In a recent article about Guantánamo — a rarity in the US mainstream media — ABC News picked up on a sad story of medical neglect and culturally inappropriate behavior by medical personnel at the prison, as conveyed to the broadcaster by Shelby Sullivan-Bennis, an attorney who represents some of the 40 men still held.
In “‘Degrading’: Aging detainees describe health care woes at Guantánamo 18 years after 9/11,” ABC News’ Guy Davies described how a “breakdown in trust between detainees and doctors” had “reached breaking point” at the prison.
The ailments of Saifullah Paracha, Guantánamo’s oldest prisoner
Davies’ article began by looking at the case of 72-year old Saifullah Paracha, Guantánamo’s oldest prisoner, who suffers from “debilitating chest pains,” an “overactive bladder and enlarged prostate,” as well as “diabetes, coronary artery disease, diverticulosis, gout, psoriasis and arthritis,” as Sullivan-Bennis told ABC News, adding that he “has also suffered two heart attacks, one of which occurred when he was held in Bagram, in Afghanistan, before his transfer to Guantánamo” in September 2004.
Paracha, a Pakistani national, was initially seized by the CIA while he was on a business trip to Thailand in July 2003, and, as Davies described it, “is alleged by the US government to have been a ‘significant member of the international al-Qaida support network through his business associations in Pakistan,’” although he has always denied these allegations.
In assessing Saifullah’s case, it is surely significant that, although he was seized because of statements made by his son Uzair, who, at the time, was being held in New York by the FBI, a federal court judge ruled in July 2018 that Uzair’s 2006 conviction for supporting Al-Qaeda “should be thrown out,” and he should be granted “a new trial based on evidence that has emerged since he was convicted,” including statements from “high value detainees” Ammar al-Baluchi, Khalid Sheikh Mohammed and Majid Khan, also held at Guantánamo, which “throw doubt on the claim, made by the prosecution in the original case, that Uzair knew he was helping an al-Qaida member,” a doubt that also extends to his father’s alleged involvement.
Despite the US military’s discredited allegations against him, Saifullah continues to be regarded as a threat by the US authorities, although attorneys and journalists describe him and 23 other men still held as “low-value detainees,” because “they live in more communal cell blocks, where they are able to take part in group activities,” and, moreover, none of them have ever been charged with a crime.
Most pertinently, as Shelby Sullivan-Bennis explained to ABC News, it was these men who, this summer, “participated in a boycott of medical services” as a protest against what they called “inadequate and culturally insensitive treatment” at the prison.
Given Saifullah Paracha’s “complex medical needs,” Sullivan-Bennis added that, in his case, she was “fearful for his life.”
As Davies described it, “The subject of detainee care has been an issue of increasing debate in recent years, with the facility now reportedly considering end of life care services for the remaining detainees, according to the New York Times,” in an article in April that I wrote about here.
As Davies proceeded to explain, “Historically at Guantánamo, detainees had been restrained during medical check-ups with a single ankle restraint to the ground, according to detainees’ statements provided to Sullivan-Bennis and shared with ABC News. But prisoner advocates say a new policy, which allegedly began in late 2017, involved detainees being brought to medical examinations being placed in handcuffs which are attached to a leather brace fitted around their stomach, prohibiting their ability, in one detainee’s words, to even ‘lift their arms to hold onto a medical record.’”
Davies added that that particular policy “was partially overturned after the boycott, with the leather brace now removed for these medical visits,” although prisoners “remain handcuffed during the medical visits,” according to Sullivan-Bennis.
Khaled Qassim and Abdul Latif Nasser
One of her clients, Khaled Qassim (aka Khalid Qassim), another “low-value detainee,” who is held for no discernibly good reason, described the new shackling policy in a June 2019 letter to Reprieve, the human rights charity whose lawyers also represent him.
Qassim, a Yemeni, wrote, “In the worst days in GITMO, when the number of detainees was in [the] hundreds, doctors used to have the authority to ask the guard force to take some of the restraints off the patient detainee while treating him in the medical space. Recently, after seventeen years, with the number of detainees far less than before, just in tens, and easier to control, the restraining rules have changed unnecessarily to something much worse.”
Under the new rules, Qassim said, “hand shackles, belly chain and the leg shackles are all on” for prisoners undergoing medical examinations, which he vividly described as “a scene that would always remind you about the tragedy of the slavery time.”
Qassim also made a point of noting, that, “Unlike any other meetings,” where these kinds of restraints would be administered by the military, ”This time, unfortunately, it happens before a doctor.” He added that this was “[t]he last thing a person expects.”
Another prisoner, Abdul Latif Nasser (aka Abdul Latif Nasir), a Moroccan national who “remains detained more than three years after being cleared for release,” and who was profiled by ABC News in June (in an article I wrote about here), corroborated these claims in a recent meeting with Sullivan-Bennis, stating that, “at routine monthly medical appointments, he had to wear ankle restraints, a stomach brace with handcuffs attached to a leather brace around his waist, with extremely tight restraints.”
As was revealed in in declassified notes from the meeting, Nasser added that “[a]ll this took place” in “the presence of two guards at all times,” with the result being that, as Nasser described it, “nothing is private,” and, because of the lack of confidentiality, prisoners “cannot discuss private topics.”
Nasser also explained that prisoners “don’t know who their doctors will be because of rotating staff,” and added that they “feel uncomfortable discussing personal medical matters and undergoing certain procedures, such as prostate exams, with female doctors, for religious reasons.”
Sullivan-Bennis added that, “when she asked Nasser how inmates would respond to a colonoscopy being performed on them by a female doctor,” he said that “some detainees would prefer to die” instead. She said that he told her, “Access to a private doctor is more important to my religion than allowing me to pray.”
Recalling how the medical treatment story unfolded, Shelby Sullivan-Bennis said that it was when she received Khaled Qassim’s letter in June that she thought to herself, “Oh my god, that’s new.”
On her next visit to Guantánamo to visit Qassim and her other clients, she found that, “although they did not expressly use the term ‘boycott,’” all 24 “low-value detainees” were “not attending their medical appointments.”
She explained that her immediate fear was that medical harm would befall Saifullah Paracha, but that she was also alarmed that all 24 of the men were engaged in a struggle with the authorities. As she described it, “You’ve got 24 people going to the same doctor and all refusing to go and my fear was that it wouldn’t move the administration to engage in a conversation.”
She added that she feared that “the result that would come would be the death of one of my clients. I mean it sounds extreme but it’s actually not very extreme.”
Sullivan-Bennis described it as “a surprise” when she learned that the boycott had, to some extent, been successful. She explained how, a month after it began, “a doctor entered the detainees’ living quarters to find out why they weren’t attending their appointments,” and was told that they were “upset with the treatment they had been receiving.”
As Sullivan-Bennis described it, “shortly thereafter things changed.“ Although prisoners “still have to wear handcuffs during medical visits,” what has changed, crucially, is that “the leather brace fitted around the stomach is no longer required.”
However, not everything has improved. Sullivan-Bennis also explained that “there used to be two doctors for low-value detainees,” but “[t]hat has now dropped to one provider, whom none of the detainees trust to give advice or care.”
In response to ABC News’ request for a comment by the Department of Defense, a spokesperson gave them some bland and generic PR talk about how they are continuing to “explore ways to provide adequate care for an aging population, with varying levels of mobility, by making appropriate modifications to existing facilities,” and claiming that prisoners “are continually assessed, as medically indicated, for signs and symptoms of any number of conditions and are treated at a dedicated medical facility by a medical staff of about 100 personnel.”
“Deprivation and Despair”
However, as was explained in “Deprivation and Despair: The Crisis of Medical Care at Guantánamo,” a report published this summer by the Center for Victims of Torture and Physicians for Human Rights,” which I wrote about here, “the central problems with medical care at Guantánamo were a ‘distrust of military medical providers’ and the subordination of patient needs to ‘security functions,’” as ABC News described it, quoting from the report.
ABC News contacted prisoners’ rights advocates to ascertain what they thought of shackling, and reported that they “emphasized that shackling a patient should only take place as a last resort,” because, they said, it “fundamentally undermines the trust that serves as the foundation of any successful doctor-patient relationship.”
Brig. Gen. Stephen Xenakis, a psychiatrist who has been visiting Guantánamo since 2009, providing independent assessments of the prisoners’ mental and physical health, told ABC News that “he ‘does not recall’ a time when patients weren’t shackled during his psychiatric evaluations, a practice that he said impedes the work of counseling.”
He further explained that “he does not have one-on-one access” with prisoners, because their attorneys are always present, but even this is disruptive when it comes to developing a necessary relationship with prisoners. As he explained, “there are some relationships that in order for them to be effective and for the person to be helped there has to be absolute confidentiality. And to have a third party in the room completely disrupts that confidentiality.”
He contrasted the situation at Guantánamo with that on the US mainland, telling ABC News that, “When evaluating individuals who have been convicted of capital offences and terrorism in the United States, there is never a third party present, [and] nor does he himself require them to be shackled.” As he further explained, “Not only does it undermine trust, but interferes with the psychiatric evaluation, which could prove critical if the men are ever brought to trial.”
He added, ”If you take the issue of what these people have disclosed after they’ve been tortured, my ability to be able to explore that with them in confidentiality means that I can accordingly advise the attorneys better about the validity of what they’ve said or not.”
Xenakis also explained that, at Guantánamo, any alleged threat that the authorities claimed was posed by prisoners — if it existed at all — was “significantly diminishing” because of their age. As he put it, “I don’t feel like I need to fear for my personal safety. I don’t think any of us feel that we’re particularly threatened.”
When ABC News “asked if he had seen or heard of any security incident that could justify shackling based on his experiences at Guantánamo over the past 10 years,” his answer was blunt: “No, not that I know of.”
“My life has no meaning”
Despite the slight improvement in the treatment of prisoners, Shelby Sullivan-Bennis was warned about the prisoners’ existential fears by Abdul Latif Nasser at a meeting on September 23, when he said, “So that’s the problem, to be honest with you, is just to stay alive, not to enjoy our life. I have no objective in my life. My life has no meaning. That is the problem that detainees suffer.”
Khaled Qassim also told her about issues relating to long-term health problems that were not being adequately addressed, claiming that the “fluctuating treatment” he was receiving “has had an impact on his mental health.” Now 41 years old, he told her that “his legs began to swell around May this year,” and were eventually “drawn to twice their size from [his] ankle all the way up to his knees.”
As ABC News explained, “Despite this obvious physical symptom, and the potential for such a swelling to be caused by cancer, or a blood clot, he was not treated for ‘several months,’” according to Sullivan-Bennis’s account of what he told her. He also stated that, although he was given a blood test, the medical authorities have not made the outcome of that test clear to him, “meaning he is still unsure of whether the situation has worsened — which can happen if swelling of this kind is left untreated — nearly five months after the appearance of swelling.” Sullivan-Bennis told ABC News that she had not seen the result son the test, but confirmed that his legs are “failing to this day.”
In a letter to another of his attorneys, Mark Maher, Qassim described his treatment as “degrading” and “fluctuating,” and stated that it had left him with “cognitive disturbance” and “concentration problems.”
Maher told ABC News, “Guantánamo is gradually becoming the world’s most unjust, most brutal, most expensive nursing home because the Trump administration has decided that none of these men held without charge for decades — many of whom have been cleared for release — should be allowed to rebuild their lives. It is hard to conceive of a more cruel, more counter-productive policy.”
As ABC News pointed out, another prisoner, the “high-value detainee” Abd al-Hadi al-Iraqi, has sued the government, claiming that his medical care amounted to “deliberate indifference” with regard to a “serious condition,” and that it violated his constitutional rights. Al-Iraqi “has a long history of back problems,” and in January 2017 a CAT scan showed evidence of “severe neural encroachment” that, it was assessed, could “easily progress to spinal stenosis.” If left untreated, this could result in “spinal cord compression and permanent neurologic[al] disabilities,” according to court filings submitted by Physicians for Human Rights.
However, al-Iraqi did not receive surgery until eight months later, in September 2017. Reflecting on this dangerously long wait, Shelby Sullivan-Bennis said, “They waited until the absolute last minute right before a hurricane [to perform the surgery]. He’s since, I think, had seven or eight back surgeries because they’d let it get to such a terrible point, essentially.”
Nevertheless, al-Iraqi’s constitutional claim, and his request for an independent medical evaluation, was turned down by District Judge Emmet G. Sullivan in October 2019, with Sullivan ruling that “assertions that his care was negligent do not amount to a constitutional violation.” Despite his chronic back problems, al-Iraqi’s military commission trial is supposed to begin next year.
Another prisoner, Ahmed Ghulam Rabbani, “has also challenged his care on constitutional grounds.” In September 2017, Guantánamo’s Senior Medical Officer determined that Rabbani, a long-term hunger striker, who had been on a hunger strike for the previous four years, “no longer needed to be force fed,” according to court filings. His attorneys argued that this constituted “deliberate indifference to his serious medical needs in violation of his Eighth Amendment Rights.”
In court filings, Rabbani said that, even if he wanted to end his hunger strike, he could not do so, because he was “entirely unable to eat normal food,” and because he ”suffered from bleeding, indigestion, colon problems [and] ulcers.”
In an emergency federal court motion, as ABC News explained, “his attorneys requested access to all his physical and psychiatric records since July 2017.” They also “wanted to appoint a medical practitioner to evaluate Rabbani, and compel GITMO staff to ‘facilitate that treatment’ deemed necessary and appropriate.” However, the court denied the motion after assessing that “the government was addressing his needs, and had ultimately provided the enteral feedings briefly before Rabbani opted to consume a liquid diet on his own.”
As lifelong imprisonment without charge or trial is, shamefully, spelled out by those running Guantánamo, with government lawyers telling a federal judge last year that prisoners could remain in Guantánamo for the next 100 years, those dealing with the repercussions include the prison’s former commander, Rear Adm. John C. Ring, who, in 2018, suggested that “the authorities were in ‘the early stages of feeling this out,’ when asked about handling end-of-life care — in other words a hospice — for US prisoners.” As ABC News explained, “The comments were widely interpreted as being critical of GITMO’s medical care,” and Ring was fired shortly after due to “a loss of confidence in his ability to command,” according to US Southern Command.
Nevertheless, Guantánamo’s Senior Medical Officer told reporters at the time that the prison “was built as sort of a stop-gap measure,” and that the authorities were ”going to have to look at a more permanent solution.”
According to Shelby Sullivan-Bennis, the idea of a hospice at Guantánamo is “perfectly realistic,” as the authorities focus on “extending [the prisoners’] lives and essentially just providing care to avoid death.” It is, she stressed, “[s]imply an avoidance of death.”