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All Too QuietWhere were the doctors and nurses at Abu Ghraib and Bagram?

By Steven H. Miles
Posted Tuesday, June 27, 2006, at 1:08 PM ET
Prisoner at Abu Ghraib. Click image to expand.

Where were the doctors and nurses at Abu Ghraib, Qaim, Bagram, and the other islands of the United States prison archipelago abroad when prisoners were being beaten, suspended, and degraded? Defense Department policies set the stage for the abuses, but the silence of prison clinicians allowed them to continue. Some medical staffers witnessed the brutality. Others saw the injuries that resulted from the abuse.

Most of what we know about the role of prison doctors and medical staffers comes from tens of thousands of pages of government documents released pursuant to a Freedom of Information Act suit brought by the American Civil Liberties Union. These papers include criminal investigations, FBI notes on debriefings of prisoners, interviews with witnesses, sworn recollections of conversations, e-mails from soldiers and intelligence personnel, autopsy reports, military base policies, and prisoners' medical records. Here are some of the incidents they reveal.

False claims of death by natural causes
Abed Hamed Mowhoush voluntarily surrendered to American military authorities in Qaim, Iraq, in November 2003. He died of torture 16 days later. According to testimony at the trial of the intelligence officers responsible for the abuse, Mowhoush was repeatedly beaten with fists, hose, sticks, and a rifle butt under the supervision of Army, Special Forces, and CIA personnel. Six of his ribs were broken. Then he was stuffed head first into a sleeping bag and wrapped in 20 feet of electrical wire. A soldier briefly crouched over Mowhoush's chest. A few minutes later, he was found to be dead. Dr. Ann Rossignol, an Air Force physician, joined the resuscitation. She was told that Mowhoush was being interrogated, lost control of his urine, and collapsed. The trial transcript shows that she did not ask for more details. A Pentagon press release stated: "Mowhoush said he didn't feel well and subsequently lost consciousness. The soldier questioning him found no pulse, then conducted CPR and called for medical authorities. According to the on-site surgeon [Rossignol], it appeared Mowhoush died of natural causes."

Somehow Dr. Rossignol missed seeing that Mowhoush's body was bruised on the arms, legs, head, neck, pelvis, and front and back of the torso. These injuries were apparent to the criminal investigators and the pathologists who conducted an autopsy. She kept silent as the inaccurate report circulated that he had died by natural causes. The military has not granted interviews in relation to Mowhoush's death. The official explanation is that the death was an unintentional homicide.

Silent witnesses
Medics have been privy to abuse and said nothing about the incidents they knew of. According to his statement in one of the Abu Ghraib investigations, medic Reuben Layton saw pictures of the abuses at the prison when they were posted as screensavers on military computers there. In late 2003, medic Neil Wallin was called to a cell after Abu Ghraib guards slammed a prisoner into a wall, lacerating his chin. He saw the prisoner with a sandbag over his head and blood running down his clothes from a 2-and-a-half-inch cut. He later told Army investigators that he saw "blood on the wall near a metal weld, which I believed to be the place where the detainee received his injury." Wallin sutured the wound with 13 stitches but did not report it because he said that he did "not know how [the prisoner] was injured if it was done by himself or another."

Silent medical records
Human-rights monitors from the International Red Cross who visited prisons described a number of prisoners at various Iraq prisons with injuries from beatings or burns that had not been recorded in medical records. At Camp Mercury in Iraq, a physician's assistant wrote that injuries to prisoners caused by guards, including fractures, were present at capture. Army investigators at Mosul prison in Iraq learned that a soldier had broken the jaw of prisoner Salah Salih Jassim. The Army investigators found that the examining physician did not record how Salih's jaw came to be fractured. Neither the examining medic nor the physician removed the prisoner's shirt to look for other bruises.

In summer 2004, an Abu Ghraib prisoner described being beaten, slammed against the wall, having his head dunked in water, and being sodomized with a baton until he bled from his rectum. An Army investigator told a physician of the allegation and requested a "medical examination specifically for trauma due to sodomy." The physician did not examine the prisoner's rectum but nonetheless reported no signs of anal tearing. The investigation was closed with a note by the investigating officer, "If there isn't medical evidence then this terrorist lied and you should find a way to charge him with perjury, filing a false statement and anything else available."

Lost medical records
A physician at an undisclosed Iraq prison told investigators that a prisoner had complained of being beaten. But the doctor said that he did not see bruising. The medical record could not be found. In 2005, Army investigators thought believable the complaint of a Tikrit inmate that he had been chilled with an air conditioner, beaten, kicked, and dragged. But they closed the investigation because no medical records could be found and the detaining soldiers could not be identified. Another Tikrit inmate described three days of beatings after which his urine became bloody. Again, Army investigators could not find a medical record. In another 2004 case in Iraq, a medic recorded, in a medical note, abrasions, bruises, a broken nose, and a fractured leg. The attending physician signed the note without examining or interviewing the battered prisoner. When the prisoner brought formal charges of abuse through the prison's complaint system, the lack of a doctor's note harmed his credibility. The prisoner decided to drop his complaint and signed a formal statement, "I swear under oath that I do not want to file a complaint against the American Forces so I can get released."

The misplacement of medical records also was used to discredit an American soldier. In January 2003, Spc. Sean Baker put on a Guantanamo prisoner's uniform to allow soldiers to practice extracting a prisoner from a cell. The extraction team did not know that Baker was an American. He recalls, "They grabbed my arms, my legs, twisted me up and … got up on my back from behind and put pressure down on me while I was face down." Guard Scott Sinclair "began to choke me and press my head against the floor." He twice "slammed my head against the floor and continued to choke me." Baker was hospitalized for brain trauma, given a medical discharge, and continues to suffer from regular seizures. The videotape of the training exercise was lost.

An Army Physical Evaluation Board concluded that Baker's injuries and disabilities were due to the beating and gave its report to Baker. Yet 18 months later, Pentagon spokesperson Maj. Laurie Arellano told reporters that Baker's medical discharge was not related to his duties in the military. When Baker released the Army Board's statement, Arellano conceded that the beatings were a factor in Baker's discharge, stating that she had new information.

In the course of the investigation by Maj. Gen. Antonio Taguba of the abuses at Abu Ghraib, Army Major Anthony Cavallaro testified, "What bothered me most about what happened at Abu Ghraib was that no soldier came forward and said this is wrong." The same can be said of the doctors, nurses, and medics.

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Steven H. Miles is professor of medicine and bioethics at the University of Minnesota, Center for Bioethics, and author of the new book Oath Betrayed: Torture, Medical Complicity, and the War on Terror.
Photograph of prisoner at Abu Ghraib by Wathiq Khuzaie/Getty Images. Photograph from Abu Ghraib on the Slate home page by Ho/Agence-France Presse/Getty Images.
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Remarks from the Fray:

As a retired military physician, I am well aware that the mindset of the majority of military doctors, especially those who are careerists, generally parallels that of the rest of the officer corps. They are staunchly conservative, overwhelmingly Christian and deeply immersed in military culture. There is often a sense of insecurity about their position as healers among a cadre of professional soldiers, and medical group commanders are among the loudest to proclaim their "warrior" roots. The "go along to get along" mentality is pervasive. In this way, they mirror the military population as a whole, and it is the price we pay for an all-volunteer army.

--rockfleet

(To reply, click here.)

During WWII the USA took most Japanese Americans and put them in detention camps till the war was over. Most of these people did nothing but have Japanese parents. Do I agree? Not really, but at the time over 2000 people died in a cowardly surprise attack and we were at war. Now 60 years later another cowardly surprise attack, another 2000 people dead, and again we are at war. Most of the detainees in Gitmo come from terrorist camps in Afghanistan or were captured in some terrorist act. Was this 60 years ago every Muslim in the country would be round up and thrown in a camp, fortunately it is 2006 and we are just rounding up the radicals that pose a threat. Is there abuse? probably, but if it saves the life of an American soldier or prevents a terrorist attack on USA soil, I say pull out their toe nails with some pliers.

--danespo

(To reply, click here.)

Vague "he-said/they-said/I-heard/I-think" facts that our free press uses to bias the world against the US is not the way to get things changed. Where are the facts??? Hard facts? Well......no records.....a guy in prison has a broken arm, bruises, well, a lot of them were captured during combat, and we dont really see any talk of what their condition was when they were captured. But we hear of, "I saw a blood stain on the wall and think that is where he got hurt" speculation.

--NoEvidence

(To reply, click here.)

While it is easy to blame individuals for lacking the moral fortitude to speak out, anyone with experience in the military, particularly one at war, can understand, yet not necessarily approve of, the degree to which camaraderie, loyalty, and patriotism might subjugate principles of beneficence. Yet this article demonstrates no effort made to obtain the perspectives of the physicians it castigates. Nor does it try to investigate what channels to express concerns and objections existed.

Publicly probing these events is critical in several respects. For any military physician, nurse, or medic, it should be a mandatory discussion so that the ethically correct course of action can be made clear; so that, when faced with such a situation, the health care provider involved has already given thought to what is the right thing to do, before feeling the pressures of loyalty and solidarity. For the general public, it should allow the opportunity to question our government as to how people who have chosen a profession dedicated to healing are asked to participate in activities that oppose those principles and how the system can be changed to prevent future episodes or to encourage the reporting of abuse.

--Chunkybeefstyle

(To reply, click here.)

Considering that the AMA prohibits physicians from participating in executions, I would like to see a strong public statement from this organization that it is unethical for physicians to participate in, ignore signs of, or cover up the effects of torture. I would like to go even farther and require that medical personnel involved in these cases be investigated thoroughly before they are allowed to return to private practice. [...] We must reassert that individuals, especially medical professionals, are accountable for their actions.

--Azdak

(To reply, click here.)

Where was the Red Cross? They had extremely limited access, if any. [...]

For most of our nation's history, we could justifiably cry "foul" that foreign POW camps did not grant access to red cross and other aid workers. Now America is in the same position of denying humanitarian access. [...]

We need military leadership with both a better committment to use force where appropriate on the ground in Iraq, as well as a good grounding in the geneva convention, rules of war, and treatment of POWs.

--baltimore_aureole

(To reply, click here.)

(6/29)

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