Evidence is emerging that medical personnel monitored the medical effects of the waterboarding of Abu Zubaydah, the al-Qaida operative who was, according to government reports, subjected to the near-drowning at least 83 times in August 2002.
The new information comes from descriptions of cables, classified as top secret and relating to the interrogation of Abu Zubaydah, that were transmitted from a Central Intelligence Agency field station to the agency's Langley, Va., headquarters nearly every day between Aug. 1 and Aug. 18 that year.
The descriptions of the cables (here and here) reveal that a daily "medical update" and "behavioral comments" along with status and threat updates were sent to CIA headquarters throughout that period. On five occasions between Aug. 4 and Aug. 9, an additional cable was sent containing "medical information" along with such information as the strategies for interrogation sessions, raw intelligence, the use of interrogation techniques to elicit information, and the reactions to those techniques. The fact that medical information was included in these cables hints that Abu Zubaydah was medically monitored during or after being subjected to those techniques. Both professional organizations and human rights groups have rejected as unethical any monitoring role for medical personnel.
A summary of the 34 cables and of a handwritten log book were released to the American Civil Liberties Union earlier this month on orders of U.S. District Judge Alvin Hellerstein, who is presiding over a Freedom of Information Act lawsuit brought by the group. The lawsuit was based on a request for records related to detainee treatment that the ACLU and four other advocacy groups made of the U.S. Departments of Defense, Justice and State and the CIA in 2003. The new summary, known as a Vaughn Index, was released in response to a motion that the ACLU filed in 2007 after then-CIA director Michael Hayden acknowledged that the agency had destroyed videotapes of detainee interrogations in 2005.
The cables themselves have not been made public, and the agency is contesting their release. In response to a request for more detail on the medical information included in the cables and the reasons that information was transmitted from the field site to CIA headquarters, CIA spokesman Paul Gimigliano wrote in an e-mail to ProPublica: "The materials speak for themselves."
The U.S. Department of Justice gave the ACLU other documents this month that suggest the cables are among nearly 550 interrogation-related cables sent from field stations to CIA headquarters between April and December 2002. Among those analyzing the new documents are National Public Radio's Ari Shapiro, the Washington Independent's Spencer Ackerman and Firedoglake's Marcy Wheeler.
The documents are the latest installment of an ongoing story about the role of doctors and psychologists in the government's efforts to pry information from suspected terrorists. Professional organizations of doctors, nurses, public health practitioners and psychologists have stated their opposition to health professionals' involvement in torture. "The AMA has taken the clear stand that the participation of physicians in torture and interrogation is a violation of core ethical values," the American Medical Association said in a statement last Friday. Last month, the AMA sent a letter to President Barack Obama reiterating, as it did during the Bush administration, that the association's ethical code prohibits physicians from participating in torture or coercive interrogation.
However, there is evidence that health personnel, at least some of them physicians, have been involved in interrogations. For example Col. Thomas M. Pappas, former chief of military intelligence at Abu Ghraib, who was interviewed as part of the Taguba investigation, testified that a psychiatrist and another doctor monitored interrogations at the prison and had the final say in what aspects of the interrogation plan were implemented.
The question raised by the cables is, How deep was the involvement of physicians or other health professionals in the actual interrogations at CIA "black sites" such as the one where Abu Zubaydah was held?
Previously released documents show that Bush officials overseeing the waterboarding of Abu Zubaydah saw the involvement of medical personnel as crucial because it could help prevent prosecution of interrogators under U.S. law. As ProPublica previously reported, Assistant Attorney General Jay S. Bybee signed a memo on August 1, 2002 spelling out those concerns and the terms under which interrogators could waterboard and slap Abu Zubaydah, subject him to "cramped confinement" and stress positions, and shove him into flexible walls.
"The constant presence of personnel with medical training who have the authority to stop the interrogation should it appear it is medically necessary indicates that it is not your intent to cause severe physical pain," the memo said.
Abu Zubaydah began cooperating in late April under questioning by Ali Soufan, a Federal Bureau of Investigation agent who said he did not use coercive methods. In congressional testimony this month, Soufan disclosed that there was a "CIA medical team supporting us" when he and other FBI and CIA personnel first spoke with Abu Zubaydah. Soufan said the medical team insisted that Abu Zubaydah, who was injured during capture and in danger of dying, be taken to a hospital for treatment.
It is unclear whether the same CIA medical team that evaluated Abu Zubaydah's health problems in the spring was still caring for him in August when he was waterboarded. Nor is it clear precisely how health personnel might have been asked to cross the line from providing medical care to participating in or supporting the interrogations, which Soufan and other sources have described as becoming increasingly abusive under the instruction of a former military Survival, Evasion, Resistance, and Escape (SERE) training psychologist contracted by the CIA. Soufan and others, including another psychologist employed by the CIA, protested the escalating techniques and left the site. The new documents do not indicate whether medical personnel might also have objected.
In a cover letter accompanying the new Vaughn Index, acting U.S. attorney Lev L. Dassin wrote, "The Government is ... acknowledging that August 2002 was the month during which Abu Zubaydah was subjected to the most intensive interrogations." An Aug. 4, 2002, cable with the subject "Abu Zubaydah Interrogation" is a typical entry in the Vaughn Index:
This is a four-page cable from the Field to CIA Headquarters. The cable includes information concerning the strategies for interrogation sessions; the use of interrogation techniques to elicit information on terrorist operations against the U.S.; reactions to the interrogation techniques; raw intelligence; a status of threat information, and medical information.
The news that medical information was being transmitted regularly to CIA headquarters throughout the time Abu Zubaydah was being repeatedly waterboarded troubled medical ethics experts interviewed by ProPublica. Normally, health professionals who work at U.S. prisons share inmates' medical information with authorities only "if there's a need to know; for example if someone has a seizure disorder, we put in a medical order for a bottom bunk," Dr. Dean Rieger, chief medical officer for Correct Care Solutions, a healthcare management company for correctional facilities, said in an interview with ProPublica. Rieger, who has been involved in corrections for more than three decades and who coauthors a column on medical ethics for the Society of Correctional Physicians, said it would be problematic to continue sharing an inmate's medical information with authorities overseeing a system "that creates the harm in the first place."
University of Pennsylvania bioethicist Arthur Caplan agreed. At that point, "you gotta start protesting and stop transmitting," he said in an interview. "The issue isn't privacy violations, it's complicity ... You're part of the torture team at that point if you're assessing injuries and saying whether the person's capable of enduring more."
Legal memos written in 2005 suggest the CIA had reached precisely the opposite conclusion -- that waterboarding and other harsh interrogations should involve personnel from the CIA's Office of Medical Services, including its physicians.
A recently declassified Justice Department memo discussed the involvement the OMS eventually had in supporting interrogations. That memo, quoting still-classified OMS guidelines from December 2004, said that the "use of the waterboard requires the presence of a physician." Another memo said that OMS doctors and psychologists had been consulted about the effects of using several techniques together, such as "when an insult slap is simultaneously combined with water dousing or a kneeling stress position, or when wall standing is simultaneously combined with an abdominal slap and water dousing" and concluded they would not cause severe pain.
Medical personnel were also given the responsibility of monitoring the interrogations for safety. "Should it appear at any time that Abu Zubaydah is experiencing severe pain or suffering, the medical personnel on hand will stop the use of any technique," Bybee's 2002 memo said.
It is unclear whether the "medical personnel" designated to monitor Abu Zubaydah's interrogation included M.D.s. "There is no role for physicians in those practices," Dr. Otmar Kloiber, secretary-general of the World Medical Association, told ProPublica. Kloiber said that physician involvement in interrogations increases the chances that questioning will devolve into abuse and torture. A physician's reassuring presence can give questioners a green light to escalate physical and mental pressure.
In a confidential International Committee of the Red Cross report made public by New York Review of Books contributor Mark Danner last month, Abu Zubaydah described to ICRC interviewers days of being waterboarded to the point he believed he would die, slammed into hard and flexible walls, and confined in a small box where one of his wounds reopened and began to bleed. "Eventually," Abu Zubaydah said, "the torture was stopped by the intervention of the doctor."
The ICRC report also reveals that other detainees who spent time in the CIA's black sites perceived that some staff who treated them or monitored their interrogations were physicians.
The potential presence of physicians as opposed to other types of personnel raises crucial questions.
Numerous officials, both Republican and Democrat, have characterized waterboarding as torture. There is widespread agreement among doctors -- whether employed by the military, other government agencies, or not -- that ethical standards prohibit physicians from using medical knowledge or information about patients to support torture.
The World Medical Association, which lists 85 countries including the U.S. as members, was established in 1947 to uphold independence and ethical behavior among physicians after the horrors of Nazi medicine were revealed. It is arguably the world's key arbiter of medical ethics.
Earlier this month, the group's governing council issued a resolution reaffirming the group's long-standing position that physicians are forbidden from "participating in, or even being present during, the practice of torture or other forms of cruel, inhuman, or degrading procedures" and must denounce those acts whenever they're aware of them.
According to officials from the WMA and the Norwegian Medical Association, which put forward the resolution, the original draft made specific reference to U.S. detention facilities. At the WMA council meeting in Jerusalem earlier this month, intense discussion ensued between normally staid physicians over whether to remove mention of the U.S. and make the language more generic.
WMA officials declined to say who took up which side.
"It got heated enough I had to call a short recess and have a cooling-off period," WMA chair Dr. Edward Hill told ProPublica. Hill, a former president of the American Medical Association, said the U.S. delegation stayed out of the debate.
But the American delegation made its views clear, according to Dr. Trond Markestad, who drafted the original resolution and who chairs the ethics committee in the Norwegian Medical Association. "They felt it was a bit unfair, wasn't really correct, to single out that one [example] since there were so many wars going on and so many things happening all over the world and since they'd already addressed this nationally."
The final version of the WMA resolution passed unanimously after language naming the U.S. was removed. The resolution condemns "reports worldwide" of "deeply unsettling practices by health professionals, including direct participation in the infliction of ill-treatment, monitoring specific methods of ill-treatment, and participation in interrogation processes."
The group also resolved to support physicians who refuse to participate in or condone torture. Kloiber told ProPublica that WMA members are concerned, for example, that physicians in areas where sharia law is adopted are being asked to carry out punishments such as amputations.
The WMA resolution calls on national medical associations, such as the AMA, to investigate breaches of fundamental medical ethics among physicians. But the AMA has not made public whether its ethics and judicial body has ever investigated or sanctioned physicians for participating in torture or cruel, inhuman or degrading treatment.
Last Friday, the Center for Constitutional Rights in New York launched an advocacy campaign that aims "to hold accountable healers that have harmed." The group is encouraging citizens to file complaints against health professionals suspected of participating in torture and to support legislation, such as a proposed bill in New York state, that prohibits health professionals from participating in torture or the improper treatment of prisoners at home or abroad.