From Nuremberg to Guantánamo, Medical Professionals Enabled Torture.

Last year marked the 70th anniversary of the Nuremberg Doctors’ Trial, in which Nazi doctors were charged for their involvement in war crimes and crimes against humanity. Much more recently, American health professionals have played a critical role in torture committed in the CIA “Black Sites” and at US military detention centers including Abu Ghraib, Bagram, and Guantánamo Bay.

Now, a journal article by two researchers from the Center for Health Law, Ethics & Human Rights evaluates the similarities between the use of medical professionals in the Holocaust and the War on Terror.

Writing in a special issue of the American Journal of Public Health, Sondra Crosby and Gilbert Benavidez (SPH’17) emphasized that the use of torture on thousands of people during the War on Terror is far from the scope and scale of the atrocities of the Holocaust. Instead, they wrote that, because the “enhanced interrogation techniques” used in Guantánamo and at CIA black sites meet the United Nations definition of torture, the involvement of medical professionals in “designing, justifying, and carrying out” those acts raises similar issues to those at the center of the Nuremberg Doctors’ Trials.

In both cases, the authors wrote, “health professionals discarded their ethical obligation to prevent harm to people and instead became agents of the state.” Both cases also shared a legal argument: The medical professionals’ actions were deemed lawful by their respective governments.

“[The] United States simply narrowed and redefined ‘torture’ to suit its security needs,” the authors wrote. “Waterboarding, throwing people against walls, suspending people by chains from a ceiling, force-feeding, confinement in boxes, extreme sleep deprivation, and repeated humiliation all became lawful and acceptable behavior.”

In 2008, Physicians for Human Rights reported the first published evidence of the psychological and physical effects of torture on 11 men detained and released from US custody without charges. The report revealed that abuse was systematic, rather than limited to “a few bad apples” in the 2004 Abu Ghraib prison scandal, the researchers wrote.

That report also described the involvement of medical professionals from detainee’s first-hand accounts, the researchers wrote: “a fleeting hope that a medic would help ease the pain and suffering and put a stop to the torture, only to have that hope extinguished when the medic said to the torturers, ‘You can continue.’”

The Obama administration’s 2009 “Torture Memos” and the 2014 US Senate Select Committee on Intelligence Report on Torture provided documentation of physicians’ involvement in torture. “Medical personnel monitored and participated in the interrogations; their participation provided a false veil of legitimacy to the program,” the researchers wrote. “Medical professionals played not just a supervisory role, but also an active role in some cases. Various torture techniques, such as rectal rehydration or waterboarding, were performed by medical personnel.” Abu Wa’el (Jihad) Dhiab, a former Guantánamo prisoner who was the first detainee to challenge his force-feeding in federal court, provided further transparency.

The researchers noted that little information is available about detainees at the black sites or military detention centers, but that a total of 780 men have been detained at Guantánamo Bay. Nine have died while imprisoned at Guantánamo, 731 have been released without charges, and 41 remain as of 2017. Of the 119 men reported to have been detained in CIA black sites, the researchers wrote, 39 are reported to have undergone “enhanced interrogation,” and 26 were detained because of mistaken identity.

“Doctors’ involvement in torture does not begin with the Nazi doctors and end with the War on Terror,” the researchers wrote, but they presented several lessons about of the conditions that allow torture, and medical professionals’ involvement in torture, to take place.

The authors argued that, by taking part in the torture program rather than taking a public stand against it, medical professionals missed an opportunity to put forward existing knowledge of the harm such treatment causes. “[The] CIA health professionals’ stated opinion that the torture program would cause no lasting damage was either willful ignorance or a lie,” the authors wrote. “In fact, the profound, long-lasting damage that occurred was a completely predictable result of the torture program.”

Although US medical societies, including the American Medical Association, have denounced physician’s participation in torture, the authors noted that these physicians have not been punished by any professional organizations or licensing boards.

The authors wrote that a major cultural change is required, where torture is unacceptable, and shifting “the focus of health care professionals’ behavior from worrying about what is legal or authorized toward a culture focused on ethics, morality, compassion, and human rights.

“This is applicable to the medical profession at large, not just to military detention centers.”

The special issue of the American Journal of Public Health was co-edited by George Annas and Michael Grodin, professors in the Center for Health Law, Ethics & Human Rights.

—Michelle Samuels