The medical professionals worked to strap the detainee "into a chair, Velcro his head to a metal restraint, then tether a tube into the man's stomach through his nose to pump in liquid nourishment twice a day."

After the Miami Herald wrote about the 30 hunger striking detainees in the Guantánamo Bay detention camps in January, we were concerned. We wrote an urgent letter to Defense Secretary Robert Gates to bring his attention to the cruel, inhuman, degrading and unlawful treatment of the 30 hunger striking detainees. In that letter, we pointed out that hunger strikes were indications of a larger problem concerning the conditions of confinement at the detention camp. A week later, Amnesty International, Human Rights First and Human Rights Watch joined us in writing to President Obama requesting full access to the detention facility at Guantánamo to independently examine and report on conditions of confinement. We still have not received an answer to our request.

When President Obama issued an executive order calling on the Department of Defense (DOD) to investigate conditions of confinement at Guantánamo and whether they conformed to Common Article 3 of the Geneva Conventions and to "other applicable laws," we hoped that the DOD report would shed some light on the actual conditions at the camp and the role of medical personnel during interrogations and forced feedings.

One month later, the DOD report came out and the DOD – unsurprisingly, since the DOD was policing itself – claimed that conditions at Gitmo were in compliance with the Geneva Conventions. We knew this was a total whitewash, and that a real independent assessment would be necessary to ascertain the actual conditions at Guantánamo.

In an article published last Friday in The Lancet medical journal, attorneys Leonard S. Rubenstein of Physicians for Human Rights and George J. Annas of the Boston University School of Public Health wrote that Guantánamo detainees lack "access to independent medical assessments, and [that] the Department of Defense has continued to refuse requests by medical and human-rights groups to do medical assessments of prisoners independently or jointly with military physicians." As a result, the health-related conclusions made in the DOD report cannot be validated. Rubenstein and Annas also noted that some of the medical personnel that were supposed to provide ethical care and assistance instead supported inhuman interrogations or forced-feedings of competent individuals, and the actions of some physicians threatened the overall health of the prisoners at Guantánamo. These physicians, therefore, are complicit in the force-feeding of hunger strikers. They write:

Military physicians have been important in stopping hunger strikes at the detention centre in Guantanamo Bay from the outset. At least since 2005, they have used restraint chairs to put hundreds of prisoners in eight-point restraints (ie, both ankles, wrists, and shoulders, one lap belt, and one head restraint) before, during, and after the placement of a nasogastric tube so that the prisoners can be force-fed. The use of coercion, physical force, or physical restraints to force-feed competent individuals on hunger strike has been condemned by the World Medical Association as a form of "inhuman and degrading treatment" that is prohibited according to Common Article 3.

Rubenstein and Annas observed that two years before this practice began; President Bush's Bioethics Council described the process as a form of torture, but this opinion was ignored by the Bush administration, which also ignored statements by leading medical associations condemning the unethical use of restraint chairs and the involvement of physicians in force-feeding. Journalist Andy Worthington concurs: He has written extensively on the issue of hunger strikers at Guantánamo, noting the severity of forced-feeding as one aspect of Bush administration's torture regime. The ramifications of these forced-feedings continue to be felt today, writes Worthington, and the excessive force used during these feedings amounts to torture.

When discussing the interrogations, Rubenstein and Annas added:

The World Medical Association, American Medical Association, and American Psychiatric Association have all established that the participation of physicians in interrogation, even in the absence of torture, is a breach of their duty not to inflict harm, and is therefore unethical.

It is not surprising that the mental health of the detainees is of particular concern to the authors of The Lancet report. They noted that the detainees continue to suffer from post-traumatic stress disorder, depression and anxiety as a result of their experiences, as evaluated by detailed psychological and medical examinations of several detainees released from Guantánamo. Rubenstein and Annas suggested three needed actions from the DOD:

1. abandon the practices that are inconsistent with medical ethics (including for-feeding competent individuals on hunger strike);
2. allow for independent medical reviews of the mental and physical health conditions of the detainees at Guantánamo; and
3. establish an independent commission to review the role of physicians and psychologists as well as the entire regime of detention and interrogation of terror suspects by the U.S. and the protocol for dealing with prisoners on hunger strikes.

President Obama has promised to depart from the Bush administration's abusive national security polices. Although his administration abandoned some of the worst abuses (i.e. torture and secret detention), much work remains to be done, including the much-needed reversal of the cruel policy of forced feeding.

Permalink |	Human Rights, Torture