By Dr. Nayyer Ali

November 07, 2007

Mental Health at Guantanamo Bay

 

For almost six years, several hundred persons captured mostly in Afghanistan have been held at the US detention facility at Guantanamo Bay. This American jail has the unique status of being totally under US control, but remaining the sovereign territory of another country, namely Cuba, from which the land is leased in perpetuity. Bush placed the prisoners there so he could deny them the benefit of the American judicial system, a ruse that worked for several years despite its patent absurdity.
Over the last two years, particularly as the courts have forced formal review of the “enemy combatant” status and both domestic and global criticism of Gitmo have mounted, the government has provided greater access to outsiders to Gitmo. Although only the International Committee of the Red Cross is allowed access to the detainees themselves, numerous groups and journalists have been given access to the facilities and staff of Gitmo. In that framework, the Muslim Public Affairs Council (MPAC), of which I am a board member and former chairman, was given the opportunity to visit Gitmo and to interview the medical staff on the issues of mental health.
I, along with Executive Director Salam Al-Marayati, DC office staffer Safiya Ghori, and APPNA psychiatrist Dr. Zahid Imran, went to the Pentagon to discuss these issues. We were allowed to ask questions directly to the treating physicians and to the head of the medical services at Gitmo for the detainees.
According to the Pentagon, there are now about 330 detainees still being held at Gitmo, out of a total of about 800. The health care facilities are apparently quite comprehensive. In addition to basic treatment facilities, an operating room and cardiac catheterization lab is available. The number of physicians and other medical personnel assigned to the detainees is quite substantial, and they are able to access care easily.
There have been four deaths at Gitmo which are still subject to medical review but are considered to have been suicides. In addition, there have been 40 attempted suicides, 12 of the attempts were apparently by a single individual.
A number of inmates have gone on hunger strike. When their malnutrition becomes severe enough to constitute a threat to their health, they are force-fed by the insertion and removal of a nasogastric feeding tube twice a day. In addition, the Gitmo staff made clear that if an inmate refused medication felt to be necessary for his life, it would be forcibly administered.
Mental illness appears to be rather prevalent among the detainees. 17% of the current inmates have a psychiatric diagnosis. 5% are suffering from depression. 5% of the inmates are currently taking psychiatric medication, and three of the inmates are diagnosed with schizophrenia.
There has been no formal intelligence testing done on the inmates, but it is of note that about 30% of the inmates are illiterate. This would suggest that a large fraction of the inmates are not exactly criminal masterminds, although they certainly could be highly motivated Jihadists.
The Gitmo medical personnel stated that their doctor-patient relationship is ethically bound to the same standards that apply to doctor-patient relationships in US prisons. There are medical personnel who are engaged in assisting interrogations, but these personnel are separate from the treating physicians.
The issue of torture was only touched on briefly. The military personnel stated categorically that no commonly mentioned coercive practices are currently being used at Gitmo. This included solitary confinement, stress positions, water boarding, sleep deprivation, and other similar practices that many critics consider tantamount to torture. It is not clear if this policy was only adopted since the new Secretary of Defense came to office. Despite these denials, released inmates, and leaked reports from the ICRC and from FBI agents that have been to Gitmo all have suggested that these practices occurred, at least at some point in the past if not now.
While the US has provided a tremendous amount of resources for the medical care of the Gitmo detainees, it does not change the fact that Guantanamo Bay remains a very potent negative symbol in the current conflict. Its very existence, and the Bush administration’s continued goal of keeping the inmates outside the American legal system or the Geneva Convention, cast a pall over America’s moral standing. No matter how well the detainees are treated, the best course of action remains the closure of Guantanamo and the transfer of the detainees into US legal custody or prisoner of war status. Comments can reach me at Nali@socal.rr.com.

 

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