Tortured Guantánamo Prisoner Mohammed Al-Qahtani Was Profoundly Mentally Ill Before His Capture

By Andy Worthington, June 21, 2016

Last week, a Periodic Review Board at Guantánamo raised a number of uncomfortable questions for the U.S. authorities: what do you do with a prisoner allegedly involved with Al-Qaeda, but who you have tortured? And what do you do if it then transpires that, before you captured and tortured this man, he already had a history of severe mental health problems?

The prisoner in question is Mohammed al-Qahtani, the 47th prisoner to face a PRB, since they were set up in 2013 to review the cases of all the prisoners not already approved for release or facing trials. Tortured for 50 days straight at the end of 2002, he was "subjected to constant interrogations marked by extreme sleep deprivation, low temperatures, stress positions and forced nudity as well as being threatened with a military dog," and "had to be hospitalized twice with a dangerously low heart rate," as the Washington Post described it last week.

It was also in the Washington Post, in January 2009, that, for the first, and, to date, only time, a senior Pentagon official, Susan Crawford, the convenor of Guantánamo’s military commissions, admitted that a prisoner in U.S. custody had been tortured. "We tortured Qahtani. His treatment met the legal definition of torture," Crawford said, adding that that was why she didn’t refer his case for prosecution, even though he had been charged in February 2008 with five other men who are still facing prosecution for the 9/11 attacks.

If al-Qahtani was not to be prosecuted, then it is legitimate to ask on what basis he continued to be held — something that the PRB is belatedly getting round to asking. However, complicating matters further for the U.S. authorities, his lawyers succeeded in getting an independent psychiatrist, Dr. Emily Keram, to be allowed to visit Guantánamo recently to assess al-Qahtani, and what she found — evidence of severe mental health problems predating his capture, and that can only have been exacerbated by his torture in U.S. hands — would seem to suggest that, if he is not to be prosecuted — if, indeed, he is mentally unfit to stand trial — then he should not continue to be held under the laws of war that the U.S. draws on to justify holding prisoners without charge or trial at Guantánamo, and should be returned to his home country.

As the Washington Post described it before al-Qahtani’s PRB, "Saudi Arabia has agreed to resettle him, according to a Saudi Interior Ministry document," and his lawyers were intending to argue that his "preexisting mental illness and the abuse he experienced at Guantánamo Bay should favor his release, as the prison is unable to provide adequate medical and psychiatric care."

In its coverage of al-Qahtani’s PRB, the Post began with two startling examples of the mental health problems that plagued him before he ever encountered members of Al-Qaeda. Their article began: "Long before Mohammed al-Qahtani was suspected of planning to participate in the attacks of Sept. 11, 2001, as the 20th hijacker, Saudi police found him naked in a garbage dumpster in Riyadh." It continued: "In another psychotic episode that took place in Mecca in 2000, Qahtani was involuntarily committed to a hospital after trying to hurl himself into the street. Doctors at the time said he was delusional and suicidal, according to medical and psychiatric records."

As Ramzi Kassem, a law professor at the City University of New York, whose legal clinic represents al-Qahtani along with Shayana Kadidal at the Center for Constitutional Rights, explained, "Mohammed was already mentally ill long before the time when he was alleged to have attempted anything. That fact calls into serious question the fairness of holding him responsible for any actions during that period of his life."

In her analysis, Emily Keram, who spent 39 hours with al-Qahtani and an interpreter in May, described how he "has schizophrenia, major depression and persistent skin lesions," and "will likely require lifelong mental health care." In her evaluation, presented to the PRB and obtained by the Post, she concluded that he "cannot receive effective treatment for his current mental health conditions while he remains in U.S. custody." She explained that he had told her that "he had suffered a head injury after being ejected from a car when he was 8 and was injured twice more in car accidents," and, in her evaluation, she concluded that he "developed psychotic symptoms in childhood that worsened as he grew older." In Mecca, for example, "he was admitted to the psychiatric unit of the King Adbul Aziz Hospital and treated with antipsychotic medication and a sedative." He also "told doctors that he wanted to kill himself," and was assessed as being "delusional."

Dr. Keram concluded that his "psychological and cognitive deficits" made him "vulnerable to ma­nipu­la­tion and coercion," which, of course, is exactly what happened when he traveled to Afghanistan in 2000, where, according to the U.S. military, "he received training at an al-Qaeda camp before meeting and swearing loyalty to Osama bin Laden," who then "singled him out to participate in the 9/11 attacks."

Dr. Keram also explained how, during the time of al-Qahtani’s torture at Guantánamo, he "thought he was dead and believed that he saw ghosts," but "an imaginary bird reassured him he was still alive," as the Post put it. Dr. Keram noted, "My interview of him was extremely disruptive to his sense of identity and induced deep feelings of anxiety and shame. He often wept. Over the days of our interview he reported experiencing increase in the intensity of frequency of PTSD symptoms."

He also told Dr. Keram that, in the Post’s words, "he had two options when he was being tortured: compliance or suicide. Because he couldn’t kill himself, he told his interrogators what they wanted to hear." As a result, Dr. Keram pointed out that "those statements were neither reliable nor credible."

The Post also noted that, in 2008, al-Qahtani had told an administrative review board that he was a "different person now than he was in the summer of 2001," and "stated he would not have participated in a mission that involved killing women and children." That same year, however, military officials wrote that he was in good health and, "although publicly released records allege [he] was subject to harsh interrogation techniques in the early stages of detention, [his] admission of involvement in UBL’s [bin Laden's] special mission to the U.S. appear to be true and are corroborated in reporting from other sources."

The U.S. case against Mohammed al-Qahtani

In its unclassified summary for al-Qahtani’s PRB, the U.S. authorities ran through his story with only a few doubts newly interjected (and italicized below). On August 4, 2001, they wrote, he "attempted to enter the United States … after almost certainly having been selected by senior al-Qa'ida members to be the 20th hijacker for the 9/11 attacks." The authorities added that he "probably understood that he was intended to be used as part of a suicide operation, but he was probably unaware of the specifics of the attack." However, he was denied entry "by Immigration and Naturalization Service officers who found the circumstances of his travel and his conduct to be suspicious."

Previously, around September 2000, according to the summary, he had traveled to Afghanistan for the first time, meeting and swearing allegiance to bin Laden, "who told [him] he would be assigned a special mission," and who directed him to meet with Khalid Sheikh Mohammad, who, it is alleged, "trained [him] on operational communications and told him to return to Saudi Arabia to obtain a new passport and visas for the U.S. and U.K." He then traveled to the UAE and "met with al-Qa'ida financial and travel facilitator Mustafa al-Hawsawi, who also facilitated the travel of four 9/11 hijackers into the U.S." Al-Hawsawi allegedly "provided [him] with money and a one-way ticket to Orlando, Florida," where he was supposed to meet Mohamed Atta, "the tactical leader and hijacker-pilot of 9/11," who "was almost certainly waiting at the Orlando International Airport for [his] arrival." However, he "failed to clear immigration and was deported back to the UAE."

He then returned to Pakistan and Afghanistan, "separately informing Mohammad and Bin Ladin [sic] about his failure to enter the U.S.," before traveling to Kabul "to fight on the frontlines against the Northern Alliance." After the U.S.-led invasion, he reportedly "fled to the mountains of Tora Bora and briefly rejoined Bin Ladin and his bodyguards before [his] capture."

In Guantánamo, it was noted, he "has been mostly compliant with the guard staff," although "he has not cooperated with his interrogators, repeatedly trying to disassociate himself from al-Qa'ida and using cover stories to account for his travels." Those compiling the summary explained that "[h]is repeated denials of terrorism involvement limit our insight into his motivation for joining al-Qa'ida or his current mindset," adding, "He is not known to have made any statements in the past 10 years renouncing the group or its ideology" — something he would need to do to stand any chance of persuading the review board to recommend his release (but see below for his lawyers' assertions that this is indeed what he has done).

The summary also noted that al-Qahtani "has consistently said he wishes to be repatriated to Saudi Arabia to be reunited with his parents and siblings," adding that his family has been supportive throughout his detention, "judging from their frequent correspondence and efforts to secure his release." It was also noted that, helpfully, "None of his family members are known to have been involved in terrorism, although they probably are in contact with other former Guantánamo Bay detainees."

The case made by al-Qahtani’s lawyers and his personal representative

Below, I’m making available the opening statement made by al-Qahtani’s personal representative (a military official appointed to help prisoners prepare for their PRBs), and a detailed statement prepared by his lawyers, Ramzi Kassem and Shayana Kadidal. The representative was "favorably impressed by Mohamed's cantor," and noted that he had "proven forthright and honest," and the lawyers provided a detailed analysis of the significance of Dr. Keram’s findings. In particular, I note how Dr. Keram explained that a key factor "precluding effective treatment of Mr. al-Qahtani's mental illnesses" at Guantánamo "is his lack of trust in medical and mental health personnel" at the prison, "owing to their predecessors' involvement in his interrogations and torture." Dr. Keram also found that, "given the unique role of family in Mr. al-Qahtani's previous episodes of psychiatric illness, it is imperative that his family members actively participate in his treatment."

As the lawyers also explain — crucially, for a parole-type hearing — al-Qahtani "bears no ill will towards the United States or any other country or government," as can, in part, be seen by "his record of compliance as a prisoner at Guantánamo and in his good relations with the guard force." The lawyers added, "In numerous conversations with us over the years, Mr. al-Qahtani has also made it abundantly clear that he does not support al-Qaida's ideology or its methods, and that he abhors wanton acts of violence against civilians, irrespective of their nationality or religion."

Whilst also acknowledging that they "have no reason to believe that the U.S. government knew of Mr. al-Qahtani's debilitating mental illnesses at the time it took him into its custody, or that it deliberately exploited those ailments in its interrogations of Mr. al-Qahtani," the lawyers also note that it remains true that "our government apprehended a severely mentally disabled man, brought him to Guantánamo, and intentionally and systematically tortured him there," and they urge the board to transfer him for secure treatment in Saudi Arabia.

I am inclined to agree with them — because al-Qahtani does not seem ever to have been psychologically coherent enough to have been responsible for his actions, and was, instead, manipulated by Al-Qaeda, like other mentally ill individuals, because the U.S. evidently cannot provide him with the necessary care, and because of his remorse, which strikes me as convincing. I have no idea, however, whether the review board will agree.

Periodic Review Board Initial Full Hearing, 16 June 2016
Mohamed Mani Ahmad Al-Kahtani, ISN 063
Personal Representative Opening Statement

Good morning, ladies and gentlemen of the Board. I am the Personal Representative of Mr. Mohamed Mani Ahmad al Kahtani. I will be assisting Mohamed this morning with his case, aided by Mr. Ramzi Kassem.

Mohamed has been overjoyed and eager to participate in the Periodic Review Process. He has maintained a record of perfect attendance for meetings with me and his Private Counsel.

I was favorably impressed by Mohamed's candor. He has proven forthright and honest in his interactions with me.

Mohamed has proven to be engaging and extremely polite throughout his interactions and discussions with me. He is quick with a smile and exudes a warm personality.

Later, Mohamed will discuss both his past life and his desire for a better life for himself in the future. He wishes to be transferred to live his life with his family and parents. Mohamed also wishes to be married and start his own family. He is open to transfer to any country.

I am confident that Mohamed's desire to pursue a better way of life if transferred from Guantánamo is genuine. I remain convinced that he does not pose a continuing significant threat to the security of the United States.

Thank you for your time and attention. I am pleased to answer any questions you have throughout this proceeding.

June 6, 2016

Statement by Private Counsel for Mohammed al-Qahtani (ISN 063)
Periodic Review Board Hearing Scheduled June 16, 2016

Esteemed Periodic Review Board Members,

We serve as pro bono counsel to Mohammed al-Qahtani (ISN 063). The Center for Constitutional Rights has represented Mr. al-Qahtani since 2005. Professor Ramzi Kassem has represented Mr. al-Qahtani since 2010. We write to provide additional information to inform your decision as to whether Mr. al-Qahtani's continued imprisonment at Guantánamo Bay is "necessary to protect against a significant threat to the security of the United States."

It is well known that Mohammed al-Qahtani was tortured in U.S. custody at Guantánamo. In fact, Mr. al-Qahtani is the only prisoner whose torture has been formally acknowledged by a senior U.S. government official. In 2009, Susan J. Crawford, then the Convening Authority in charge of the U.S. Department of Defense's Military Commissions, explained that she had refused to authorize Mr. al-Qahtani's capital trial by military commission in 2008 because "we tortured Qahtani." The torture left Mr. al-Qahtani in a "life-threatening condition," again by Crawford's admission. He was hospitalized twice during his interrogation at Guantánamo because he was on the brink of heart failure and death.

What is not well known, however, is that long before Mr. al-Qahtani was taken into U.S. custody, he suffered from a number of severe psychiatric disabilities. As the expert witness in this matter, Dr. Emily A. Keram, attests in her separate report, Mr. al-Qahtani suffered from schizophrenia, major depression, and possibly neurocognitive disorder due to traumatic brain injury. He was mentally ill not only prior to his imprisonment and torture at Guantánamo but also long before the period of time when he was alleged to have participated in criminal acts. Dr. Keram's report is based on extensive conversations with Mr. al-Qahtani at Guantánamo, on a telephonic interview with his family in Saudi Arabia, and on her review of records of an involuntary psychiatric hospitalization in 2000 that were independently obtained by his legal team.

Mr. al-Qahtani developed psychotic symptoms in his childhood, which worsened as he grew into his teens and twenties. His mental troubles trace back to a string of traumatic brain injuries, beginning with one sustained in a car accident when he was only eight years old. His family recalled "episodes of extreme behavioral dyscontrol" over the years, including one when the Riyadh police contacted the family because they had found Mr. al-Qahtani naked in a garbage dumpster, spells of "auditory hallucinations," and an incident where Mr. al-Qahtani threw a new cellular phone out of a moving car because he believed it was affecting his emotional state.

These symptoms persisted and, in late-May of 2000, Mr. al-Qahtani was involuntarily committed in Mecca for "an acute psychotic break." Medical records from the hospitalization reviewed by Dr. Keram reveal that Mr. al-Qahtani was involuntarily committed to the psychiatric unit of a hospital for a period of days after local police arrested him as he was attempting to throw himself onto moving traffic. According to the hospital medical records, Mr. al-Qahtani expressed suicidal wishes, and was given antipsychotic medication and sedatives. As a result of this episode, counsel learned, Mr. al-Qahtani lost his job as a civilian driver at the Armed Forces Hospital in the Saudi city of Kharj.

Perhaps most importantly, Dr. Keram concluded that Mr. al-Qahtani's pre-existing mental illnesses likely impaired his capacity for independent and voluntary decision-making well before the United States took him into custody, and left him "profoundly susceptible to manipulation by others." These findings call into serious question the extent to which it would be fair to hold Mr. al-Qahtani responsible for any alleged actions during that period of his life. They also cast doubt on any claims that Mr. al-Qahtani would have been entrusted with sensitive information about secret plots.

Moreover, Dr. Keram found that "Mr. al-Qahtani's pre-existing psychotic, mood, and cognitive disorders made him particularly vulnerable to [...] the conditions of confinement and interrogation" his U.S. captors inflicted on him at Guantánamo under the guise of the "First Special Interrogation Plan." In fact, according to Dr. Keram, the combination of solitary confinement, sleep deprivation, extreme temperature and noise exposure, stress positions, forced nudity, body cavity searches, sexual assault and humiliation, beatings, strangling, threats of rendition, and water-boarding, amounting to "severely cruel, degrading, humiliating, and inhumane treatment" that Mr. al-Qahtani endured would have profoundly disrupted and left long-lasting effects on a person's sense of self and cognitive functioning "even in the absence of pre-existing psychiatric illness."

Applied to Mr. al-Qahtani, the torture and conditions of his confinement at Guantánamo were nothing short of devastating, exacerbating his pre-existing psychological ailments. Besides taxing him physically to the point that he was on the brink of death and had to be hospitalized twice, they caused psychotic symptoms that included repeated hallucinations involving ghosts and a talking bird. Mr. al-Qahtani also often soiled himself, cried uncontrollably, and conversed with himself and with others who were not present. It appears to be in significant part the undeniable impact that torture and imprisonment at Guantánamo had on Mr. al-Qahtani's health that drove the Convening Authority for the U.S. Department of Defense's Military Commissions, Susan Crawford, to drop the charges against him.

Today, Mr. al-Qahtani's condition is exactly as one would expect for a man who suffered from severe psychiatric illness before being subjected to a systematic and brutal program of physical and psychological torture. "In addition to Mr. al-Qahtani's pre-existing psychiatric diagnoses," which have not subsided, Dr. Keram concludes, "he has developed posttraumatic stress disorder (PTSD)" resulting from his torture, interrogation, and imprisonment. As a doctor with the U.S. Department of Veteran Affairs who has treated patients with PTSD secondary to both combat stress and Prisoner of War confinement for the past 14 years, Dr. Keram found that Mr. al-Qahtani's PTSD symptoms are not only "consistent with those exhibited by survivors of torture," but also that they "have been present for years."

Given the present state of Mr. al-Qahtani's mental health, Dr. Keram believes that he "will likely require lifelong mental health care," at least initially in an "inpatient or residential" setting. In her view, "appropriate treatment" of Mr. al-Qahtani's complex condition "requires a culturally-informed multi-disciplinary approach" that would include "supportive psychotherapy, cognitive-behavioral therapy, skills-based therapy, and psychotropic medication."

Crucially, Dr. Keram concludes "that Mr. al-Qahtani cannot receive effective treatment for his current mental health conditions while he remains in U.S. custody at GTMO or elsewhere, despite the best efforts of available and competent clinicians." Among the factors precluding effective treatment of Mr. al-Qahtani's mental illnesses in U.S. custody is his lack of trust in medical and mental health personnel at Guantánamo owing to their predecessors' involvement in his interrogations and torture. Also, Dr. Keram finds that, "given the unique role of family in Mr. al-Qahtani's previous episodes of psychiatric illness, it is imperative that his family members actively participate in his treatment."

Dr. Keram's conclusion, therefore, is that Mr. al-Qahtani would receive effective treatment if he is repatriated to the Kingdom of Saudi Arabia. The Saudi Ministry of Interior's custodial rehabilitation and aftercare program for former Guantánamo prisoners would provide Mr. al-Qahtani with the medical attention he direly needs on an inpatient basis, while access to his family would complement his treatment. We have obtained a written assurance from the Saudi Ministry of Interior addressed to the members of this Periodic Review Board, offering security and humane treatment guarantees regarding Mr. al-Qahtani and expressing its readiness to welcome him in its rehabilitation and aftercare program.

Turning to Mr. al-Qahtani's family, as their sworn letters and the videos they recorded for the Board amply attest, they are prepared to provide him with all of the emotional, personal, and financial support and guidance he will need should he be repatriated to Saudi Arabia and committed in its rehabilitation and aftercare program. Mr. al-Qahtani's family includes many relatives who are in the Saudi military and police or otherwise in government service. They have every interest in ensuring Mr. al-Qahtani's successful reintegration into family life and society, if he is ever medically cleared for release from the care of the Saudi rehabilitation program.

Today, you will hear from Mr. al-Qahtani himself. He will probably tell you what he has often told us — that his only wish is to go home and lead a peaceful, steady life. Despite the horrific abuse that he barely survived in U.S. custody, Mr. al-Qahtani bears no ill will towards the United States or any other country or government. Proof of that can be found in his record of compliance as a prisoner at Guantánamo and in his good relations with the guard force. In numerous conversations with us over the years, Mr. al-Qahtani has also made it abundantly clear that he does not support al-Qaida's ideology or its methods, and that he abhors wanton acts of violence against civilians, irrespective of their nationality or religion.

In sum, we have no reason to believe that the U.S. government knew of Mr. al-Qahtani's debilitating mental illnesses at the time it took him into its custody, or that it deliberately exploited those ailments in its interrogations of Mr. al-Qahtani. The facts nonetheless remain the same: our government apprehended a severely mentally disabled man, brought him to Guantánamo, and intentionally and systematically tortured him there.

Perhaps more than any other prisoner, Mohammed al-Qahtani's continuing imprisonment at Guantánamo represents everything about the prison that is inconsistent with our proclaimed national values, offending allies and critics alike the world over. To begin to turn the page on this ugly chapter in our country's recent history, surely, our government must release from its custody the one man whose torture it has officially acknowledged.

This Board should repatriate Mr. al-Qahtani to Saudi Arabia, where he will be committed in one of that country's advanced psychiatric facilities — an opportunity that he and his family sadly did not seize in 2000. Once there, Mr. al-Qahtani will receive the treatment that he has needed for far too long and he will not pose a threat to the United States or anyone else.

Thank you for taking into consideration the information we have provided. We remain at your disposal to address any questions you may have regarding Mr. al-Qahtani.

Very truly yours,

Prof. Ramzi Kassem
Main Street Legal Services, Inc.
City University of New York School of Law

Shayana Kadidal, Esq.
Center for Constitutional Rights