Slow Death at Guantánamo: Why Torture and Open-Ended Arbitrary Detention Are Such Bad Ideas

Camp Six at Guantanamo, photographed in 2010.

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By Andy Worthington, April 30, 2019

Let's be clear about two things before we start: torture and indefinite imprisonment without charge or trial are never acceptable under any circumstances. Torture is prohibited under the U.N. Convention Against Torture, introduced in 1985 and ratified by Ronald Reagan, and Article 2.2 of the Convention states, unequivocally, "No exceptional circumstances whatsoever, whether a state of war or a threat of war, internal political instability or any other public emergency, may be invoked as a justification of torture."

In addition, indefinite imprisonment without charge or trial is unacceptable because there are only two ways in which it is acceptable for countries that claim to respect the rule of law to deprive someone of their liberty: either by trying them for a crime in federal court, or holding them as a prisoner of war until the end of hostiliites, with the protections of the Geneva Conventions.

After 9/11, however, the U.S. created a network of torture prisons around the world, and invented a third category of prisoner — illegal or unlawful enemy combatants — who had no rights whatsoever.

As well as it being legally unacceptable to torture people or to hold them indefinitely without charge or trial, the use of both of these tactics also raises other complications, as is apparent at Guantánamo, where, as Carol Rosenberg has just reported for the New York Times, the tortured men who can't be released, and those indefinitely detained, who the U.S. government, under Donald Trump, doesn't want to release, are aging, and will need a level of care that, to date, the U.S. government has shown no willingness to provide.

In "Guantánamo Bay as Nursing Home: Military Envisions Hospice Care as Terrorism Suspects Age," Carol Rosenberg, reporting from Guantánamo as she has done relentlessly since the prison opened, began by stating, "Nobody has a dementia diagnosis yet, but the first hip and knee replacements are on the horizon. So are wheelchair ramps, sleep apnea breathing masks, grab bars on cell walls and, perhaps, dialysis. Hospice care is on the agenda."

As she added, last year those in charge at the prison were told to "draw up plans to keep the detention center going for another 25 years, through 2043."

"At that point," Rosenberg added, "the oldest prisoner, if he lives that long, would be 96." As she also explained, "Another of the 40 people still held here — the Palestinian known as Abu Zubaydah, who was confined to a box the size of a coffin while held at a secret CIA site and waterboarded 83 times to break him — would be 72. Like him, a number of the detainees are already living with what their lawyers say are the physical and psychological aftereffects of torture, making their health especially precarious as they head toward old age."

In a frank discussion wth Rosenberg and other reporters, Rear Adm. John C. Ring, the prison commander, said, "Unless America’s policy changes, at some point we’ll be doing some sort of end of life care here." He added, "A lot of my guys are pre-diabetic. Am I going to need dialysis down here? I don’t know. Someone’s got to tell me that. Are we going to do complex cancer care down here? I don’t know. Someone’s got to tell me that."

These are clearly pressing questions. As Rosenberg explained, "The prison is envisioning communal nursing home-style and hospice care confinement" for the 40 men still held. As military commanders put it, prisoners already "suffer typical middle-age conditions: high blood pressure and cholesterol, joint pain, diabetes and, lately, sleep apnea." However, the appropriate response is not a straightforward matter. As Rosenberg described it, "the military is grappling with an array of questions about how much medical care the prisoners should receive, how it should be delivered and how much Congress will provide to pay for it."

When military personnel fall ill, and have "medical needs that the small base hospital cannot provide, like an MRI," they are flown to the nearest major military hospital, in Jacksonville, Florida, 822 miles away. Unhelpful laws passed since 9/11, however, prevent the military from taking Guantánamo prisoners to the U.S. for any reason.

As a result, prisoners with non-routine medical needs have had to have expensive visits to Guantánamo arranged. As Rosenberg explained, "Cardiologists have for more than a decade come to consult on some prisoners’ cases. Other specialists have made regular visits to do colonoscopies and examine orthopedic injuries. A prosthetist comes for those with long-healed battlefield amputations."

For now, Rosenberg was told, "no prisoner has cancer and anybody using a wheelchair can get himself in and out of it," but the future is uncertain. Adm. Ring said the military "had no geriatric or palliative care physicians," and so he was "sending a team to see how the federal Bureau of Prisons handles sick and dying convicts."

The prison, Rosenberg explained, "has a revolving medical staff of 140 doctors, nurses, medics and mental health care providers," who care for the prisoners but "also provide some services to the 1,500 troops assigned to the prison."

However, there does not appear to be much political willingness to address the issues raised by the prisoners aging. Rosenberg noted that the Pentagon "is seeking $88.5 million to build a small prison with communal hospice care capacity" for the so-called "high-value detainees" —15 men previously held in CIA black sites, including those allegedly responsible for the 9/11 attacks. To date, however, Congress has "declined to fund it, citing more urgent Defense Department infrastructure needs."

Rosenberg added that their defense lawyers and medical experts they work with "call them Guantánamo’s sickest," adding that, although the military would like to attribute their ailments to aging, the reality is that some "are actually the aftermath of CIA torture."

Marine Maj. James Valentine, who represents Hambali, 55, an Indonesian allegedly responsible for terrorist attacks in south east Asia, "is due for a knee replacement," with Maj. Valentine explaining that the damage to his knee "directly resulted from his first year of CIA captivity, when he was always shackled at the ankles."

More severe is the case of Mustafa al-Hawsawi, 50, one of the alleged 9/11 co-conspirators, who, as Rosenberg described it, "has for years suffered such chronic rectal pain from being sodomized in the CIA prisons that he sits gingerly on a pillow in court, returns to his cell to recline at the first opportunity and fasts frequently to try to limit bowel movements," according to his lawyer, Walter Ruiz, who added that he has "become dependent on a narcotic painkiller called Tramadol to make it through the day."

Although Rosenberg stated that it "may strike some people as odd that the military is discussing complicated, expensive medical care" for prisoners, "especially those the Pentagon prosecutor wants sentenced to death," Dr. Stephen N. Xenakis, a psychiatrist and retired Army brigadier general, who has consulted on Guantánamo cases since 2008, said that, although it might seem paradoxical, "we don’t let people just die in this country. It violates all of our ethics, our medical ethics."

A particularly challenging case is that of Abd al Hadi al Iraqi, one of the last prisoners to be brought to Guantánamo, in 2008, who "underwent three spine surgeries in September 2017, the first on his lower back, another on his neck and a third to drain a postoperative hepatoma." In October, however, "a senior officer at Guantánamo’s community hospital declared in an email that the patient’s 'cervical fusion has failed,'" and "offered three possible options: giving Mr. Hadi a neck brace and hoping for the best; bringing in a special screwdriver from a Navy hospital in Portsmouth, Va., to remove hardware inserted in the patient’s neck in an earlier operation, or transporting him to the Portsmouth hospital for complex surgery." That last option, however, was "obviously not pursued nor explored further given the legal restrictions," according to a prison spokesperson.

As Rosenberg further explained, "Court filings show Mr. Hadi has chronic pain and back spasms, for which he is prescribed a variety of painkillers and muscle relaxants. His surgeon has testified that Mr. Hadi may not improve. At a hearing on his case in March, guards brought him to court in a wheelchair; he used a walker to transfer to a cushioned rehabilitation chair."

She added, "Mr. Hadi, now 58, has a February 2020 trial date. To ensure his attendance, the Pentagon fast-tracked bringing a wheelchair-accessible holding cell to the court compound where legal proceedings take place. It was already on order in anticipation of a population of aging detainees. It is triple the size of the court’s other five holding cells, large enough to hold a hospital bed and, according to a case prosecutor, will have a video monitor so Mr. Hadi can watch a feed of his trial from the bed. It will also have a phone to let him or a lawyer call the courtroom next door, if he has something to say."

As Rosenberg also explained, "The military has already figured out what to do when a detainee dies because that has happened nine times since 2006."

I can't, however, end this article without noting that, on the day Rosenberg's article was published, Adm. Ring "was abruptly fired for unknown reasons," as the Guardian explained, adding that a "statement from U.S. Southern Command said the change in leadership was 'due to a loss of confidence in his ability to command.'"

The Guardian added that officials "said the decision to relieve Ring of his command was not connected to the interviews he gave on detainees’ health issues, but was the result of a month-long investigation that had been submitted to the head of Southern Command, Adm. Craig Faller, in mid-April," although whether or not that is true remains to be seen. The timing certainly seems suspicious.