[Ppnews] Broken laws, Broken Lives - Medical Evidence of Torture by US Personnel and Its Impact

[Political Prisoner News]

A Report by Physicians for Human Rights
June 2008
http://brokenlives.info/
BROKEN LAWS,
BROKEN LIVES
Medical Evidence of Torture by
US Personnel and Its Impact

List of Acronyms

BHS: Behavioral Health Science Teams
CIA: Central Intelligence Agency
CIDT: Cruel, Inhuman, or Degrading Treatment
DoD: Department of Defense
DTA: Detainee Treatment Act of 2005
ECHR: European Court of Human Rights
ERB: Ethics Review Board
FBI: Federal Bureau of Investigation
IACHR: Inter-American Court of Human Rights
ICRC: International Committee of the Red Cross
ICCPR: International Covenant on Civil and
Political Rights
ICTR: International Criminal Tribunal for Rwanda
ICTY: International Criminal Tribunal for Yugoslavia
IRF: Immediate Reaction Force
IRCT: International Rehabilitation Council for
Torture Victims
MCA: Military Commissions Act of 2006
MDD: Major Depressive Disorder
NOS: Not Otherwise Specified
OLC: Office of Legal Counsel, Department
of Justice
PHR: Physicians for Human Rights
POW: Prisoner of War
PTSD: Post-traumatic Stress Disorder
SERE: Survival, Evasion, Resistance, and
Escape training
SOP: Standard Operating Procedure
TVPA: Torture Victims Protection Act of 1991
WCA: War Crimes Act


This report tells the largely untold human story of
what happened to detainees in our custody when
the Commander-in-Chief and those under him
authorized a systematic regime of torture. This story is
not only written in words: It is scrawled for the rest of
these individual’s lives on their bodies and minds. Our
national honor is stained by the indignity and inhumane
treatment these men received from their captors.

The profiles of these eleven former detainees, none
of whom were ever charged with a crime or told why
they were detained, are tragic and brutal rebuttals to
those who claim that torture is ever justified. Through
the experiences of these men in Iraq, Afghanistan, and
Guantanamo Bay, we can see the full-scope of the damage
this illegal and unsound policy has inflicted —both on
America’s institutions and our nation’s founding values,
which the military, intelligence services, and our justice
system are duty-bound to defend.

In order for these individuals to suffer the wanton
cruelty to which they were subjected, a government
policy was promulgated to the field whereby the Geneva
Conventions and the Uniform Code of Military Justice
were disregarded. The UN Convention Against Torture
was indiscriminately ignored. And the healing professions,
including physicians and psychologists, became
complicit in the willful infliction of harm against those
the Hippocratic Oath demands they protect.

After years of disclosures by government investigations,
media accounts, and reports from human
rights organizations, there is no longer any doubt as to
whether the current administration has committed war
crimes. The only question that remains to be answered
is whether those who ordered the use of torture will be
held to account.

The former detainees in this report, each of whom
is fighting a lonely and difficult battle to rebuild his life,
require reparations for what they endured, comprehensive
psycho-social and medical assistance, and even an
official apology from our government.

But most of all, these men deserve justice as required
under the tenets of international law and the United
States Constitution.

And so do the American people.

Major General Antonio
Taguba, USA (Ret.)
Maj. General Taguba led the US Army’s official
investigation into the Abu Ghraib prisoner abuse
scandal and testified before Congress on his
findings in May, 2004.

Preface
1
This report provides first-hand accounts and
medical evidence of torture and cruel, inhuman,
or degrading treatment or punishment (“illtreatment”)
of eleven former detainees who were held
in US custody overseas. Using internationally accepted
standards, Physicians for Human Rights (PHR) conducted
medical evaluations of the former detainees to document
the severe, long-term physical and psychological
consequences that have resulted from the torture and illtreatment.

The evaluations provide evidence of violation
of criminal laws prohibiting torture and of the commission
of war crimes by US personnel.

Four of the men evaluated were either arrested in or
brought to Afghanistan between late 2001 and early 2003
and later sent to Guantánamo Bay, Cuba, where they
were held for an average of three years before release
without charge. The other seven were detained in Iraq
in 2003 and released without charge later that year or in
2004, with an average period of detention of six months.
All of the former detainees evaluated by PHR reported
having been subjected to multiple forms of torture or
ill-treatment that often occurred in combination over a
long period of time.

The medical evaluations were based in each case
on intensive two-day clinical interviews that included
diagnostic testing and, in two cases, review of medical
records. With this evidentiary record, this report provides
the most detailed account available thus far of the experience
of detainees in US custody who suffered torture — a
war crime — at the hands of US personnel. Additionally,
this report provides further evidence of the role health
professionals played in facilitating detainee abuse by
being present during torture and ill-treatment, denying
medical care to detainees, providing confidential medical
information to interrogators, and failing to stop or document
detainee abuse.

Methods of torture experienced by the former
detainees evaluated by PHR included interrogation and
detention practices such as isolation, sleep deprivation,
forced nakedness, severe humiliation and degradation,
and sensory deprivation that were officially authorized
by military and civilian officials during certain periods
when these men were incarcerated. Additional practices
recounted by the interviewees including beatings
and other forms of severe physical and sexual assault
that, while not officially authorized by government documents
now part of the public record, came to be part of
a regime of brutality at the facilities where the detainees
were held.

This report demonstrates that the permissive environment
created by implicit and explicit authorizations by
senior US officials to “take the gloves off”4 encouraged
forms of torture even beyond the draconian methods
approved at various times between 2002 and 2004.5 In an
environment of moral disengagement that countenances
authorized techniques designed to humiliate and dehumanize
detainees, it is not surprising that other forms
of human cruelty such as physical and sexual assault
were practiced. The fact that these unauthorized torture
practices happened over extended periods of time at
multiple US detention facilities suggests that a permissive
command environment existed across theatres and
at several levels in the chain-of-command. This climate
allowed both authorized and unauthorized techniques to
be practiced, apparently without consequence.

Given the limited number of detainees evaluated, the
findings of this assessment cannot be generalized to the
treatment of all detainees in US custody. The patterns of
abuse documented in this report, however, are consistent
with numerous governmental and independent investigations
into allegations of detainee ill-treatment,6 making
it reasonable to conclude that these detainees were not
the only ones abused, but are representative of a much
larger number of detainees subjected to torture and illtreatment
while in US custody.

Methods
PHR identified individuals through referring nongovernmental
organizations and law firms that provide
legal representation to former and current detainees in
US custody. The evaluations were conducted between
December 2006 and September 2007, after consent was
obtained by the individuals. No former detainee PHR
located who was eligible and consented to an evaluation
was excluded from the study. For each former
detainee, a team of two experienced clinicians evaluated
the individual and documented allegations of torture
and ill-treatment in accordance with the guidelines for
assessing physical and psychological evidence of torture
set out in the Istanbul Protocol, Manual on the Effective
Investigation and Documentation of Torture and Other
Cruel, Inhuman or Degrading Treatment or Punishment
(hereafter Istanbul Protocol).7 Sources of information
for the medico-legal reports include the clinical interview,
psychological testing, physical examinations and
medical diagnostic tests. The Guantánamo Bay detention
medical records of one individual and an independent
medical record of another former detainee were available
for review as well. In each case, the clinicians provided
opinions on possible torture and ill-treatment based on
correlations between individual allegations of torture
and specific physical and psychological evidence. They
found no evidence of deliberate exaggeration in any
case. The study was approved by PHR’s Ethics Review
Board. In order to protect confidentiality, the names of
the individuals evaluated were changed and information
that could potentially identify the former detainees has
been omitted.

Summary of Findings
Synopses of the Cases of Former Detainees
Profiled

The following summaries of three evaluations of the
eleven cases illustrate the torture and ill—treatment
that the detainees experienced and the resulting
long-term physical and psychological harm. The torture
and ill-treatment described were corroborated by the
medical evidence.

Kamal is in his late forties. He served in the Iraqi Army
during the 1980s and later became a businessman and
Imam of a local mosque. In September 2003 he was
arrested by US forces. At the time of his arrest, he was
beaten to the point of losing consciousness. After being
brought to Abu Ghraib prison, he was kept naked and
isolated in a cold dark room for three weeks, where both
during and in between interrogations he was frequently
beaten, including being hit on the head and in the jaw with
a rifle and stabbed in the cheek with a screwdriver.

He was then placed in isolation in a urine-soaked
room for two months. When Kamal was allowed to wear
clothes, they were sometimes soaked in water to keep him
cold. On approximately ten occasions he was suspended
in a stress position, causing numbness that lasted for a
month. He was made to believe that his family members
were also in prison and that they were being raped and
tortured. He recounted, “[T]hey were telling me, making
me hear voices of children and women, and told me they
were my children and [wife].” He was eventually transferred
to a tent area of Abu Ghraib, where he remained
for seven months until his release in June 2004.
PHR’s clinicians found physical and psychological
evidence consistent with the abuse Kamal reported.

He continues to experience chronic pain in his jaw and
numbness from the suspensions. He also meets diagnostic
criteria for several psychiatric diagnoses, including
major depressive episodes, a panic disorder, and posttraumatic
stress disorder (PTSD) that are attributable to
his experience in detention. Particularly striking is the
severity of Kamal’s depressive symptoms, with feelings
of hopelessness, worthlessness, and guilt, and difficulty
sleeping. His symptoms are indeed so severe that, in the
opinion of PHR’s clinicians, they would qualify him for
hospitalization in the United States.

Amir is in his late twenties and grew up in a Middle
Eastern country. He was a salesman before being
arrested by US forces in August 2003 in Iraq. After his
arrest, he was forced, while shackled, to stand naked
for at least five hours. For the next three days, he and
other detainees were deprived of sleep and forced to run
for long periods, during which time he injured his foot.

After Amir notified a soldier of the injury, the soldier
threw him against a wall and Amir lost consciousness.
Ultimately, he was taken to another location, where he
was kept in a small, dark room for almost a month while
being subjected to interrogations that involved shackling,
blindfolding, and humiliation. Approximately one month
later, he was transferred to Abu Ghraib. At first he was
not mistreated, but then was subjected to religious and
sexual humiliation, hooding, sleep deprivation, restraint
for hours while naked, and dousing with cold water. In
the most horrific incident Amir recalled experiencing, he
was placed in a foul-smelling room and forced to lay face
down in urine, while he was hit and kicked on his back
and side. Amir was then sodomized with a broomstick
and forced to howl like a dog while a soldier urinated
on him. After a soldier stepped on his genitals, he
fainted. In July 2004, he was transferred to the prison
at Camp Bucca, where he reported no abuse. He was
returned to Abu Ghraib in November 2004 and released
two days later.

Amir continues to experience physical symptoms
consistent with the abuse he reported. Physical examination
revealed features consistent with his account,
including tenderness of one of his testicles and rectal
tearing. Psychologically, he continues to suffer from
debilitating symptoms of severe PTSD, disturbed sleep,
moodiness, anxiety, sexual dysfunction, hostility and
outbursts of anger, and very frequent suicidal thoughts.
He has changed from a stable provider for his family to an
unemployed man. Although stressors related to the war
in Iraq may exacerbate his symptoms, his most debilitating
symptoms are attributable to his experience of
torture and sexual violation. “No sorrow can be compared
to my torture experience in jail,” he said. “That is the
reason for my sadness.”

Youssef is in his early thirties. Unable to find work in his
country of origin, he sought employment in Afghanistan.
In late 2001 or early 2002, Youssef was detained as he
attempted to cross the Afghanistan-Pakistan border
without a passport while trying to return home. He was
held in a Pakistani prison for two months, where he was
often shackled in unsanitary conditions and given little food.
During this time, he was interrogated by US personnel
and eventually hooded, shackled, and transferred to the
US detention facility in Kandahar, Afghanistan.

In Kandahar, Youssef was immediately interrogated
and subjected to beatings with sticks and fists as well as
kicking, although he did not sustain serious injuries at the
time. After that, he was stripped naked. The first night he
was not allowed to sleep, as guards hit the detainees and
threw sand at them. While in Kandahar, Youssef endured
forced nakedness, intimidation by dogs, hooding, and
repeated assaults by being thrown against a wall. He was
subjected to electric shock from a generator, feeling “as
if my veins were being pulled out.”

After about six weeks, he was transferred to the US
detention facility at Guantánamo Bay, Cuba. During the
transatlantic flight he was dressed in an orange suit,
fitted with dark goggles and headphones and shackled
to the floor of the plane. The tight cuffs caused his wrists
to swell. Upon arrival, he was stripped, sprayed with
water and examined by a doctor. Like other detainees,
he described the conditions at Camp X-Ray as deplorable,
with detainees living in cages that were extremely
hot and denied anything but a bucket for a toilet. In Camp
X-Ray lengthy interrogations accompanied by sleep
deprivation began. Small infractions such as speaking
with other detainees led to beatings, and a person whom
he perceived to be a doctor checked the injuries of the
detainees after the beatings. In order to avoid beatings,
Youssef was compliant. Nevertheless, the Immediate
Reaction Force (IRF) team forced him into stress positions,
including sitting on his knees with his hands
pressed together behind his back or head and tied to
his feet, forcing his legs up.

After approximately three months, Youssef and others
were transferred to Camp Delta, where general cell
conditions were better, although detainees were rarely
let out of their cells. He was beaten once for hiding food
in his cell. An IRF team also sprayed him in the eyes with
what may have been pepper spray, so that “my whole
body would feel like it was burning — not just my face,
but my whole body
I felt like I was losing consciousness
from the burning.”

His interrogations, which took place almost every
other day during his initial period at Guantánamo and he
would be kept in the interrogation room for as long as
eighteen to twenty hours. He denied having been beaten
during the lengthy interrogations or while being held in
the interrogation room. Youssef described these episodes
as some of his most painful experiences at Guantánamo.
He was chained and forced to assume stressful positions;
at times, ice-water was poured on him and, at
other times, loud music was played. He was deprived
of access to the toilet and time for prayer. While being
held in the interrogation room, the temperature in the
room would be made extremely cold or hot for extended
periods of time. Demands for confessions were constant,
accompanied by claims by interrogators that his name
was found on documents and that his brother, who has
leukemia, had been arrested; soldiers also threatened
to shoot him. Humiliation was part of the interrogation
regime: he was forced to look at pornography, and
soldiers ripped the Koran apart and threw it in the toilet
in front of him. He described being horrified by an incident
in which a naked woman entered the interrogation
room and smeared what he believed to be menstrual blood
on him. He reported being given injections of unknown
substances against his will, and these injections often
caused rashes several hours later. He believes that in
some interrogations medical personnel were present and
that they examined him periodically. Although he was not
privy to the discussions between the medical personnel
and interrogators, it appeared to Youssef that that the
medical personnel were being consulted as to whether
interrogations should continue. They always did.

At one point while at Camp Delta at Guantánamo,
Youssef asked to speak with a psychologist because of
the distress and sadness he felt due to the separation
from his family. He believes that not only did his interrogators
have access to the information he shared
with the psychologist, but that they exploited it by
threatening that he would spend the rest of his life in
Guantánamo. Following this interrogation session, he
was moved to what he believed to be the worst section
of Camp Delta, where he was not allowed to have a
blanket or mattress.

After being transferred out of Camp Delta and signing
a form, he was released in the fall of 2003. He was again
handcuffed and chained to the floor of the plane during
the lengthy flight. Upon returning home, he served over
a year of military service, during which he was mostly
confined in a psychiatric hospital because he was deemed
“too aggressive.”

On physical examination, Youssef was noted to have
surgical scars on his wrists consistent with his report of
surgery following his release for chronic wrist pain as a
result of shackling during his detention. Pain in his right
wrist still persists. He also has a scar on the back of his
left wrist consistent with the handcuffing he described.
While Youssef experienced symptoms of depression
before detention, PHR’s evaluators concluded that these
symptoms became more pronounced, disabling and
chronic as a result of his experience; he also now suffers
from moderate PTSD. Many of his physical symptoms,
including shortness of breath and “heart problems,” are
consistent with a panic disorder. Youssef acknowledged
difficulty functioning and has not found steady employment
since his detention.

Common Experiences of Torture and Ill-Treatment

Even though the eleven detainees examined by PHR were
held at different places, and each person’s experience
was unique, certain detention and interrogation practices
appear over and over again in the accounts.

Beatings During Arrest, Transport, and Initial Custody

Many of the most severe injuries from beatings that
the former detainees reported were sustained shortly
after they were arrested. All seven of the men who
were detained in Iraq (hereafter referred to as “the
Iraqi former detainees”) recounted experiencing violent
treatment during their arrests, some of which involved
severe physical assault on their family members as well
as destruction or looting of their homes.

The beatings inflicted on detainees at US facilities at
Bagram and Kandahar in Afghanistan were particularly
intense, and included beatings with sticks and fists, kicks
to the stomach and genitals and blows to the head. As a
result, Haydar, who was held at Kandahar before being
transferred to Guantánamo, lost three of his teeth and
Rasheed, who was held at both Bagram and Kandahar
facilities, lost consciousness and was hospitalized.

Similarly, all former detainees held at Guantánamo
reported that the most intense and widespread physical
beatings they experienced at the facility took place during
transfer and shortly after arrival there.

The Iraqi former detainees also reported severe beatings
during the first days and weeks of detention at facilities
including one at Baghdad International Airport. Hafez,
who was held at a US facility at Baghdad International
Airport and Abu Ghraib for over seven months, was forced
to the ground and beaten severely on his legs and back,
causing his lips, forehead, and nose to bleed; he also
reported being stripped and having his chest and pubic
hair ripped out by hand and being simultaneously beaten,
hit, and choked while being doused with cold water.

While physical evidence of beatings often may not be
detectable in later medical evaluations, findings from
bone scans of six of the former detainees as well as
scars and lesions visible during physical examination
are consistent with the history of beatings described by
the victims.

Deprivation of Basic Necessities and Sanitary Conditions

All of the former detainees reported frequent denial
of basic necessities during periods of their detention;
over half of the men evaluated reported being denied
food on at least one occasion. Each former detainee
also reported being subjected to extreme temperatures
during his confinement.

The conditions detainees in Iraq endured were particularly
appalling. Among the conditions one or more of
the detainees reported were placement in a urine-soaked
punishment room, being forced to wear soiled underwear,
often for weeks or months at a time, denial of access to
food, water and toilets of any kind, and exposure to cold
without blankets.

Two of the detainees who were held in Guantánamo
during the first year the facility was in operation reported
harsh physical conditions and being housed in steel
cages. Although as time passed, the physical conditions
improved there, deprivation sometimes accompanied
by acts of cruelty continued. Haydar reported that in
Guantánamo the soldiers would often either spit in or
throw out part of their food rations.

Stress Positions: Forced Standing, Handcuffing, and Shackling

All of the former detainees reported having been
subjected to painful stress positions that involved having
their hands and feet bound for extended periods of times,
or suspension from walls or barbed wire. These positions
were often coupled with the use of blindfolding,
sleep deprivation, isolation, and exposure to temperature
extremes, either as components of interrogations
or conditions of confinement.

For example, three former detainees evaluated by
PHR reported that in Guantánamo they were kept in
extremely hot or cold interrogation rooms, chained in a
crouching position to a ring on the floor for eighteen to
twenty hours. Two of the Iraqi former detainees reported
losing consciousness as a result of being subjected to
stress positions.

Findings on medical examination were consistent with
these accounts. All of the former detainees reported that
they continue to suffer from a wide range of musculoskeletal
pains. For example, Laith, an Iraqi former detainee
who was held in Abu Ghraib for nine months, reported
arm numbness and weakness following being suspended
by his arms, which is highly consistent with a brachial
plexus (nerve group supplying the upper extremity) injury
that often results from suspension.

Isolation, Sensory Deprivation, or Bombardment

A) Prolonged Isolation
All of the former detainees reported being subjected
repeatedly to lengthy periods of isolation that ranged
from ten days to as long as two months in duration. The
interviewees reported that, while being kept in isolation,
they were subjected to shackling, blindfolding,
physical abuse, humiliation, sexual humiliation, and
stress positions, as well as temperature extremes and
light control.

During periods of isolation, the Iraqi former detainees
consistently reported being kept hooded and naked in
small, dark holding cells that made Rahman, who was
held at Abu Ghraib for nine months, feel “claustrophobic.”
Similarly, former Guantánamo detainees reported that
they were repeatedly held in isolation. The psychological
impact of isolation and other forms of abuse was
enormous. Rasheed engaged in hunger strikes, exhibited
psychotic behavior, and even became suicidal after
prolonged isolation.

B) Hooding/Blindfolding
Sensory deprivation by means of hooding or other types
of blindfolding was frequently used in combination with
other techniques in the places the former detainees were
held (Afghanistan, Iraq, and Guantánamo Bay, Cuba).
According to the detainees, blindfolding and hooding
instilled in them a sense of fear, disorientation, and
dependency on their captors.

According to the detainees evaluated, sensory deprivation
was employed in Afghanistan during arrest and
transportation between facilities as well as during
interrogations. At Guantánamo, however, the four
detainees evaluated experienced hooding only when
being transferred. In Iraq, hooding was routinely used
during interrogations and general detention and was
combined with forced nakedness and isolation, among
other techniques.

C) Sensory Bombardment
Eight former detainees reported that sensory bombardment
with loud noise or music was utilized frequently
in what appeared to be a strategy to disorient them or
disrupt detainees’ sleep.
The detainees who were held in Afghanistan reported
that they were subjected to loud music over long periods
of time, and in one case exposed to powerful flood lights
twenty-four hours a day. At Guantánamo, Rasheed
reported that during a period of isolation and frequent
lengthy interrogations, his cell was bombarded with loud
unpleasant noise.

The former detainees reported that in Iraq this technique
was combined with forced running, isolation, and
sleep deprivation. Similar to three other Iraqi former
detainees, Morad, who was held in various facilities for
a total duration of ten months, was subjected to “deafening,
loud music” while being held in Saddam Hussein’s
former ranch (used as a US detention facility).

Threats of Harm to Detainees and Their Families

Almost all of the detainees reported being threatened
with severe harm, most commonly through verbal
threats during interrogations. Eight of the eleven men
reported that the US military utilized dogs to instill fear
in the detainees. Two of the Iraqi former detainees were
threatened with execution, and two others were threatened
with forced disappearance since they did not have
prisoner identification numbers, were unregistered, and
therefore considered “ghost” detainees. Youssef recalled
being threatened with being shot by a guard during an
interrogation in Guantánamo.

Interrogators also told detainees that their families
would be killed or severely harmed. Laith told PHR that
the interrogators “were threatening me
they were saying
‘Then you will hear your mothers and sisters when we are
raping them.’” Interrogators also threatened detainees
with harm or torture following their release. Strikingly,
transfer to Guantánamo was a threat used on half of
the former detainees held in Iraq. Yasser recalled being
told he would be sent to Guantánamo “where even dogs
won’t live.”

Use of Extreme Temperatures

All of the former detainees reported being exposed to
extremes of temperature in their cells. For some of the
Iraqi former detainees, this practice was coupled with
weeks of isolation and sexual humiliation; for others,
this practice was used as a form of group punishment.
Four detainees, of whom three were held in Guantánamo,
reported that cold water was poured on them during
interrogation. In the cases of three individuals who were
held in facilities in Iraq, cold water was used in combination
with lengthy interrogations, sensory bombardment,
beatings, and sexual humiliation.

Electric Shocks, Sexual Assault, and Physical Assault

In addition to the beatings upon arrest, initial
detention and transfer described earlier, some of the
detainees were physically assaulted again later during
their detention. Two former detainees were sodomized
with a broomstick or a rifle at Abu Ghraib and three were
subjected to electric shock (two in Iraq and one while at
Kandahar, Afghanistan).

Physical assaults during detention included being
kicked, stepped on, dragged, slapped, and forcefully
thrown against a wall. Adeel, who was later transferred
to Guantánamo Bay, reported receiving daily beatings
while he was held at the Bagram facility. The Iraqi former
detainees described being struck with a rifle, stabbed
in the cheek with a screwdriver, burned on the chest
with a cigarette, and other episodes of severe physical
abuse during interrogations that in some cases resulted
in loss of consciousness. Five former detainees reported
soldiers exploiting detainees’ injuries. For example,
Yasser, who was held at Abu Ghraib for four months,
stated that his injured hand was deliberately stepped on
and squeezed by soldiers at Abu Ghraib.

Of the Guantánamo detainees, only one reported
routine physical abuse: Rasheed reported frequent beatings
and one episode of harsh beatings during an interrogation.
Youssef and Haydar stated that multiple times
the IRF teams (referred to by the former detainees as
the “riot police”) subjected them to chemical spray and
pressurized water, which left Haydar “writhing on the
ground in pain.”

Many of the physical assaults reported would likely
have resulted in bruises and soft tissue injuries that
would not leave lasting physical marks. However, the
bone scan findings of six individuals, and scars and
healed lesions observed on physical examination of
all detainees corroborated their specific allegations
of physical assault. Scarring on Yasser’s thumbs was
highly consistent with the scarring caused by electric
shock. Further, reports of rape and sexual assault were
corroborated in two cases by medical examination.

Sleep Deprivation

Nine of the eleven former detainees evaluated reported
that they were often subjected to sleep deprivation, in
combination with other techniques, through loud noise
or banging, use of cold water, or stress positions. Laith
explained: “If you ask me about being chained to the
window [standing], it was every day. They were especially
doing that at night, to prevent me from me sleeping.”

Sexual, Religious, Cultural, and Other Forms of
Degrading Treatment

According to detainee accounts, humiliation was
pervasive in detention facilities in both Iraq and Afghanistan.
Guards taunted, shamed, insulted, spat and urinated
upon, and embarrassed detainees, forced most to be
naked, observed some on the toilet, wrote degrading
phrases in indelible marker on the body of one, and forcibly
cut the beards and shaved the heads of others. In
one incident, Amir reported having been pulled by a leather
dog leash in Abu Ghraib and was ordered to “howl like
dogs do.” He was repeatedly kicked when he refused
to do so.

Cultural and religious humiliation was reported by
more than half of the individuals evaluated, and took many
forms, including taunting men at prayer and desecrating
the Koran. Rasheed stated that in protest of such
practices, detainees in all five blocks of Guantánamo
held a simultaneous uprising by banging their heads
against the walls and demanding “an end to the mocking
of their religion.”

One of the worst forms of humiliation detainees
reported, though, was sexual, and it was reported by virtually
all of the individuals evaluated by PHR, at facilities
in Afghanistan, at Guantánamo, and in Iraq. The forms
of sexual humiliation were as varied as they were cruel:
parading men naked in front of female soldiers, forcing
them to disrobe before female interrogators, touching or
provoking them in a humiliating way, and forcing them to
watch pornography or real or feigned sexual activities.
Furthermore, nakedness became the normal mode of
operation in the Iraqi detention facilities, especially in
Abu Ghraib, where the detainees were forced to be naked
for long periods of time. Kamal stated that his genitals
were touched multiple times during interrogations in Abu
Ghraib. Further, he reported that when the American
soldiers “got me naked, they used to bring all female
soldiers to look at me and say, ‘Hello, Imam’.”

Witnessing Torture and Cruel Treatment

More than half of the former detainees evaluated
by PHR recounted witnessing torture and other cruel,
inhuman or degrading treatment towards other detainees
by US personnel. Two detainees witnessed other detainees
being bitten by dogs; others witnessed detainees being
subjected to various forms of sexual humiliation. In Abu
Ghraib, Rahman recounted that he was forced to watch
other detainees being forced to simulate anal intercourse
and recalled that the detainees “were begging, ‘This is a
sin against our religion, please show mercy.’ The soldiers
were pushing them into each other, and these guys were
trying to push away, and this was more than half an hour
and this was in front of our eyes.”

Health Professional Complicity and Denial of
Medical Care

Health professionals in detention settings are required by
domestic and international standards not only to provide
medical care to detainees but to protect their health and
well-being. A few of the former detainees reported that
they received appropriate care from health professionals
while in US custody.8 Adeel was diagnosed and treated
for tuberculosis while detained in Guantánamo, and
Morad received “humane treatment” from a doctor for
his diabetic foot ulcer.

At the same time, former detainees reported that
medical personnel played a role in facilitating torture
and ill-treatment in all three theatres of operations
through the monitoring of abuse during interrogations,
providing medical information to interrogators, denying
medical care, and failing to take action to stop and/or
document detainee abuse. Three of the Iraqi former
detainees and one former Guantánamo detainee reported
that individuals acting in a health professional capacity
examined their condition during an episode of torture or
physical abuse but made no effort to stop it. Two former
Guantánamo detainees suspected that the psychologist
shared information about them with interrogators.

Several men reported facing difficulties accessing
care while in detention. At Guantánamo, Youssef
recounted that he never received treatment despite
his “many, many” requests for medical attention to his
persistent stomach pain, as well as for swelling in his
wrists. Two men detained at Abu Ghraib reported being
denied medical treatment, including for injuries inflicted
by soldiers. In response to PHR’s query whether or not
any doctors treated Amir’s injuries in Abu Ghraib; he
responded: “Did I need to ask for help? I was there naked
and bleeding
 .These were not real doctors.”

In addition, all the former detainees from Guantánamo
reported that they were given injections or medication
without their consent and medical procedures were
performed on them against their will.

The medical records of one of the former detainees,
Rasheed, illuminate the role of medical personnel at
Guantánamo, and PHR’s evaluators were able to compare
his account with entries in his medical file. The records
are largely consistent with his own account: shortly after
arriving at Guantánamo in 2002, Rasheed’s mental health
began to deteriorate; he attempted suicide and other acts
of self-harm, including self-mutilation. Mental health
staff at Guantánamo responded with heavy doses of
medication, which made him feel unbearably hot and
made his skin and joints ache. When his acts of selfharm
continued, medical staff placed him in restraints
and treated his access to bottled water and blankets as
privileges. In response to his repeated requested to be
removed from isolation, the medical files note that the
psychiatric personnel “informed him that [they] had no
control over that and told him to ask his interrogator to
have him moved.”

It is not clear exactly how long Rasheed was kept in
isolation or how long Rasheed’s interrogations continued
after his severe signs and symptoms appeared —
although it appears to have been at least one year. What
is clear, though, is that during the critical periods in
2002 and 2003 when his health severely deteriorated,
his health condition did not result in halting interrogations,
nor in relieving a regime of isolation and sleep
deprivation; nor do the records indicate that the medical
staff connected his ill-treatment — including use of isolation,
sleep deprivation, physical assault, violation of his
religious and moral codes, and the use of sexual humiliation
— to the obvious decline in his mental condition.
Nor is there evidence from the records that the medical
staff intervened to end his torture, except for one note
with a recommendation that resulted in a brief move out
of isolation. Instead, the thinking of the medical staff
appears reflected in a medical note that mentions him
being subject to “routine stressors of confinement.”

Further, one of the most likely diagnoses for Rasheed’s
psychological symptoms, PTSD, is never mentioned in
the medical record. The medical staff thus not only failed
to document that Rasheed was being tortured through
the use of isolation and other methods (and presumably
did not report it), but also became complicit themselves
in his abuse. Indeed their mental health interventions
may have worsened Rasheed’s suffering by patching
him up so that further interrogation and torture could
be inflicted.

Short-Term and Lasting Harm from Torture
and Ill-Treatment

All the detainees experienced severe, even excruciating
physical pain from being kicked, punched, choked,
shocked or sodomized, and many were terrorized by both
the experience of the assaults on them and threats of
more to come. Most of the detainees lost consciousness
at least once as a result of beatings or other physical
assaults. Some experienced bruising and trauma to
their genitals. Some of the men were not only severely
injured as a result of torture, but they then had to endure
additional pain from the exploitation of those injuries by
their tormenters. Almost all of the men PHR interviewed
continue to experience physical after-effects from the
torture they experienced, including chronic headaches as
well as persistent pain in their limbs, joints, back, muscles,
and ligaments from being beaten or kept suspended or
in other stress positions for long periods of time.

The experience of torture was horrifying to the men as
it was taking place. Men experienced shame, humiliation,
and terror that they or their loved ones would suffer even
more; others were terrified by the claustrophobic conditions
of isolation. These in turn brought about symptoms
ranging from chest pain to severe anxiety to sleeplessness.
One reported: “I was having really bad nightmares

I felt like I couldn’t breathe.” According to medical files,
during an interrogation session in Guantánamo one
detainee had a seizure and “was unresponsive and fell

[while] his feet [were] buckled.”

Lasting Psychological Consequences
of Ill-Treatment

With one exception, the former detainees have experienced
and continue to experience severe psychological
effects of torture and ill-treatment as a result of their
detention in US custody. All but one feel utterly hopeless
and isolated, and lack the ability to sleep well, work, or
engage in normal social relationships with their families.
Seven individuals disclosed having contemplated
suicide either while in detention or after being released.
Most of the released detainees, to this day, live with
severe anxiety, depression, and post-traumatic stress
disorder, including intrusive recollections of trauma
suffered in detention, hyperarousal (persistent symptoms
of increased arousal, e.g., difficulty falling or
staying asleep, anger, and hypervigilance), avoidance
and emotional numbing behavior. PHR’s clinicians determined
that these symptoms were directly related to the
torture and ill-treatment reported having taken place
while in US custody, even after taking into account the
fact that the released Iraqi former detainees are living
in a war-torn environment. Amir explained, “These are
the memories that I can never forget. I want to forget,
but it is impossible.”

For the four detainees who had experienced symptoms
of depression or other mental disorders prior to detention,
torture and ill-treatment by the US Personell severely
exacerbated these conditions, and in one case it ignited
such deep despair and dysfunction as to lead the detainee
to repeated suicide attempts while at Guantánamo.

Diminution of Social and work Life After Detention

Many former detainees reported encountering social
stigma and fear in their communities as a result of their
status as former US detainees. Some relocated, and others
attempted to do so unsuccessfully. All except one have
lost their livelihood and are facing financial hardships,
and many were concerned about their physical safety and
security. These fears are not unfounded as three Iraqi
former detainees were rearrested and detained by both
American forces and the Iraqi government, though subsequently
released. Since the interviews were completed,
PHR has authoritatively learned that one of the former
Guantánamo interviewees has been arrested in his home
country and is still being detained.

Legal Prohibitions Against Torture
and Ill-Treatment

All of the abusive interrogation techniques and patterns
of ill-treatment endured by these eleven men — including
beatings and other forms of severe physical and sexual
assault, isolation, sleep deprivation, forced nakedness,
severe humiliation and degradation, and sensory deprivation,
many of which were experienced over long periods of time and
often in combination with other prohibited acts — constituted
acts of torture as well as cruel, inhuman or degrading
treatment under domestic criminal statutes and international
human rights and humanitarian treaties, including
the Convention Against Torture and the Geneva Conventions,
that were in effect at the time the acts were committed.

According to courts and entities responsible for interpreting
the Convention Against Torture, including the UN
Special Rapporteur on Torture and the UN Committee
Against Torture, each of the interrogation techniques
and conditions of incarceration and treatment identified
in this report, when considered on its own, constitutes
prohibited conduct in the form of torture or cruel,
inhuman or degrading treatment or punishment. In
fulfilling its obligation to assess and report upon the
human rights conditions in other countries, the US State
Department relies upon international human rights treaties
including the Convention Against Torture; in innumerable
instances, it has identified the very practices
evidenced by this study, when committed in foreign countries,
as torture or cruel, inhuman or degrading treatment
or punishment. In addition, based on the severity
of physical and psychological pain and suffering caused
by these practices, the Istanbul Protocol has determined
that they constitute torture and/or ill-treatment.9 Likewise,
the medico-legal evidence leaves little doubt that the interrogation
methods used by US personnel constitute torture
under the US Torture Act, the Uniform Code of Military
Justice (UCMJ),11 and other laws.

Recommendations

Based on the findings of this investigation, the United
States should take the following actions:
The executive branch must repudiate all forms 1. of
torture and cruel, inhuman or degrading treatment.
It should explicitly and in writing establish a uniform
standard of conduct for all agencies that prohibits
any of its military, intelligence or other officials,
including all forms of contract personnel, from
engaging in torture and cruel, inhuman or degrading
treatment, including but not limited to any of the
following interrogation or conditions of confinement
methods, either alone or in combination:

• Stress positions
• Beatings and other forms of physical assault
• Use of extremes of temperature
• Waterboarding or any other form of simulated
drowning
• Threats of harm to the detainee, his family, or
friends
• Sleep deprivation
• Sensory bombardment through the use of
extreme noise and/or light
• Violent shaking
• Religious, cultural, and sexual humiliation
including, but not limited to, forced nakedness
• Prolonged isolation
• Sensory deprivation, including, but not limited
to, hooding and blindfolding
• Use of psychotropic, mind-altering, or other
drugs for the purpose of decreasing resistance
or gaining information
• Mock execution
• Exploitation of phobias, psychopathology, or
physical vulnerability
• Rape and sexual assault
• Electric shocks
• Deprivation of basic necessities and sanitary
conditions

Congress should enact into law the prohibitions listed
above and establish criminal liability for their violation.
The executive branch and Congress should establish
an independent commission to fully investigate and
publicly report on the circumstances of detention
and interrogation in Bagram, Kandahar, and elsewhere
in Afghanistan, Iraq, Guantánamo Bay, and other
locations since 2001. This independent commission
should have subpoena power to compel witnesses
and have full access to all classified materials
concerning interrogation techniques and conditions
of detention, including medical records and documentation
by behavioral health science consultant
personnel, in order to establish a full public record.

The investigation should extend to individuals in the
position of making policy as well as those who carried
those policies out, including all healthcare profes-
sionals who were in the position of providing care or
supporting the interrogation of detainees.

All individuals who played any role in the torture
or ill-treatment of detainees, including those
who authorized the use of methods amounting to
torture or exercised command authority over them,
should be held to account through criminal and civil
processes (such as disciplinary action). Officials at
every level should be held accountable for crimes
they committed or for the acts of officials subordinate
to them. Health professionals, both civilian
and uniformed, who engaged in or facilitated the
abuse of detainees and/or failed to report torture
and ill-treatment should be investigated, appropriately
sanctioned, and disciplined via the Department
of Defense, other executive branch agencies, and
state licensing boards.

The government should issue a formal apology to
detainees who were subjected to torture and/or illtreatment
as part of US military and intelligence
operations since fall 2001 in Afghanistan, Iraq,
Guantánamo Bay, Cuba, and elsewhere.

The government should establish a fair process for
compensation and victim assistance, including
access to rehabilitation and re-integration services, for
individuals subjected to torture or ill-treatment in
US custody.

All places of detention operated by the United States
should be subject to monitoring by international
bodies that investigate detainee treatment and
are capable of reporting findings to the public and
government, including the UN Special Rapporteur
on Torture, the UN Committee Against Torture, and
the International Committee of the Red Cross. These
organizations tasked by treaties to which the United
States is a party must be granted full access to
detainees, their medical records, and all other pertinent
files documenting past and current treatment
of detainees during their incarceration. Furthermore,
Congressional and executive branch oversight of
US military and intelligence activities relevant to
detainee treatment and interrogation should be
immediately strengthened and improved.

The US Department of Justice should publicly
release all legal opinions and other memoranda
concerning standards regarding interrogation and
detention policy and practices.




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