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Oath Betrayed: Torture, Medical Complicity, and the War on Terror

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After 9/11, the U.S. military began using physicians, psychologists and other medical personnel to assist in the interrogations of prisoners at Guantanamo Bay and elsewhere. We take a look at the role of doctors and interrogation with Dr. Steven Miles, an expert in medical ethics and author of the new book, “Oath Betrayed: Torture, Medical Complicity, and the War on Terror.” [includes rush transcript]

While the issue of military tribunals and the legal status of prisoners at Guantanamo Bay remains in the media spotlight, another aspect of the US prison camp is largely being left out of the discussion in the corporate media–the abuse of prisoners at Guantanamo and the active participation of doctors in torture.

After 9/11, the Pentagon began using so-called behavioral science consultants, or “biscuit” teams to help interrogators obtain information from prisoners at Guantanamo Bay and elsewhere. These medical teams reportedly advised the military on how to “break” detainees to make them more cooperative.

  • Dr. Steven Miles, author of “Oath Betrayed: Torture, Medical Complicity, and the War on Terror.” He is a professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics. He is also a practicing physician.

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We’re joined now by Dr. Steven Miles, Professor of Medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics. He’s author of a new book that examines the role of doctors in torture; it’s called Oath Betrayed: Torture, Medical Complicity, and the War on Terror. We welcome you to Democracy Now!

DR. STEVEN MILES: Thank you so much.

AMY GOODMAN: Do you take heart from the ruling of the Supreme Court yesterday?

DR. STEVEN MILES: The Supreme Court ruling is a great ruling, because Common Article 3, which is what the Supreme Court specifically referred to, not only provides for fair trials, but also is the section that addresses torture and cruel and inhuman and degrading treatment, so that the Supreme Court specifically said that that portion of international law is binding on all prison sites in the war on terror. I think it also lays a foundation for saying that the United States is knowingly culpable for its ongoing violations of these and past violations, because the Supreme Court didn’t say it applied starting now. It says it applied from the very beginning. These are war crimes.

JUAN GONZALEZ: Your book, Oath Betrayed, goes beyond that to look at specifically the role of medical professionals in this war on terror, and there’s obviously a raging debate now in medical circles over to what degree doctors, nurses and medics are being complicit in torture. But you’ve now compiled together a lot of the existing record, right, of these cases?

DR. STEVEN MILES: Right. The ACLU put a FOIA suit, a Freedom of Information Act suit, out and pulled down 35,000 records, which actually give a very good picture of the medical system in the war on terror. And that medical system looks very much like, oh, for example, the way physicians were complicit in torturing Argentina or Paraguay or Chile. Basically they hid torture. They delayed the release or concealed death certificates pertaining to deaths by torture. They helped design and monitor harsh interrogations, and they neglected basic medical needs as they failed to record injuries from torture and failed to report that torture up the chain of command or to places that could stop it.

AMY GOODMAN: Can you talk about Abu Ghraib for a minute, before we go back to Guantanamo, to talk about the role of doctors, to talk about the role of medics, of nurses. In the most famous cases, when people hear about them, I think they think about soldiers abusing. What about the role?

DR. STEVEN MILES: Well, one of the most famous pictures from Abu Ghraib, of course, is the body of Monadel Jamadi wrapped in ice. He was arrested at his home and put up a fight. He was then bound. He was flipped into a Humvee. He was kicked and beaten and hit with a rifle butt while he was transported to Camp Jenny Pozzi, just outside of Baghdad. There, a medic was in the room, as he was saying, “I can’t breathe. I feel like I’m going to die.” He was interrogated briefly at Camp Jenny Pozzi. At that point, he was taken to Abu Ghraib.

He was admitted to Abu Ghraib in the early hours of the morning. He was admitted as a CIA ghost prisoner. Now, what this meant was that he was not given the customary medical enrollment. In fact, he wasn’t registered in the prison at all.

He was naked. He was cold. He was complaining of shortness of breath. His head was in a sandbag, and then he was tied to — his wrists were tied together behind his back and then lifted up and tied to a window bar behind him, so that if he sank down, that his shoulders would be wrenched. And, in fact, about an hour later, he did sink down. Now, keep in mind the man was in a sandbag over his head, and he was found to have died.

Now, at that point the army did an autopsy, but the autopsy was concealed, as was the death certificate. It did find that he died of torture. And, in fact, the first time we learned of this case was about six months after it happened. By concealing this, what the Armed Forces Institute of Pathology and the Defense Department did was, they delayed public knowledge of a profound problem inside the prisons and essentially disabled an early warning system about torture.

JUAN GONZALEZ: Sticking on Abu Ghraib for a second, obviously if there is one scandal that really changed massively Iraqi public opinion toward the occupation and American presence, it was Abu Ghraib, but your story also documents how some of the same — the same unit that was involved with some of the abuses, there were signs previous to that of abuses of prisoners that were not dealt with by the military, in essence creating sort of the policy go-ahead for the kinds of tortures that then later developed at Abu Ghraib.

DR. STEVEN MILES: Yeah, one of my favorites was, Schlesinger was assigned by the Defense Department — he was a former Secretary of Defense —- to go investigate human rights abuse there. And he said, 'Well, of course, America only tortures in the ticking time bomb scenario.' And so, he said, 'Here is a great case.' And he talks about this lieutenant colonel who, after a prisoner was beaten in order to get information about an attack on his unit, stuffed his head in a barrel and then discharged his gun next to the guy’s head. Well, this guy was actually working with us and was betrayed, as many of the prisoners were, on a tip by jealous other players. In fact -—

AMY GOODMAN: The prisoner was working with the U.S. forces?

DR. STEVEN MILES: Yeah, he was not a prisoner. He was actually a U.S. employee, and somebody else said that he was getting ready to attack our unit. And, in fact, around 85% of the prisoners in Iraq and 60% in Guantanamo are innocent of any insurgency or al-Qaeda activity by the Military Intelligence’s own estimate. In this case, we picked up one of our own employees. So Schlesinger said —- well, the guy blurted out a bunch of names after they fired a gun next to his head, and Schlesinger said, “This is a great example of a ticking time bomb case.” But the problem was -—

JUAN GONZALEZ: And the ticking time bomb case is what?

DR. STEVEN MILES: Well, you torture a person, and then you get immediate information to protect your unit, okay?

AMY GOODMAN: Because there might be a ticking time bomb.

DR. STEVEN MILES: Right, and in this case they said that this guy knew about an impending attack on this unit. Okay, but the guy gave out names of people who were innocent, just because he was scared. We alienated him as an informant, and none of these names panned out. But here’s the follow-up to the story: what they did then was they let this lieutenant colonel off very lightly and they allowed him discharge with a pension, okay? And about a hundred congressmen gave him dinners across the United States.

AMY GOODMAN: This is the man who put this prisoner’s head in a barrel, put a gun next to his head in the barrel and shot it off, the prisoner thinking his head was going to be blown off?

DR. STEVEN MILES: Exactly. After torturing him for about an hour. And then what happened was, when they let him off, they had these other soldiers who were beating up prisoners on the mistaken belief that these prisoners were involved in the rape of Jessica Lynch. Jessica Lynch, I don’t believe, was raped. But these guys had nothing to do with it, even if she was. They were miles away from this. And what happened was they tied these guys down on the ground or held them down on the ground, while the soldiers kicked them between their legs. Well, since they had just let this current lieutenant colonel off for shooting a gun next to this other guy’s head, they decided to let these soldiers off with very minor sanctions, despite the recommendations of the commanders in the field.

And then what happened was that this same unit was the unit that was sent over to Abu Ghraib and essentially had been given a green light for abuse of prisoners, so that instead of a ticking time bomb being prevented by torture in the case of Schlesinger’s anecdote, what really happened was a green light was given for abuses of prisoners.

AMY GOODMAN: We’re talking to Steven Miles, Professor of Medicine at University of Minnesota, a faculty member of its Center for Bioethics, and a practicing physician. His book is called Oath Betrayed: Torture, Medical Complicity, and the War on Terror. Can you talk about another horrifying, but famous image of an Iraqi prisoner, and that was the dead prisoner on ice?

DR. STEVEN MILES: Yeah. That was the Monadel Jamadi case that I just spoke about.

AMY GOODMAN: What about the man originally who you begin the case with, and that is something that Charles Graner, who became famous and is now in prison, had to do with.

DR. STEVEN MILES: Yeah, this guy — I think his name was Al-Sheikh — what he did was — a guard, an Iraqi trustee working in Abu Ghraib, smuggled in a pistol. The U.S. military found out about this. This is a legitimate security threat in the prison. And they wound up taking him down violently, which is appropriate, because he drew the gun on the guards in the cell block. But he was injured in the course of this and went to a hospital. And he had a dislocated shoulder, and he had a very badly injured leg.

When he came back to the cell block, Graner was suspending him by his shoulder, his dislocated shoulder, and a medic and a doctor saw that the shoulder was dislocated and saw that he was being suspended on two occasions and asked the guards not to do it, but fundamentally did not report the abuse and did not intervene to prevent this from happening. The guy obviously couldn’t take the weight off of his shoulder, because of his injured leg.

Now, this guy also had a surgical drain in place from the operation, and a nurse in the middle of the night saw that this drain was in place and went to the doc and said, “They shouldn’t have left this open drain in place. It should be either taken out or it should be properly capped so an infection can’t go back up the drain.” And the doc said, “Well, that’s the problem over in the MASH unit. They should take care of that in the hospital. That’s not my problem.” And the nurse warned the doc about his Geneva obligations, and he said, “Well, you do what you’re going to do. I’m going to bed.”

AMY GOODMAN: So, this was Sergeant Theresa Adams, who was the nurse, and a Dr. Ackerson, that you write about, was the doctor. Is that right?

DR. STEVEN MILES: I don’t recall the name of the doc.

JUAN GONZALEZ: Let me ask you, within the medical profession, aside from the existing international conventions that exist around torture, you also delve into what are the particular ethical imperatives that have been adopted by various medical societies over the years, guiding doctors and nurses in their work.

DR. STEVEN MILES: Yeah, this has been an ongoing story. Right after World War II, people were horrified by the role of physicians and nurses in the treatment of POWs in Germany and Japan. And so, this standard of docs emerged right after that and evolved through the World Medical Association, culminating in the Declaration of Tokyo. And it’s progressively gotten more stringent, because of the fact that around 60% of torture victims report seeing a health professional involved in monitoring their interrogation, setting up how harsh the interrogation can be, and so forth. And these standards are well known.

Now, what’s so interesting about the Defense Department analysis and the Department of Justice analysis of how to proceed with the abuse of prisoners is they don’t make a single reference to any of this literature. In fact, they treat the medical personnel just like any other soldier, whereas medical personnel who are taking care of prisoners of war have a primary and exclusive obligation just to the health of the prisoners.

JUAN GONZALEZ: They’re, in essence, functioning almost like lawyer would be in representing a soldier who is — or a prisoner who is charged with a crime, that they have a particular direct responsibility to their patients.

DR. STEVEN MILES: Well, I think that’s right. The other thing is that the U.S. government, the British government, the Israeli government and presumably the East bloc countries, as well, have all done extensive research on course of interrogation, and it doesn’t work. It gets bad information. One military intelligence guy I was talking to in Iraq said that what we were doing was we were sending our soldiers out on these dangerous sorties because they were chasing wild-goose chases from information we obtained by torture.

And in the most egregious example, the bio-weapons collaboration between Saddam Hussein and al-Qaeda was information that came from a prisoner that we transported to Egypt and then tortured. He gave that information, and that became a key part of the rationale for the entire war on terror.

AMY GOODMAN: We’re talking to Dr. Steven Miles. We’ll come back to him after break.


AMY GOODMAN: We’re talking now, though, about torture. The book Oath Betrayed: Torture, Medical Complicity, and the War on Terror is written by Steven Miles, our guest. I wanted to ask you about the debate that’s going on now in the psychiatric and psychological community. Both the American Psychiatric Association and the American Medical Association have adopted policies discouraging their members from being involved in military interrogations. But their counterpart, the American Psychological Association, far larger than the American Psychiatric Association, has not adopted such a policy. Earlier this month, we had a discussion on Democracy Now! on the role of psychiatrists and psychologists in military interrogations. We talked to the President of the American Psychological Association, Dr. Gerald Koocher. This is an excerpt of what he had to say.

DR. GERALD KOOCHER: Obviously there are some people who don’t think that psychologists should assist in the military at all. That’s a political preference and a social statement, but there are many very beneficial things that psychologists have done in the military. One example is that the lead officer sent in to help clean up Guantanamo Bay was a psychologist, a U.S. Army colonel, who was sent in to help to clean up the abuses as soon as they were reported. There’s another APA member, a civilian employee at the Navy who was sent to Guantanamo and was one of the first people to file complaints with his superiors about things that he observes down there, and he reportedly brought about some changes.

I wish I had the assurance that Jane Mayer and that Dr. Reisner apparently have that there are APA members doing bad things at Guantanamo or elsewhere, because any time I have asked these journalists or other people who are making these assertions for names so that APA could investigate its members who might be allegedly involved in them, no names have ever been forthcoming.

AMY GOODMAN: Dr. Gerald Koocher, President of the American Psychological Association a few weeks ago on Democracy Now! The New York Times wrote a piece a few weeks ago saying that the military is turning away from psychiatrists, because of their policy that they should not be involved with interrogations, and is now relying on psychologists. You heard what Dr. Gerald Koocher had to say. There’s a growing movement within the American Psychological Association for psychologists to withhold dues from the American Psychological Association, to withdraw from the APA, and the question of whether there will be a resolution put forward that says “no involvement in interrogation.” What is your response to Koocher and that?

DR. STEVEN MILES: Well, I think that it’s interesting that Koocher talks about the psychologists who did resist the abuses and then says that the ones who participated have to be APA members, or something like that. But there actually is a well-known name, a psychologist by the name of Leso. And Leso participated in the interrogation of a guy called Qahtani. Qahtani was subjected to an incredibly brutal and extended interrogation, which included such stupid things as running three liters of saline into his body, and then when he needed to urinate, keeping him strapped to a table so he had to pee on himself. And then also he was chilled with an air conditioner to the point where his heart actually slowed down. He was hospitalized, and then he was brought out to be interrogated some more after he was re-warmed, and then he was chilled again, and his heart again slowed down.

In addition to that there was a whole set of degrading psychological techniques applied to him, and it appears that this Leso was directly involved in the oversight of that. The complete interrogation log is available on the Time website.

So, the problem — overall problem, though, is that American medicine was entirely caught off guard by the American military involvement in brutal treatment. This does represent a break in terms of our treatment of POWs compared to World War II, Korea, Vietnam and Gulf War I. And the AMA and the American Psychiatric Association have come out with very good standards, but the problem is they waited four years to do so.

The APA came out about a year after the Abu Ghraib pictures constituting a committee where the clean voting block, by about two-thirds voting block, was people with former military experience. And there was a group think within this process which essentially wound up creating an accommodation between psychologists and, of course, of interrogation. They said that the Geneva Conventions had to apply, but they allowed psychologists to conceal their identity, they allowed psychologists to work with interrogations so long as they were safe and legal in order to make them effective.

Well, this government’s definition of what’s a legal interrogation is infinitely elastic and so that this is not a profound barrier to psychologists, and it doesn’t surprise me that the military will shift over to working with psychologists. In fact, they screen the docs before they go down to Guantanamo to make sure they have no moral objections to force-feeding and then they take the docs who don’t have an objection to force-feeding, and those are the docs who get to go to Guantanamo.

AMY GOODMAN: Explain force-feeding.

DR. STEVEN MILES: Well, hunger-striking is a form of political protest by prisoners. It’s against medical ethics for prison physicians to force-feed prisoners, because what it’s felt that it does is that by keeping a prisoner alive, it basically extends the abuse of the prisoner, okay? And that’s exactly what’s happening in Guantanamo. These prisoners have no rights, they have no correspondence, anything like that, and so by feeding them, all that’s being done is their indeterminate sentences, their lack of correspondence, and the other types of interrogational abuse are being extended. And so the military is tying them into six-point chairs — legs, thorax, abdomen and arms — and then sticking a tube down them, running a bunch of food in, pulling the tube out, and because docs object to this professionally, they’re selecting a subset of docs to take down to Guantanamo to do this procedure.

JUAN GONZALEZ: I’d like to get back to your comment where you said that you thought that what was happening in the war on terror was a break with past practices of the U.S. military. How big is that break, really, because obviously there have been instances where client states with which — or allies of the United States were participating in terror, and there are questions clearly about how the U.S. military acted in Vietnam with the Phoenix Program and other programs where there were documented cases of torture, of captured Viet Cong?

DR. STEVEN MILES: Yeah, I think it’s important to recognize I’m talking here about the military medical system and its treatment of POWs. The subset of issues of the U.S. support for client states that engage in torture has happened commonly throughout South America, for example, is one thing. The Phoenix Program was actually operated in coordination with the government of South Vietnam, in which we supplied lists of people to be captured, interrogated and killed by the South Vietnamese. But with regard to the actual operation, the medical treatment of POWs, we really, I think, have set the standard up until now.

JUAN GONZALEZ: And in your book, you often refer to what happened during World War II and Nazi Germany. And many Americans who are not that familiar with our practices there would say that you’re stretching the analogy to begin to compare what we’re doing here as a country that is involved in torture with what happened in Nazi Germany.

DR. STEVEN MILES: Well, I think that’s a fair criticism, and the only point that I make about World War II is that’s where the standards came from. And I think there’s a big difference between what’s going on in Iraq and Afghanistan and Guantanamo with Nazi medicine, because in Nazi medicine what the docs did was they created this theory of race hygiene and eugenics which justified this wholesale genocide policy.

Similarly in the Soviet Union they developed this — the physicians developed this concept of sluggish schizophrenia, which resulted in the imprisonment for treatment of dissidents. What this looks like is much more like the experience in South American prisons, where the physicians come in and essentially certify that you’re going to be able to take this kind of abuse and then going ahead and monitoring it. And then, in the case of several of the South American countries, there were physicians who wrote false death certificates, some of which were actually disbarred after the reign of terror in various countries and at least one of whom was assassinated after the reign of terror.

AMY GOODMAN: The Los Angeles Times says, “The real blockbuster in the Hamdan decision is the court’s holding that Common Article 3 of the Geneva Convention applies to the conflict with al-Qaeda, a holding that makes high-ranking Bush administration officials potentially subject to prosecution under the Federal War Crimes Act.” You talked about this holding the highest-level officials accountable.

DR. STEVEN MILES: Right. The U.S. War Crimes Act is a fascinating law. It’s very short. Go look it up on the web, anybody who’s listening. What it says is this: not only have we endorsed Geneva as a treaty, okay, but in addition, we made it a federal crime for a U.S. government employee to violate Geneva. And so, it’s not just a violation of international law, it’s a violation of federal law.

Now what the Bush administration has been arguing is that the President’s discretionary war-making powers allow him to set aside any law, besides our treaty obligations, which is an incredibly dangerous thing. And what this does is set the stage for domestic prosecution of U.S. officials for violating the War Crimes Act, but also in a really interesting case that was brought by the Center for Constitutional Rights against Rumsfeld in Germany, the German prosecutor declined to subpoena or indict Secretary of Defense Rumsfeld because it had not yet been shown that the U.S. courts would fail to do so. With this Supreme Court ruling, I think that the ground is cleared for asking whether or not the U.S. judicial system will rise to its responsibility and enforce the Geneva Accords.

JUAN GONZALEZ: You talk in your book that as you were reading these 35,000 pages of documents on the various mistreatment and torture of prisoners, that you yourself became transformed as you delved into these stories. Can talk about that a little?

DR. STEVEN MILES: Yeah, when I first saw these pictures from Abu Ghraib, the question was, “Well, where were the docs?” because docs and nurses are frontline human rights monitors. They’re there when the Red Cross isn’t. They can get into any part of the prison, and furthermore, even if they don’t see the abuse, they see the signs of the abuse, and we are trained to find abuse when it’s crafted to be indiscernible, okay, as a lot of abuse is.

And so I’m reading along, I’m just trying to understand why there was a failure of reporting, and all of sudden what I’m seeing is that the medical system is entirely integrated into the abuse, that there was a structure, there was an actual policy mechanism that can be seen for the delayed release of torture-related homicides, that there was an entire structure for culling patients medical records for information on their vulnerabilities, incorporating that into harsh, incursive interrogation plans, monitoring those plans, designing those plans with psychological insights to exploit the particular characteristics of Islamic men, and then monitoring the disintegration of these men, and feeding that back into the torture plans. It’s an amazing story. It was very discouraging to read. But in every country that’s fought torture, and Chile’s a good example, the docs have played a key role in stopping it.

AMY GOODMAN: Dr. Steven Miles, I want to thank you very much for being with us. His book is Oath Betrayed; Torture, Medical Complicity, and the War on Terror.

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