First, Do Harm

Cross posted from The American Prospect

Dr. Steven H. Miles is the author of Oath Betrayed: Torture, Medical Complicity and the War on Terror (Random House 2006). Miles, an expert in medical ethics, human rights, and international health care, is professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics. His book explores the role of military physicians in aiding and abetting abuse and torture at U.S. detention facilities in Iraq, Afghanistan, and Guantamano.

Why focus on the role of doctors in torture and abuse?

I’ve done a lot of international relief work with international NGOs [non-governmental organizations], where I’ve been up to my eyeballs in human rights abuses. When the pictures from Abu Ghraib came out, it was clear that this was more than a matter of a few bad apples. You don’t have torture of this kind without a command that authorizes it. The question then was why the doctors hadn’t blown the whistle. I wrote an article for the medical journal Lancet in August 2004 based on the Taguba report and on congressional hearings, about how physicians were involved in designing abusive interrogation procedures and in falsifying death certificates to hide abuses. The Department of Defense reacted by criticizing the tone of that article but did not contradict any of the factual claims.

Then, six days before the 2004 election, the government dropped 6,000 documents in response to the ACLU’s Freedom of Information Act request. This was too much to analyze before the election. Another 15,000 pages came in January 2006, and another 15,000 in the next four months. This material gave me my story.

What did you find based in these documents?

The government’s policy was to do coercive interrogations. Donald Rumsfeld set up a “rump” interrogation system within the Army, which came up with new a new, non-doctrinal set of policies for the Joint Interrogation and Detention Centers, or JDICs, in all three theaters. There was an administratively similar system for all three theaters—Iraq, Afghanistan, and Guantanamo Bay. General Geoffrey Miller, who first set up the Guantanamo interrogation center, went to Iraq and Abu Ghraib to “Gitmoize” the interrogation systems there. Miller gave his policies to General Sanchez, who was the commander in Iraq, who spread them to the whole of Iraq. Captain Carolyn Wood, who had run the interrogation program in Bagram, in Afghanistan, brought policies from there.

What were doctors doing?

Physicians failed to record injuries. They failed to get accounts of the origins of injuries. They failed to look for other related injuries. For example, one kid was seen by U.S. medics after his jaw was broken at the prison; the physician diagnosed a broken jaw, but he didn’t make any inquiry as to how it happened and did not even take off the boy’s shirt to look for other signs of trauma. This kind of behavior is a violation of standard medical practices.

Clinical records are a form of contemporaneous evidence of the injury, the treatment, and the patient’s account of how the injury occurred. Bruises are transient; assault victims may be afraid to testify. Clinical records are often the best immediate evidence. If there aren’t kept, entire investigations can be compromised. When this kind of lack of medical documentation makes criminal investigations impossible, it is possible to speak of physicians being accessories after the fact to the crime.

A similar pattern occurred in the delayed release of death certificates and autopsy reports. This allowed Defense Department officials to not inform the public of deaths by torture or to claim that prisoners who died of homicide by torture died of natural causes. Physicians who knew otherwise remained silent. These were violations of Geneva Convention requirements for reporting death. The knowledge of these homicides could have been an early warning that something was seriously wrong in the prisons, but it was disabled.

Isn’t this just “what happens” in wartime?

This is exactly what the Geneva Conventions are meant to prevent. The Geneva Conventions apply to those who are no longer fighting, to those who are “hors de combat.” They are not about battlefield ethics. They are about prisoners who have been disarmed. Geneva is a set of standards for preventing armies from making war on captives. In medical terms, this means providing minimal medical care, preventing epidemics in camps, and not torturing.

Was there pushback within the administration?

There’s a set of correspondence from the FBI that shows that the Bureau went crazy when they saw what was being done at Guantanamo. It tried to teach the Army what the Bureau had learned from doing behavioral analysis—there was a meeting held at a hotel in the South of the United States. The FBI knew from doing behavioral science research that to get accurate information from someone, you have to establish a rapport; you have to cross cultural barriers; you have to develop negotiation strategies. It’s not different in kind from plea bargaining. The Army rejected all of this—and the bottom line is that the FBI lost.

What do you make of arguments in justification of torture?

There was “salon talk” across the United States, by people like Alan Dershowitz and Charles Krauthammer, that you have to torture in order to stop “ticking time bombs.” And the Schlesinger report [one of the official investigations into abuse] even includes an example of a “ticking time bomb” that was allegedly successfully defused by using coercive interrogation. But when you look at the Taguba report and other sources, you find that this wasn’t true. Schlesinger cut and polished the story to show how the ticking time bomb worked in practice. But the larger narrative, which came from other government sources, showed that no useful information was in fact gained from this abuse. And the Lieutenant Colonel involved was not punished, over the protest of other field commanders. Because he was not punished, this gave a green light to abuse across the field. The message got sent clearly to the Military Police unit that went on to Abu Ghraib.

Is there any justification for torture?

No. There’s a huge literature that shows that coercive interrogation methods don’t work. It comes from the KUBARK and MBARK CIA research projects. The British and the Israelis have the same experiences. Torture procures bad intelligence, alienates informants, and enrages populations. There was a decline in public support for the U.S. among Iraqis when the Abu Ghraib pictures came out. It also endangers soldiers who are sent out on wild goose chases into hostile territory. The United States cannot use the Geneva Conventions to appeal on behalf of our own POWs or on behalf of endangered friends of democracy.

The U.S. has taken the international community into a post-Geneva Convention world. We have established the principle that the national executive with the acquiescence of the legislature can unilaterally revoke international law and standards for prisoners. This notion of unlimited sovereignty has been used already elsewhere to justify torture, genocide, and other crimes against humanity. This new post-Geneva world is extremely dangerous. We have entered it without a plan for rebuilding a framework for international law.

Aziz Huq: “First, Do Harm” (PDF)