Of the many gruesome details revealed in the Senate’s summary of its 6000-page report on the CIA’s post-9/11 torture program, perhaps the worst is the Agency’s use of “rectal rehydration” and “rectal feeding” on at least five detainees. In case, like me, you had never heard of these methods before, they denote, respectively, the insertion of water and food into an individual’s anus by tube or enema. The summary shows that Khalid Sheikh Mohammed was rectally hydrated, that Abu Zubaydah was given Ensure (a liquid nutrient) via his backside, that Majid Khan was fed with Ensure, and that once his plate of hummus, pasta with sauce and pine nuts was pureed and “rectally infused” (Khan later tried to self-harm, chewing into his own elbow).

The report states that these procedures were used “without medical necessity” in an attempt to control and coerce the detainees. Rehydration is described, in the summary, “as helping to ‘clear a person’s head’ and effective in getting KSM to talk.” (page 83), and is discussed as a means of “behavior control” (footnote 584 on page 100 gives voluminous evidence).

You would think that even Michael Hayden, who has appeared numerous times in public to rebut the torture allegations, would not stoop so low as to defend these practices. But in an interview with CNN’s Jake Tapper last Thursday, he did just that. Tapper naively assumed that the rectal rehydration was an “unauthorized” form of abuse carried out by rogue CIA sadists deviating from Agency guidelines. But Hayden cut in, “No, stop, that was a medical procedure…The people responsible there for the health of these detainees saw that they were becoming dehydrated.” Tapper then replied incredulously, “Pureeing hummus and pine nuts?” “Jake, I’m not a doctor and neither are you,” Hayden said, “but what I am told is this is one of the ways that the body is rehydrated. These were medical procedures.”Tapper still wasn’t convinced: “Are you really defending rectal rehydration?”

It is unclear who “told” Hayden these were medical procedures, but a number of highly-qualified doctors have challenged his comments. In interviews with the International Business Times both Dr Steven Miles and Dr. J Wesley Boyd of Harvard Medical disputed the necessity of rectal feeding and hydration. Boyd said it was “totally false” that rectal hydration was a legitimate medical procedure. “We hydrate people normally by handing them water, handing them a glass or bottle of water and you drink it. If you’re unconscious and unable to drink fluid, in those instances we would place an IV in your arm and run fluids into you that way. That is a legitimate medical procedure. … Rectal feeding is full-on 100 percent torture, period. It’s about humiliation, it’s about degradation and exerting control and obviously about inflicting pain.”

This view was echoed in a factsheet compiled by the US-based rights group Physicians for Human Rights. The document states that, “Rectal hydration is almost never practiced in medicine because oral and intravenous routes of fluid administration are more effective.” While the large colon has the “capacity to absorb fluids”, it has a “very limited capacity to absorb nutrients. Pureed food and nutritional supplements, such as Ensure, should never be administered rectally.” Rectal hydration is only used in very rare circumstances, with wounded soldiers or terminally ill patients, when oral or intravenous access is not possible.

Professor Thomas Burke of Harvard Medical School is quoted as saying, “For all practical purposes, it’s never used. No one in the United States is hydrating anybody through their rectum. Nobody is feeding anybody through their rectum.” Burke told the Washington Post that he polled several of his colleagues and found that none of them had ever used these methods. In its June 2013 rebuttal to the Senate’s summary the CIA insisted the rectal feeding and hydration were applied partly because they were “safer” than using IV needles with uncooperative prisoners, and more efficient than conducting oral procedures. But, according to Burke, “Every day in the United States, health workers encounter uncooperative, belligerent or mentally disturbed patients who need hydration or sustenance. “And [in] none of them do we put a tube in their bottom,” he said.”

Dr Steven Field, of NYU’s School of Medicine, adds, “In over 30 years of gastroenterology practice I never used rectal hydration. Also, rectal feeding simply doesn’t make physiologic sense. The colon cannot absorb even pureed food.”

As the factsheet shows, it is clear from the Senate’s summary that these methods were used without medical necessity, to coerce and humiliate the prisoners. It concludes by stating unequivocally that “Insertion of any object into the rectum of an individual without their consent constitutes a form of
sexual assault.”

Dr Allen Keller, Director of the NYU/Bellevue Program for Survivors of Torture, said, “This was done not solely for therapeutic reasons but as another form of abuse or humiliation”. Keller added, “Given the circumstances, this is sodomy with the intention of humiliation under the guise of medical treatment.”

Dr Howard Markel, of the University of Michigan, told PBS that rectal feeding and hydration are “almost never done”, as they are antiquated, inefficient methods dating back to the 18th and 19th centuries. ““It’s annoying and humiliating to have it done to you,” Markel wrote, adding, “If the fluids you are infusing into the rectum and colon are not the right balance of electrolytes, etc., your bowels could violently — and painfully — expel the contents all over you and the floor. Speaking as a physician, there is no place [for this] in medical treatment today. It’s a barbaric way to feed, let alone rehydrate anyone in the 21st Century [my emphasis].””

In a separate piece, Cornell Law Professor Michael Dorf writes that “there was no medical reason why the CIA chose rectal feeding and hydration for its prisoners”. He continues, “The CIA used rectal feeding and rectal hydration–rather than some less instrusive method of forced feeding or no forced feeding at all–specifically for the purpose of inflicting pain and humiliation on the prisoners. Put more starkly, in addition to threatening to rape the mothers of some of its prisoners, the CIA used rectal feeding and rectal hydration to anally rape prisoners.” According to international law (from the International Criminal Tribunal for the Former Yugoslavia and the International Criminal Tribunal for Rwanda) “systematic use of rape or other serious sexual violence is a war crime and/or a crime against humanity,” Dorf writes.

According to Hayden, the notion that rectal feeding and hydration were used to control or coerce detainees was based on “one half-ass, unwarranted comment in one email” in the Senate’s report. But the summary is amply documented: footnote 584, relating to the procedures, is so replete with evidence that it occupies most of page 100, for example. And, besides, the full report is about 6000 pages long and presumably contains more information. Senate Committee Chair Dianne Feinstein put out a statement on her website, “CIA’s Use of Rectal Hydration, Feeding Not Medical Procedures”, detailing the numerous instances from the report showing these methods were applied to control the detainees.

In short, Hayden is scraping the barrel. The procedures used by CIA were unnecessary, criminal and unethical: they constitute torture and sexual assault. As J Wesley Boyd told International Business Times, “”Medical personnel should only work toward the health and betterment of people.” He added later, “Whatever state boards of medicine these physicians are licensed through, they should certainly take action against them.””

UPDATE I

Dick Cheney has weighed in on the rectal feeding and hydration controversy with predictable delicacy this afternoon during an interview with Chuck Todd on Meet the Press. Todd asked him if the insertion of pureed food into Majid Khan’s anus amounted to torture. Cheney said it was not one of the approved techniques and believes “it was done for medical reasons”. Todd shot back that the medical community disputed his view. Cheney then referred to the CIA’s rebuttal (debunked by the doctors in question). It’s not entirely clear, given the lack of concrete detail in Cheney’s remarks, that he has read a) the summary b) the CIA’s rebuttal or c) knows anything about the doctors’ criticisms of rectal feeding. Might is right.

UPDATE II

While specific attention has been paid to the revolting, sadistic nature of rectal infusions, forced-feeding has not only been used by CIA, but was (and still is) applied by the military at Guantanamo Bay. While the stated purpose of military forced-feeding is to keep prisoners alive, it is likely that the extreme force and cruelty of the procedure – involving violent cell extractions, restraint chairs and repeated insertions of feeding tubes – is intended to break prisoners into ending their hunger strikes. Back in 2006 General Craddock admitted as much to the New York Times‘ Eric Schmitt and Tim Golden:

“On Tuesday, General Craddock said he had reviewed the use of the restraint chairs, as had senior officials at the Department of Defense, and they concluded that the practice was “not inhumane.” General Craddock left no doubt, however, that commanders had decided to try to make life less comfortable for the hunger strikers, and that the measures were seen as successful. “Pretty soon it wasn’t convenient, and they decided it wasn’t worth it,” he said of the hunger strikers. “A lot of the detainees said: ‘I don’t want to put up with this. This is too much of a hassle.’ ”

So, grisly though rectal hydration might be, it is not the only example of humiliating forced-feeding procedures used to coerce and control prisoners.