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Do CIA Cables Show Doctors Monitoring Torture?

Sheri Fink

A version of this story was published on [1]Salon [1].

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 [2] and here [3])
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

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 [4]
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 [5], the Washington Independent's Spencer Ackerman [6] and Firedoglake's Marcy

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 [8], testified that a psychiatrist and another doctor monitored interrogations [9] 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 [10],
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

"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

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."



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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 [11],
quoting still-classified OMS guidelines from December 2004, said that
the "use of the waterboard requires the presence of a physician." Another memo [12]
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 [13] 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

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 [14].

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 [15]
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 [16], that prohibits health professionals from participating in torture or the improper treatment of prisoners at home or abroad.

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