In a detailed analysis of the Senate’s torture report, Physicians for Human Rights – a US-based rights group – found that CIA medical personnel might have committed war crimes by monitoring and approving the use of torture, and by conducting research on prisoners.

Some outlets had already noted the prominence of health professionals in the Senate’s summary, but PHR‘s new report, authored by a host of experienced medical professionals, offers the most thorough treatment of this subject so far. Based on its analysis of the summary, PHR finds that “health professionals played not only a central, but an essential role in the CIA torture program – to an extent not previously understood…Without the participation of health professionals, this illegal program might have been prevented.” Although the torture started with psychologists, it involved three medical professions: psychologists, physicians (including psychiatrists), and physician assistants. PHR enumerates eight categories of abuse by health professionals “that violate their ethical and legal obligations.”

For instance, the summary shows that medical professionals designed, directed and profited from the torture program. SERE psychologists James Mitchell and Bruce Jessen (referred to in the text by the pseudonyms Swigert and Dunbar) devised a list of “enhanced interrogation techniques” for CIA in the summer of 2002. These techniques were based on Dr Martin Seligman’s theory of “learned helplessness” and adopted from various tactics inflicted on trainees at the US military’s SERE (Survival, Evasion, Resistance and Escape) school, where Mitchell and Jessen had both worked.

The summary provides the fullest description yet of “the scope of Mitchell’s and Jessen’s involvement in the torture program,” according to PHR. They performed psychological assessments of prisoners prior to their torture, drew up brutal interrogation plans and then administered the techniques themselves. And they did not do this for free, either: the summary shows that Mitchell and Jessen profited handsomely from the torture program, eventually launching their own company (Mitchell, Jessen & Associates) and bagging $81 million of a mammoth $180 million contract from CIA. By 2007, the torture program was overwhelmingly outsourced to contractors (many of them from Mitchell, Jessen & Associates, according to the summary). Some CIA personnel protested about conflicts of interest, noting how Mitchell and Jessen would evaluate the effectiveness of techniques they themselves administered and stood to profit from, cashing in to the tune of $1800 per day (four times the pay of other interrogators). A racket, in other words.

In his new book, Pay Any Price, published just before the Senate released its executive summary, reporter James Risen drew on the example of Mitchell and Jessen to show how greed and ambition drove US counter-terrorism policies in the wake of 9/11. However, Risen makes clear that the psychologists were not lone rangers, but part of a much broader constellation of doctors and behavioral scientists working for the US government. In a recent article, Jeff Kaye shows that Mitchell and Jessen were closely involved with the intelligence community before they concocted “enhanced interrogation techniques”. In early 2002 they appeared with other carefully-selected scientists and intelligence professionals at a conference sponsored by the FBI and American Psychological Association (now under investigation thanks to revelations of CIA collusion published in Risen’s new book). Far from being an outsider, plucked randomly out of a hat, Mitchell was already part of the counter-terrorism fold before the Agency sent him to Thailand for Abu Zubaydah’s interrogation. Some have placed excessive blame on the contractors, implying they hijacked a panicky, innocent CIA and conned its officials into adopting torture.

Back to the summary, PHR explains that doctors inflicted harm on captives, most clearly in their use of “rectal feeding” and “rectal rehydration” (I wrote a detailed post about this recently). They also helped give legal cover for the torture program: Office of Legal Counsel lawyers had argued, in an August, 2002 memo, that “enhanced interrogation techniques” would be safe and lawful provided doctors were present to safeguard the prisoners’ health. The doctors therefore monitored torture sessions to make sure CIA’s abuses stayed within the broad legal limits laid down by the Justice Department, limits which – according to PHR – were meaningless and permitted torture and cruelty.  By assessing prisoners before and during interrogation, and deeming them to be mentally and physically fit, the doctors were effectively approving their torture. The analysis gives various examples from the Senate’s summary to support this point, including the case of two CIA detainees who broke their feet during an escape attempt. The medics initially recommended they not be placed in stress positions but, two weeks later, a physician assistant, with the approval of other OMS doctors, determined that the prisoners’ wounds were “sufficiently healed to allow being placed in the standing sleep deprivation process.” The summary also shows that doctors were present throughout the waterboarding of Khalid Sheikh Mohammed and Abu Zubaydah, recommending the former be waterboarded with saline solution to forestall the possibility of water intoxication, and suggesting the latter be transferred to a liquid diet as he was vomiting copiously in response to the waterboarding. Former CIA Director Michael Hayden insisted that Abu Zubaydah had been switched to Ensure because he was recovering from abdominal surgery. “If this were the case,” PHR states, “it raises the question of why an individual recovering from abdominal surgery would be subjected to waterboarding, to the point of vomiting and losing consciousness.”

As PHR writes, doctors should never participate in torture and to do so constitutes a gross violation of domestic and international law, along with their ethical obligation to “do no harm” . Dr Atul Gawande of Harvard Medical School responded to the revelations of medical complicity in torture with a series of fierce tweets, such as:

3/The torture could not proceed w/o medical supervision. The medical profession was deeply embedded in this inhumanity.

— Atul Gawande (@Atul_Gawande) December 10, 2014

Even more alarming is PHR‘s contention that CIA doctors were conducting human subjects experimentation. They collected data from the interrogations and analyzed it with a view to improving the safety of the techniques; they shared this information with the Justice Department who then incorporated it into their memos legitimizing the torture. Although the doctors were, in theory, working to protect the prisoners, they were, in effect, facilitating their abuse by helping Bush lawyers justify waterboarding and other brutal practices. PHR extracts various sections in the summary where medical personnel express concern about playing this role. For example, two officers were asked to perform an independent review of the program, and responded: “… that it would not be possible to assess the effectiveness of the CIA’s enhanced interrogation techniques without violating “Federal Policy for the Protection of Human Subjects” regarding human
experimentation.” (p. 13) As Dr Steven Reisner said during a recent discussion at Al Jazeera’s The Stream, “In their zeal to protect the government against charges of torture, they actually committed an equally heinous crime, which was human subjects research.” Such research is prohibited by domestic statute and also by the Nuremberg Code (created in response to the Nazi medical experiments at Auschwitz and elsewhere). PHR writes, “If further investigation establishes that human subjects research without consent was performed systematically on detainees then such activities are violations of the Nuremberg Code and could constitute a crime against humanity.”

These assertions are not new. PHR had already raised concerns in 2010 that doctors were conducting research on prisoners and a bipartisan report found last year that doctors working for the military and CIA were complicit in torture. Moreover Mitchell’s and Jessen’s importance as architects of “enhanced interrogation” had emerged gradually in the last several years, thanks to reporting by Jane Mayer (in her book The Dark Side, for example) and Katherine Eban at Vanity Fair (see here and here). But new evidence gleaned from the Senate’s summary provides compelling proof that doctors played an indispensable role in the torture program and violated numerous laws and ethical codes in the process. In fact, as human-rights researcher Nathaniel Raymond said on Al Jazeera, “Health professionals, in their engagement in this program, actually violated more laws and ethics than the other personnel involved”. That being so, PHR calls on President Obama to establish a blue-ribbon federal commission, with full subpoena powers, to investigate the role of medical professionals in CIA torture and, if appropriate, recommend those culpable for prosecution (last week PHR had still not received a response from the administration). Given Obama’s refusal, throughout his presidency, to hold Bush-era torturers accountable for their crimes, such an inquiry is unlikely to get off the ground, effectively meaning that the egregious legal and ethical violations documented by PHR will go unpunished. This not only has grave implications for the rule of law in America, but also increases the likelihood that such atrocities will repeat themselves.

UPDATE

Democracy Now hosted a long discussion today about the role of health professionals in the CIA torture program. The show featured Nathaniel Raymond – one of the co-authors of PHR‘s analysis – who described the involvement of doctors in torture after 9/11. Raymond also talked about the ongoing (and aforementioned) investigation into the American Psychological Association which, he says, was “potentially engaged in racketeering related to its relationship with CIA and White House officials”.