PHR Library

Letter from Physicians to James Schlesinger, Chair of the Independent Panel to Review Department of Defense Detention Operations

Dear Mr. Schlesinger:

Reports of inhuman treatment and torture of persons detained by the United States in Iraq, Afghanistan, Guantánamo and elsewhere are deeply disturbing and require a full review to understand the events that took place, hold accountable all those who participated or authorized interrogation techniques that are prohibited by international and domestic law, and to assure that these techniques are no longer being used and will not be in the future. We appreciate the effort of the Independent Panel to Review DoD Detention Operations that you chair to review the adequacy of Pentagon investigations and to inform an appropriate U.S. response. It is a critically important mandate.

As individual members of the medical community and in conjunction with Physicians for Human Rights, we are writing to request action by the panel that is consistent with medical knowledge about torture. As you may know, the medical community has long taken a strong stand against torture because of knowledge gained from both clinical evaluations and peer-reviewed studies of the impact of torture and because of the temptation of custodians to rely on physicians and other medical personnel to aid interrogations through medical evaluations before, during and after interrogation. The evidence is very strong that torture and inhuman treatment have a long-term impact on individuals, and so-called stress and duress techniques that fall short of physical assault can bring more severe harm than physical injury in the long term because the sense of loss of control is associated with post-traumatic effects. Consistent with this evidence and with international law, both the American Medical Association and the World Medical Association have taken the position that torture and cruel, inhuman and degrading treatment may never be practiced and that it is unethical for physicians to aid torture in any way.

We urge you to assure that your panel's report covers key issues relating to the impact of interrogation tactics on the physical and mental health of detainees, reliance on medical personnel for support in interrogations, and withholding of or interference with medical services for ill or wounded detainees.

First, we urge you to assure a full inquiry into all "stress and duress" interrogation techniques, by all agencies of the government, used in the past and used now; their impact; and whether and to what extent interrogators and/or custodians improperly denied detainees access to medical care or misused medical information. These include, among others, use of threats, sleep deprivation, prolonged placement in uncomfortable positions, hooding, regulation of diet, sensory manipulation, and others. Based on the facts that have emerged to date, a full inquiry requires examination of facts relating to the following subjects at all facilities where interrogations take place by or on behalf of U.S. forces from any agencies, from the end of 2001 until the present:

• An inventory of what techniques have been used and what techniques were authorized, and with what restrictions and approvals required.
• Review of records of interrogation, including medical records of individuals subject to them.
• A review of the impact of interrogation practices on detainees, including a full review of all deaths in detention.
• An assessment of whether officials from the International Committee of the Red Cross had access.
• Whether physicians from the International Committee of the Red Cross were denied access to detainees, or certain of them, and if so, what restrictions were imposed, for what purpose, and with what result.
• Whether and to what extent interrogators and/or custodians breached confidentiality with respect to detainee medical records, as has been reported in the press, and whether medical records were reviewed by interrogators or their agents, and if so, by whom, when, and for what purpose. This includes whether custodians and/or interrogators used information from ICRC physician interviews with detainees, including the fact of such interviews, for the purposes of interrogation, which reportedly resulted in the refusal of ICRC physicians to come to Guantánamo for approximately one year.
• Whether and to what extent interrogators or custodians denied or threatened to deny medical care to detainees.
• Whether and to what extent physicians and other health personnel were asked to and did monitor health conditions for the purpose of determining or monitoring the use of particular interrogation techniques, e.g., monitoring nutritional intake.
• The quality of medical care provided to detainees subjected to interrogation.

Some information on each of these matters has appeared in the press, but most of it comes from a handful of leaked or released documents. A full investigation is needed and should include interviews with health personnel at Guantánamo, Abu Ghraib and elsewhere, as well as tasking orders, physician reports, and cable traffic related to the health of detainees and the role of physicians in assessments before or after interrogation. Also, as noted above, we believe the panel should address all agencies and all officials. To the extent that the panel's mandate does not include officials at the highest levels of government or agencies beyond the Department of Defense, we ask that the panel urge that a body be appointed that has the authority to conduct an independent investigation.

Second, significant ethical questions about the role physicians and other health personnel have played need to be addressed. Health personnel employed by the Department of Defense and other agencies should abide by ethical standards of the World Medical Association, the American Medical Association and other relevant bodies. The Declaration of Tokyo, adopted by both bodies, prohibits participation of physicians in torture and all forms of cruel, inhuman, and degrading treatment. This includes providing "knowledge" to "facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment." It also prohibits the physician's presence when any of these practices take place. This has been interpreted to prohibit examinations prior to or after interrogation because such examinations involve health personnel in calibrating coercive or unlawful techniques of interrogation. We urge that your investigation determine whether physicians participated willingly or were required to participate in such activities. An inquiry into whether they adhered to these standards should be part of a full investigation. Questions to consider include the following:

• Whether health professionals voluntarily or involuntarily participated in interrogations or assessed detainees before, during or after interrogation for the purpose of aiding the interrogation process through monitoring of diet, sleep or other health matters.
• Whether health professionals voluntarily or involuntarily shared information about detainees, either orally or in writing (including release to interrogators of medical records and opinions) with interrogators.
• Whether health professionals complied with their obligations to report torture and cruel, inhuman and degrading treatment when they become aware of it. This also includes the role of health professionals in reporting deaths in detention.
• Whether physicians raised objections to abusive practices or took measures to protect prisoners from them.

In requesting your attention to these issues, we do not presuppose unethical behavior on the part of physicians or other medical personnel.

We again wish to express our appreciation for the task you are undertaking and urge that you assure that an investigation examines all of these matters.

Sincerely,

Marcia Angell, M.D., Senior Lecturer in Social Medicine, Harvard Medical School
Holly G. Atkinson, M.D., President, Physicians for Human Rights
Frank Davidoff, M.D., Editor Emeritus, Annals of Internal Medicine
Howard Hiatt, M.D., Harvard Medical School
Eric Kandel, University Professor, Columbia University
Donald A. Rowley, M.D., University of Chicago School of Medicine
Janet Rowley, M.D., University of Chicago School of Medicine
Leonard S. Rubenstein, J.D., Executive Director, Physicians for Human Rights*
David Satcher, M.D., former Surgeon General of the United States

* Please direct any response to Leonard Rubenstein at Physicians for Human Rights.