Adapted from Appendix I, Oath Betrayed:  America’s Torture Doctors by Stephen H. Miles with permission of the author. For individual or classroom use only. Do not duplicate or share.

Mohammed al-Qahtani was Guantanamo 063. A Saudi citizen, he allegedly was assigned by Al-Qaeda to join one of the hijacking crews for the 9/11 attacks in the United States. He was arrested in Afghanistan in December 2001 and promptly sent to Guantanamo for extended interrogation. In 2008, charges against him were dropped “without prejudice,” meaning that they could be reinstated later. It is widely believed that public reports of the abusive nature of this interrogation meant that he could not be tried. The prisoner claims that any admissions he made were only done to stop the mistreatment.

Four documents describe the interrogation. The first is an untitled 83-page log covering a period from November 23, 2002 to January 11, 2003.¹ The log was released by TIME magazine; the Defense Department admits its authenticity.^{2 3} Its author is anonymous: “ORCON” [ORiginator CONtrolled]. The other documents are from an Army investigation initiated by FBI complaints about the interrogation.^{4 5 6}

This case discussion guide has two parts.

• Part I shows how the medical staff monitored this interrogation and how they responded to medical complications arising from the abuse.
• Part II shows how the psychologists managed this interrogation and responded to the abuses.

Each part contains numbered paragraphs of information. The data is followed by questions to start the discussion. At the end of this Appendix, Tables 4 and 5 contain excerpts from international law and ethics codes to inform the discussion.

Part I: Physicians, Nurses, and Medics

1. The log covers a period in the middle of al-Qahtani’s interrogation that began earlier in 2002 and continued into at least 2003. For eleven days, beginning November 23, al-Qahtani was interrogated for twenty hours each day by interrogators working in shifts. He was kept awake with music, yelling, loud white noise or brief opportunities to stand.
2. The first “recuperation” from this regimen was entirely occupied by an emergency hospitalization. His heart rate slowed to thirty-five beats per minute. While hospitalized, body chemistries were corrected. An ultrasound was done to search for clots in his legs as a possible cause of edema; it was negative. The prisoner slept through most of the 42-hour hospitalization after which he was hooded, shackled, put on a litter, and taken by ambulance to an interrogation room for more interrogation.
3. Between the return to interrogation on December 8 and the end of the log January 11, Al-Qahtani was allowed one six-hour and one twelve-hour sleep. Otherwise, the exhausted and increasingly non-communicative prisoner was allowed naps of one to four hours as he was interrogated. The log ends with a discharge for another “sleep period.”
4. Clinicians regularly visited the interrogation cell to assess and treat the prisoner. Medics and a female “medical representative” checked vital signs several times per day; drew blood, and suggested enemas for constipation or intravenous fluids for dehydration. The prisoner’s hands and feet became swollen as he was restrained in a chair. These were inspected and wrapped by medics and a physician. One entry describes a physician checking “for abrasions from sitting in the metal chair for long periods of time. The doctor said everything was good.” Guards, medics and a physician offered palliative medications such as aspirin to treat his swollen feet.
5. Intravenous fluids were regular given over the prisoner’s objection. For example, on November 24, the prisoner refused water; a Captain-interrogator advised him that the medic “can administer IV [sic: the log’s contraction for intravenous fluids of an unspecified volume is used throughout this article] fluids once the Captain and the Doctor on duty are notified and agree to it.” Nine hours later, after taking vital signs, medical personnel administered “two bags” of intravenous fluids. Later that day, a physician evaluated al-Qahtani in the interrogation room and told him that he could not refuse medications or intravenous fluids and that he would not be allowed to die.
6. The next day, interrogators told the prisoner that he would not be allowed to pray if he would not drink water. Neither a medic nor a physician could insert a standard catheter into the vein, so a physician inserted a “temporary shunt” to allow an intravenous infusion. The restrained prisoner asked to go the bathroom and was given a urinal instead. Thirty minutes later, he was given “three and one-half bags of IV” and he urinated twice in his pants. The next day, the physician came to the interrogation room and checked the restrained prisoner’s swollen extremities and the shunt.
7. From December 12 to 14, al-Qahtani’s weight went from 119 to 130 pounds (54 to 59 kilograms) after being given six IVs. On December 14, al-Qahtani’s pulse was 42 beats per minute. A physician was consulted by phone and said that “operations” could continue since there had been no significant change. (Investigators noted a second episode of slow pulse in February 2003 after the period covered by interrogation log.)Al-Qahtani received three more IVs on the December 15 and complained of costophrenic pain. A physician came to the interrogation cell, examined him, made a presumptive diagnosis of kidney stones and instructed the prisoner to take fluids. The next day blood was drawn in the cell.
8. The Army investigation focused on whether the techniques were authorized by Defense Department policy. They found that the prolonged sleep deprivation was authorized. Cooling with an air conditioner was authorized “environmental manipulation.” Notwithstanding bradycardia requiring hospitalization, the investigators asserted, “There are no medical entries indicating the subject . . . ever experienced medical problems related to low body temperature.” The Defense Department did not allow an Admiral’s investigation to review those hospital records.⁸ Army investigators found no evidence that al-Qahtani was physically assaulted and pointed out that medical records did not find “medical conditions of note.”

Discussion Questions: (See Table 1 and 2 for References)

1. In your view, is any part of the medical aspects of this interrogation “Torture” and “Cruel, Inhuman or Degrading Treatment or Punishment?”
2. Who was responsible for Al-Qhatani’s physical health?
3. Is there a difference between the responsibilities of the medical personnel who came to the interrogation room to take vital signs or treat edema compared to those who treated Al-Qahtani during his hospitalization?
4. Discuss the actions of the medical personnel in relation to medical ethics codes.
5. Discuss the ways that diagnoses and patient assessments were made, for example in paragraph 7.
6. Discuss the ways that treatments including intravenous fluids, were provided and monitored.
7. Are medical ethics codes unreasonable for prisoners of war?
8. Should any of the clinicians who saw or knew of this interrogation have reported it? If the military command did not act on the complaint, should information have been passed to a group like the International Committee of the Red Cross or Amnesty International?
9. Should any of the physicians or nurses or medics who assisted or knew of this interrogation be investigated for possible licensing or professional censure or criminal prosecution?

Part II: Psychologists

1. In October 2002, before the events covered by the log, a Behavioral Science Consultation Team (BSCT) psychologist oversaw the use of Zeus, a military working dog, who was brought to the interrogation room to growl, bark, and bares his teeth at al-Qahtani. FBI agents objected to the use of dogs and withdrew. Army investigators concluded that the dog was properly authorized as a technique to “exploit individual phobias.”
2. The psychologist, who chaired the BSCT at Guantanamo, was logged as present at the start of the interrogation on November 23. On November 27, he suggested putting the prisoner in a swivel chair to prevent him from fixing his eyes on one spot and thereby avoiding looking at the interrogators. On December 11, al-Qahtani asked to be allowed to sleep in a room other than the one in which he was being fed and interrogated. The log notes that “BSCT” advised the interrogators that the prisoner was simply trying to gain control and sympathy.
3. The interrogation plan repeatedly used the prisoner’s religion. He was subjected to techniques called “Good Muslim,” “Bad Muslim,” “Judgment Day,” “God’s Mission” and “Muslim in America.” He was called “unclean” and “Mo” [for Mohammed]. He was lectured on the true meaning of the Koran, instruction which especially enraged him when done by female soldiers. He was not reliably told, despite asking, when the interrogation was coinciding with Ramadan, a time when Moslems have special obligations. He was not reliably allowed to honor prayer times. The Koran was intentionally and disrespectfully placed on a television (deemed to be an authorized control measure) and a guard “unintentionally” squatted over it while harshly addressing the prisoner. Army investigators concluded that there was “no evidence that [al-Qahtani] … was subjected to humiliation intentionally directed at his religion.”
4. Transgressions against Islamic and Arab mores for sexual modesty were employed. The prisoner was forced to wear photographs of “sexy females” and to study sets of such photographs to identify whether various pictures of bikini-clad women were of the same or a different person. He was told that his mother and sister were whores. He was forced to wear a bra; a woman’s thong was put on his head. He was dressed as a woman and compelled to dance with a male interrogator. He was told that he had homosexual tendencies and that other prisoners knew this. Although continuously monitored, interrogators repeatedly strip searched him as a “control measure.” On at least one occasion, he was forced to stand naked with women personnel present. Female interrogators seductively touched the prisoner under the authorized use of approaches called “Invasion of Personal Space” and “Futility.” On one occasion, a female interrogator straddled the prisoner as he was held down on the floor.
5. Other degrading techniques were logged. His head and beard were shaved to show the dominance of the interrogators. He was made to stand for the United States anthem. His situation was compared unfavorably to that of banana rats in the camp. He was leashed (a detail omitted in the log but recorded by investigators) and made to “stay, come, and bark to elevate his social status up to a dog.” He was told to bark like a happy dog at photographs of 9/11 victims and growl at pictures of terrorists. He was shown pictures of the attacks; photographs of victims were affixed to his body. The interrogators held an exorcism (and threatened another) to purge evil Jinns that the disoriented, sleep-deprived prisoner claimed were controlling his emotions. The interrogators quizzed him on passages from a book entitled, “What Makes a Terrorist and Why?,” that asserted that people joined terrorist groups for a sense of belonging and that terrorists must dehumanize their victims as a way to avoid feeling guilty at their crimes.
6. Al-Qahtani professes to be a broken man who gave false information under pressure.

Discussion Questions: (See Table 1 and Table 2 for References.)

1. Army investigators concluded that the cumulative effect of this “creative, aggressive, and persistent” interrogation was “degrading and abusive” but did not constitute “torture” or “inhumane” treatment but did not define distinctions between these words. In your view, are any of the psychological techniques used in this interrogation “Torture” and “Cruel, Inhuman and Degrading Treatment or Punishment?”
2. Who was responsible for al-Qhatani’s mental health?
3. Discuss the ethics of the actions of the BSCT personnel, who were psychologists.
4. Are medical and psychological ethics codes unreasonable for prisons in time of war?
5. Should any of the psychologists who saw or knew of this interrogation have reported it? If the military command did not act on the complaint, should information have been passed to a group like the International Committee of the Red Cross or Amnesty International?
6. Should any of the psychologists who assisted or were silent about this interrogation be investigated for possible licensing or professional censure or criminal prosecution?
7. Michael Gelles, PsyD, Chief of the Navy Criminal Investigative Service learned of the Al Qahtani interrogation. As a psychologist and seasoned interrogator, he was shocked. He sent a complaint which was supported by his superiors and went to the White House. White House legal counsel eventually dismissed the complaint and ratified coercive interrogations.⁹ Should Dr. Gelles have considered passing information he had to non-governmental organizations like the International Committee of the Red Cross? Should government policy provide whistle blower protection if he had?
8. Despite his objections to the Al-Qahtani interrogation, Dr. Gelles supports the engagement of psychologists in interrogations. He writes,

   Having worked with law enforcement, the intelligence community and correctional officers, I am very familiar with the structure and function of detention facilities. I am too aware of how easily aggression can get out of hand, and how the well intentioned can become carried away with emotion and perverse purpose and drift across boundaries, all of which may result in aggressive, violent and humiliating acts to detainees. We know that well trained professionals, clear guidelines, established procedures and scrupulous oversight serve to keep in check aggression and the tendency to over identify with a role and a method. Removing trained professional psychologists from these settings will impact the degree of oversight and inevitably increase the likelihood of abuse, thus having precisely the opposite effect of what occurred as a result of my involvement at Guantanamo Bay.¹⁰

   Do you agree with Dr. Gelles? How would you define proper and improper roles for behavioral scientists in interrogation?

Table 1. Excerpts from International Law

• Definition of “Torture:” any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.
  —United Nations Convention Against Torture
• Definition of “Cruel, Inhuman or Degrading Treatment or Punishment:” should be interpreted so as to extend the widest possible protection against abuses, whether physical or mental, including the holding of a detained or imprisoned person in conditions which deprive him, temporarily or permanently of the use of any of his natural senses, such as sight or hearing, or of his awareness of place and the passing of time.
  —United Nations’ Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment

Table 2: Excerpts from Medical Ethics Codes

United Nations. Principles of Medical Ethics Relevant to the Protection of Prisoners Against Torture.

It is a gross contravention of medical ethics, … for health personnel, particularly physicians, to

1. engage, actively or passively, in acts which constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment, …
2. be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health, …
3. (a) apply their knowledge and skills in order to assist in the interrogation of prisoners … in a manner that may adversely affect the physical or mental health or condition of such prisoners … ; (b) certify, or to participate in the certification of, the fitness of prisoners … for any form of treatment or punishment that may adversely affect their physical or mental health … or to participate in any way in the infliction of any such treatment or punishment …,
4. participate in any procedure for restraining a prisoner … unless such a procedure is determined in accordance with purely medical criteria as being necessary for the protection of the physical or mental health or the safety of the prisoner or detainee himself … and presents no hazard to his physical or mental health.

World Medical Association

The doctor's fundamental role is to alleviate the distress of his or her fellow men, and no motive whether personal, collective or political shall prevail against this higher purpose.

For the purpose of this Declaration, torture is defined as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason.

The doctor shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedure is suspected, accused or guilty, and whatever the victim's belief or motives, and in all situations, including armed conflict and civil strife.

The doctor shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment. The doctor shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment are used or threatened.

The American Medical Association

Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physicians’ role as healer and thereby erodes trust in both the individual physician-interrogator and in the medical profession. Physicians should not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation. Physicians may participate in developing effective interrogation strategies that are not coercive but are humane and respect the rights of individuals. When physicians have reason to believe that interrogations are coercive, they must report their observations to the appropriate authorities. If authorities are aware of coercive interrogations but have not intervened, physicians are ethically obligated to report the offenses to independent authorities that have the power to investigate or adjudicate such allegations.

American Psychiatric Association

No psychiatrist should participate directly in the interrogation of persons held in custody …. Direct participation includes being present in the interrogation room, asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees. However, psychiatrists may provide training to military or civilian investigative or law enforcement personnel on recognizing and responding to persons with mental illnesses, on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise.

Royal College of Psychiatrists

a. “It is a gross contravention of medical ethics, as well as an offence under applicable international instruments and UK law for health personnel, particularly registered medical practitioners, to engage, actively or passively, in acts which constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment.”

b. “Health personnel are only to be involved in professional relationships with prisoners or detainees for the purposes of evaluating, protecting or improving their physical and mental health.”

c. “Health personnel are not to: (i.) Apply their knowledge and skills in order to assist in the interrogation of prisoners and detainees in a manner that may adversely affect their physical or mental health; this includes certifying or stating that a detainee meets a specific mental or physical standard for interrogation. (ii.) Certify, or to participate in the certification of, the fitness of prisoners or detainees for any form of treatment or punishment that may adversely affect their physical or mental health, or to participate in any way in the infliction of any such treatment or punishment. (iii.) Question detainees about matters unless they are relevant to their medical care.”

1. ORCON [Authoring agency classified by Originator Control]. Interrogation Log Detainee 063. http://www1.umn.edu/humanrts/OathBetrayed/inter-log-det-063.pdf (Accessed July 7, 2008).
2. Zagorin A, Duffy M. Inside the interrogation of detainee 063. Time Jun. 20, 2005, 26-33.
3. Department of Defense. Guantanamo provides valuable intelligence information. News Release 592-05, June 12, 2005. http://www.defenselink.mil/releases/2005/nr20050612-3661.html Accessed July 8, 2009.
4. United States Army. Final Report Investigation into FBI Allegations of Detainee Abuse at Guantanamo Bay, Cuba Detention Facility [Section entitled “First Special Interrogation Plan,” pp 13-21], Jun 5, 2005. http://www1.umn.edu/humanrts/OathBetrayed/d20050714report.pdf (Accessed July 8, 2008).
5. AR 15-6 Report, GTMO Investigation, FBI Allegations of Abuse (assorted documents of various dates). http://www1.umn.edu/humanrts/OathBetrayed/Schmidt-Furlow%20Report%20Enclosures%20I.pdf (Accessed July 8, 2008).
6. AR 15-6 Report, GTMO Investigation, FBI Allegations of Abuse (assorted interviews of various dates). http://www1.umn.edu/humanrts/OathBetrayed/Schmidt-Furlow%20Report%20Enclosures%20II.pdf (Accessed July 8, 2008).
7. Bashour TT, Gualberto A, Ryan C. Atrioventricular block in accidental hypothermia--a case report. Angiology 1989;40:63-6.
8. Church A. Untitled Report for Secretary of Defense. March 2005. http://www.aclu.org/pdfs/safefree/church_353365_20080430.pdf
9. Mayer J. The Dark Side. Doubleday Press, New York, 2008.
10. Letter from Michael Gelles. Posted on Psyche, Science and Society. Accessed July 8, 2008. http://psychoanalystsopposewar.org/blog/2007/03/21/whistle-blower-michael-gelles-throws-in-lot-with-pro-abuse-american-psychological-association/