Hippocratic Oath AWOL at Military Prisons

NEW YORK - Secret detention centers in Iraq and Afghanistan must be included in U.S. military monitoring of prisoner mistreatment, according to an article in the Lancet medical journal that details collusion between medical staff and abusive interrogators.

While much evidence in the ongoing military investigations has been made public, the article also notes that two earlier U.S. Army probes remain classified, and that thousands of pages of appendices to the initial report on Abu Ghraib prison by U.S. Maj. Gen. Antonio Taguba are unavailable.

The article, by University of Minnesota professor Steven Miles, alleges that in some cases doctors revived Iraqi detainees who had collapsed – permitting their abuse to continue – faked death certificates and medical records to cover up torture, and failed to provide basic health care.

Three major probes continue into abuses of prisoners resulting from the U.S. military's "war on terror" – one examining the role of the military intelligence unit that ran interrogations at Abu Ghraib outside Baghdad, another by the U.S. Navy Inspector General on practices at detention centers in Iraq, Afghanistan and Guantanamo Bay in Cuba, and the last by a Pentagon-appointed panel that will assess previous reports and make recommendations.

Senior defense officials say the report on Abu Ghraib, due this week, will lay blame on some two-dozen guards and soldiers, but exonerates senior commanders of wrongdoing. Medical personnel are expected to be faulted, but it is unclear what sanctions would be brought against them.

"The inspector general's report and ICRC [International Committee of the Red Cross] report suggests that there was a widespread failure to provide basic clinical facilities, screening and records," said Miles, a professor at the university's Center for Bioethics.

"The direct abuses appear to be sporadic, [but] until we have a full inquiry that includes the secret detention centers, we will not know the answers," he told IPS.

High-ranking army officials confirmed that a doctor and psychiatrist helped design, approve and monitor interrogations at Abu Ghraib, under a 2003 mandate that detainees be "medically and operationally evaluated as suitable" for questioning.

Conditions at the prison were first publicly exposed in April, when graphic photos of sexual and physical abuse were leaked to the news media.

But while some medical staff knew of the mistreatment and had an ethical duty to disclose it, "no unprompted reports of abuses were initiated by medical personnel before the official investigation into practices at Abu Ghraib," the Lancet notes in an accompanying editorial.

Depositions by detainees and military personnel described incidents such as a doctor allowing a medically untrained guard to sew up a beaten prisoner's wound, and a medic inserting an intravenous tube into the corpse of a detainee who died under torture in order to create evidence that he had been alive at the hospital.

In another case, an Iraqi man arrested by U.S. soldiers was found months later by his family comatose in an Iraqi hospital, with skull fractures and burns on the bottoms of his feet. The accompanying U.S. medical report stated that heatstroke had triggered a heart attack, but did not mention the injuries.

Miles told IPS his research found that medical records were falsified at some 10 sites in Iraq and Afghanistan.

In one example, soldiers tied a beaten detainee to the top of his cell door and gagged him. The death certificate said he died of "natural causes ... during his sleep." Following media inquiries, the Pentagon revised the certificate to say the death was a "homicide" caused by "blunt force injuries and asphyxia."

Prohibitions on medical staff participating in torture and ill treatment are enshrined in several accords, including the Istanbul Protocol, a guide to assist doctors in documenting torture, the 1975 Tokyo Declaration and the Geneva Conventions.

Doctors must also swear to the Hippocratic Oath, whose words include: "I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm."

"Military doctors can be placed in a difficult position, but the problem of dual loyalty, to patients and to their employers, is well recognized," Miles writes in the article. "If Abu Ghraib is to leave a legacy of reform, it will be important to clarify how the breakdown occurred. The emerging evidence points to policy and operational failures."

For instance, in February 2002, U.S. President George W. Bush signed an executive order asserting that the Geneva Conventions did not apply to detainees believed to belong to the al-Qaeda terrorist group or members of Afghanistan's former Taliban regime.

Six months later, the Justice Department issued a memorandum distinguishing cruel, inhumane or degrading treatment – which could be permitted in U.S. military detention centers – from torture, which was ordinarily banned, Miles notes.

Abu Ghraib prison employees did not receive any human rights training, although some advocates say this is hardly an excuse.

"People know intuitively what's right and wrong, whether or not they've been briefed on human rights law," said Alistair Hodgett of Amnesty International. "But these principles are also a key protection for U.S. personnel – abiding by the rules helps us and breaching them hurts us."

"Our concern is that there is a critical lack of independence since the investigations are being conducted by the Defense Department," Hodgett added in an interview. "That's why we are calling for an independent probe and possibly a special prosecutor."

Human rights workers say the collusion of health workers in torture is especially repugnant because it recalls the atrocities committed by individuals during the Nazi regime in Germany during World War Two and by repressive regimes in Latin America in the 1970s.

On Aug. 6, Physicians for Human Rights sent a letter to James Schlesinger, chairman of the Pentagon panel, urging investigators of the abuse to look specifically into the role that medical personnel played.

The group told IPS it has not received any formal response, and it remains to be seen whether its concerns will be addressed in the panel's final report.

(Inter Press Service)