they defer to them in every instance.’”

Sharqawi al-Hajj — tortured in Jordan on behalf of the CIA before his transfer to Guantánamo in 2004 — has numerous health problems, but as the report states, “In July 2017, after several weeks of a hunger strike because of increasing despair over his poor health and indefinite detention, Mr. Al Hajj fell unconscious and required emergency hospitalization. Shortly thereafter, he brought an emergency motion for an independent medical evaluation and production of his medical records. The government opposed both requests and, as of June 2019, the court had not ruled.” In addition, it was noted that he “refuses mental health care at Guantánamo for lack of trust.”

In the case of Abd al-Rahim al-Nashiri, held and tortured in CIA “black sites” for over four years, Dr. Sondra Crosby, one of the few medical professionals who has been allowed to visit the prison and assess prisoners, stated in 2015 that he “is most likely irreversibly damaged by torture that was unusually cruel and designed to break him … Making matters worse, there is no present effort to treat the damage, and there appear to be efforts to block others from giving him appropriate clinical care.”

Below I’m posting the executive summary of the report, which provides a good summary of the report’s key findings and recommendations, but I do urge you to read the whole report if you have the time.

Deprivation and Despair: Executive Summary

From the inception more than 17 years ago of the Guantánamo Bay detention center located on the U.S. naval base in Guantánamo Bay, Cuba, senior detention facility personnel have consistently lauded the quality of medical care provided to detainees there. For example, in 2005, Joint Task Force (JTF) Guantánamo’s then-commander said the care was “as good as or better than anything we would offer our own soldiers, sailors, airmen or Marines.” In 2011, a Navy nurse and then deputy command surgeon for JTF Guantánamo made a similar claim: “The standard of care here is the best possible standard of care (the detainees) could get.” In late 2017, Guantánamo’s senior medical officer again echoed those sentiments: “Detainees receive timely, compassionate, quality healthcare … [which is] … comparable to that afforded our active duty service members on island.”

There have been many more such assertions in the intervening years and since. Following an in-depth review of publicly available information related to medical care at Guantánamo — both past and present — as well as consultations with independent civilian medical experts and detainees’ lawyers, the Center for Victims of Torture and Physicians for Human Rights have determined that none of those assertions is accurate.

To the contrary, notwithstanding Guantánamo’s general inaccessibility to independent civilian medical professionals, over the years a handful of them have managed to access detainees, review medical records, and interface with Guantánamo’s medical care system to a degree sufficient to document a host of systemic and longstanding deficiencies in care. These include:

• Medical needs are subordinated to security functions. For example, prosecutors in a military commission case told the judge explicitly that the commander of Guantánamo’s detention operations is free to disregard recommendations of Guantánamo’s senior medical officer.

• Detainees’ medical records are devoid of physical and psychological trauma histories. This is largely a function of medical professionals’ inability or unwillingness to ask detainees about torture or other traumatic experiences during their time in the CIA’s rendition, detention, and interrogation program, or otherwise with respect to interrogations by U.S. forces — which has led to misdiagnoses and improper treatment.

• In large part due to a history of medical complicity in torture, many detainees distrust military medical professionals which has led repeatedly to detainees reasonably refusing care that they need.

 • Guantánamo officials withhold from detainees their own medical records, including through improper classification.

• Both expertise and equipment are increasingly insufficient to address detainees’ health needs. For example, a military cardiologist concluded that an obese detainee required testing for coronary artery disease, but that Guantánamo did not have the “means to test” him, and so the testing was not performed. With regard to mental health, effective torture rehabilitation services are not, and cannot be made, available at Guantánamo.

• Detainees have been subjected to neglect. One detainee urgently required surgery for a condition he disclosed to Guantánamo medical personnel in 2007 — and they diagnosed independently in 2010 — but he did not receive surgery until 2018 and appears permanently damaged as a result.

• Military medical professionals rotate rapidly in and out of Guantánamo, which has caused discontinuity of care. For example, one detainee recently had three primary care physicians in the course of three months.

• Detainees’ access to medical care and, in some cases, their exposure to medical harm, turn substantially on their involvement in litigation. For example, it appears extremely difficult, if not impossible, for detainees who are not in active litigation to access independent civilian medical professionals, and for those who are to address a medical need that is not related to the litigation. For detainees charged before the military commissions, prosecution interests have superseded medical interests, as with a detainee who was forced to attend court proceedings on a gurney writhing in pain while recovering from surgery.

These deficiencies are exacerbated by — and in some cases a direct result of — the damage that the men have endured, and continue to endure, from torture and prolonged indefinite detention.

It is long past time that the medical care deficiencies this report describes were acknowledged and addressed. Systemic change is necessary; these are not problems that well-intentioned military medical professionals — of which no doubt there are many, working now in an untenable environment — can resolve absent structural, operational, and cultural reform. Nor, in many respects, are they problems that can be fully resolved as long as the detention facility remains open.

Guantánamo should be closed. Unless and until that happens, the Center for Victims of Torture and Physicians for Human Rights call upon Congress, the Executive Branch, and the Judiciary to adopt a series of recommendations aimed at meaningfully improving the status quo. These include, but are not limited to: lifting the legal ban on transferring detainees to the United States and mandating such transfers when detainees present with medical conditions that cannot be adequately evaluated and treated at Guantánamo; ensuring detainees have timely access to all of their medical records upon request while otherwise maintaining confidentiality of those records (especially with regard to access by prosecutors); and allowing meaningful and regular access to Guantánamo by civilian medical experts, including permitting such experts to evaluate detainees in an appropriate setting.

If the United States declines to take the steps this report recommends, complex medical conditions that cannot be managed at Guantánamo should be expected to accelerate in frequency and escalate in severity.

* * * * *

Andy Worthington is a freelance investigative journalist, activist, author, photographer, film-maker and singer-songwriter (the lead singer and main songwriter for the London-based band The Four Fathers, whose music is available via Bandcamp). He is the co-founder of the Close Guantánamo campaign (and see the latest photo campaign here) and the successful We Stand With Shaker campaign of 2014-15, and the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (click on the following for Amazon in the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. He is also the co-director (with Polly Nash) of the documentary film, “Outside the Law: Stories from Guantánamo” (available on DVD here — or here for the US), and for his photo project ‘The State of London’ he publishes a photo a day from seven years of bike rides around the 120 postcodes of the capital.

In 2017, Andy became very involved in housing issues. He is the narrator of a new documentary film, ‘Concrete Soldiers UK’, about the destruction of council estates, and the inspiring resistance of residents, he wrote a song ‘Grenfell’, in the aftermath of the entirely preventable fire in June 2017 that killed over 70 people, and he also set up ‘No Social Cleansing in Lewisham’ as a focal point for resistance to estate destruction and the loss of community space in his home borough in south east London. For two months, from August to October 2018, he was part of the occupation of the Old Tidemill Wildlife Garden in Deptford, to prevent its destruction — and that of 16 structurally sound council flats next door — by Lewisham Council and Peabody. Although the garden was violently evicted by bailiffs on October 29, 2018, and the trees were cut down on February 27, 2019, the resistance continues.

To receive new articles in your inbox, please subscribe to Andy’s RSS feed — and he can also be found on Facebook (and here), Twitter, Flickr and YouTube. Also see the six-part definitive Guantánamo prisoner list, The Complete Guantánamo Files, the definitive Guantánamo habeas list, the full military commissions list, and the chronological list of all Andy’s articles.

Please also consider joining the Close Guantánamo campaign, and, if you appreciate Andy’s work, feel free to make a donation.

9 Responses

  1. Andy Worthington says...

    When I posted this on Facebook, I wrote:

    Here’s my latest article, publicizing a powerful new report, ‘Deprivation and Despair: The Crisis of Medical Care at Guantanamo,’ by the Center for Victims of Torture (CVT) and Physicians for Human Rights (PHR), which thoroughly refutes claims by the US authorities that Guantanamo prisoners receive care equivalent to that of US service members.

    In fact, as the authors of the report state, the experiences of prisoners and of independent civilian medical experts — on those occasions when they have been granted access to prisoners — actually provide “specific violations of the Nelson Mandela Rules, the universally recognized UN standard minimum rules for the treatment of prisoners, which the United States has championed.”

    I do hope you have time to read the report,and that you’ll share it if you find it useful. The link to it is here: https://www.cvt.org/DeprivationandDespair

  2. Tom says...

    John Kelly is now on the board of directors of a for profit concentration camp that’s abusing illegal migrants seeking asylum.

  3. Andy Worthington says...

    Thanks for that, Tom. I hadn’t kept up with his movements after he became Secretary of Homeland Security, a position which I see, from a quick online search, he held from when Trump took office until July 31, 2017, when he then became White House Chief of Staff, until January this year. As you note, however, he has recently joined the board of Caliburn International, “the parent company of Comprehensive Health Services, which operates Homestead and three other shelters for unaccompanied migrant children in Texas”, as CBS News explained in May, adding that its ‘Homestead’ facility “is the nation’s only site not subject to routine inspections by state child welfare experts.” CBS News also explained that, “Prior to joining the Trump administration in January 2017, Kelly had been on the board of advisors of DC Capital Partners, an investment firm that now owns Caliburn.”
    CBS News also noted that, during Kelly’s tenure in government, “the administration pursued ambitious changes to immigration enforcement, and the average length of stay for an unaccompanied migrant child in U.S. custody skyrocketed.”
    See: https://www.cbsnews.com/news/john-kelly-joins-board-of-caliburn-international-company-operating-largest-unaccompanied-migrant-children-shelter/
    Kelly’s comments to Congress regarding aging Guantanamo prisoners were a rare example of something resembling humanity on his part. As head of US Southern Command, he opposed the closure of Guantanamo under Obama, although, to his credit, he was also apparently somewhat critical of Trump’s intention to issue an executive order to keep Guantanamo open. But as you suggest, it is his record on immigration that is currently most troubling, and I hope the US media are doing some proper investigations into who else, apart from Kelly, is profiting from the degradation and misery in the US’s Mexican border camps.
    Guantanamo references here: https://www.andyworthington.co.uk/2016/01/19/pentagon-blocks-prisoner-releases-from-guantanamo-including-74-pound-yemeni-hunger-striker/
    https://www.andyworthington.co.uk/2017/08/30/donald-trump-is-still-trying-to-work-out-how-to-expand-the-use-of-guantanamo-rather-than-closing-it-for-good/

  4. Andy Worthington says...

    Ed Charles wrote:

    Will see if I can get this translated [for the World Can’t Wait’s Spanish website] as soon as the ground stops moving that is.

  5. Andy Worthington says...

    Thanks, Ed. I’ve only just seen the earthquake story: https://www.latimes.com/local/lanow/la-me-major-earthquake-southern-california20190705-story.html
    I experienced an earthquake of that magnitude in Mexico City five years ago. It was a pretty disturbing experience, although thankfully there were no fatalities.

  6. Andy Worthington says...

    Elena Landriscina wrote:

    Thank you for this important article Andy

  7. Andy Worthington says...

    You’re welcome, Elena. Thanks for your interest!

  8. Andy Worthington says...

    Tashi Farmilo-Marouf wrote:

    It’s astounding that in our day and age, we can obtain such detailed knowledge about something unjust going on but we’re unable to put an absolute stop to it.

  9. Andy Worthington says...

    And even what we do know has rarely been revealed through official channels, Tashi. Most of it has only come about through the Supreme Court-mandated access for lawyers that was granted in 2004, and subsequent struggles – to secure the right for prisoners to be visited by independent medical experts, for example.
    One particularly depressing aspect of the report is the authors pointing out that, unless prisoners are “involved in active litigation,” the authorities basically ignore whatever medical or psychological needs they may have. As the report states, “unless a detainee is involved in active litigation, it appears to be extremely difficult, if not impossible, for him to access independent civilian medical professionals, and, in some cases, medical records.”
    An example given is of Abu Faraj al-Libi, a “high-value detainee” who hasn’t been changed, and is therefore a “forever prisoner.” When his counsel sought permission for Dr. Stephen Xenakis “to be assigned to Mr. al Libi’s case and to be granted permission to medically evaluate him as a health-care provider,” the Convening Authority, the office that oversees the military commissions, stated, “I may only appoint experts at government expense to assist the defense in military commissions. There are no charges pending against Mr. al Libi nor, per your request, are you seeking to have Dr. Xenakis aid in your legal representation of Mr. al Libi. Your request seeks to address a medical condition which you believe a licts Mr. al Libi. Given the circumstances, I may not grant your request.”

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Andy Worthington

Investigative journalist, author, campaigner, commentator and public speaker. Recognized as an authority on Guantánamo and the “war on terror.” Co-founder, Close Guantánamo, co-director, We Stand With Shaker. Also, singer and songwriter (The Four Fathers) and photographer (The State of London).
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